Recurrent Respiratory Papillomatosis (RRP)
Recurring HPV growths in the airway and voice box
Quick Facts
- Type: HPV-related airway condition
- Cause: Human papillomavirus (HPV)
- Main site: Voice box and vocal cords
- Hallmark: Hoarseness, recurring growths
Overview
Recurrent respiratory papillomatosis (RRP) is a condition in which wart-like growths called papillomas develop in the respiratory tract, most commonly on the vocal cords and elsewhere in the voice box (larynx). The growths are caused by the human papillomavirus (HPV), and their defining feature is that they tend to come back repeatedly even after being removed, sometimes requiring many procedures over a person's lifetime.
RRP can begin in childhood (juvenile-onset) or in adulthood (adult-onset). Although the papillomas are not cancer, they can narrow the airway and affect the voice, and in rare cases they spread deeper into the windpipe and lungs. Because the growths recur, treatment focuses on keeping the airway open and preserving the voice rather than achieving a one-time cure.
Symptoms
Symptoms depend on where the growths are and how large they become. The most common is a change in the voice.
- Hoarseness or a weak, breathy voice that does not resolve
- In young children, an abnormal or weak cry
- Noisy breathing or a high-pitched sound when breathing in
- Chronic cough
- Difficulty breathing as growths enlarge
- Recurrent respiratory infections or a feeling of something in the throat
In children especially, worsening noisy breathing or breathing difficulty is a warning sign of airway narrowing that needs prompt medical attention.
Causes
RRP is caused by certain types of HPV, the same family of viruses that cause many warts. The way the virus is acquired differs by age of onset:
- Juvenile-onset: Often linked to exposure to the virus during birth, when a baby passes through an infected birth canal.
- Adult-onset: Thought to relate to HPV acquired through intimate contact, though the exact route is not always clear.
Having the virus does not mean a person will definitely develop RRP, and most people exposed to these HPV types never develop airway growths. Why the virus persists and causes recurring papillomas in some people is not fully understood.
Risk Factors
- Birth to a mother with genital HPV (for juvenile-onset)
- Exposure to HPV through intimate contact (for adult-onset)
- First-born delivery and prolonged labor, which are associated with juvenile-onset
- A young mother
HPV vaccination is expected to reduce the future occurrence of RRP by lowering the spread of the responsible virus types.
Diagnosis
Diagnosis involves directly viewing the airway and confirming the growths:
- Laryngoscopy: Using a thin flexible or rigid scope to see the voice box and vocal cords.
- Examination under anesthesia: A more thorough look at the airway, often combined with removal of growths.
- Biopsy: Examining tissue to confirm papillomas and identify the HPV type.
- Imaging: Sometimes used if spread to the windpipe or lungs is suspected.
Treatment
Because the growths recur, treatment aims to remove them, maintain a clear airway, and preserve the voice while limiting damage to surrounding tissue.
- Surgical removal: Repeated procedures, often using specialized instruments or lasers, to remove papillomas while protecting the vocal cords.
- Adjuvant medications: Medicines may be used in addition to surgery in people who need very frequent procedures.
- Voice therapy: To support communication when the voice is affected.
- Airway monitoring: Ongoing follow-up because regrowth is common.
The number of procedures needed varies widely from person to person, and the disease course is unpredictable.
Prevention
- HPV vaccination, which protects against the virus types responsible and is expected to reduce future cases
- Routine prenatal care and discussion of HPV with a healthcare provider during pregnancy
- Following up regularly if RRP is diagnosed, to manage recurrences early
There is no guaranteed way to prevent RRP in someone already infected, but reducing spread of the virus through vaccination is the most promising preventive measure.
When to See a Doctor
See a doctor for a hoarse voice or abnormal cry that lasts more than two to three weeks, or for any unexplained persistent change in a child's voice or breathing. Seek emergency care for:
- Difficulty breathing or struggling to breathe
- Noisy, high-pitched breathing that is worsening
- Bluish lips or severe breathlessness
These signs can indicate dangerous airway narrowing and need immediate attention.
Frequently Asked Questions
Why does respiratory papillomatosis keep coming back?
The growths are driven by an HPV infection that persists in the airway tissue, so even after papillomas are removed, new ones can form. This is why RRP often requires repeated procedures and ongoing follow-up rather than a single cure.
Is recurrent respiratory papillomatosis cancer?
No. The papillomas themselves are benign growths, not cancer. However, they can narrow the airway and affect the voice, and in rare cases they spread deeper into the lungs, so careful monitoring is important.
How do children get RRP?
Juvenile-onset RRP is often linked to exposure to HPV during birth, when a baby passes through an infected birth canal. Most babies exposed to the virus do not develop RRP, and why some do is not fully understood.
Can the HPV vaccine help prevent RRP?
The HPV vaccine protects against the virus types responsible for most cases and is expected to reduce the future occurrence of RRP by lowering the spread of these viruses. It does not treat existing disease.
When is RRP a medical emergency?
Difficulty breathing, worsening noisy or high-pitched breathing, or bluish lips signal dangerous airway narrowing and require emergency care. Persistent hoarseness or an abnormal cry without breathing trouble should be evaluated promptly but is not an emergency.
References
- National Institute on Deafness and Other Communication Disorders (NIDCD). Recurrent Respiratory Papillomatosis.
- Centers for Disease Control and Prevention (CDC). HPV and Recurrent Respiratory Papillomatosis.
- MedlinePlus, U.S. National Library of Medicine. Laryngeal papillomatosis.
- American Academy of Otolaryngology-Head and Neck Surgery. Recurrent Respiratory Papillomatosis.