A condition in which multiple, warty growths are found in the airway, especially in the larynx.
The condition can occur at any age. It most often arises under the age of 4 in children.
RRP is caused by infection with human papilloma viruses Types 6 or
ll. In 60 % of cases the child's mother has a history of genital warts
giving rise to the possibility that the infection is acquired during
Symptoms & Signs
Hoarseness is the commonest symptom, particularly if the hoarseness
is progressive and not obviously related to shouting or screaming.
Features of upper airway obstruction may also occur. These include
shortness of breath, noisy breathing especially breathing in (stridor)
and occasionally breathing difficulty at night. Sometimes warts are
visible elsewhere both on the skin and in the mouth and throat.
Complications of the Disorder
In the severest cases the condition can be lethal because rapidly
recurrent warts block the airway or affect the lungs; fortunately this
is very unusual.
Diagnosis is by examination of the airway. This can some times be
done in the clinic with a cooperative older child but is most often done
under anaesthetic by microlaryngocopy and bronchoscopy.
No single drug has been shown to be uniformly successful in the
treatment of RRP. Various antiviral drugs have been shown to have
success in some individuals but all have their side effects. They
include Acyclovir, Inteferon-alpha, Ribavirin and Inosine Pranobex. The
drug Cimetidine, usually used for indigestion has also recently been
shown to be helpful in some severe cases.
In most cases the mainstay of treatment is surgical with removal of
the papillomata from the airway via microlaryngoscopy. The most
commonly used treatment is the carbon dioxide laser which vapourises the
warts while doing minimal damage to underlying tissues but other lasers
or removal methods are sometimes used in particular cases. The
complications of laser surgery include scarring of the airway,
unintended laser burns to tissues on the laser pathway and a very small
risk of causing fire in the airway.
In some cases it is necessary to perform a tracheostomy because rapid
regrowth of the papillomatas makes it impossible to keep the airway
clear in any other way.
The principal problem with treating RRP is that like warts elsewhere,
the papillomata tend to recur, patients may therefore require multiple
treatments over the course of a number of years.
About 50% of patients recover eventually but relapse can occur many years later.