Respiratory Papillomatosis - HPV Virus-Related Vocal Cord Damage
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The frequency of oral HPV virus is increasing. Uncontrolled and multiple partner relationships, unsafe sexual intercourse and the increasing prevalence of the virus are increasing the frequency of oral and laryngeal HPV-related lesions in ENT practice. Wart-causing HPV strains are usually non-carcinogenic subtypes and can be recognized by clinical examination or by the various symptoms they cause. Laryngeal papillomatosis is a rare but important disease caused by human papillomavirus (HPV), especially types 6 and 11. It results in the growth of benign tumors or papillomas in the larynx, especially in the vocal cords. These growths can lead to voice changes, respiratory difficulties and, in severe cases, airway obstruction. Although not cancerous, papillomas tend to recur, making management difficult. In laryngeal and vocal cord warts, both examination and treatment of the wart are more difficult than in other oral papillomas. This is because it is not easy to perform a procedure on a patient who is breathing in the larynx and vocal cords and is not under anesthesia, blood dripping into the airway or irritation in the patient can cause great distress, and it is not easy for patients to notice it when it does not show symptoms.
Causes and Risk Factors
Laryngeal papillomatosis is caused by HPV, which can be transmitted through vaginal, anal or oral sexual contact. The HPV virus spreads into the mouth and from there to the larynx. Oral HPV virus is usually present in patients who have oral sex with more than 10 people. In this case, it is not necessary for patients to have lesions in the mouth, and it can easily be transmitted to another person without them knowing it and cause warts to appear in the infected person. Vertical transmission from mother to child during birth is a common route and leads to juvenile onset recurrent respiratory papillomatosis (JORRP).
Risk factors for laryngeal and vocal cord HPV infection include:
- Early exposure to HPV
- Frequent oral sexual contact (exposure to different subtypes of HPV)
- A weakened immune system (can cause widespread and recurrent laryngeal and vocal cord papillomas in an infected person)
- A mother with genital HPV infection at the time of delivery (can be easily transmitted to the baby)
Laryngeal and Vocal Cord Papillomatosis Symptoms
The primary symptoms of laryngeal papillomatosis include:
- Hoarseness or chronic voice changes
- Respiratory difficulties
- Cough
- Stridor (a high-pitched sound when breathing)
- Airway obstruction in severe cases
- Coughing up pieces of warts, sometimes bloody
Laryngeal and Vocal Cord Papillomatosis Diagnosis
Diagnosis involves a combination of clinical evaluation and endoscopic examination. The following procedures are commonly used:
- Laryngoscopy: A flexible or rigid scope is inserted to visualize papillomas. Both the larynx and vocal cords can be evaluated endoscopically using a 70-degree larynx probe. The images above were obtained during an endoscopic larynx examination.
- Stroboscopy: Used to assess vocal cord vibration and function.
- Biopsy: A sample is taken to confirm the presence of HPV and rule out malignancy.
- HPV Test: Determines the specific strain of the virus in question. HPV DNA can be screened from a mouthwash, swab, or incisional biopsy material. General anesthesia is more appropriate for larynx and vocal cord biopsy.
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Laryngeal and Vocal Cord Papillomatosis Treatment Options
While there is no permanent cure for laryngeal papillomatosis, several treatments can help manage symptoms and prevent recurrence. As seen in the images above, in patients with altered and damaged vocal cord structures, the likelihood of "loss of voice, hoarseness or voice changes" improving with treatment is very low. The following treatment options are available for laryngeal and vocal cord papillomatosis:
Surgical Removal
Microlaryngeal Surgery: Papillomas are removed using cold instruments or CO2 laser surgery. Under a microscope, hollow metal instruments are placed in the larynx. Microsurgical procedures or laser-assisted wart excision, wart cauterization or wart vaporization procedures can be performed through these instruments with the help of a microscope. The procedure is performed under general anesthesia and an intubation tube is placed in the patient's airway during the procedure. Blood or vapor from the wart area is prevented from being transmitted to the lower respiratory tract and at the same time the patient's airway is secured.
Microdebrider Excision: A microdebrider is used to remove papillomas while preserving healthy tissue. Again, the procedure is performed under general anesthesia.
Adjuvant Therapy
- Cidofovir Injections: An antiviral drug that is injected into the affected area to reduce recurrence.
- Bevacizumab (Avastin): An anti-VEGF treatment that blocks blood vessel formation and slows papilloma growth.
Photodynamic Therapy
A light-activated drug is used to target and destroy papilloma cells while minimizing damage to healthy tissue.
HPV Vaccine
The Gardasil-9 vaccine protects against HPV types 6 and 11, reducing the incidence of new papillomas and the severity of existing ones. Vaccination does not provide 100% immunity against HPV infection.
Laryngeal and Vocal Cord Papillomatosis Precautions and Preventive Measures
Since laryngeal and vocal cord papillomatosis is linked to HPV infection, precautions focus on reducing viral transmission:
- Safe Sexual Practices: Use of barrier methods such as condoms and dental dams during oral sex. "Monogamous" and "safe sexual intercourse" are the most important rules in a faithful relationship.
- HPV Vaccine: Recommended for both men and women before sexual activity begins.
- Regular Medical Checkups: Early detection of HPV-related lesions can prevent complications.
- Avoiding Smoking and Alcohol: These factors can worsen vocal cord irritation and promote papilloma growth. Regular sleep and healthy nutrition are also important for patients to maintain high body resistance.
- Protection of Oral Flora Bacteria: In order to protect the bacteria in our mouth, which form a protective layer against pathogenic microorganisms, it is beneficial to consume foods that have undergone natural fermentation, seasonal fruits and vegetables through the mouth. Unnecessary and regular use of antiseptic oral gargles containing alcohol or chlorhexidine gluconate may cause permanent damage to the natural flora bacteria of the mouth. Again, preventing reflux, preventing sleeping with the mouth open and nasal care are also important. Maintaining oral hygiene and regular dental check-ups are also beneficial.
Is Safe Oral Sex Possible?
Our mouth is not normally an organ created for sexual intercourse, but if oral sex is to be performed, you can follow these recommendations to minimize the risk of contracting or transmitting HPV during oral sex:
- Use a condom or dental dam regularly.
- Maintain good oral hygiene to reduce mucosal sensitivity.
- Avoid oral sex if you or your partner has active genital warts or lesions.
- Get vaccinated against HPV for long-term protection.
- It is important for both you and your partner to be monogamous.
Laryngeal papillomatosis is a challenging condition that requires ongoing treatment. Although benign, its effects on voice and breathing can be serious. It can cause permanent voice damage. Advances in surgical techniques, adjunctive treatments, and HPV vaccination provide effective ways to manage and prevent this disease. Public awareness and safe sexual practices are crucial in reducing HPV transmission and associated complications.
Is Active Hexose Correlated Compound (AHCC) Effective for Laryngeal and Vocal Cord Papillomatosis?
Treatment for laryngeal and vocal cord papillomatosis caused by human papillomavirus (HPV) is controversial. While traditional treatments focus on surgery and antiviral therapies, alternative options such as Active Hexose Correlated Compound (AHCC) have gained interest due to their potential immune-boosting effects.
What is AHCC?
AHCC is a natural extract derived from the mycelium of the shiitake mushroom. It has been widely studied for its immune-modulating properties, particularly its ability to enhance the body’s ability to fight viral infections, including HPV. Although controversial, research suggests that AHCC may help clear persistent HPV infections, raising questions about its potential effectiveness in treating HPV-related conditions such as laryngeal papillomatosis (source >> AHCC® Supplementation to Support Immune Function to Clear Persistent Human Papillomavirus Infections - PMC / Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study - PMC).
Does AHCC Work for Laryngeal and Vocal Cord Papillomatosis?
Although AHCC has shown promise in clearing HPV infections in preliminary studies, its effectiveness in treating recurrent respiratory papillomatosis (RRP), including laryngeal and vocal cord papillomatosis, is still being investigated. Some case reports suggest that individuals who use AHCC experience improved symptoms and fewer recurrences, but large-scale clinical trials are still needed to confirm its role as a treatment option.
Current Evidence and Considerations
Studies on AHCC and HPV: Studies have shown that AHCC may help clear high-risk HPV infections, but its effects on low-risk HPV strains (such as HPV-6 and HPV-11, which cause papillomatosis) are not well established.
Immune System Benefits: AHCC may increase natural killer (NK) cell activity and cytokine production, potentially slowing the progression of papillomatosis. Additional Uses: Some experts believe that AHCC can be used in conjunction with surgical and medical treatments to reduce recurrence rates.
Search result link where you can find articles prepared by Dr. Murat Enöz about Oral HPV and published on this website (you can also reach previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=Oral+HPV
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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