Understanding 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

Recurrent respiratory papillomatosis (RRP) is a disorder characterized by wart-like growths (papillomas) on the surface lining of the airway passages (also called the respiratory tract, which includes the throat, voice box, and trachea). RRP is caused by infection with a virus called human papilloma virus (HPV). Because this viral infection is very difficult to eliminate, RRP frequently recurs even after removal of the growths.

• Recurrent: Regrows after removal since infection is very difficult to eliminate
• Respiratory: Having to do with the breathing passageway, which includes the throat, voice box, and trachea
• Papillomas: Wart-like growths caused by the human papilloma virus (HPV) that occur on the surface of infected lining cells

RRP is characterized by the growth of wart-like tumors (papilloma) on the lining cells of the air passageway (respiratory tract); these tumors are caused by infection with HPV. These tumors often have a cauliflower-like appearance, and either have a slim stalk (pedunculated) or no stalk (sessile).

Patient A: Mild RRP	Patient B: Severe RRP
Legend VF: vocal folds L: left side R: right side View from the top of voice box with patient facing examiner Patient A: Mild recurrent respiratory papillomatosis on the left vocal fold Patient B: A more magnified view shows severe recurrent respiratory papillomatosis on the right vocal fold Patient C: Normal vocal folds, smooth surface on both sides	Patient C: Normal Vocal Folds

(click photos for larger images)

RRP occurs mostly on the vocal folds, although growths may also be detected in the trachea (windpipe), bronchi, and occasionally the lungs.

A distinguishing aspect of this disease is the tendency for the growths (papillomas) to recur after surgical removal. Current therapies have not been able to prevent multiple recurrences.

RRP is a potentially life-threatening disease because it can result in complete respiratory obstruction.

Red Flag

Any and all airway problems require immediate attention.

RRP is a rare disease. There are perhaps 20,000 active cases in the United States.

RRP occurs in both children and adults.

Juvenile onset RRP is rare and is almost always diagnosed by age ten and usually before the age of five. It occurs in boys and girls equally.

• Statistics indicate that first-born children delivered vaginally to young mothers (under the age of 20) with active condyloma (viral warts of the genital tract) during pregnancy are at greatest risk.

In adults, RRP may be found at any age. Adult males in their 30s are somewhat more likely to get RRP.