Recurrent Respiratory Papillomatosis, as the name describes, is a recurring disease characterized by the growth of small papillomas, or tumors, in the respiratory tract. It is caused by the human papilloma virus (HPV). According to The Recurrent Respiratory Papillomatosis Foundation, RRP is a rare disease with an estimated 6,000 active cases in the United States. Although they primarily occur in the larynx (throat) and around the vocal cords, these growths may spread downward and affect the trachea, and even as far down as the bronchi and occasionally the lungs. In the past, RRP has been referred to as laryngeal papillomatosis and juvenile laryngeal papillomatosis. One of the most troublesome aspects of this disease is the recurring nature of papillomas which can return even following treatment procedures to remove them.
How Do You Get RRP?
Recurrent respiratory papillomatosis is caused by two types of human papilloma virus (HPV)
It can occur in adults, as well as infants and small children, who may have contracted the virus during the birthing process.
Recurrent Respiratory Papillomatosis (RRP) Symptoms:
- Hoarse or weak voice
- Difficulty in speaking
- Complete loss of voice
- Difficulty breathing
- Chronic cough
- Swallowing difficulties
- Noisy breathing, or stridor
Diagnosis of RRP:
Your doctor will examine the larynx as the first step in diagnosing RRP. The papillomas that form as a result of RRP have a distinct appearance. Examination of the larynx is easily done with a small telescope that is placed into the mouth to visualize the structures of the throat WITHOUT going down the throat. Most patients report that the examination causes little to no discomfort.
Figure 1- Papilloma occluding almost the entire trachea, causing this patient severe shortness of breath.
The characteristic behavior of RRP is recurrence after successful treatment. This characteristic is one of the criteria for a diagnosis of recurrent respiratory papillomatosis.
Treatment of Recurrent Respiratory Papillomatosis:
Once the diagnosis of RRP has been made, treatment options are considered. Unfortunately it is not a disorder which can be treated by oral medications. Surgery to remove papillomas is considered the gold standard of treatment. The goal of surgical treatment for RRP is to remove as much of the papillomatosis as possible without injuring the surrounding structures such as the vocal cords.
The traditional form of surgery is performed under general anesthesia for the comfort and safety of the patient. Once the patient is fully asleep, a special scope is used to hold the mouth open so that the throat can be visualized. Now papilloma, like other laryngeal diseases, can be treated in the office without need for sedation or an IV using a laser. A biopsy is generally taken of the affected areas. Lasers, micro-instruments and injections are used to treat the involved areas. According to research and studies performed on the treatment of RRP, the ideal laser treatment option for papillomas is the KTP Laser.
KTP Laser Treatment for Recurrent Respiratory Papillomatosis:
The goal of treatment using the KTP laser remains the same- treat the papilloma while causing the least amount of trauma to the surrounding structures, mainly the vocal cords. The KTP laser targets the vessels supplying blood to the papillomas, in essence destroying the papilloma.
Recovery Following Surgery for Recurrent Respiratory Papillomatosis:
Following surgical removal of the papillomas, patients often complain of a sore throat, changes in taste, weakness or discomfort in the tongue, and/or mild hoarseness. These post operative symptoms are all considered to be normal and tend to resolve on their own within a few days. There have been rare instanced where these symptoms lasted for several months before resolving.
Following the procedure it is strongly recommended to avoid speaking, including whispering, for 1 week. Speaking after surgery can significantly delay healing following surgery and may permanently damage the healing vocal cords. After this 1 week period it is advised that you slowly begin using your voice in moderation. Overuse and exaggeration is strongly discouraged during this recovery period. Your voice may still be hoarse, so try and keep your talking to a minimum until healing is complete. Although there is technically no dietary limitations, a soft diet is recommended for the first few days following surgery, but normal diet can be resumed as tolerated. Other post operative instructions and restrictions, if any, will be discussed with you by your surgeon.