Laryngeal Papillomatosis – Vocal Papillomas – Recurrent Respiratory Papillomatosis

Vocal papillomas or vocal fold papillomas are mostly benign lesions, typically presenting with a cauliflower-like or characteristic “bunch-of-grapes” appearance. Under higher magnification, there are detectable vascular protrusions, called villi, which bleed when pressure is applied to them.

Vocal fold papillomas can occur in isolation. However, they are usually found in larger formations or widely spread across the tissue. In extreme cases, laryngeal papillomatosis can affect the entire vocal fold region and grow into the airway passages.

Vocal papillomas are subdivided into two forms. The first — called juvenile papillomatosis — primarily affect children. The age peak lies between 4 and 6 years of age. The second form affects adults. The age peak lies between the third and fifth decade of life.

Vocal papillomas develop from a viral disease triggered by the human papilloma virus (HPV). Although a large proportion of the population is infected with HPV viruses, only few patients suffer from the typical symptoms, at a rate of two to three per 100,000 persons.

The HPV causing laryngeal papillomatosis can be classified into different virus subtypes. This subdivision is especially important because it allows classification of the presenting pathologies into low-risk and high-risk types.

The low-risk types caused by the HPV subtypes 6 and 11 are the most common. With these types of HPV, the risk of malignant progression is rather rare. Patients with the high-risk types must get more frequent check-up examinations due to the higher malignancy rate.

Over a period of several months, this 29-year-old rock musician had been noticing problems with his voice. His voice was hoarse with pitch breaks; he had increasing complaints when speaking; his singing voice had lost its quality, particularly in the high range. When he presented, he had been virtually unable to sing for six weeks.

The patient was a non-smoker and did not have any other diseases relevant to the symptoms.

The videostroboscopic examination by his ENT specialist revealed substantial cauliflower-like changes on both vocal folds. The vibrations of his vocal cords were almost completely absent on both sides, his voice quality was hoarse, his average speaking pitch was markedly lowered. He was no longer able to sing.

The patient was recommended to undergo a phonosurgical procedure. In a single session, the visible papillomatous lesions were then surgically removed from both vocal folds by delicate dissection. After two weeks of voice rest, the vocal folds exhibited remarkably good vibratory behavior; vocal fold closure was for the most part complete.

His voice quality was strong and clear and his average speaking pitch was markedly higher. The patient perceived his voice as pleasant and the quality of his singing voice was back to the level of six months prior. The patient was advised to get a postoperative vaccination with a tetravalent vaccine.