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Laryngeal Distribution of Recurrent Respiratory Papillomatosis

by Amy E. Hamaker •

What is the distribution of recurrent respiratory papillomatosis (RRP) lesions in previously untreated patients at initial presentation across a specified 21 laryngeal anatomic regions?

Bottom line
In untreated RRP patients presenting to three laryngology clinics, males had more anatomic sites affected by papilloma than females and the membranous vocal folds were most likely to be affected.

Background: RRP a relatively rare chronic disease caused by human papillomavirus (HPV) infection, is the most common benign tumor of the larynx. To date, RRP lesion distribution within the larynx has been reported only for cohorts in which some or all patients received treatment prior to analyses. Because the link between RRP treatment and recurrence is not well understood, this may mask the true natural distribution and progression of the disease.

Study design: Multi-institutional, retrospective case series of 83 previously untreated patients diagnosed with adult-onset RRP between 2007 and 2017.

Setting: New York University School of Medicine; University of Pittsburgh Medical Center, Penn.; University of Washington School of Medicine, Seattle.

Synopsis: Of the 83 patients, 67 were male and 16 were female. Forty-three patients reported using GERD medication at the time of diagnosis. Males had a significantly higher average number of diseased regions and were nearly three times more likely than females to have lesions in any region. PPI use increased the odds of a lesion occurring in any region by a factor of more than 1.5, and PPI users were 2.5 times more likely to have lesions in the posterior and subglottic regions compared to nonusers. Lesions were over seven times more likely to occur on the true vocal folds (TVFs) or anterior commissure compared to other regions; twenty-nine patients had disease limited exclusively to the TVFs. Within the TVFs, disease was greater than 3.5 times more likely to occur in the membranous vocal folds compared to the cartilaginous vocal folds. Lesions were least likely to occur in the epiglottic or subglottic regions. Limitations included a lack of information regarding size or number of lesions within a region, the small number of females, and potential bias due to the patient draw from three academic voice centers.

Citation: Benedict PA, Ruiz R, Yoo M, et al. Laryngeal distribution of recurrent respiratory papillomatosis in a previously untreated cohort. Laryngoscope. 2018;128:138–143.