What is recurrent respiratory 

papillomatosis?

Recurrent respiratory papillomatosis (RRP) is a disease 

in which tumors grow in the air passages leading 

from the nose and mouth into the lungs (respiratory 

tract). Although the tumors can grow anywhere in 

the respiratory tract, their presence in the larynx (voice 

box) causes the most frequent problems, a condition 

called laryngeal papillomatosis. The tumors may vary in 

size and grow very quickly. They often grow back even 

when removed. 

What is the cause of RRP?

RRP is caused by two types of human papilloma virus 

(HPV), called HPV 6 and HPV 11. There are more than 

150 types of HPV and they do not all have the same 

symptoms. 

Most people who encounter HPV never develop any 

illness. However, many HPVs can cause small wart-like, 

non-cancerous tumors called papillomas. The most 

common illness caused by HPV 6 and HPV 11 is genital 

warts. Although scientists are uncertain how people 

are infected with HPV 6 or HPV 11, the virus is thought 

to be spread through sexual contact or when a 

mother with genital warts passes it to her baby during 

childbirth. HPV 6 and HPV 11 can also cause disease of 

the uterine cervix and, in rare cases, cervical cancer. 

According to the Centers for Disease Control and 

Prevention, the incidence of RRP is rare. Fewer than 

2,000 children get RRP each year.

Who is affected by RRP?

RRP affects adults as well as infants and small children 

who may have contracted the virus during childbirth. 

According to the RRP Foundation, there are roughly 

20,000 cases in the United States. Among children, 

the incidence of RRP is approximately 4.3 per 100,000; 

among adults, it’s about 1.8 per 100,000.

Parts of the respiratory tract 

affected by RRP

NIDCD Fact Sheet

Recurrent Respiratory Papillomatosis 

or Laryngeal Papillomatosis

u.s. department of health & human services ∙ national institutes of health ∙ National Institute on Deafness and Other Communication Disorders voice, speech, language language
of the throat and angle the mirror down toward the 

larynx to inspect it for tumors.

A direct laryngoscopy is conducted in the operating 

room with the use of general anesthesia. This method 

allows the otolaryngologist to view the vocal folds and 

other parts of the larynx under high magnification. 

This procedure is usually used to minimize discomfort, 

especially with children, or to enable the doctor to 

collect tissue samples from the larynx or other parts of 

the throat to examine them for abnormalities.

How is RRP treated?

There is no cure for RRP. Surgery is the primary method 

for removing tumors from the larynx or airway. 

Because traditional surgery can result in problems due 

to scarring of the larynx tissue, many surgeons are now 

using laser surgery, which uses an intense laser light as 

the surgical tool. Carbon dioxide lasers—which pass 

electricity through a tube containing carbon dioxide 

and other gases to generate light—are currently the 

most popular type used for this purpose. In the past 

10 years, surgeons have begun using a device called a 

microdebrider, which uses suction to hold the tumor 

while a small internal rotary blade removes the growth. 

Once the tumors have been removed, they have a 

tendency to return unpredictably. It is common for 

patients to require repeat surgery. With some patients, 

surgery may be required every few weeks in order 

to keep the breathing passage open, while others 

may require surgery only once a year. In the most 

extreme cases where tumor growth is aggressive, a 

tracheotomy may be performed. A tracheotomy is a 

surgical procedure in which an incision is made in the 

front of the patient’s neck and a breathing tube (trach 

tube) is inserted through an opening, called a stoma, 

What are the symptoms of RRP?

Normally, voice is produced when air from the lungs is 

pushed past two side-by-side elastic muscles—called 

vocal folds or vocal cords—with sufficient pressure to 

cause them to vibrate (see figure on page 1). When 

the tumors interfere with the normal vibrations of the 

vocal folds, it causes hoarseness, which is the most 

common symptom of RRP. Eventually, the tumors 

may block the airway passage and cause 

difficulty breathing. 

Because the tumors grow quickly, young children 

with the disease may find it difficult to breathe when 

sleeping, or they may experience difficulty swallowing. 

Adults and children may experience hoarseness, 

chronic coughing, or breathing problems. The 

symptoms tend to be more severe in children than in 

adults; however, some children experience some relief 

or remission of the disease when they begin puberty. 

Because of the similarity of the symptoms, RRP is 

sometimes misdiagnosed as asthma or 

chronic bronchitis. 

How is RRP diagnosed?

Two routine tests for RRP are indirect and direct 

laryngoscopy. In an indirect laryngoscopy, an 

otolaryngologist—a doctor who specializes in diseases 

of the ear, nose, throat, head, and neck—or speechlanguage pathologist will typically insert a flexible 

fiberoptic telescope, called an endoscope, into a 

patient’s nose or mouth and then view the larynx on 

a monitor. Some medical professionals use a video 

camera attached to a flexible tube to examine the 

larynx. An older, less common method is for the 

otolaryngologist to place a small mirror in the back 

NIDCD Fact Sheet

Recurrent Respiratory Papillomatosis 

or Laryngeal Papillomatosis

voice, speechlanguage
into the trachea (windpipe). Rather than breathing 

through the nose and mouth, the patient will now 

breathe through the trach tube. Although the trach 

tube keeps the breathing passage open, doctors try to 

remove it as soon as it is feasible. 

Some patients may be required to keep a trach tube 

indefinitely in order to keep the breathing passage 

open. In addition, because the trach tube re-routes all 

or some of the exhaled air away from the vocal folds, 

the patient may find it difficult to speak. With the help 

of a voice specialist or speech-language pathologist 

who specializes in voice, the patient can learn how to 

use his or her voice.

Adjuvant therapies—therapies that are used in addition 

to surgery—have been used to treat more severe cases 

of RRP. Drug treatments may include antivirals such as 

interferon and cidofovir, which block the virus from 

making copies of itself, and indole-3-carbinol, a cancerfighting compound found in cruciferous vegetables, 

such as broccoli and Brussels sprouts. To date, the 

results of these and other adjuvant therapies have 

been mixed or not yet fully proven.

What research is being conducted 

on RRP?

Scientists and clinicians are working to discover more 

about RRP. While HPV 6 and HPV 11 are known causes, 

millions of people are exposed to these two viruses 

without developing the disease. It is not known why 

some people are more at risk than others or why some 

cases are much more serious than others. 

Researchers funded by the National Institute on 

Deafness and Other Communication Disorders (NIDCD) 

are exploring how our genes and immune system may 

contribute to our risk for contracting the disease as 

well as the severity of its symptoms. Researchers are 

also studying other possible therapies for RRP. In one 

clinical trial, researchers are investigating whether a 

common anti-inflammatory drug can inhibit an enzyme 

that promotes tumor growth in RRP, thus reducing the 

recurrence of tumors in children and adults with RRP. 

Researchers are also investigating the effectiveness of 

a pulsed dye laser, a laser that delivers short intense 

pulses of light, to determine if it is more effective at 

preserving the surrounding tissue while removing 

tumors from vocal folds. In one NIDCD-sponsored 

clinical investigation, researchers are studying whether 

a certain dietary supplement can work with the pulsed 

dye laser to decrease the rate of recurrence of tumors 

in children with RRP. To read about these and other 

clinical trials that are recruiting volunteers, go to 

http://www.clinicaltrials.gov.

Where can I get more information?

The NIDCD maintains a directory of organizations 

that provide information on the normal and 

disordered processes of hearing, balance, smell, taste, 

voice, speech, and language. Please see the list of 

organizations at http://www.nidcd.nih.gov/directory.

Use the following keywords to help you search for 

organizations that can answer questions and provide 

printed or electronic information on RRP:

• Papillomatosis 

• Speech-language pathologists 

• Rare disorders 

• Laryngology

more
For more information, additional addresses and phone 

numbers, or a printed list of organizations, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

NIDCD supports and conducts research and research training on the 

normal and disordered processes of hearing, balance, smell, taste, 

voice, speech, and language and provides health information, based 

upon scientific discovery, to the public.

voice, speech, languagehearing, balancesmell, taste

NIDCD Fact Sheet: Recurrent Respiratory Papillomatosis 

or Laryngeal Papillomatosis

NIH Publication No. 10-4307

October 2010

For more information, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

Internet: http://www.nidcd.nih.gov

The NIDCD Information Clearinghouse is a service of the 

National Institute on Deafness and Other Communication 

Disorders, National Institutes of Health, U.S. Department 

of Health and Human Services.