Dr. Aref Awa, Consultant ENT Surgeon and Head of the ENT Surgery Department.
The Ear, Nose and Throat (ENT) Surgery Department at Al-Ahli Hospital recently performed surgery on a patient having a rare condition affecting some 3.7% in one million people.
The 35-year-old patient with vocal papillomas suffered for many years until he was diagnosed and treated at the Al-Ahli Hospital on October 13 and has recovered well.
Vocal papillomas are growths that occur in the airway, most commonly on the vocal cords. They are caused by human papilloma virus (HPV). Because the growths are located on the vocal cords (the entry to the lungs), if they grow large enough they can impair the ability to breathe. Also, if left untreated, papillomas may spread into the lungs and can cause serious complications.
Appropriate treatment of papilloma is extremely complicated and involves management of medical problems as well as complex surgical and in-office techniques. This includes laser and microlaryngeal surgery as well as utilization of the newest anti-viral medications available.
“Vocal papillomas are a very rare condition and this is the first time we have performed such a surgery at the Al-Ahli Hospital. We performed the microlaryngeal surgery and cleaned the vocal cord. The patient is completely well and his voice is back to normal,” said Dr. Aref Awa, Consultant ENT Surgeon and Head of the ENT Surgery Department.
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“This patient had undergone the same treatment in the US but unfortunately he developed side effects and couldn’t recover fully,” he added.
Two years back Anas Sukkar had realized hoarseness in his voice and had to take too much effort to speak. Initially he thought it was normal due to his habit of talking loud. However after a week, Anas consulted an ENT specialist and he was told that his voice will improve and nothing to worry.
But when things didn’t change for another two weeks, Anas consulted the ENT specialist again. At that time he was diagnosed with vocal papillomas. Anas was advised to take treatment in the US as he was a citizen there.
Yet, his condition didn’t improve and he had side effects like throwing out and he lost around 10kg of his weight. “I went through a lot but didn’t get my voice back. Then a friend recommended to see Dr. Aref at the Al-Ahli Hospital,” said Anas.
Dr. Aref fixed the surgery date for Anas, nine days after his first appointment. And it was a one- hour microlaryngeal surgery.
“I even forgot my real voice as I was sounding hoarse. But with the surgery at Al-Ahli Hospital, I was able to talk and hear my voice again after two years,” said Anas speaking very clear and loud.
According to Dr. Aref, the recovery after the surgery was very fast and Anas will have to come to the hospital only for a follow-up in six months.
Symptoms of papilloma vary based on the severity of disease and your voice demands.
You will possibly notice:
• Hoarseness in your speaking voice
• Hoarseness (irregular, inconsistent quality) in your professional voice (singing, voiceover, etc)
• Difficulty breathing
• A sensation of a foreign body in the throat
• Hearing two pitches at the same time
• Decreased range (no longer hitting higher notes easily)
• Inability to sing quietly
• Throat discomfort, pain, or tightness
• In children, symptoms are different and may include, weak cry, episodes of choking, hoarseness
What do papilloma look like?
A papilloma is a warty growth that comes off the surface of the vocal fold. It is dense and solid and may have small spots of darker red within it. These vocal cords are nearly replaced by papilloma. Normal vocal cords are white. Everything pink on the vocal cords is papilloma (see arrows).
How do I know if I have a papilloma?
The only way to know if your symptoms are due to a papilloma is to have your vocal cords examined. This requires the use of videostroboscopy by a laryngologist.
Vocal papilloma complications
There are complications to papillomas. By definition, this is a surgical disease that often requires several surgeries to adequately control.
If surgery is done by someone who is not skilled in micro laryngeal surgery, this will lead to: Permanent hoarseness, scarring, painful phonation / voice use or permanent loss of vocal range. Papillomas also have potentially life-threatening complications:
Malignant transformation: 3-5% of papillomas may become cancerous
Distal spread: If left untreated, papillomas can spread further into the airway, specifically into the lungs. Here they can cause devastating consequences, including death.
How can I avoid having a complication?
Early diagnosis is the key to avoiding these complications. As soon as diagnosis is suspected, treatment must be initiated quickly to avoid the complications listed above.
