Laryngeal papilloma and reflux
She had 8 surgeries for laryngeal papilloma over 24 years. Then for the past 3 years, her ENT kept telling her she had reflux laryngitis. She was not getting better on acid reflux treatment, and came to visit me. She had recurrent papillomatosis.
Not everyone has a high-resolution endoscope and not everyone looks close enough to identify papilloma even when it exists. There is also the unfortunate and pervasive belief that when something obvious is not found, the hoarseness must be due to reflux. The top photo is taken with a high-quality endoscope, but from the typical viewpoint above the larynx, including above the epiglottis. It is difficult to appreciate the papilloma growing on the right vocal cord. In the second photo, the papilloma is much easier to appreciate.
After her first excision, we have been able to manage her recurrences in the office, using a laser through the endoscope to ablate the papillomas.