Gastroesophageal reflux disease and pharyngolaryngeal reflux in children with chronic laryngeal pathology

A prospective non-randomized trial was made to evaluate incidence of gastroesophageal reflux disease (GERD) and pharyngolaryngeal reflux (PLR) in children with chronic laryngeal pathology. A total of 46 children aged 6 to 15 years were examined including 16 patients with recurrent respiratory papillomatosis, 15 patients with acquired laryngotracheal scarry stenosis and 15 patients with vocal nodules and functional dysphonia. Combination of GERD with PLR is a factor of risk for scarry laryngostenosis in a child with recurrent respiratory papillomatosis. If it is impossible to perform 24-h pH-monitoring of the esophagus for detection of GERD or PLR in patients with chronic laryngeal pathology, antireflux therapy is prescribed empirically. It is necessary to establish significant diagnostic criteria of PLR.     

Experience with the treatment of cicatrical laryngotracheal obstruction in children

A total of 152 children presenting with various forms of laryngotracheal obstruction were admitted to the Russian Children's Clinical Hospital during the period between 1995 and 2009. Cicatrical stenosis predominated in the structure of chronic laryngeal obstruction accounting for 33% of the cases. In the overwhelming majority of these patients, the main cause underlying the process of formation of rough cicatrical tissue in the larynx was a long-standing intubation injury (3-4 days during the inflammatory reaction and 7-8-day laryngeal intubation period). The patients with pronounced cicatrical obliteration of the larynx underwent laryngotracheal reconstruction of the laryngeal lumen with the formation of an external passage, removal the cicatrical conglomerate with the obligatory enlargement of the laryngeal cross section area in the stenosed region, and subsequent long-term prosthetic treatment with plastic closure of tracheostoma. Endoscopic microsurgery in the cicatrical stenosis region during direct laringoscopy under video control was used to treat the patients with superficial forms of cicatrical stenosis, such as membrane stenosis, synechiae, and circular stenosis, characterized by moderate narrowing of the laryngeal lumen.     

Tracheal, bronchial, and pulmonary papillomatosis in children

OBJECTIVES: To compare the clinical course of tracheal, bronchial, and pulmonary papillomatosis with clinical course of laryngeal papillomatosis in children. STUDY DESIGN: The records of the 448 children with recurrent respiratory papillomatosis treated in St. Vladimir Moscow Children's Hospital between 1988 and 2003 were reviewed. In all cases, the diagnosis was confirmed histologically. Age at onset of symptoms, age at first surgery, number of surgical procedures, mean duration of surgical interval, possible causes, and age at a point of papillomatosis spread in the lower airways and course of the disease were analyzed. SETTING: Academic children's hospital. RESULTS: Papillomas extension down to lower airways was observed in 40 children (8.9%). Among 40 patients with lower airway recurrent respiratory papillomatosis, 8 (20%) demonstrated pulmonary involvement. The basic cause of papilloma extension to lower airways appeared to be tracheotomy performed in children with laryngeal papillomatosis (92.5% of cases). Incidence of satellite pharyngeal and esophageal papillomatosis is significantly higher in patients with lower airways papillomatosis, presenting evidence of lager process extension. The clinical course of lower airways papillomatosis is more aggressive as compared with laryngeal papillomatosis, and treatment efficacy in such children is lower. CONCLUSIONS: All the patients with laryngeal papillomatosis having a history of tracheotomy require a regular endoscopic control and chest radiographs or computed tomography scanning because tracheal or pulmonary papillomatosis may occur in such patients even several years after decannulation. The prognosis for the disease after development of pulmonary papillomatosis is always serious.     

儿童复发性喉乳头状瘤样病变的临床研究

目的　探讨儿童喉乳头状瘤样病变 (juvenilrecurrentlaryngealpapillomatosis,JRLP)的治疗方法及儿童复发性呼吸道乳头状瘤 (juvenileonsetrecurrentrespiratorypapillomatosis,JORRP)与小儿喉尖锐湿疣 (infantilelaryngealcondylomaacuminatum ,ILCA)的关系。方法　回顾分析 1994年 3月～ 2 0 0 2年 3月诊治的 4 4例JRLP的临床资料。结果　 4 4例中普通组织病理学诊断为ILCA 2 8例 ,JORRP 16例 ;采用斑点杂交和聚合酶链反应检测人乳头状瘤病毒阳性率达 4 2 / 4 4。JRLP患儿平均初诊时间 1 6岁 ,平均手术次数 5 3次 ,平均手术间隔期 2 4个月 ;在总共 2 33次手术中 ,各种并发症总发生率为 3 9%。目前 ,长期缓解 18例 ,正在随访的有 11例 ,失访 10例 ,死亡 5例。手术加有治疗目的的气管切开 (延长手术间隔期 )和手术加中药两种治疗方式效果较好。JORRP和ILCA存在广泛的共性。结论　深入研究JORRP和ILCA的关系具有十分重要的理论价值和临床意义。应尽量避免用气管切开术来缓解JRLP所引起的喉梗阻 ,手术加有治疗目的的气管切开术和手术加中药治疗两种治疗方式值得进一步探讨。     

小儿复发性呼吸道乳头状瘤病38例临床分析

目的 :探讨小儿复发性呼吸道乳头状瘤病 (JORRP)的临床特点。方法 :回顾分折 1986年 6月～ 2 0 0 0年 6月收治的 JORRP 38例资料。结果 :平均发病年龄 2 .9岁 ,首次诊断平均年龄 3.5岁 ,平均手术 3.45次 ,术后并发喉功能障碍 8例 (2 1.0 5 % ) ,气管切开 19例 (5 0 .0 % ) ,6例气管造口有乳头状瘤传播 (31.5 8% )。结论 :JORRP是儿童最常见的喉部肿瘤 ,由于易复发 ,常需多次手术 ;手术应注意保存喉部正常组织 ;气管切开要慎重 ,以防病变局部接种和邻近器官传播     

Interferon therapy and immunotherapy in children with respiratory papillomatosis

The ENT clinic of St-Petersburg Pediatric Medical Academy for 15 years admitted 126 children with respiratory papillomatosis 10 months to 15 years of age. 111 of them had laryngeal papillomatosis. The scheme of combined treatment was adjusted to interferon status of the patients. Replacement therapy with recombinant interferon--viferon--was applied in low production of alpha/beta-interferon but high serum interferon. In low serum interferon and intact interferon reserves the treatment was combined: interferon inductor--cycloferon plus viferon. In all the children the above treatment was given following surgical (microendoscopic) removal of laryngeal papillomas. The clinical course of laryngeal papillomatosis ran in accordance with changes of interferon status in the majority of cases.     

儿童复发性喉乳头状瘤样病变的临床研究

目的 探讨儿童喉乳头状瘤样病变(juvenil recurrent laryngeal papillomatosis，JRLP)的治疗方法及儿童复发性呼吸道乳头状瘤(juvenile onset recurrent respiratory papillomatosis，JORRP)与小儿喉尖锐湿疣(infantile laryngeal condyloma acuminatum，ILCA)的关系。方法 回顾分析1994年3月～2002年3月诊治的44例JRLP的临床资料。结果 44例中普通组织病理学诊断为ILCA 28例，JORRP 16例；采用斑点杂交和聚合酶链反应检测人乳头状瘤病毒阳性率达42／44。JRLP患儿平均初诊时间1．6岁，平均手术次数5．3次，平均手术间隔期2．4个月；在总共233次手术中，各种并发症总发生率为3．9％。目前，长期缓解18例，正在随访的有11例，失访10例，死亡5例。手术加有治疗目的的气管切开(延长手术间隔期)和手术加中药两种治疗方式效果较好。JORRP和ILCA存在广泛的共性。结论 深入研究JORRP和ILCA的关系具有十分重要的理论价值和临床意义。应尽量避免用气管切开术来缓解JRLP所引起的喉梗阻，手术加有治疗目的的气管切开术和手术加中药治疗两种治疗方式值得进一步探讨。     

Lower airway papillomatosis in children

Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest X-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.     

喉部分切除术后并发喉狭窄的原因及处理

目的探讨喉癌行喉部分切除术后并发喉狭窄的原因及处理方法。方法回顾性分析2008-2013年住院治疗的28例喉癌术后并发喉狭窄的临床资料,28例患者根据引起狭窄的原因、狭窄的程度及狭窄的部位采取不同的治疗方式。其中2例术后联合放疗引起急性喉梗阻患者予以激素、抗感染治疗;16例患者行支撑喉镜下CO2激光切除术;5例患者行喉裂开术;5例患者行多次及多种联合手术。结果 28例患者中26例拔除气管导管,拔管率92.8%;2例患者手术后瘢痕及肉芽组织增生造成再次狭窄,随访至今仍未拔除气管导管。结论支撑喉镜下CO2激光切除术是喉癌行喉部分切除术后并发喉狭窄的首选方法,合理的修复缺损并喉腔重建、积极抗感染及治疗胃食管反流将会明显的减少喉部分切除术后喉狭窄的发生几率。     

喉狭窄喉成形术经验(附77例报告)

本文介绍喉狭窄成形手术新经验：①不以扩张为主，而是按照创伤修复规律做喉成形手术，再造喉腔结构；②不同病因类型的喉狭窄采用不同类型成形术式来治疗；③尽量采用自体组织，坚持就近取材原则，创新术式。文章报告77例喉狭窄治疗效果，获成功拔管者74例（占96．1％）。     

儿童复发性呼吸道乳头状瘤病临床研究

OBJECTIVE: To study the clinical behavior of juvenile-onset recurrent respiratory papillomatosis in order to find some factors correlated to the development of this disease, and to sum up the significance and experience of CO2 laser surgery. METHOD: Sixty patients with juvenile-onset recurrent respiratory papillomatosis from September 1995 to December 1998 were retrospectively analyzed. RESULTS: The age of onset in 50 cases (83.3%) was below 4 years, and the peak-age was 2 years. The rates of recurrence were 72.0% and 45.7% (chi 2 = 4.71, P < 0.05) below and over 2 years, respectively. The rates of aggressive disease were 88.0% and 54.3% (chi 2 = 7.66, P < 0.01) below and over 2 years, respectively. The predominant sites of the disease were the vocal cords, the false vocal cords, the laryngeal ventricle, the laryngeal surface of the epiglottis and the subglottic region. Tracheostomy induced the development of tracheal papilloma, therefore should be avoided as possible. Laryngeal papilloma might be divided into four types on the basis of the growth manner and surface form corresponding to clinical behaviors. Five patients were followed-up for 1.5 years without recurrence, 18 patients had fewer recurrences following treatment, 33 patients were under treatment, and 3 patients died. Nineteen patients lost follow-up. The major complications included laryngeal and tracheal stenosis. CONCLUSION: Clinical behaviors of juvenile-onset recurrent respiratory papillomatosis were relevant to the age, growth form and tracheotomy. CO2 laser was an ideal instrument for ablation of the laryngeal papillomas with the following advantages: simple management, less bleeding, preservation of laryngeal structure and avoidance of tracheostomy.     

Prevalence of human papilloma virus types and their influence on the course of the disease in children suffering from recurrent respiratory papillomatosis

The type of human papilloma virus (HPV) was determined in 26 children aged between 1 year 10 months to 15 years 5 months suffering from recurrent respiratory papillomatosis (RRP). Polymerase chain reaction identified DNA of HPV type 6, 11, 16 and 18. HPV DNA was detected in all the patients including fifteen patients infected with HPV type 11; seven patients infected with HPV type 6; four children infected with HPV type 6 and 11. Types 16 and 18 of HPV were not detected. The analysis of RRP course has found that laryngeal papillomatosis runs a more aggressive course in cases with HPV type 11 infection than in those with HPV type 6.     

Papillomatosis of the lower respiratory tracts in children

Papillomatosis of the trachea, bronchi and lungs was investigated in 40 children with papillomatosis of the lower airways in comparison with 408 children with laryngeal papullomatosis. All the patients were operated in 1988-2003 with histological verification of the diagnosis. Papillomas involved the lower airways because of tracheotomy (92.5%) or tracheal intubation (7.5%). Papillomatosis of the lower airways runs a more aggressive course than laryngeal papillomatosis, its treatment efficacy is worse. All the patients suffering from laryngeal papillomatosis with a history of tracheotomy need a regular endoscopic and x-ray control as papillomatosis of the trachea and/or lungs may develop in them several years after decanulation. Pulmonary papillomatosis has an invariably poor prognosis.     

Intralesional cidofovir injections for recurrent laryngeal papillomatosis: first results

BACKGROUND: The treatment of recurrent laryngeal papillomatosis still presents an important therapeutic problem. This primarily benign disease of the larynx is caused by an infection with the human papilloma virus (HPV) and forms epithelial neoplastic papillomas. Therapy in larynx obstructing papillomatosis usually requires laser ablation. Cidofovir acts virustatically as an nucleosidanalogon. Currently pilot studies investigate the effectiveness of intralesional Cidofovir injection. PATIENTS AND METHODS: The present study covers the period from October 2001 to March 2003. Seven patients, age of five to 70 years, were treated with intralesional injections of Cidofovir after microlaryngoscopic ablation of laryngeal papillomas. In all patients papillomatosis was confirmed histologically and a clinical-phoniatric examination and a photo documentation pre- and postoperatively was carried out. We treated patients to a maximum of six sessions. RESULTS AND CONCLUSIONS: After three to six sessions of laser ablation of the papillomas and intralesional injections with Cidofovir a distinct papilloma reduction could be observed in all patients and in two cases a complete remission was achieved. The follow-up period of seven to 15 months revealed no recurrent laryngeal papillomatosis. The majority of patients showed a defined voice improvement. There were no local or systemic side-effects caused by the virustatic drug. Intralesional injection of Cidofovir appears to develop into a promising adjuvant therapy option in recurrent laryngeal papillomatosis. First results of the study seem to achieve a considerable reduction of the previously high rate of recurrence of laryngeal papillomatosis.     

Intralesional Cidofovir application in recurrent laryngeal papillomatosis

Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical–phoniatric examinations and was photographed for documentation. After 2–7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8–30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible. This paper was presented at the 5th ELS Congress in Lisbon, 10–13 July 2004     

Management of complex glottic stenosis in children with recurrent respiratory papillomatosis

Objectives

To describe our management of complex glottic stenosis in tracheotomy dependent children with severe recurrent respiratory papillomatosis.

Methods

Retrospective chart review at a tertiary care children's hospital.

Results

Three children with complex glottic stenosis secondary to severe recurrent respiratory papillomatosis were treated at our institution since 2011. Two patients had complete stenosis, and the third had near-complete stenosis. Two patients were managed using balloon dilation alone, and the third also underwent laryngotracheal reconstruction with posterior costal cartilage grafting. Two patients have been successfully decannulated and the third has been tolerating continuous tracheotomy capping for greater than twelve months. All three patients underwent aggressive debridement of papillomatosis and balloon dilation every 4–6 weeks until their burden of disease was controlled. In two patients, the glottic airway was patent, and the third continued to have complete restenosis between procedures and required laryngotracheoplasty with multiple post-operative dilation procedures to establish an adequate glottic airway.

Conclusions

Severe laryngeal stenosis is a well-described complication of recurrent respiratory papillomatosis, but its management is not well-defined. Aggressive management of papillomatosis with frequent debridement is critical in successfully managing laryngeal stenosis. Balloon dilation alone may be surprisingly effective in these patients, and laryngotracheoplasty can be used as an adjunct procedure in those patients who fail balloon dilation. Given the quality of life issues and concerns regarding distal spread of disease with tracheotomies in these patients, we feel that aggressive management and early decannulation is in the patient's best interest.     

Endotracheal tube obstruction: a rare complication in laser ablation of recurrent laryngeal papillomas

During the past 25 years, use of the carbon dioxide (CO2) laser has been accepted as the most appropriate surgical method for the treatment of recurrent laryngeal papillomatosis. Although CO2 laser technology and surgical techniques continue to improve, laser-related complications still occur. We describe a case of a very rare complication--to our knowledge, only the second such case reported in the literature--in which an endotracheal tube was almost completely obstructed by a piece of papillomatous tissue during CO2 laser microlaryngoscopy for the treatment of recurrent laryngeal papillomatosis.     

喉硬结病的临床特点与治疗

目的　探讨喉硬结病的临床特点和治疗方法。方法　回顾性分析 1981年 5月～ 2 0 0 2年12月收治的 4 3例经病理证实的喉硬结病患者的临床资料和治疗方法。结果　 4 3例中声嘶 4 3例次、呼吸困难 19例次。喉部病变以萎缩期为主 2例 ,肉芽肿期为主 35例 ,瘢痕期为主 6例。主要病变局限于声门区 13例 ,局限于声门下区 1例 ;累及声门上区和声门区 18例 ,累及声门区和声门下区 8例 ,声门上区、声门区和声门下区均受累 3例。采用抗生素治疗 2 4例 ,手术治疗 7例 ,放射治疗 2例。采用抗生素治疗 2 4例中 ,18例治愈 ,另 2例复发后再进行抗生素治疗治愈 ;2 4例中 4例伴 2度或 3度喉阻塞者行预防性气管切开术。 1例伴 2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。 6例伴喉狭窄的瘢痕期患者通过手术成形治愈。 1例采用放射治疗后 4年复发 ,1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论　硬结病可侵犯喉部导致发声困难和喉阻塞 ,抗生素治疗对多数喉硬结病患者有效 ,治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

The role of ultrasonic diagnosis in pediatric laryngology

In order to have a visual picture of the larynx, laryngeal preparations and larynxes of 50 healthy children were exposed to ultrasonic scanning. Also, 48 children, aged 9 months to 15 years, were examined 77 times: their complaints were dysphonia and/or impaired breathing. On the basis of the findings sonographic signs of laryngeal papillomatosis were described (18 children). Ultrasonic observations were in the norm in catarrhal laryngitis (10 children) and limited forms of hyperplastic laryngitis (18 children). Ultrasonic examination helped diagnose impaired mobility of vocal cords. It is recommended to use ultrasonic visualization for rapid diagnosis of ENT diseases in children as well as for surveillance of children with laryngeal papillomatosis.     

Recurrent respiratory papillomatosis in pregnancy: a case of emergent airway management

Recurrent respiratory papillomatosis is a benign neoplastic process involving squamous epithelium of the respiratory tract, typically the vocal folds. In cases of aggressive growth, or uncontrolled disease, airway compromise and respiratory distress can occur. Human papillomavirus (HPV) is known to be the etiologic agent in this disease process, as well as in condyloma acuminata, or genital warts. Studies have shown that HPV-induced condyloma acuminata can worsen during pregnancy. We present a case of airway obstruction requiring emergent tracheostomy in a pregnant patient with known laryngeal recurrent respiratory papillomatosis. The management of this condition and some theories regarding its response to certain hormonal states are discussed.