Recurrent Respiratory Papilloma (RRP)
Recurrent Respiratory Papilloma (RRP) is a rare disease that affects roughly 2,000 people in the United States. As the name states, the disease occurs in the respiratory tract, but localizes primarily around the vocal folds in the voice box. This leads to changes in voice with “hoarseness” or a rough scratchy or breathy voice. The disease can start in childhood or present in adulthood as well. Often patients are treated with one or two surgeries on the voice box and the disease goes away. However, at the Grabscheid Voice and Swallowing Center, we often see patients whose disease continues to reoccur after multiple surgeries. Our experts are experienced in managing patients with multiple recurrences and have special tools available to them to assist in management.
RRP and HPV
RRP is caused by the Human Papilloma Virus (HPV). An individual with the virus in the tissues that line the respiratory tract develops warty-like growths that can interfere with the normal function of these tissues or block the airway. There are many different subtypes of the HPV virus, the ones that grow the larynx (subtype 6 and 11), are not usually associated with an increased risk of turning into cancer. This is unlike the forms that often grow in the female genital tract (types 16 and 18) that area associated with an increased risk of cancer.
HPV is transmitted from person to person through direct contact, but not all patients with the virus in their system express the disease. Scientists do not know what make a particular person express the disease, while their spouse or other close contact family members never show any signs of infection.
RRP can express itself in both children and adults. There is no predilection based on gender. Children usually develop symptoms of the disease before the age of 5 and often are the first born of young mother under the age of 20 with an active infection in their vaginal tract. Adults can begin to express the disease at any age.
Symptoms of Recurrent Respiratory Papilloma
The symptoms of an active RRP infection are most commonly a change in voice. The voice becomes harsh, weak, rough or strained. Rarely patients can notice breathing problems. Even more rarely patients can notice breathing problems in the absence of voice changes. Sometimes parents can hear these breathing changes in their children. This audible breathing noise is call stridor and the patient should seek immediate medical attention for their child if the stridor is consistent.
RRP is typically diagnosed through a careful examination by an experienced otolaryngologist. Here at the Grabscheid Voice and Swallowing Center, our clinicians have state-of-the-art equipment to help them visualize the larynx and respiratory tract with high resolution. This makes the identification of even small viral lesions possible. These systems are cameras that can be placed through the nose or mouth and then visualized on high definition monitors to help our clinicians study the area in question. Light filters on the cameras (narrow band imaging) in the clinic help to identify early subtle changes of the disease.
Treatments for RRP
Surgical excision is the mainstay of treatment for patients with RRP. The goal of surgery is to remove the papilloma and to spare the surrounding tissue not expressing any sign of disease. The papilloma arises in the very top layers of the mucosa. Therefore, these top layers can be removed without causing significant scar. Surgeons at Mount Sinai have worked with laser manufactures to design and develop computerized systems for the CO2 laser than precisely control the depth that the laser will penetrate the diseased tissue. Using this instrumentation, the diseased top layers can be removed and the uninvolved tissues can be maximally preserved. With these techniques many patients, if not scarred from prior procedures, can be returned to near normal voice.
In addition, to surgical therapy, medical therapy may slow the regrowth of RRP. While no one therapy works for all patients, if surgical excision is not resulting in acceptable control of the disease, the clinicians at the Grabscheid Voice and Swallowing Center have the ability to help you try these adjunctive therapies, including Interferon, Celebrex, and Mitomycin injections.
What to Expect at Your Appointment
When you visit the Grabscheid Voice and Swallowing Center and have the diagnosis of RRP, the clinicians will review any existing records that you bring and then examine your thoroughly. This will be done with telescopes or endoscopes through your nose and mouth. The clinician will also attach special light filters that highlight the appearance of RRP and make it easier to identify small lesions.
After a thorough history and physical examination, the clinician will review potential treatment options and help you to make a choice for the option that best fits your needs.