Respiratory papillomatosis is the most common non cancerous tumor of the upper airway in children. It is caused by the human papilloma virus. Papillomas are small “wart- like” growths. It can be found in the nose, pharynx (throat), larynx (voice box), trachea (windpipe), esophagus (swallowing tube) and, occasionally, the lungs.
Laryngeal papillomas are the most common.
Show AllThe most common symptom noted with laryngeal papilloma is a change in voice quality such as hoarseness or loss of voice. The changes are usually gradual and do not get better except when papilloma are removed. Children may have recurrent croup symptoms such as a barky or “seal-like” cough or stridor (noisy breathing). Due to the slow growth of papilloma within the airway, children rarely have sudden breathing problems but, over a period of time, may develop severe airway obstruction.
While the child is awake, a small flexible telescope is passed through the nose and throat to look for papillomas in the upper airway, to the level of the vocal cords. If the papillomas are in the upper airway, they are visible with this scope.
A Microscopic Laryngoscopy and Bronchoscopy (MLB) may need to be done to look at the airway below the level of the vocal cords in addition to the voice box. This is done in the operating room with the child under a general anesthetic.
The goal of treatment for recurrent respiratory papillomatosis is maintaining a safe airway. This is done by repeated removal of the papilloma. In a small number of children with very severe disease a tracheotomy may be needed to maintain a safe airway. This is quite rare, however. Surgical treatment will not cure a patient of laryngeal papilloma but it is the most common treatment for RRP until the child’s immune system fights off the virus (HPV) and the papillomas go into remission or regression.
Various surgical treatment methods exist for removing papillomas. Lasers are able to vaporize the papilloma tissue. Mechanical shavers (microdebriders) have been developed through which papilloma can be suctioned and cut free from the surrounding tissue with great accuracy.
Several other types of medical treatment have also been explored in the treatment of laryngeal papilloma (RRP). None of these other medical treatments have consistent results. Cidofovir is an antiviral medication effective against DNA viruses. The usefulness of injections of this medication into the papilloma is currently being investigated.
The control of esophageal reflux disease with medications has also been helpful in the treatment and slowing of virus activity in some patients.
The natural history of recurrent respiratory papillomatosis is one of eventual spontaneous resolution in most children. When this resolution will occur is unknown. Surgical intervention is necessary to maintain a safe airway until the papillomas regress. Though treatments utilized should not create damage to surrounding airway structures, any surgical procedure can have complication. Extension of papilloma into the trachea and lungs can occur. This makes treatment of the disease much more difficult and life-threatening problems may develop.
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
