Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis or glottal papillomatosis, is a rare medical condition (2 per 100,000 adults and 4.5 per 100,000 children), caused by a HPV infection of the throat.
RRP is typically diagnosed by an ear, nose and throat physician (ENT) performing an examination of the larynx. Some physicians may start with a mirror examination, which is done using a mirror placed in the back of the throat reflecting light down the throat and onto the vocal folds.
More typically a doctor or a trained speech-language pathologist diagnoses RRP via an indirect laryngoscopy in the ENT office. This involves the placement of a flexible fiberoptic camera through the nose to further visualize the vocal folds in the throat or the use of a straight, rigid camera placed through the mouth that shines down the throat onto the vocal folds. In addition to allowing the ENT to view the larynx, a video record can also be obtained with these instruments.
Some otolaryngologists or speech pathologists may use a videostroboscopy to obtain an even more detailed look. However, to make an absolutely definitive diagnosis of RRP a direct laryngoscopy (usually in conjunction with surgical removal of papilloma growths) must be performed in an operating room with the patient under general anesthesia at which time a biopsy is taken and tested for HPV.
In some cases the direct laryngoscopy is the only option, usually this involves young children in distress, where instrumenting the airway outside of the operating room might be hazardous. It is most desirable, however, to have a diagnosis of RRP before a surgical procedure so as to facilitate family awareness/expectations and so the anesthesiologist, surgeon and OR nurses will be properly prepared.
Pediatricians who are unfamiliar with this disease often misdiagnose RRP. Many times shortness of breath and stridor are mistakenly assumed to be the result of asthma or croup. The consequences of these errors may be serious as papillomas are at least partially obstructing the airway to cause these symptoms and should be removed immediately.
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