How the disease develops
The human papillomavirus penetrates the cells of the mucous membrane of the respiratory tract and causes them to rapidly divide. Small papillary growths appear on the surface of the folds, resembling cauliflower, which gradually increase in size and merge. First, they prevent the folds from closing and change the voice, then they begin to occupy the lumen of the larynx. The virus persists in the surrounding apparently healthy mucosa, so even after complete removal, the formations appear again - this explains the need for repeated operations.
- Proliferation of mucous membrane under the influence of a virus
- Localization most often on the vocal folds
- Possible spread to the trachea and bronchi
- Virus persistence in the surrounding mucosa
- Tendency to relapse after removal
- Juvenile and adult forms
Causes and routes of infection
The causative agent is human papillomavirus of low oncogenic risk, most often types 6 and 11, the same ones that cause genital warts. Children become infected mainly when passing through the birth canal of a mother with human papillomavirus infection, and the disease manifests itself in the first years of life. In adults, infection is associated with oral-genital contact, as well as with a long-standing latent infection, which is activated when immunity decreases. The course is aggravated by smoking, reflux and repeated trauma to the mucous membrane with frequent interventions.
- Human papillomavirus types 6 and 11
- Infection of a child during childbirth
- Human papillomavirus infection in the mother
- Oral-genital route in adults
- Decreased immunity
- Smoking and reflux as aggravating factors
Symptoms
The first and most common sign is a change in the voice: in a child, from birth or from an early age it is hoarse, weak, sometimes almost silent, in an adult it gradually becomes hoarse. As the formations grow, noisy breathing appears, first with exertion and crying, then at rest. The child can breathe with retraction of the compliant areas of the chest. Less common are coughing, a feeling of obstruction in the throat, and choking. It is important that there is no fever or pain, which distinguishes the disease from infectious croup.
- Persistent hoarseness, up to loss of voice
- Noisy breathing and shortness of breath
- Retraction of intercostal spaces in children
- Cough and feeling of obstruction in the throat
- No fever or pain
- Worse from colds
- Attacks of difficulty breathing
Diagnostics
The main method is endoscopic examination of the larynx, which in children is performed with a flexible endoscope and, if necessary, under anesthesia using a microscope. The doctor evaluates the number, size and location of formations, the degree of narrowing of the lumen, and involvement of the trachea. The removed tissue must be sent for histological examination to confirm the diagnosis and exclude malignant degeneration, which is rare, but possible. Additionally, the type of virus is determined, since this affects the prognosis of the course.
- Endoscopy of the larynx, in children - with a flexible endoscope
- Examination under anesthesia with a microscope
- Assessment of the prevalence and degree of narrowing
- Histological examination of removed tissue
- Human papillomavirus typing
- Monitoring the condition of the trachea and bronchi
Treatment and prevention
The basis of treatment is careful removal of papillomas endoscopically with maximum preservation of healthy mucous membrane, since rough interventions lead to scars and persistent voice impairment. Operations often have to be repeated, and the intervals between them are determined by the growth rate of the formations. With very frequent relapses and spread to the lower respiratory tract, the doctor may additionally prescribe antiviral or other therapy. An important preventive measure is vaccination against the human papillomavirus before the onset of sexual activity.
- Gentle endoscopic removal of papillomas
- Maximum preservation of healthy mucosa
- Repeated interventions as relapses occur
- Additional therapy for aggressive course
- Reflux treatment and smoking cessation
- Vaccination against HPV
- Regular observation by an ENT doctor
