[4][5] Laryngeal papillomatosis is initially diagnosed through indirect laryngoscopy upon observation of growths on the larynx and can be confirmed through a biopsy.
[7][9][2][10] Laryngeal papillomatosis is primarily treated surgically, though supplemental nonsurgical and/or medical treatments may be considered in some cases.
[8][5] Laryngeal papillomatosis is caused by human papillomavirus (HPV) infection, most frequently types 6 and 11,[13] although genotypes 16, 18, 31, and 33 have also been implicated.
[14][13] In general, physicians are unsure why only certain people who have been exposed to the HPV types implicated in the disease develop laryngeal papillomatosis.
[6][8] In indirect laryngoscopy, the tongue is pulled forward and a laryngeal mirror or a rigid scope is passed through the mouth to examine the larynx.
[12][6] Another variation of indirect laryngoscopy involves passing a flexible scope, known as a fiberscope or endoscope, through the nose and into the throat to visualize the larynx from above.
[12] The appearance of papillomas has been described as multiple or rarely, single, white growths with a lumpy texture similar to cauliflower.
[1][17][18] A confirmatory diagnosis of laryngeal papillomatosis can only be obtained through a biopsy, involving microscopic examination and HPV testing of a sample of the growth.
[14] As of 2014, there was no permanent cure for laryngeal papillomatosis, and treatment options aimed to remove and limit the recurrence of the papillomas.
[7][10] Typically performed using a laryngeal endoscopy, surgery can protect intact tissues and the individual's voice, as well as ensure that the airway remains unobstructed by the disease.
[9][2][7][10] Tracheotomies are offered for the most aggressive cases, where multiple debulking surgery failures have led to airways being compromised.
[8] This method should be avoided if at all possible, since the breathing tube may serve as a conduit for spread of the disease as far down as the tracheobronchial tree.
Microdebriders are gradually replacing laser technology as the treatment of choice for laryngeal papillomatosis, due to their ability to selectively suction papillomas while relatively sparing unaffected tissue.
[2] Some varieties of nonsurgical treatments include interferon, antiviral drugs (especially cidofovir, but also ribavirin and acyclovir), and photodynamic therapy.
[9][2][7][10][12] The monoclonal antibody against vascular endothelial growth factor (VEGF), bevacizumab, has shown promising result as an adjuvant therapy in the management of recurrent respiratory papillomatosis.
The evolution of laryngeal papillomatosis is highly unpredictable and is characterized by modulation of its severity and variable rate of progression across individuals.
[8][1][11] Factors that might affect the clinical course of the condition include: the HPV genotype, the age at onset, the elapsed time between the diagnosis and first treatment in addition to previous medical procedures.