Any child presenting with a voice disturbance with or without stridor is recommended to have diagnostic flexible fiber-optic laryngoscopy. [ncbi.nlm.nih.gov]

• Fishing

  Boon Chye Gan, Nor Shahida Abd Mutalib, Hamidah Mamat and Hisham Abdul Rahman, Impacted fish bone in the larynx masquerading as laryngeal papillomatosis: Report of a rare case, Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 17, 3, (163), [doi.org]

• Hypoxemia

  Possible complications included complete airway obstruction, pulmonary aspiration of gastric contents, hypoxemia, fetal distress, and preterm labor. [ncbi.nlm.nih.gov]

• Food Intolerance

  A detailed medical history followed by an oral food challenge was successful at identifying food intolerances in all 4 patients. [ncbi.nlm.nih.gov]

• Angioedema

  Vinciya Pandian, Gooi Zhen, Stanola Stanley, Marco Oldsman, Elliott Haut, Lynette Mark, Christina Miller and Alexander Hillel, Management of difficult airway among patients with oropharyngeal angioedema, The Laryngoscope, 129, 6, (1360-1367), (2018). [doi.org]

• Epistaxis

  Disclosure of Conflicts Vasovagal reaction, epistaxis, incomplete removal of RRP lesions, may require multiple procedures, anterior glottic web formation. References Zeitels SM, Akst LM, Burns JA, Hillman RE, Broadhurst MS, Anderson RR. [csurgeries.com]

  Simonds, J, Miller, F, Mandel, J, Davidson, TM, The effect of bevacizumab (Avastin) treatment on epistaxis in hereditary hemorrhagic telangiectasia. Laryngoscope 2009 ;119: 988 – 92. Google Scholar | Crossref | Medline | ISI 16. [dx.doi.org]

Preoperative Workup Blood pressure and heart rate measurements before the procedure. [csurgeries.com]

Microdirect Laryngoscopy (Suspension Microlaryngoscopy or Direct Laryngoscopy) Good example of positioning/setup: Microdirect Laryngoscopy case example Repeat DL/B with videorecording at least every eight to 12 weeks Baseline CXR, repeated annually Additional workup [medicine.uiowa.edu]

Clinical Testing and Workup An indirect laryngoscopy involves holding a small mirror in the back of the throat. An ENT physician will reflect light off the mirror to illuminate the throat and detect the presence of papillomas. [rarediseases.org]

An extensive workup has not found a source of blood loss. [f1000research.com]

If advancing degrees of atypia are found, closer observation and further workup is mandated. CLINICAL PRESENTATION The initial disease presentation and subsequent clinical course in adult RRP compared with childhood-onset RRP is markedly different. [journals.lww.com]

• Cavitary Lesion

  Multiple nodular and cavitary lesions, some with air fluid level, were found in both lung fields at chest radiography and scintigraphy. [ncbi.nlm.nih.gov]

  A computed tomographic scan of the chest obtained when the patient was 10 years old showed discrete nodular papillomas (Panel B, arrow) and multiple cavitary lesions in the lung fields. She subsequently died of complications of pneumonia. [nejm.org]

  After completion of therapy, a follow-up HRCT of the lungs showed no changes in the size and number of lesions; one cavitary lesion was revealed. [pubs.sciepub.com]

  Multiple cavitary lesions with thick, irregular walls and multiple nodules were also observed in both lungs (Figure 3 and 4). Diagnosis Recurrent tracheobronchial papillomatosis with pulmonary involvement due to HPV types 6 and 11. [appliedradiology.com]

• Atelectasis

  Changes secondary to pulmonary papillomatosis included atelectasis, infection and bronchiectasis. Respiratory papillomatosis involving pulmonary parenchyma is associated with a poor prognostic outcome. [ncbi.nlm.nih.gov]

  Enlargement of a previously described lesion and mediastinal lymphadenopathy should increase the suspicion of malignancy. 6 In addition, parenchymal complications, such as pneumonia, abscess, and atelectasis, can be seen. [appliedradiology.com]

• Herpes Simplex Virus Type 2

  Herpes simplex virus type 2 was present in 9/20 (45.0%) patients with papillomatosis and in 0/20 control patients (P = .001). Five specimens were positive for both pepsin and herpes simplex virus type 2. No samples were positive for ChT. [ncbi.nlm.nih.gov]

  Zeleník, Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult‐onset recurrent respiratory papillomatosis (prospective case–control study), Clinical Otolaryngology, 42, 3, (597-601), (2016). Ernst Eber, Juan L. [doi.org]

Therefore, we designed the scheduled protocol for treatment of RRP with increasing treatment intervals. The dose was kept at 1 mg/kg but after 4 treatments at 2-week intervals, each subsequent treatment interval was increased by 1 week. [dx.doi.org]

OBJECTIVE: The treatment of recurrent respiratory papillomatosis (RRP) continues to be difficult. Adjuvant pharmacological treatment is increasingly being used, and intralesional cidofovir injection remains the leading option. [ncbi.nlm.nih.gov]

Prognosis The prognosis is often good and morbidity low in most cases. Younger children, especially those under the age of 3 years, and adults with HPV-11 infection generally experience a more severe disease course. [orpha.net]

Although previous reports suggest a poor prognosis for lung cancer associated with papillomatosis, we have successfully treated 1 such patient, who presented with three synchronous pulmonary malignancies, using parenchyma-sparing resection techniques. [ncbi.nlm.nih.gov]

What is the prognosis/outlook? Because there is no cure yet, the prognosis is guarded. Patients can certainly live full lives, but often require repeated procedures over time to remove the growths. [chicagovoicecare.com]

The etiology, medical and physical therapeutic management, anesthetic management, and complications of patients with RRP are presented. [ncbi.nlm.nih.gov]

A literature search was performed to characterize the epidemiology, imaging findings and management of this condition. The patient underwent 30 courses of surgery over 21 years and presented disseminated pulmonary papilloma after childbirth. [ncbi.nlm.nih.gov]

DERKAY, Epidemiology of recurrent respiratory papillomatosis, APMIS, 118, 6‐7, (450-454), (2010). [dx.doi.org]

Epidemiology of recurrent respiratory papillomatosis. APMIS. 2010 ;118(6-7): 450 - 454. Google Scholar | Medline | ISI [oadoi.org]

The peer-reviewed literature was culled to provide a comprehensive review encompassing AO-RRP and anogenital papilloma, as well as general HPV virology and pathophysiology. PubMed and Google Scholar databases were searched from 1975 to July 2014. [ncbi.nlm.nih.gov]

Evidence Review The peer-reviewed literature was culled to provide a comprehensive review encompassing AO-RRP and anogenital papilloma, as well as general HPV virology and pathophysiology. [doi.org]

Pathophysiology HPV, the virus associated with cutaneous warts, genital condyloma, and cervical cancer, causes RRP. While more than 20 types of HPV can cause genital warts, only 2 of these, HPV-6 and HPV-11, cause the vast majority of cases of RRP. [emedicine.medscape.com]

Functionally, these groupings correlate with their tissue preference as well as similar pathophysiology. 16 The HPVs are members of a large family of papillomaviruses that infect vertebrates ranging from birds to humans, causing epithelial neoplasms that [clinicalgate.com]

Although cesarean section may prevent the exposure of children to the HPV virus during childbirth, its effectiveness in preventing RRP is debatable and the procedure itself carries an increased risk of complications. [ncbi.nlm.nih.gov]

These medications include: Indole 3-carbinol Antiviral medications such as interferon Bevacizumab Preventing Recurrent Respiratory Papillomatosis The HPV vaccine can prevent the development of RRP. [utswmedicine.org]

Prevention: HPV vaccine The HPV vaccine is effective in preventing the virus that causes recurrent respiratory papillomas. [chop.edu]