Recurrent Respiratory Papillomatosis (RRP) is a disease in which wart-like growths appear on the vocal cords, in other parts of the larynx (voice box) and less commonly in the lower airways, throat, or esophagus. RRP is caused by the human papillomavirus (HPV). Unfortunately, because treatments typically do not completely eradicate the virus causing papilloma, the disease often recurs. If severe, recurrent respiratory papillomatosis can also result in breathing or swallowing difficulties.

When the disease primarily affects the larynx, it is referred to as laryngeal papillomatosis and can impair how vocal cords close and vibrate, resulting in a raspy voice.

Treatment

The mainstay of treatment for recurrent respiratory papillomatosis involves surgery through the mouth to remove the diseased tissue, restoring voice and, in severe cases, improving the airway. Because papilloma is confined to the surface membrane of the vocal cords, surgery should not damage the underlying vibratory layer of the vocal cords and, if this layer has not been damaged by prior treatment, should result in vocal improvement.

Surgery

The KTP laser is a relatively new tool for surgical management of recurrent respiratory papillomatosis and is particularly valuable for treatment because of its selective absorption by blood vessels. Papilloma requires a robust blood supply to grow and contains relatively more blood vessels than surrounding, undiseased tissue. Use of this particular laser may extend the intervals between surgeries by more completely treating the visibly diseased membranes and therefore may result in improved voice outcomes compared to other types of surgical techniques that are commonly used  to manage this disease.

Office-Based Treatment

Once RRP is adequately controlled in the operating room, patients with recurrent disease may be candidates for awake treatment in the office, without the need for general anesthesia or even sedation.

Laryngeal Bevacizumab (Avastin) Injections

Laryngeal injections of the anti-angiogenesis drug bevacizumab (Avastin) may delay the recurrence of laryngeal papillomatosis. This additional treatment can be performed either in the operating room along with KTP laser treatment or, in many patients, as an office-based procedure.

Our Voice Center is one of only a handful of centers across the country offering comprehensive management of recurrent respiratory papillomatosis with both the KTP laser (in the operating room and in the office) as well as with laryngeal bevacizumab injections. NorthShore's Aaron D. Friedman, MD was one of the investigators in the first several studies pioneering the use of bevacizumab as an adjuvant treatment in patients with recurrent respiratory papillomatosis.

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