Laryngeal Papillomatosis

What is laryngeal papillomatosis?

Laryngeal papillomatosis (pronounced “pa-puh-LOW-ma-TOE-sis”) are benign (noncancerous), wart-like tumors that form inside of your larynx (voice box). The tumors, called papillomas, may spread to other parts of your respiratory tract. The human papillomavirus (HPV) causes this condition, which affects children and adults.

What is recurrent respiratory papillomatosis (RRP)?

Healthcare providers perform laser surgery to remove the papillomas. Unfortunately, these tumors are like warts. They often grow back, multiply and spread. If you have a lot of tumors, they can block or obstruct your airways. When this happens, you have recurrent respiratory papillomatosis (RRP).

What parts of your body does laryngeal papillomatosis affect?

Papilloma tumors affect your respiratory system. They can form anywhere within the airways that connect your mouth and nose to your lungs. Although, the tumors rarely develop inside of your lungs. The most common place for them to grow is inside of your larynx. For this reason, healthcare providers call the condition laryngeal papillomatosis or LP.

What are the types of laryngeal papillomatosis?

Healthcare providers determine the type of laryngeal papillomatosis based on when your symptoms occur.

• Juvenile-onset laryngeal papillomatosis is a more aggressive type that causes symptoms before age 12. The tumors are more likely to spread and come back after treatment. Children get the virus that causes this type of laryngeal papillomatosis during childbirth. It comes from their mothers’ infection.
• Adult-onset laryngeal papillomatosis causes symptoms during adulthood. This less aggressive type grows and spreads slower than the juvenile-onset LP.

How common is laryngeal papillomatosis?

More than 42 million Americans have some type of HPV, which is a type of sexually transmitted disease (STD). Still, it’s rare to develop laryngeal papillomatosis from an HPV infection.

It’s estimated that 20,000 Americans have recurrent respiratory papillomatosis caused by laryngeal papillomatosis. The tumors affect approximately 2 out of 100,000 adults and 4 out of 100,000 children.

What causes laryngeal papillomatosis?

HPV causes laryngeal papillomatosis. Even though millions of people have HPV, only a small number develop laryngeal papillomatosis. Medical experts aren’t sure why this is.

There are approximately 200 different types of HPV. HPV type 6 and HPV type 11 account for 9 out of 10 cases of recurrent respiratory papillomatosis. These HPV types also cause genital warts. Adults can transmit HPV types 6 and 11 that cause laryngeal papillomatosis through oral sex. You can also get these types through anal and genital intercourse.

A person who is pregnant with genital warts may pass the virus to their child during labor and delivery. This risk is greater if the birthing parent is newly infected or there’s prolonged labor. Longer labor means more viral exposure for your baby.

What are the symptoms of laryngeal papillomatosis?

Laryngeal papillomatosis causes symptoms similar to asthma or chronic bronchitis. It’s the second most frequent cause of hoarseness in children. Adults may also be hoarse.

Children and adults may experience:

• Chronic cough.
• Difficulty swallowing (dysphagia) or eating.
• Shortness of breath (dyspnea) or difficulty breathing.
• Sleep issues like snoring and sleep apnea.

How is laryngeal papillomatosis diagnosed?

You or your child may see an otolaryngologist. This medical doctor specializes in diagnosing and treating conditions that affect your ear, nose and throat (ENT). You may know this professional as an ENT.

To make a diagnosis, your provider performs a laryngoscopy to view inside your nose and throat (pharynx).

There are two ways to perform a laryngoscopy:

• Indirect fiberoptic laryngoscopy: Your provider gently inserts a flexible tube with a scope, light and camera (laryngoscope) into your nose and down your throat. For adults and some children, a provider may use a local anesthetic spray to numb your nasal cavity. Children who might have a harder time cooperating might receive general anesthesia so they can sleep through the procedure.
• Direct laryngoscopy: Your provider may need further information or biopsies to confirm your diagnosis. In this case, a provider will give you general anesthesia. They may insert thin instruments through a laryngoscope to take samples of tissue to biopsy.

How is laryngeal papillomatosis treated?

There isn’t a cure for laryngeal papillomatosis. Your healthcare provider may perform laser surgery to destroy the tumors. This procedure usually takes place in an outpatient setting, which means you go home the same day.

Unfortunately, these tumors often come back. A small number of people have so many tumors that it’s difficult to breathe. If this happens, you may need surgical treatment every few weeks to open your airways.

How is recurrent respiratory papillomatosis treated?

Your healthcare provider may try other therapies if you need more than four laser surgeries in one year due to recurrent respiratory papillomatosis. One of the treatments is the HPV vaccine. Providers typically give this vaccine to children and young adults to lower their risk of getting HPV. But studies show it can also help if you already have HPV that causes recurrent papillomas in your throat.

Other treatments may include:

• Antiviral medications.
• Chemotherapy.
• Medications to treat GERD (chronic acid reflux).
• Photodynamic therapy.

What are the complications of laryngeal papillomatosis?

Surgery to treat laryngeal papillomatosis can damage your vocal cords. You may develop vocal cord lesions that affect your ability to talk and swallow.

Rapidly growing tumors can block your airways. In rare instances, you may need a tracheostomy. Your healthcare provider inserts a tube into your trachea (windpipe) to keep your airways open.

Can you prevent laryngeal papillomatosis?

Using condoms can lower your risk of getting HPV. Condoms can also protect your partners if you have the virus. Condom protection includes the use of dental dams during oral sex.

The HPV vaccine protects against the HPV types that cause laryngeal papillomatosis. It also protects against seven other types of HPV that cause cancers like:

• Anal cancer.
• Cervical cancer, vaginal cancer and vulvar cancer.
• Penile cancer.
• Throat cancers like laryngeal cancer and oropharyngeal cancer.

Children can get the first dose of the HPV vaccine starting at age 9 and a second dose before age 15.

Unvaccinated adults younger than 26 can also get the vaccine. Adults need three doses. If you’re 27 to 45 years old, sexually active with more than one partner and don’t have HPV, you may also benefit from vaccination. You should talk to your healthcare provider about vaccination.

Can a cesarean birth prevent juvenile-onset laryngeal papillomatosis?

No. Babies born via cesarean birth (C-section) can still catch HPV from their mom and go on to develop laryngeal papillomatosis. However, your healthcare provider may still recommend a C-section if you have large genital warts that block the birth canal.

What is the outlook for someone with laryngeal papillomatosis?

Laryngeal papillomatosis is a chronic, long-term condition. Even with repeated surgeries, the tumors often come back. You’ll see your healthcare provider regularly to check for signs of recurrence.

When should I call the doctor?

Call a healthcare provider if you experience:

• Chronic cough.
• Difficulty breathing, eating or swallowing.
• Persistent hoarseness.
• Sleep issues.

What should I ask my provider?

You may want to ask your healthcare provider:

• What type of HPV do I have?
• What treatments can help?
• Do I need surgery?
• Should I get the HPV vaccine?
• How can I lower the risk of infecting others with HPV?
• Should I look for signs of complications?

Is laryngeal papillomatosis an STD?

HPV, the virus that causes laryngeal papillomatosis, is an STD. But laryngeal papillomatosis and recurrent respiratory papillomatosis aren’t STDs. You can infect another person with HPV, but you can’t infect someone with laryngeal papillomatosis. Though, a person may develop LP if they get HPV.

Can laryngeal papillomatosis become cancerous?

The types of HPV (types 6 and 11) that most commonly cause laryngeal papillomatosis don’t cause cancer. In contrast, oropharyngeal HPV infections that affect your throat can cause head and neck cancers. Other types of HPV infections can cause cancers that affect the female reproductive system, male reproductive system or anus.

Still, about 1% to 4% of adults have laryngeal papillomas from other strains of HPV that turn into squamous cell carcinoma of the larynx.

A note from Cleveland Clinic

It can be unsettling to find out you or your child have a condition brought on by an STD. But millions of people have HPV, so you’re certainly not alone. If you do develop laryngeal papillomatosis, it’s important to know there’s a good chance that the tumors will come back after surgical treatment. Rapidly growing or recurring tumors can affect your breathing, leading to recurrent respiratory papillomatosis. Your healthcare provider may try other treatments to prevent tumor growth and recurrence.