Laryngeal papillomas, also known as vocal cord papillomas, are benign growths of the mucous membrane caused by the human papillomavirus (HPV). Papillomas on the vocal cords can affect their ability to vibrate, leading to early symptoms of hoarseness and roughness. The oncogenic HPV is a DNA virus that affects the epithelial cells of the skin and mucous membranes.

Laboratory analysis of blood serum can differentiate between subtypes, with types 6 and 11 being the most common in laryngeal papillomatosis. Other serotypes have also been identified, although less frequently.

The neoplasia manifests as wart-like growths in the larynx and other areas such as the epiglottis or trachea.

Cancer development:

HPV subtypes 6 and 11 rarely cause malignant changes and are classified as "low-risk" virus types. Other HPV subtypes such as 16, 18, 41, and 43 are more frequently associated with malignant changes and are classified as "high-risk."

Transmission:

The mode of transmission is not clearly established. However, there have been isolated cases of HPV infection in the mother's genital area and subsequent laryngeal papillomatosis in the child. In adults, transmission is associated with oral sexual contact.

People with laryngeal papillomatosis typically experience hoarseness and sometimes breathing difficulties. The disease is characterized by frequent recurrence (recurrent respiratory papillomatosis, RRP).

Diagnosis:

We have the ability to examine the surface of the vocal cords in detail using local anesthesia, HD optics, and specialized light filtering, allowing us to make an early suspicion diagnosis and initiate appropriate treatment. However, a definitive diagnosis still requires histological examination, which can also determine the HPV type and confirm the benign nature of the papillomas.

Treatment:

After confirming the diagnosis (sampling/biopsy), the papillomas should be removed using laser ablation while preserving the mucous membrane.

Surgery under general anesthesia with CO2 laser:

The standard approach involves removing the papilloma using a CO2 laser under general anesthesia. Since the papillomas only affect the superficial layers of the epithelium, deeper defects on the vocal cords should be avoided.

Treatment under local anesthesia with Blue Laser or KTP laser (Potassium-Titanyl-Phosphate laser):

This treatment is considered less invasive. The laser beams are absorbed by blood vessels, leading to the drying out of the papillomas after a few days.

Other treatment options:

▶ Vaccination:

A combination vaccine is available against HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52, and 58. Vaccination provides protection against initial HPV infection by the corresponding serotypes. However, a reduced tendency for recurrence in the larynx following immunization after surgery has not been proven.

▶ Systemic Bevacizumab:

Bevacizumab (e.g., Avastin®) is a humanized monoclonal antibody (IgG1 subtype) that targets the vascular endothelial growth factor (VEGF) and inhibits the blood supply to tumors.

This therapy has shown promising results.

Future prospects:

DNA vaccines are a promising immunological strategy for the treatment of laryngeal papillomas.

Immunologic responses to a novel DNA vaccine targeting HPV-11 E6E7 - PMC (nih.gov)

Patient testimonial: Vocal Cord Papillomas - Surgery

I have been under the care of Dr. Nasr since the end of 2020 after having undergone over 10 outpatient surgeries by my ENT doctor. When my ENT doctor referred me to a phoniatrist, she immediately sent me to Dr. Nasr, saying, "He is the best in the field!" And that's exactly how I feel. I have already had multiple surgeries performed by Dr. Nasr and have had countless follow-up examinations. From the beginning, I have felt very comfortable and, above all, understood. I have been struggling with papillomas on my vocal cords my entire life, and a synechia has also required treatment. For several months, I was voiceless and could only whisper. Dr. Nasr discusses various treatment options with me each time, explains the pros and cons, and shows me how the surgeries will proceed. And most importantly, he does not pressure me into treatment but allows me to make a free choice and supports me in my decision. Dr. Nasr always takes a lot of time, studies the images, and always strives for the best possible outcome for me. I couldn't imagine a better doctor, and I am grateful to have been referred to him after all these years. Thank you, Dr. Nasr!

Schedule an appointment

To make an appointment, you can reach us by phone at 01752920000, contact us via WhatsApp, or send us an email at contact@thevoiceclinic.de.

Alternatively, you can also visit us directly (please make an appointment in advance):

TheVoice Clinic

Medical Center for Voice Disorders, Swallowing Difficulties, Respiratory Diseases, and Laser Therapy

Dr. med. A. Nasr

Bahnhofstraße 22

71034 Böblingen

We look forward to helping you!