Clinical and sociodemographic characteristics associated with disease severity in juvenile recurrent respiratory papillomatosis: A study of 104 patients in a tertiary care pediatric hospital

doi:10.1016/j.ijporl.2018.02.025

International Journal of Pediatric Otorhinolaryngology

Volume 108, May 2018, Pages 63-66

https://doi.org/10.1016/j.ijporl.2018.02.025 Get rights and content

Abstract

Background

Juvenile recurrent respiratory papillomatosis (JRRP) is generally aggressive and with a high recurrence rate. Currently, there is no definite curative treatment for JRRP. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required.

Objective

The aim of this study was to establish the clinical and socioeconomic characteristics of pediatric patients with JRRP and its relationship with the severity of the disease in a tertiary care pediatric hospital.

Results

A strong relationship was observed between the severity of the disease and the age at the time of diagnosis, and having a tracheostomy. A moderate association was found between the severity of the disease and the age at the time of the study, the area of origin and the recurrence rate. None of the socioeconomic statuses had a correlation with the severity of the JRRP.

Conclusions

JRRP is associated with multiple surgeries due to the recurrence and aggressiveness of the disease. The socioeconomic status does not seem to influence the severity of the disease, whereas younger patients and users of tracheostomy should receive a more strict follow-up given the increased risk of severe disease.

Introduction

Juvenile recurrent respiratory papillomatosis (JRRP) is the most common neoplastic laryngeal pathology in childhood [1]. Its etiological agent is human papillomavirus (HPV), and subtypes 6 and 11 are responsible for more than 90% of JRRP cases [2], with no relationship between HPV type and clinical severity [3].

The clinical course of JRRP is variable. However, most of the cases present progressive growth of the lesions, compromising the permeability of the airway.

The juvenile form develops in patients less than 20 years of age [4]. This form of the disease is generally aggressive and with a high recurrence rate. A variable prevalence has been reported depending on the age of presentation, country and socioeconomic status of the population studied. However, according to several series, the estimated prevalence is 1–4 per 100,000 children, with an approximate incidence of 4 per 100,000 [1,[4], [5], [6], [7], [8], [9]].

The JRRP has a high negative impact on the patient's quality of life [5], due to repeated hospital admissions, social stigma, and anxiety about facing new procedures or possible contagion to relatives. Additionally, quality of life of children with JRRP is worse in comparison to children with other laryngeal pathologies such as unilateral vocal fold paralysis and vocal fold nodules [6]. On the other hand, it has been estimated that the cost of recurrent respiratory papillomatosis care is 6 times higher in children than in adults [7], with an annual cost in the United States for a single case of JRRP of $ 57,996 [5].

Although JRRP is fundamentally benign, a malignant transformation may occur in less than 1% of cases [2]. Currently, there is no definite curative treatment for JRRP and its clinical behavior is markedly aggressive [10]. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required.

Section snippets

Materials and methods

This is a retrospective cohort study.

Results

A total of 104 patients were included, all with JRRP confirmed histopathologically by biopsy of the lesions and surgically treated from January 1998 to May 2014.

Discussion

Juvenil recurrent respiratory papillomatosis (JRRP) is a complex pathology, due to its chronic and recurrent nature, as well as the lack of a gold standard treatment. Although theoretically universal vaccination against the human papillomavirus could effectively prevent the disease, the real situation in our environment is very far from this possibility [[8], [9], [10], [11]].

The present study constitutes the largest series of pediatric cases with an established diagnosis of JRRP treated in a

Conclusions

Recurrent respiratory papillomatosis has a more aggressive and recurrent presentation in children than in adults. Currently, there is no gold standard for its management; therefore, it is important to continue studying the factors that affect the severity and recurrence of the disease, such as vaccines, antibodies against HPV and adjuvant methods.

Lower age at the time of diagnosis, as well as the need for a tracheostomy are associated with the severity of the disease, followed by the area of

Conflicts of interest

None.

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Cited by (5)

Comparison of Treatment for Recurrent Respiratory Papillomatosis at a Public County Versus Private Academic Hospital
2022, Journal of Voice
Citation Excerpt :
Human papillomavirus (HPV) 11 genotype and younger age of onset are known risk factors for greater disease severity, as defined by having increased anatomical involvement, undergoing more frequent surgical intervention, or requiring adjuvant medical therapy.2,3 Currently, there is insufficient understanding of the social determinants of health that affect the clinical course of RRP.2,4,5 Social determinants of health are the social and demographic factors that influence disease incidence, healthcare access and outcomes, and may be more closely tied to morbidity and mortality than disease biology per se.6
To compare patient, disease and treatment characteristics of patients treated for recurrent respiratory papillomatosis (RRP) at a public county versus a private hospital.
A retrospective cohort study was conducted of adult patients undergoing treatment for RRP at a tertiary-care academic center (TAC, n = 48) versus public safety net hospital (PSNH, n = 14), both staffed by the same Otolaryngology providers.
There was no difference between cohorts in age, gender, medical comorbidities, history of juvenile-onset presentation, or history of prior treatment at a different institution. PSNH patients were more likely to be Hispanic/Latino, primarily speak Spanish, have public or no insurance, and reside in a zip code with lower median income compared with TAC patients. Despite living significantly closer to the hospital, PSNH patients were more likely than TAC patients to present with respiratory symptoms (50% versus 20.8%, P = 0.04), and exhibit more than one involved laryngeal subsite at their first surgical intervention (78.6% versus 27.1%, P = 0.001). They also had high rates of referral for otolaryngologic care via the emergency department (42.9%) rather than outpatient specialty referral (35.7%) and were more likely than TAC patients to require urgent intervention (21.4% versus 2.1%, P = 0.03). There was no difference in time interval from first clinic visit to procedure date or total number of treatments.
PSNH patients present with more severe and symptomatic RRP disease compared with TAC patients. This finding may be related to sociodemographic disparities leading to poorer access in care.
Trends in recurrent respiratory papillomatosis treatment
2021, Acta Otorrinolaringologica Espanola
La papilomatosis respiratoria recurrente (PRR) consiste en tumores benignos en las vías respiratorias causados por la infección del virus del papiloma humano. Las lesiones pueden provocar cambios en la fonación y obstruir las vías respiratorias. El objetivo de este estudio es evaluar las diferentes terapias quirúrgicas y adyuvantes disponibles para el tratamiento de esta afección que se han reportado en los años recientes. Se realizó una búsqueda en PubMed de artículos sobre el tratamiento de la PPR publicados entre 2014 y 2018. De los encontrados, 40 artículos con 1.425 pacientes con PRR cumplieron con los criterios. De estos, 24 artículos evaluaban el uso de terapias adyuvantes como el bevacizumab, el cidofovir y la vacuna contra el virus del papiloma humano. Ha habido un aumento en las opciones terapéuticas adyuvantes para la PRR en los últimos años. El conocimiento de estas opciones resalta las lagunas y oportunidades en la atención de estos pacientes, abre la puerta a nuevos protocolos para controlar la enfermedad, aumenta los intervalos quirúrgicos y nos guía hacia nuevos caminos en el futuro.
Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.
Role of CO2 Laser and Microdebrider in the treatment of Juvenile onset recurrent respiratory papillomatosis
2023, Journal of the Pakistan Medical Association
Long-term outcomes of juvenile-onset recurrent respiratory papillomatosis
2021, Clinical Otolaryngology
COVID-19 voluntary social isolation and its effects in sociofamily and children’s behaviorc
2020, Salud Mental

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Clinical and sociodemographic characteristics associated with disease severity in juvenile recurrent respiratory papillomatosis: A study of 104 patients in a tertiary care pediatric hospital

Abstract

Background

Objective

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Conflicts of interest

Respir. Med.

Otolaryngol. Head Neck Surg.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Otolaryngol. Clin North Am.

Otolaryngol. Head Neck Surg.

Recurrent respiratory papillomatosis: a review

Laryngoscope