Risk factors for severity of juvenile-onset recurrent respiratory papillomatosis at first endoscopy

Abstract

Objective: The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation.

Methods: Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement.

Results: Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P=0.03). The odds ratio for risk of >14 procedures in 3-level involvement was 20.43 (P=0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P=0.16).

Conclusions: RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.

Keywords: Children; Cidofovir; Human papillomavirus; Juvenile-onset papillomatosis; Larynx.