Recurrent Respiratory Papillomatosis (RRP)

Treat larynx papillomatosis gently with the (blue) laser

Recurrent respiratory papilloma (RRP) – What is it?

Recurrent respiratory papilloma (RRP) are benign lesions that – in the head-and-neck region – predominantly grow inside of the larynx (laryngeal papillomatosis). When they involve the vocal folds, they mostly induce hoarseness. RRP tend to be a chronic problem because proper treatment is not based on radical excision, but mass reduction. However, there are good therapeutic options that we can offer our patients to try to eradicate all papilloma.

Papillomas are benign growths caused by the HPV virus (Human Papilloma Virus), comparable to warts. If the larynx with the vocal folds is affected, one speaks of a larynx papillomatosis (larynx papillomatosis) or laryngeal papillomatosis. This acute voice disorder is one of the rare voice disorders (around 3 out of 100,000 people). Since the papillomas disturb the vibrations of the vocal folds, hoarseness usually occurs at an early stage.

Our voice clinic is highly specialized is diagnosing all reasons and effects of Recurrent Respiratory Papilloma (RRP) problems and offers state-of-art therapeutical options to regain a mostly normal voice function. Patients come from all over the world for phonosurgical treatment, e.g. photoangiolytic laser surgery with KTP or blue laser, injections, and therapeutic vaccination. We perform surgery in the office or in general anesthesia, both in an ambulatory setting.

As an alternative to the removal of laryngeal papillomas under general anesthesia, a laser surgery with a photoangiolytic laser (KTP laser or Blue Laser) can be performed under superficial spray anesthesia and without pain. (See video above). The laser is used to obliterate only the blood vessels within the vocal fold, sparing the overlying mucosa – similar to the dermatological treatment of spider veins in the skin. Sclerosing the superficial vessels within the vocal fold causes the papillomas to „dry up“ after a few days. This procedure can save the patient from multiple general anesthesias.
Laryngeal papillomas, like warts, can recur even after complete surgical removal. Many patients require multiple surgeries. We have developed a concept in treatment in which surgical ablation under general anesthesia and / or local anesthesia is combined with injection of a virostatic agent and other measures, and with which we have had very good experience.

With the surface, which appears dotted with a special vascular pattern, the suspected diagnosis can be included or excluded with a high degree of certainty if the endoscope optics are of the appropriate quality. However, the final confirmation of the diagnosis must be made by a histological examination of the tissue. The HPV type can also be determined and the benign nature of the change can be demonstrated.

In this interesting new article, Markus Hess and Susanne Fleischer describe their technique for managing recurrent laryngeal papillomatosis in an outpatient setting using channelled endoscopes.

Papillomas with a typical, dotted surface. Image taken during  examination with flexible endoscopy with high-resolution optics (white light).
recurrent respiratory papilloma
The same finding in flexible endoscopy, now with NBI illumination.
Kehlkopfpapillomatose MEDICAL VOICE CENTER
The same finding during KTP lasering, which is performed under local anesthesia.