Editor's Note: This Manuscript was accepted for publication January 24, 2008.
Recurrent Respiratory Papillomatosis: A Review†
Version of Record online: 2 JAN 2009
Copyright © 2008 The Triological Society
Volume 118, Issue 7, pages 1236–1247, July 2008
How to Cite
Derkay, C. S. and Wiatrak, B. (2008), Recurrent Respiratory Papillomatosis: A Review. The Laryngoscope, 118: 1236–1247. doi: 10.1097/MLG.0b013e31816a7135
- Issue online: 2 JAN 2009
- Version of Record online: 2 JAN 2009
- Recurrent respiratory papillomas;
- childhood hoarseness;
- human papillomavirus;
Recurrent respiratory papillomatosis (RRP), which is caused by human papillomavirus types 6 and 11, is the most common benign neoplasm of the larynx among children and the second most frequent cause of childhood hoarseness. After changes in voice, stridor is the second most common symptom, first inspiratory and then biphasic. Less common presenting symptoms include chronic cough, recurrent pneumonia, failure to thrive, dyspnea, dysphagia, or acute respiratory distress, especially in infants with an upper respiratory tract infection. Differential diagnoses include asthma, croup, allergies, vocal nodules, or bronchitis. Reports estimate the incidence of RRP in the United States at 4.3 per 100,000 children and 1.8 per 100,000 adults. Infection in children has been associated with vertical transmission during vaginal delivery from an infected mother. Younger age at diagnosis is associated with more aggressive disease and the need for more frequent surgical procedures to decrease the airway burden. When surgical therapy is needed more frequently than four times in 12 months or there is evidence of RRP outside the larynx, adjuvant medical therapy should be considered. Adjuvant therapies that have been investigated include dietary supplements, control of extra-esophageal reflux disease, potent antiviral and chemotherapeutic agents, and photodynamic therapies; although several have shown promise, none to date has “cured” RRP, and some may have serious side effects. Because RRP, although histologicallybenign, is so difficult to control and can cause severe morbidity and death, better therapies are needed. The potential for a quadrivalent human papilloma vaccine is being explored to reduce the incidence of this disease.