Laryngeal Papillomatosis in Children

Definition

A condition in which multiple, warty growths are found in the airway, especially in the larynx.

Incidence/Age

The condition can occur at any age. It most often arises under the age of 4 in children.

Causes

RRP is caused by infection with human papilloma viruses Types 6 or ll. In 60 % of cases the child's mother has a history of genital warts giving rise to the possibility that the infection is acquired during birth.

Symptoms & Signs

Hoarseness is the commonest symptom, particularly if the hoarseness is progressive and not obviously related to shouting or screaming.

Features of upper airway obstruction may also occur. These include shortness of breath, noisy breathing especially breathing in (stridor) and occasionally breathing difficulty at night. Sometimes warts are visible elsewhere both on the skin and in the mouth and throat.

Complications of the Disorder

In the severest cases the condition can be lethal because rapidly recurrent warts block the airway or affect the lungs; fortunately this is very unusual.

Tests

Diagnosis is by examination of the airway. This can some times be done in the clinic with a cooperative older child but is most often done under anaesthetic by microlaryngocopy and bronchoscopy.

Treatment

Medical

No single drug has been shown to be uniformly successful in the treatment of RRP. Various antiviral drugs have been shown to have success in some individuals but all have their side effects. They include Acyclovir, Inteferon-alpha, Ribavirin and Inosine Pranobex. The drug Cimetidine, usually used for indigestion has also recently been shown to be helpful in some severe cases.

Surgery

In most cases the mainstay of treatment is surgical with removal of the papillomata from the airway via microlaryngoscopy. The most commonly used treatment is the carbon dioxide laser which vapourises the warts while doing minimal damage to underlying tissues but other lasers or removal methods are sometimes used in particular cases. The complications of laser surgery include scarring of the airway, unintended laser burns to tissues on the laser pathway and a very small risk of causing fire in the airway.

Tracheostomy

In some cases it is necessary to perform a tracheostomy because rapid regrowth of the papillomatas makes it impossible to keep the airway clear in any other way.

Outcomes

The principal problem with treating RRP is that like warts elsewhere, the papillomata tend to recur, patients may therefore require multiple treatments over the course of a number of years.

About 50% of patients recover eventually but relapse can occur many years later.