Laryngeal Papillomatosis (Recurrent Respiratory Papillomatosis)
HPV-related growths in the voice box and airway
Quick Facts
- Type: Viral (HPV) airway condition
- Cause: Human papillomavirus (HPV)
- Main symptom: Persistent hoarseness
- Course: Growths often recur and need repeat treatment
Overview
Laryngeal papillomatosis, also called recurrent respiratory papillomatosis (RRP), is a condition in which wart-like growths (papillomas) form in the larynx, or voice box, and sometimes elsewhere in the airway. The growths are benign, meaning not cancerous, but they tend to come back after removal, which is why the condition is described as recurrent.
The growths are caused by infection with certain strains of human papillomavirus (HPV). Because they affect the vocal cords, the most common symptom is a hoarse or weak voice. In some people, especially young children, the growths can narrow the airway and cause breathing problems, making prompt evaluation important.
Symptoms
Symptoms reflect growths interfering with the vocal cords and airway:
- Persistent hoarseness or a weak, breathy voice, often the first sign
- A chronic cough
- Noisy breathing or a high-pitched sound (stridor) as growths enlarge
- Shortness of breath, especially in children with airway narrowing
- Difficulty swallowing in some cases
In infants and young children, a changed or weak cry, noisy breathing, or breathing difficulty should be evaluated promptly, as airway narrowing can become serious.
Causes
Laryngeal papillomatosis is caused by infection of the airway lining with human papillomavirus, most often the same low-risk types that cause genital warts. The virus prompts the lining to form wart-like growths.
- In children: The virus is usually passed from the mother during birth.
- In adults: The route of infection is less certain and may relate to earlier exposure to the virus.
Most people exposed to HPV never develop papillomatosis, and why some do is not fully understood.
Risk Factors
- Being born to a mother with genital HPV infection (for the childhood form)
- Exposure to HPV
- The condition has two peaks, one in young children and one in adults
Diagnosis
Diagnosis involves looking at the larynx and confirming the growths:
- Laryngoscopy: A small lighted scope used to view the voice box and identify the characteristic growths.
- Biopsy: Examining removed tissue under a microscope to confirm papilloma and identify the HPV type.
- Imaging: Occasionally used if growths extend deeper into the airway or lungs.
Treatment
There is no cure that reliably eliminates the virus, so treatment focuses on controlling the growths and protecting the airway and voice:
- Surgical removal: The mainstay, using lasers, microdebriders, or other tools to remove growths while sparing healthy tissue; often repeated as growths recur.
- Adjuvant medicines: In selected cases, drugs that help slow regrowth.
- Voice care: Speech therapy to support and protect the voice.
Because the condition often recurs, many people need repeated procedures over time. The frequency varies widely from person to person.
Prevention
- HPV vaccination is expected to reduce future cases by preventing infection with the responsible virus types
- Routine HPV vaccination is recommended for adolescents before exposure
- Regular follow-up helps detect and treat recurrent growths early
When to See a Doctor
See a doctor for hoarseness or a voice change lasting more than two to three weeks, or for a child with a persistently weak or abnormal cry. Seek emergency care for noisy, difficult, or rapidly worsening breathing, a high-pitched sound when breathing in, or any sign that the airway is becoming blocked, as airway narrowing can be life-threatening.
Frequently Asked Questions
What causes laryngeal papillomatosis?
It is caused by infection of the airway lining with human papillomavirus (HPV), usually the low-risk types that also cause genital warts. In children the virus is typically passed from the mother during birth, while in adults the route is less clear.
Is laryngeal papillomatosis cancer?
No. The growths are benign, meaning not cancerous. However, they can recur and, by affecting the airway, can cause hoarseness and sometimes breathing problems, so they are monitored and treated.
Why does it keep coming back?
The HPV that causes the growths stays in the airway lining even after the visible growths are removed, so new growths often form. Many people need repeated procedures to keep the airway clear and the voice working.
Can the HPV vaccine help prevent it?
HPV vaccination targets the virus types responsible for the condition and is expected to reduce future cases. Routine vaccination of adolescents before exposure is recommended.
When is laryngeal papillomatosis an emergency?
Seek emergency care for noisy, difficult, or rapidly worsening breathing, a high-pitched sound when breathing in, or other signs of a blocked airway. This is especially important in young children, in whom airway narrowing can progress quickly.
References
- National Institute on Deafness and Other Communication Disorders (NIDCD). Recurrent Respiratory Papillomatosis.
- Centers for Disease Control and Prevention (CDC). HPV and RRP.
- MedlinePlus, U.S. National Library of Medicine. Recurrent respiratory papillomatosis.