Diagnosis of Recurrent Respiratory Papillomatosis

Key Glossary Terms

Recurrent Respiratory Papillomatosis (RRP)
Wart-like growths in the airway passages caused by the human papilloma virus; these growths usually form on the vocal folds, causing a voice disorder

Human Papilloma Virus (HPV)
The virus that causes recurrent respiratory papillomatosis; HPV also causes genital warts

Papilloma
Wart-like growth caused by the human papilloma virus (HPV)

Glossary

RRP is typically diagnosed by an otolaryngologist (also known as an ear, nose and throat physician or ENT), who performs an examination of the voice box. Several techniques for examining the voice box may be used by the otolaryngologist.

Because papillomas have a typical appearance, they are usually easily identified when the otolaryngologist examines the voice box. Visual examinations may be performed with the following techniques.

• Mirror examination: Some physicians may start with a mirror examination. A small mirror is placed at the back of the throat to reflect light down the throat and onto the vocal folds, enabling the otolaryngologist to see the voice box.
• Rigid or flexible laryngoscopy: More typically, an ENT physician diagnoses RRP by performing a flexible or rigid laryngoscopy, a procedure that uses a lighted tube to view the voice box. When performed in an outpatient setting, this is called an indirect laryngoscopy. (For more information, see Laryngoscopy/Stroboscopy.)
• Laryngoscopy in the operating room under general anesthesia: Laryngoscopy may be performed in the operating room with the patient under general anesthesia, a procedure referred to as direct laryngoscopy. In some cases direct laryngoscopy the only option. For example, young children may not be able to cooperate with an examination in the physician's office. Direct laryngoscopy is also applicable to patients with a significant amount of narrowing in the throat.

Key Information

HPV subtype identification of minimal benefit to current treatment strategies: Currently, routine testing of RRP tissue – which may be obtained during a biopsy or surgery – to determine the type of HPV is generally not pursued. Only in rare cases would test results change the care and treatment of the RRP patient.

Diagnosis by Visualization of Wart-Like Growths on the Vocal Folds: In most cases, experienced otolaryngologists can identify RRP by simply by visualizing the wart-like growths.

Red Flag

RRP Sometimes Mistaken for Asthma or Croup in Children

Physicians not familiar with RRP may not correctly identify this disease.

• Sometimes, shortness of breath and noisy breathing are mistaken for asthma or croup. Thus, children may occasionally be treated for asthma and croup without any improvement in their breathing difficulties.
• Patients with papillomas that are partially blocking the airway and causing shortness of breath and noisy breathing should consult with a physician immediately to determine whether emergency surgery to remove the papillomas is indicated.

Red Flag

Any and all airway problems require immediate attention.