Department of Otolaryngology

Recurrent respiratory papillomatosis (RRP)

Understanding the Disorder

Recurrent respiratory papillomatosis (RRP) is a benign growth of upper airway. It is thought to be associated with Human Papilloma Virus (HPV) type 6 and 11. Juvenile onset RRP is found in children younger than age 12. Otherwise they are considered adult onset. These lesions tend to occur in the airway where the respiratory lining transitions into squamous (skin-type) lining such as on the superior and undersurface of the true vocal folds. It is a disease that tends to regrow after treatment thus long-term surveillance is required. In addition, there is a small risk of these lesions transforming into cancer after a long period (~5%).



  • Progressive hoarseness
  • Progressive shortness of breath
  • Difficulty swallowing


Patient History

A history of the duration and progression of the aforementioned symptoms is assessed.

Flexible Laryngoscopy

Careful examination of the larynx is essential to identify any RRP lesions in the larynx.

Other investigations

Biopsy is key to confirm the diagnosis of RRP and rule out any abnormal tissues.


Surgery is the gold standard of treatment for RRP. Multiple surgeries are usually requires. Surgery can involve a laser or other instruments. If the lesions regrow rapidly after surgery, adjuvant treatments can be considered, including indole-3-carbinol dietary supplementation, cidofovir intraleional injections or bevacizumab (Avastin) intralesional injections.