ETIOPATHOGENESIS OF RECURRENT LARYNGEAL PAPILLOMATOSIS AND CONTEMPORARY TREATMENT STRATEGIES

Recurrent laryngeal papillomatosis is a rare and chronic disease of the larynx caused by infection with human papillomaviruses type 6 or 1. Larynx is the most common location of papillomas with changes in voice as the first presenting symptom. Patients suffer from wart-like growths in the aerodigestive tract, recurrences and possible life-threatening obstruction of the airway. The course of the disease is unpredictable. Although spontaneous remission is possible, variable clinical course may include frequent recurrence of disease, significant morbidity and frequent surgical procedures. The mechanisms responsible for the variability in the clinical course and the persistence of latent HPV infection remain unknown. It is considered that both adaptive and innate immune response made by patients with papillomatosis support chronic infection. Patients with laryngeal papillomas are unable to produce an effective HPVspecific T-cell response, as shown by an altered CD8+ subset and the Th1/Th2 cytokine imbalance with suppression of Th1 response. There is a genetic association between certain HLA type II genes with severe course of disease and downregulation of HLA type I genes. Surgical excision, including new methods such as microdebrider, aims to secure an adequate airway and improve and maintain an acceptable voice, but may cause serious complications like stenosis of the airway. When papillomas recur, old and new adjuvant methods may be tried. Intralesional cidofovir injection is shown as effective and secure in the majority of cases. Recent advances in immune system research may provide the improvement of our treatment modalities and prevention strategies.