Papillomas are the most common laryngeal tumors of infancy and childhood (1–7). Children are more prone to this affliction than adults, particularly if the papillomas are multiple. The sex incidence is roughly equal, with a slight male predominance. The lesions are more likely to recur after removal if the patient is under the age of sixteen years. Most investigators (8) feel it is impossible to detect histologic differences between papillomas removed from a child and those removed from an adult or between single and multiple papillomas. Hoarseness is the most common, and usually the first, symptom of this disorder. The only other consistent symptom is respiratory distress occasioned by obstruction caused by the papillomas. Both symptoms depend upon the extent and location of the lesions. The primary treatment of these tumors is surgical removal. A single removal effects a permanent cure in the majority of cases, although recurrences are common and should be treated in the same manner as the original lesion. Some patients have undergone more than 100 procedures for removal of laryngeal papillomas. Many types of therapy, including steroids, sex hormones, Aureomycin, irradiation, and autogenous vaccines, have been employed. The long list of therapeutic agents indicates a lack of consistent results from any. Some reports suggest that these tumors on rare occasions undergo spontaneous malignant degeneration. Undoubtedly such a change has occasionally followed radiation therapy, although there is no convincing evidence that it has ever occurred in the absence of an aggravating factor of this nature. Radiation is rarely, if ever, indicated in the treatment of this disorder. We have recently encountered two patients with laryngeal papillomatosis exhibiting pulmonary complications indicative of spread of the lesions into the distal bronchi and pulmonary parenchyma. Although no histologic proof has been obtained, the striking similarity between these cases and others reported in the literature is convincing that this complication has supervened. The rarity of the condition and its serious consequence occasion this report. Case Reports Case I: S. D., a 5-year-old white male, was admitted to the University of Kentucky Medical Center on Sept. 12, 1964, because of severe respiratory distress. The patient had been troubled with wheezing, dyspnea, and hoarseness for several months. The dyspnea had increased in severity during the few weeks prior to hospital admission. Post-traumatic hydrocephalus had been successfully treated with a Pudenz ventriculoatrial shunt four years prior to admission. The only significant physical findings were marked bilateral inspiratory retraction, hyper-resonance to percussion, and inspiratory and expiratory wheezes. Neither rales nor rhonchi were heard.
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Rosenbaum et al. (1968) studied this question.