Seeing the Vocal Light: A Case of Laryngeal Papillomatosis

What is laryngeal papillomatosis?

The diagnosis of vocal cord papilloma can prove to be one of the most challenging voice conditions for sufferers . For voice therapists, our interventions are often limited and restricted to pre and post surgery assessment and advice.

Papillomatosis is a rare condition in which small benign tumours caused by the human papillomavirus (HPV) infect the throat. The condition can begin in childhood – juvenile papillomatosis, or in later years – adult laryngeal papillomatosis. As well as possible narrowing of the airway, the laryngeal wart type swellings very often cause voice changes. The typical voice presentation is husky and strained with a tendency to be high pitched also, at least intermittently.

How is it usually managed?

Most commonly, ENT management of the condition is surgical with repeat operations to remove the papilloma which tend to return. In most cases, the individual will enter periods of remission and in some, the virus may remain dormant after one of these remission periods. The amount of surgical procedures to remove the papilloma has a strong impact on voice quality since repeated surgeries causes scar tissue which causes the vocal cords to stiffen and loose flexibility. The vocal consequences of this most usually mean the person has a consistently hoarse voice with loss of vocal range.

The case of Miss M

A young lawyer came to see me who complained of tightness in the larynx and persistent vocal strain over many years. She explained that she’d had at least thirty separate ENT surgeries in her younger years for her juvenile papillomatosis.

On hearing her voice and the increase in symptoms which took her back to see an ENT as an adult, I assumed that the virus may have returned in her larynx . However, to her surprise also, the ENT assessment revealed that the papilloma had not returned.

Miss M was keen to gain some reduction of her symptoms and increase in her vocal ability; her work was being heavily impacted due to the weakness of her voice and inability to project it in meetings. I explained the nature of vocal fold scarring and its tendency to cause consistent voice strain . However, the fact that no papilloma had returned was a good sign and I suggested to her that we targeted reducing laryngeal constriction and muscle tension which would by now be an additional condition of her larynx overlying the original laryngeal pathology.

Over 6 sessions, I worked with Miss M with larynx opening exercises involving false vocal fold retraction. Some vocal improvements were made by sessions 2 and 3 and crucially, in spite of the hard work involved to maintain the false fold retraction, Miss M felt relief in her throat and was experiencing less vocal fatigue.

Hark! I see a voice

The most illuminating moment of voice therapy is when clients see the vocal light. I remember the moment Miss M’s light was switch on and she grasped the concept of how having an open larynx feels. By this stage, I was encouraging her to actively feel this. Once she grasped the feeling, both external and internal, I increased the length of the tasks and Miss M increased her efforts further so that the release of larynx constriction was further maintained. Having learnt a technique that she understood and could repeat, she was able to continue to make sustained progress. The brightest light in voice therapy is when clients can apply the voice techniques to their everyday voice . Empowering clients and putting them in control of their voice is the ultimate outcome of voice therapy and training.