Recurrent respiratory papilloma (RRP) – What is it?
Laryngeal papilloma are benign growths caused by HPV viruses (human papilloma virus), comparable to warts. If the larynx with the vocal folds is affected, it is called laryngeal papillomatosis or laryngeal papillomatosis. This acute voice disorder is one of the rare voice disorders. Because the papilloma interferes with the vibration of the vocal folds, hoarseness usually occurs early on.
A large part of the population is infected with HPV viruses, but only a few get sick with visible symptoms (in Germany about 3 out of 100,000). Different types of viruses (HPV types) are known. The virus types most commonly detected in laryngeal papillomatosis are HPV types 6 and 11 (low-risk types). Malignancy is very rare with these types. Certain HPV types (high-risk types) have a higher risk of malignant degeneration. There are two forms, the “juvenile-onset” form, which affects children, and the “adult-onset” form in adults. Much about the development of laryngeal papillomatosis is still unclear.
If the vocal fold papilloma are not yet very widespread, diagnosis is usually only possible with special examination techniques and high-resolution optics. We have the possibility, under local anesthesia with HD-chip-on-the-tip optics and special light filtering, to see the vocal fold surface strongly magnified, so that we can make the tentative diagnosis at an early stage and initiate appropriate therapy.
With the surface appearing dotted by a special vascular pattern the suspected diagnosis can be ruled in or out with a high degree of certainty given the appropriate quality of the endoscope optics. The final confirmation of the diagnosis must nevertheless be made by histological examination of the tissue. This can also determine the HPV type and prove the benign nature of the change.
Papilloma 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 papilloma disturb the vibrations of the vocal folds, hoarseness usually occurs at an early stage.
Our voice clinic is highly specialized in 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, 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 anesthesia.
Laryngeal papilloma, 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 anaesthesia and/or local anaesthesia 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.