Structural Changes in Vocal Fold : Papilloma


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Papillomas are wart-like lesions that develop on the surface of the vocal folds, but often invade deeper into the vocal fold’s layered structure and even into the vocalis muscle. Papillomas are persistent tumors (typically benign) thought to be caused by viruses, although no clear etiology has been established. They tend not to be transmitted between family members, nor has any genetic pattern been identified. Papillomas are usually found equally in both genders of children usually appearing between the ages of two and four years. Less frequently, the disorder can begin in adult years, and the incidence of adult onset is increasing. In children, the development of papilloma usually decreases with age and often papillomas may disappear altogether during puberty.

Due to the often invasive nature of the Papilloma, the vocal quality in these patients is typically severely dysphonic. Because of the diffuse locations and rapid spread of the papilloma, medical treatments are aggressive, including interferon therapy and laser excision. Multiple laser surgeries are often required to control these tumors, and these repeat procedures can create vocal fold scarring. The biggest concern with Papilloma the fact that papillomas are known to spread within the upper airway, involving the larynx, trachea, and bronchus potentially leading to compromised respiration.

Although aggressive medical and surgical management is necessary for the treatment of these lesions, direct voice therapy may be beneficial in some patients as well. There is some evidence that papilloma spread and severity may be reduced in patients who avoid hyper functional voice use and reduce excessive medial compression of the vocal folds. Additionally, treatment may be required to assist patients in reestablishing optimal voice quality after surgery, especially when vocal folds are scarred due to multiple procedures.

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