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Otolaryngol Clin North Am 2021 Jun 4. Epub 2021 Jun 4.

Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Building 10, Room 7N240C, Bethesda, MD 20892, USA. Electronic address:

This article aims to educate readers on adjuvant therapies for recurrent respiratory papillomatosis (RRP). Although antivirals are injected locally into papillomas as an adjuvant treatment, new biologics targeting vascular endothelial growth factor or induction of human papillomavirus (HPV)-specific immunity are gaining traction with demonstration of clinical benefit and mechanism of action in retrospective case series and prospective clinical trials. The future of RRP treatment, alone or in combination with surgery, lies in the careful clinical study of vascular and immune targeting agents that balance the risk of adverse events with the chance for elimination of HPV-infected cells. Read More

Int J Surg Case Rep 2021 May 29;83:106054. Epub 2021 May 29.

Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Indonesia. Electronic address:

Introduction And Importance: Tracheobronchial papillomatosis is an aggressive form of RRP with the spread of papillomas to the subglottis, trachea, bronchus and pulmonary parehchyma. Surgical operation for removing the papilloma is extremely difficult and need a lot of periodical bronchoscopy.

Case Presentation: The first patient was a 25-year-old male who had an RRP history since the age of 6 months. Read More

Infect Genet Evol 2021 Jun 2:104948. Epub 2021 Jun 2.

Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt.98, H-4032 Debrecen, Hungary. Electronic address:

Interaction of the long control region (LCR) and the E2 protein of HPV11s was studied by in silico modelling and in vitro functional analysis. Genomes of HPV11s from fifteen (six known and nine novel) patients (two solitary papillomas, eleven respiratory papillomatoses of different severity, one condyloma acuminatum and one cervical atypia) were sequenced; E2 polymorphisms were analysed in silico by protein modelling. E2 and LCR variants were cloned into pcDNA3. Read More

Expert Opin Pharmacother 2021 Jun 3. Epub 2021 Jun 3.

Consultant in Otolaryngology/Head & Neck surgery, Aintree University Hospital, Liverpool, UK.

Introduction: Recurrent respiratory papillomatosis is a rare human papillomavirus (HPV) induced condition where warts grow within the airway and especially the larynx to effect voice and restrict breathing.

Areas Covered: A PubMed search using the following search terms was performed: respiratory papillomatosis and cidofovir, alpha-interferon, bevacizumab, PD1, HPV vaccines. Surgery remains the mainstay of treatment. Read More

Microorganisms 2021 May 27;9(6). Epub 2021 May 27.

Department of Otolaryngology, Fukushima Medical University, Fukushima 960-1295, Japan.

Nasopharyngeal cancer (NPC) is known to be associated with Epstein-Barr virus (EBV). Pre-treatment and post-treatment detection of plasma cell-free EBV DNA has been shown to be useful as a diagnostic as well as a prognostic factor in NPC. On the other hand, the incidence of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is increasing. Read More

Cancers (Basel) 2021 May 23;13(11). Epub 2021 May 23.

Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is the most common benign neoplasm of the larynx in children, presenting with significant variation in clinical course and potential for progression to malignancy. Since JoRRP is driven by human papillomavirus (HPV), we evaluated viral factors in a prospective cohort to identify predictive factors of disease severity. Twenty children with JoRRP undergoing routine debridement of papillomas were recruited and followed for ≥1 year. Read More

Ann Otol Rhinol Laryngol 2021 May 30:34894211021276. Epub 2021 May 30.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

Objective: To present an uncommon but serious, recently identified complication of checkpoint inhibitor therapy in a patient treated with pembrolizumab infusion for disseminated recurrent respiratory papillomatosis (RRP).

Methods: Case report.

Results: A 43-year-old woman with underlying asthma developed acute hypoxic respiratory failure within 24 hours of her third infusion of pembrolizumab for treatment of intractable, disseminated recurrent respiratory papillomatosis. Read More

Acta Otorhinolaryngol Ital 2021 Apr;41(2):146-150

Department of Otorhinolaryngology, AIIMS, New Delhi, India.

Objective: Respiratory papillomatosis involving the trachea is a challenging problem. In this paper, we present our experience in the management of 13 cases of tracheal papillomatosis and the difficulties encountered in the procedure. The surgical technique and results are discussed. Read More

Ear Nose Throat J 2021 May 18:1455613211012112. Epub 2021 May 18.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health, CA, USA.

We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close follow-up and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium. Read More

J Voice 2021 May 12. Epub 2021 May 12.

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA.

Recurrent respiratory papillomatosis (RRP) is a benign neoplastic disease of the respiratory tract that is caused by human papilloma virus (HPV). The current standard of care is surgical excision with adjuvant treatment as needed. Multiple adjuvant treatments have been used with some success, but long-term control of disease remains difficult. Read More

Int J Pediatr Otorhinolaryngol 2021 Jul 5;146:110737. Epub 2021 May 5.

Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objective: Recurrent respiratory papillomatosis (RRP) is known for its recurrent relapse despite various surgical and non-surgical treatments. Vascular Endothelial growth factor (VEGF) receptor expression on tissue is reported to be raised in RRP, and anti-VEGF targeted treatment is being explored to decrease recurrences. This study aims to identify the patients most suitable for systemic anti-VEGF therapy. Read More

Epidemiol Health 2021 10;43:e2021019. Epub 2021 Mar 10.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.

Objectives: Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11 and is potentially preventable through vaccination. This study estimated the incidence of juvenile-onset RRP before the implementation of the national HPV vaccination program in Korea.

Methods: We conducted a cohort study using claims data provided by a mandatory insurance program to estimate the incidence of RRP and associated healthcare use. Read More

Laryngoscope Investig Otolaryngol 2021 Apr 13;6(2):340-345. Epub 2021 Mar 13.

Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School Children's Hospital of the King's Daughters Norfolk Virginia USA.

Objective: Despite recent advancement recurrent respiratory papillomatosis (RRP) remains a rare but challenging benign airway neoplasm. In recent years there has been significant shifts in incidence of this disease due to changes in vaccination and prevention for human papilloma virus (HPV) and its related pathology. This review will highlight the epidemiology, prevention and treatment of RRP. Read More

Laryngoscope Investig Otolaryngol 2021 Apr 28;6(2):226-233. Epub 2021 Jan 28.

Department of Head and Neck Surgery Ronald Reagan UCLA Medical Center Los Angeles California USA.

Objectives: To identify studies evaluating the epidemiology of recurrent respiratory papillomatosis (RRP), including patient demographics, human papillomavirus (HPV) immunology, clinical course, surgical and medical treatments, and psychosocial factors.

Methods: A systematic literature search through PubMed was performed to identify studies evaluating the epidemiological factors associated with RRP. All studies were screened through a priori selection criteria using the titles and abstracts. Read More

Surg Technol Int 2021 04 9;38. Epub 2021 Apr 9.

Fox Chase Cancer Center, Philadelphia, PA.

Adult Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus in which papilloma grows from the respiratory epithelium. Patients can suffer from significant respiratory distress secondary to tracheal or bronchial obstruction by papilloma and the mainstay of treatment is bronchoscopic debridement. There are a variety of techniques to resect the endoluminal tumor, including CO2 or YAG laser, argon plasma coagulation, microdebrider and cold forceps. Read More

Ann Otol Rhinol Laryngol 2021 Apr 9:34894211007227. Epub 2021 Apr 9.

Bastian Voice Institute, Downers Grove, IL, USA.

Objective: To determine if brincidofovir, an oral analog of cidofovir that achieves high tissue levels of the active metabolite with low systemic toxicity, has an observable effect on HPV-related disease of the larynx.

Methods: Two patients with laryngeal recurrent respiratory papillomatosis (one each of genotypes 6 and 11) and 1 with recurring aryepiglottic fold (genotype 16) received oral brincidofovir according to protocol. Close-range videoendoscopic examinations were done during and after the study period to observe disease behavior in the absence of other interventions, and after subsequent surgical intervention. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021 Apr;35(4):312-315

Department of Otolaryngology Head and Neck Surgery，Beijing Tongren Hospital，Capital Medical University，Key Laboratory of Otolaryngology Head and Neck Surgery（Capital Medical University.

To analyze the causes and related factors of postoperative complications of Juvenile-onset recurrent respiratory papillomatosis（JORRP）. One hundred and seventy cases of JORRP who underwent surgical treatment in Beijing Tongren Hospital of Capital Medical University from 2017 to 2019 were followed up, and the types of complications, age of first operation, number and frequency of operations, and underwent tracheotomy or not were reviewed. According to the presence or absence of postoperative complications, the patients were divided into a complication group and a control group, and the differences between the two groups and related factors causing postoperative complications were compared. Read More

Front Oncol 2021 8;11:596499. Epub 2021 Mar 8.

INSERM-U970, PARCC, Université de Paris, Paris, France.

Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. The course of the disease remains unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. Our study aimed to identify histologic severity risk factors in patients with JoRRP. Read More

Laryngoscope 2021 Mar 15. Epub 2021 Mar 15.

Section on Translation Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A.

Recurrent respiratory papillomatosis (RRP) is currently treated with repeat surgical resection of papillomatous disease that does not address the fundamental underlying issue of chronic infection with low-risk human papillomavirus. Here, we review the biology and immunology of low-risk human papillomavirus (HPV) infections. Antiviral or antiangiogenic adjuvant treatments similarly address the papillomatous disease itself but do not activate HPV immunity. Read More

Prev Med 2021 Mar 4;144:106321. Epub 2021 Mar 4.

University of Cambridge, Cambridge, United Kingdom.

Prophylactic HPV vaccination has been a great public health success. For >20 years, clinical trials were conducted with the 2-, 4-, and/or 9-valent vaccines in young-adult females, mid-adult women, males, and adolescents. In all studies, the vaccines were highly efficacious, immunogenic, and well tolerated. Read More

Ann Otol Rhinol Laryngol 2021 Mar 1:3489421998215. Epub 2021 Mar 1.

Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA.

Objectives: The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice.

Methods: A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Read More

Case Rep Pediatr 2021 9;2021:8847436. Epub 2021 Feb 9.

Women and Children's Hospital, CAMC/West Virginia University-Charleston, Charleston, WV, USA.

Recurrent respiratory papillomatosis is a respiratory disease caused by human papillomavirus and can infect any part of the aerodigestive tract, but the larynx is most involved (Derkay et al. 2010). This report is a discussion about a 7-month-old male that presented to our institution for respiratory distress. Read More

Clin Infect Dis 2021 Feb 23. Epub 2021 Feb 23.

Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Background: Juvenile onset recurrent respiratory papillomatosis (JORRP) is a rare and serious disease caused by human papillomavirus (HPV) presumably acquired during vaginal delivery. HPV vaccination of females through age 26 years, recommended in the United States since 2006, can prevent HPV transmission. We assessed trends in JORRP cases before and after HPV vaccine introduction in the United States. Read More

J Clin Lab Anal 2021 Apr 28;35(4):e23712. Epub 2021 Jan 28.

Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México.

Background: Recurrent respiratory papillomatosis (RRP) is a respiratory tract disease that affects children and adults and is characterized by the recurrent proliferation of multiple papillomas. The etiologic agent is the human papillomavirus, mainly genotypes 6 and 11. Furthermore, polymorphisms in TAP1 appear to influence the selection of antigenic peptides and the transport process to the rough endoplasmic reticulum, for their subsequent presentation to T lymphocytes, an essential process against viral diseases and tumor processes. Read More

Sex Transm Dis 2021 04;48(4):278-284

Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.

Introduction: We estimated the lifetime medical costs of diagnosed cases of diseases attributable to human papillomavirus (HPV) infections acquired in 2018.

Methods: We adapted an existing mathematical model of HPV transmission and associated diseases to estimate the lifetime number of diagnosed cases of disease (genital warts; cervical intraepithelial neoplasia; and cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers) attributable to HPV infections that were acquired in 2018. For each of these outcomes, we multiplied the estimated number of cases by the estimated lifetime medical cost per case obtained from previous studies. Read More

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):363-367. Epub 2020 Oct 27.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The objective of the study was to review the imaging features of proven pediatric primary lung tumors, with a purpose of detecting key distinguishing features among the various entities.

Materials And Methods: We retrospectively reviewed multidetector computed tomography (CT) images of 17 pediatric patients with primary lung tumors. For each examination, various CT image descriptors were used to characterize the pulmonary nodules/masses; including location, size, number, morphology, cavitation, calcification, intense enhancement, airway involvement, chest wall/pleural involvement, mediastinal/vascular involvement, and nodal enlargement. Read More

Indian J Otolaryngol Head Neck Surg 2021 Jan 7:1-8. Epub 2021 Jan 7.

Department of Anaesthesiology, Pratiksha Hospital, Borbari, Mahapurush Madhabdev Path, Guwahati, Assam 781036 India.

Otorhinolaryngologists, particularly dealing with airway cases, are subjected to highest risk of COVID 19 aerosolisation, self infection and transmission. Moreover, airway cases, which mostly present as emergency, cannot be deferred. Being a tertiary airway centre and having received a number of airway cases, most of them requiring prompt surgical intervention, our airway surgery and anaesthesiology team had to work in conjunction to adapt and readapt the practice over the past few months, striving to achieve effective airway surgery protocols, to minimize exposure and prevent transmission of COVID 19. Read More

Viruses 2021 Jan 6;13(1). Epub 2021 Jan 6.

Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is driven by human papillomavirus (HPV) low-risk strains and is associated with significant morbidity. While previous studies of 2D cultures have shed light on disease pathogenesis and demonstrated the utility of personalized medicine approaches, monolayer cultures lack the 3D tissue architecture and physiology of stratified, sequentially differentiated mucosal epithelium important in RRP disease pathogenesis. Herein we describe the establishment of JoRRP-derived primary cell populations that retain HPV genomes and viral gene expression in culture. Read More

Laryngoscope 2021 Jan 7. Epub 2021 Jan 7.

Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China.

Objective: To investigate the clinical characteristics and long-term outcomes of juvenile onset recurrent respiratory papillomatosis (JORRP) with or without pulmonary involvement.

Methods: A group of patients with JORRP who had clinical course over an extended period of time (at least 5 years) in the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital were included in this retrospective study. Lung/bronchus involvement was revealed by lung imaging. Read More

Laryngoscope 2021 06 6;131(6):E1941-E1949. Epub 2021 Jan 6.

Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.

Study Design: Delphi method-based survey series.

Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. Read More