PATTERNS, TREATMENT STRATEGIES, AND OUTCOMES OF ADULT LARYNGEAL PAPILLOMATOSIS: INSIGHTS FROM A THREE YEAR STUDY IN AN ENT DEPARTMENT OF TERTIARY CARE HOSPITAL

Abstract

Background: Adult laryngeal papillomatosis is a recurrent benign laryngeal disorder caused by human papillomavirus, frequently associated with significant voice morbidity and repeated surgical interventions. The disease follows an unpredictable clinical course with frequent recurrences, leading to cumulative laryngeal trauma and impaired quality of life. Despite advances in microlaryngeal surgical techniques, optimal management remains challenging due to variability in disease severity, recurrence patterns, and functional voice outcomes. Incorporation of validated clinical severity and voice-related quality-of-life measures is essential for comprehensive assessment and outcome evaluation. Regional data from South India addressing these parameters remain limited.

Objectives: To evaluate the clinical patterns, treatment strategies, disease severity, and voice-related outcomes of adult laryngeal papillomatosis over a three-year period in a tertiary care hospital.

Methods: This observational study was conducted in the Departments of ENT of tertiary care Hospitals of Pune, Hyderabad and KMCH, Bihar over three years from March 2022. Adult patients diagnosed with laryngeal papillomatosis were included. Ten variables were analyzed: age, gender, site of involvement, symptom burden, Modified Severity Score (MSME), Voice Handicap Index (VHI) score, number of surgical interventions, and type of surgical treatment, recurrence rate, and functional voice outcome. Diagnosis was confirmed by laryngoscopy and histopathology. Disease severity was graded using MSME, and voice-related quality of life was assessed using VHI. Surgical management included microlaryngeal excision using cold instruments or microdebrider. Statistical analysis was performed using appropriate tests, with p < 0.05 considered significant.

Results: Most patients were males (68%), with a mean age of 45 ± 12 years. Hoarseness was the predominant symptom (92%), and glottic involvement was observed in 74% of cases. Higher MSME scores were significantly associated with multisite disease and increased recurrence (p = 0.03). Multiple surgical interventions were required in 61% of patients. Postoperative improvement in VHI scores was observed in 79% of patients; however, those undergoing ≥3 surgeries demonstrated poorer voice outcomes and persistently higher VHI scores (p = 0.04). Conclusion: Adult laryngeal papillomatosis is associated with high recurrence rates and significant functional voice morbidity. Higher disease severity (MSME) and multisite involvement significantly increase recurrence risk (p = 0.03), while repeated surgical interventions adversely affect voice-related quality of life as reflected by VHI scores (p = 0.04). Early diagnosis, objective severity grading, structured voice assessment, and long-term follow-up are crucial for optimizing functional outcomes and disease control.