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Laryngeal Papillomatosis

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Introduction: Laryngeal papillomatosis is a rare HPV-associated disorder characterized by the development of recurrent papillomas in the respiratory tract. It is caused by low-risk HPV types 6 and 11. In juvenile cases, the infection is transmitted to the baby during delivery if the mother has HPV infection of the anogenital region. Other mechanisms of transmission may also exist. The mode of transmission in adult-onset cases is uncertain. It usually presents as multiple papillary tumors involving true vocal cords but may spread to false vocal cords, epiglottis, subglottic areas, and even trachea and bronchi.

Clinical Presentation: Juvenile laryngeal papillomatosis affects children or adolescents and is more aggressive than adult-onset disease. The most common presenting symptom is hoarseness which worsens progressively. The voice may become weak, raspy or low pitched. Breathing becomes labored and noisy due to airway obstruction. Some patients develop difficulty speaking (dysphonia) or even lose their voice altogether (aphonia). Infants may develop choking episodes, a weak cry, and failure to gain weight. If left untreated, papillomas can create life threatening airway obstruction.

Image source: Omland T, Lie KA, Akre H, Sandlie LE, Jebsen P, et al. (2014) Recurrent Respiratory Papillomatosis: HPV Genotypes and Risk of High-Grade Laryngeal Neoplasia. PLoS ONE 9(6): e99114. doi:10.1371/journal.pone.0099114; used under Creative Commons Attribution License.

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