The causative agent of recurrent pathology is the papilloma virus, which disrupts the process of proliferation of epithelial cells. Fibroepithelial tumors are diagnosed with the same frequency in adults and children.
Papillomas in the throat progress rapidly, blocking the airways, which leads to asphyxiation.
Even after surgical removal of neoplasms and subsequent drug treatment of patients, the risk of re-proliferation of the transitional epithelium remains.
The mechanism of development of the disease
What is the mechanism of development of papilloma in the throat? Human papillomavirus destructively affects the development of tissues, as it infects the proliferating cells of the basal layer of the transitional epithelium. Even single virions provoke infectious processes in the larynx. The causative agent of the pathology is distinguished by a high tropism in relation to the mucous epithelium of the respiratory organs.
Replication of DNA by pathogens is observed only in the cells of the basal layer of tissues; in other layers of the epithelium, virions practically do not persist. Subsequent stimulation of viral expression can occur at any time after tissue injury. According to histological studies, viral DNA is retained in the pharyngeal mucosa in patients with prolonged remission.
The reactivation of the papillomavirus is provoked by immunosuppressive conditions, exacerbation of chronic pathologies and allergic reactions.
Pathomorphology
Recurrent papillomatosis of the larynx looks like wart tumors with exophytic growth. Most often, neoplasms appear at the junction of the squamous and ciliary epithelium - the laryngeal surface, soft palate, vocal folds, epiglottis, tracheal bifurcation, etc. On microscopic examination, papillomas look like finger-like rigid outgrowths located on the connective tissue stroma.
Important! Papillomatous formations can develop into malignant tumors.
Keratinization of benign neoplasms may indicate the development of squamous cell carcinoma. In children, the disease progresses rapidly, affecting not only the mucous membranes of the larynx, but also the vocal cords. Untimely removal of papillomas in the throat area often leads to dysfunction of the vocal apparatus and the development of aphonia.
Causes
Why does papillomatosis of the larynx occur? The reasons for the development of pathology are not fully understood. It is known that the papillomavirus enters the human body mainly through sexual and household routes. In addition, cases of transplacental and congenital infection of newborns have been recorded.
Virions actively multiply in the affected tissues only after exposure to provoking factors, which include:
- decreased immunity;
- work at gas-polluted enterprises;
- violation of cellular metabolism;
- endocrine diseases;
- unsuccessful tracheotomy;
- secondary immunodeficiencies;
- psycho-emotional overstrain;
- allergic conditions;
- exposure to ultraviolet radiation and chemical agents.
The mere presence of papillomavirus in the human body is not the cause of the development of a benign tumor.
Laryngeal papillomatosis in infants most often develops in the absence of breastfeeding. Mother's milk contains immune cells that prevent the child's body from decreasing the reactivity. The composition of artificial mixtures contains only trace elements and vitamins, which practically do not stimulate the child's immune system.
Clinical manifestations
If a swelling has formed in the throat, what indicates the development of papillomatosis in the larynx? At the initial stages of tumor development, it is difficult to diagnose pathology, since small papillomas practically do not cause discomfort. However, in the case of localization of fibroepithelial neoplasms near the vocal cords and larynx, patients most often complain of the following clinical manifestations:
- decrease in the timbre of the voice;
- hoarseness of voice;
- breathing disorder;
- asphyxiation attacks;
- suffocating cough;
- discomfort when swallowing;
- shortness of breath on exertion;
- hemoptysis.
Important! Ignoring the problem leads to hyperkeratosis of the vocal cords and the development of dysphonia.
It should be noted that papilloma on the tonsil and in the larynx in about 15% of cases entails complications. One of the most formidable complications is malignancy of benign tumors, the risk of which increases many times over when neoplasms spread to the bronchi.
How to understand that there is a papilloma in the throat? Symptoms of the pathology are specific, however, papillomatosis can be diagnosed only with a significant increase in the size of the tumors. The disease is especially dangerous for children, since they have a narrower lumen in the larynx. The growth of neoplasms narrows the lumen of the airways, which leads to impaired breathing and asphyxiation.
Classification of papillomatosis
As a rule, with the development of papillomavirus in the throat area, several benign tumors form at once. Sometimes in patients over the age of 30, solitary papillomas are found, which are large formations with a diameter of 1.5-2 cm.Even after undergoing surgical and drug therapy, the tumors recur, which entails the development of polyposis.
Depending on the degree of spread of benign neoplasms, several forms of papillomatosis are distinguished:
- local - minor damage to the epithelial tissues of the larynx, in which tumors cover up to 30% of the glottis;
- diffuse - multiple neoplasms on both sides of the throat, covering the glottis by 60-70%;
- obliterating - clogging of the glottis by more than 80%.
Most often, pathology develops in patients during puberty and menopause. Hypo- and hyperfunction of the gonads leads to instability of the hormonal background and, accordingly, a decrease in the body's resistance. In the case of damage to the transitional epithelium by the papillomavirus, the growth of benign tumors is observed. Depending on the method of infection and the age of the patient, the following types of papillomatosis are distinguished:
- congenital - infection of the child's body occurs either in the womb, or when the child passes through the birth canal;
- acquired - pathogenic viruses are transmitted by household or sexually through contact with an infected person;
- juvenile - diagnosed in children in the first few years of life;
- recurrent - develops in patients in puberty and is characterized by a high risk of recurrent tumors.
An overgrown papilloma in the throat leads to the development of stenosis and acute asphyxia.
Diagnostics
The clinical manifestations of papillomatosis of the throat are similar to those of diphtheria, false croup, squamous epithelial cancer, etc. It is possible to accurately determine the type of disease only in the case of passing differential diagnostics by an otolaryngologist.The following types of medical examinations allow diagnosing pathology:
- laryngoscopy - examination of the mucous membranes of the larynx with a laryngoscope, with which it is possible to detect neoplasms on the walls of the respiratory tract and vocal cords;
- histological analysis - microscopic examination of tissue samples to determine the characteristics of the tumor;
- microlaryngostroboscopy - a hardware study, with the help of which it is possible to identify pathologies in the vocal apparatus and the nature of the closure of the vocal cords;
- computed tomography - a study of the structure of the pharynx, which allows to determine the prevalence of tumor formations;
electroglottography - calculation of the amplitude of vibration of the vocal cords, thanks to which it is possible to determine the type of tumor.
electroglottography - calculation of the amplitude of vibration of the vocal cords, thanks to which it is possible to determine the type of tumor.The gland affected by the tumor is most often removed, however, cardinal methods of therapy have not yet been developed for the treatment of neoplasms in the larynx. As a rule, the papilloma of the larynx is removed surgically, after which the patient undergoes a course of drug therapy. However, this does not exclude the possibility of re-growth of the transitional epithelium in the pharynx.
Operative treatment
Surgical treatment is performed with the ineffectiveness of drug therapy or a strong proliferation of papillomas in the larynx. To reduce the likelihood of recurrence, the surgeon must remove up to 95% of benign tumors in the ENT organs. To remove neoplasms, modern endoscopic methods of treatment are used, which involve mini-operations in the airways.
Some of the most effective and painless methods for removing benign tumors include:
- cryodestruction - freezing of neoplasms with liquid nitrogen, which leads to the destruction of pathological tissues;
- argon plasma coagulation - contactless excision of papillomas with radio wave radiation, enhanced by the action of an inert gas;
- electrocoagulation - removal of benign tumors with a constant electric current followed by "sealing" the blood vessels;
- ultrasonic disintegration - destruction of papillomas inside the throat by high-intensity ultrasonic waves.
Important! Extra-laryngeal methods of therapy with the use of a tracheostomy in 80% of cases lead to a relapse of the pathology.
To prevent papilloma in the throat from forming again, over the next 10-15 days, the patient should take the following types of medications:
- glucocorticosteroids - reduce tissue swelling and accelerate regeneration processes in the laryngeal mucosa;
- immunostimulants - increase immunity, which prevents the re-development of papillomavirus;
- estrogen preparations - inhibit the reproductive activity of virions, thereby reducing the risk of recurrence of the disease.
In the first 10 days after removal of neoplasms, the patient should adhere to a sparing diet, which consists in eating food of a liquid consistency - soups, cereals, mashed potatoes, etc.
Anti-relapse therapy
Surgical treatment refers to the methods of palliative, i.e. symptomatic therapy, since it does not exclude the likelihood of re-formation of fibroepithelial tumors. The passage of drug therapy allows you to increase the inter-relapse periods. To prevent papillomas in the throat from appearing again, the following medications are included in the conservative treatment regimen:
- interferon preparations (Genfaxon, Viferon) - increase local and general immunity, thereby reducing the risk of developing human papillomavirus;
- immunomodulators (Panavir, Viruter) - stimulate the activity of immunocompetent cells that prevent the reproduction of opportunistic microorganisms;
- antiviral agents ("Allokin-Alpha", "Acyclovir") - interfere with the replication of viral DNA, as a result of which the number of papillomaviruses in the body is reduced;
- cytostatics ("Vartek", "Roncoleukin") - prevent pathological division of epithelial cells, which reduces the likelihood of papillomas;
- hormonal drugs ("Proginova", "Duphaston") - inhibit the synthesis of androgens, which slows down the process of division of cells of the transitional epithelium;
Interferon therapy is one of the most effective methods of treating papillomatosis. Interferon preparations stimulate immunocompetent cells, thereby increasing the resistance of epithelial tissues against pathogenic viruses.
Forecast
Despite intensive research and development of new methods of treatment, it is not always possible to completely eliminate laryngeal papillomas. The course of recurrent papillomatosis is not always predictable, therefore, no specialist will dare to guarantee the absence of relapses. The exact mechanism of development and the reasons for the manifest course of the pathology are not fully understood.
It is believed that immunodeficiency states, which cause the variability of the clinical manifestations of papillomatosis, can provoke the development of the disease. In the case of a favorable course of the pathology, the persistence of the papillomavirus persists, which in the future may lead to tumor recurrence and the development of complications.
In other words, the treatment of the disease remains only symptomatic. Endolaryngeal surgery can eliminate stenosis of the larynx. The passage of anti-relapse therapy, which involves the use of drugs with immunostimulating and cytostatic action, helps to reduce the risk of re-development of neoplasms.
