Recurrent Respiratory Papillomatosis (RRP)
Wart-like growths in the airway passages caused by the human papilloma virus; these growths usually form on the vocal folds, causing a voice disorder
Human Papilloma Virus (HPV)
The virus that causes recurrent respiratory papillomatosis; HPV also causes genital warts
Wart-like growth caused by the human papilloma virus (HPV)
What are the risk factors for the development and transmission of RRP?
RRP in Children – from Mother to Child
There is considerable evidence that RRP in children results from the transmission of HPV from mother to child.
Virology studies have found a link between genital warts and child-onset RRP. Human papilloma virus (HPV) types 6 and 11 are responsible for 80 to 90 percent of genital warts cases. HPV types 6 and 11 are also responsible for nearly 100 percent of juvenile-onset RRP.
A cesarean birth might play a preventative role for juvenile-onset RRP.
Transmission via placenta: Several research studies have suggested that the transmission of the virus may occur prior to birth via the placenta. If this theory is true, there is no guarantee that a ceasarian section can prevent transmission of the virus to the child.
Possible multiple transmission routes: Although statistically rare, some children born by ceasarian section have developed juvenile-onset RRP, perhaps supporting the idea that there may be multiple transmission routes of HPV from mother to child.
Adult RRP – Risk Factors
In adults, RRP is also caused by infection with HPV types 6 and 11. However, there does not appear to be a statistically significant relationship with birth factors, as is seen in juvenile-onset RRP cases. This probably indicates that, in cases of adult-onset RRP, the infection is not likely acquired at birth. There is some speculation that for many adults RRP may be sexually transmitted.
Questions on route of infection: No scientific evidence has been collected that supports the theory that RRP is a sexually transmitted disease to the throat region from oral sex.
Case in point: The widespread exposure of individuals to the human papilloma virus without actual infection offers further evidence that RRP in adults is most likely not sexually transmitted.
Why does RRP occur?
Beyond the previously noted risk factors regarding the transmission of HPV, it is still not very well understood why only certain individuals develop RRP.
It is estimated that approximately 5 percent (5 in 100) of the U.S. population may have HPV in their respiratory tract, but less than 0.005 percent (5 in 100,000) of those infected ever develop RRP.
Some experts speculate that perhaps those few who develop RRP have some subtle deficiency of the immune system. Research is underway to determine this possible deficiency.
What are the symptoms of RRP?
The most common symptom of RRP is a hoarse, strained, breathy voice. The size and location of the masses within the vocal fold opening account for the degree of voice dysfunction. When lesions form near or on the vocal folds, hoarseness can occur even with small lesions.
Breathing difficulty is more common in children but can occur in adults. If the growths become cauliflower-like within the opening of the breathing passage (where you breathe), they can block the breathing passage. As a result, shortness of breath can occur. Although this is more common in children, in some situations RRP can cause breathing difficulties in adults, especially during exercise.
Symptoms in Young Children with RRP
Young children with RRP can have the following symptoms:
- Weak cry
- Chronic cough
- Swallowing difficulties
- Noisy breathing; noisy breathing-in (inspiratory stridor) can sound like a high-pitched whistle or snore as a child strains during inhalation, usually during sleep
Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
Stridor is a sign of difficulty passing air.
Any breathing difficulty needs immediate medical attention.
What is the expected disease course for a patient with RRP?
An Unpredictable Spectrum – From a “Mild Disease” to a “Lifetime of Surgeries”
Disease variation: The disease course may vary greatly from one RRP patient to the next and even over time for an individual patient.
Unknown factors, little predictability: Since the factors controlling this variability are not well understood, physicians cannot predict how many surgeries a particular patient may need and whether the papillomas will spread beyond the larynx (this is quite rare).
RRP in children worse: Juvenile-onset RRP (in which the disease begins in childhood) is typically more aggressive than adult-onset RRP. This greater severity appears to be more than simply an issue of the size of the airway.
Specific virus strain of HPV: Another factor that may influence RRP aggressiveness is the specific type of HPV involved.
Promise of Hope
Medical treatment options that have emerged recently and those anticipated in the near future should significantly help to reduce the number of surgeries RRP sufferers may face over a lifetime.
Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.
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