PAPILLOMA

Location:

* Tumor starts in the epithelium
* May occur in various parts of the larynx: subglottally,
    at level of vocal folds and supraglotically

Etiology:

* Virus of the papovavirus group
* Occurs in both children and adults
* Know as juvenile papilloma in children and is very resistant to eradication

Effect:

* Presence interferes with glottal closure depending on the extent of lesion
* Increased stiffness created by lesion impedes horizontal excursion of the folds
* Mucosal wave absent in the area of lesion
* Tendency to proliferate and obstruct airway

Perceptual signs and Symptoms

* Hoarseness is the primary symptom
* Due to extensive involvement of true vocal folds, a low pitch may result
* Severe dysphonia
* Individual may become completely aphonic

Measureable Physiological Signs

* No measurable physiological data reported for individuals
   with papillomas of the vocal folds

* Due to increased stiffness of the cords greater expiratory air pressures is expected

Observable Physiological Signs

* Laryngoscopy: Papilloma will typically present as a
    whitish cluster of tissue, comparable in texture to a raspberry

* Stroboscopy: Papillomas will interfere with glottal closure

Pathophysiology

* Papillomas affect vocal fold vibration by increasing the
    mass and stiffness of vocal folds and altering the biomechanical
    characteristics of the mucosa

* Lesions may be removed surgically, but tend to recur especially in children

* With multiple surgical excursion, the membranous cover of the may be
    damaged to interfere with amplitude and vibratory behavior

* Treatment with interferon has been tried but with inconclusive results

Dana Hohman, 1997