Recurrent Respiratory Papillomatosis
Recurrent respiratory papillomatosis (RRP) or simply "papilloma" or "laryngeal papilloma" is a condition caused by a relatively common virus (HPV or Human Papilloma Virus.) An infection with HPV causes lumpy growths to form on the vocal cords. These growths are not cancerous but in their extreme form can cause some difficulty with breathing. Typically, however, the growths are small and cause a mild or moderate dysphonia (hoarseness.) We don't currently have a cure for patients with RRP but we do have several treatment strategies that appear to be effective in controlling this disease.
The mainstay of therapy involves a trip to the operating room where a laser or special tool called a microdebrider is used to remove these wart-like growths. If the number of growths is small, or if most of it has been removed in the operating room already, we are then able to use either the C02 laser or the pulsed-dye laser in the clinic. We are able to use our transnasal telescope after the administration of topical anesthesia only. This has the advantage of being speedy, safe, well-tolerated, and avoids general anesthesia.
Cidofovir is an antiviral medication that was not designed specifically for the Human Papilloma Virus, but there is good evidence supporting its use in some cases of RRP. This medication tends not to cure the papilloma, but rather extends the time between future treatments. Because these lesions tend to recur (thus the name), it can be frustrating for both the patient and the surgeon. As our strategies for managing this condition become less invasive, the disruption to our patient's life is minimized.