title: American Society of Pediatric Otolaryngology members' experience with recurrent respiratory papillomatosis and the use of adjuvant therapy.
abstract: OBJECTIVE
  To evaluate how evolving treatment technologies have affected our management of recurrent respiratory papilloma (RRP) since the last comprehensive survey of pediatric otolaryngologists in 1998.
  
  
  METHODS
  Web-based survey of all American Society of Pediatric Otolaryngology members residing in the United States, Canada, Europe, and Australia.
  
  
  RESULTS
  Evaluable survey results were tabulated from 74 practitioners in 62 separate practices managing 700 current children with RRP. A total of 150 (21%) of these patients presently receive adjuvant medical therapies with cidofovir and interferon, accounting for more than two thirds of the total. Sixty-one percent of patients treated with cidofovir have experienced a beneficial response. Distal spread of RRP has occurred in 94 (13%) of the 700 patients. Half of the practices surveyed have experienced a death from RRP, with 89% of deaths directly related to RRP. The laryngeal microdebrider (53%) has supplanted the carbon dioxide laser (42%) as the preferred means of surgically removing papilloma from the larynx in children. Spontaneous, apneic, and jet ventilation (88%) anesthesia techniques have replaced the use of laser-safe endotracheal tubes (10%) as the preferred anesthetic management. Routine human papillomavirus subtyping is practiced by 45% of respondents while 15% treat all their patients with antireflux medications. Half of respondents send lesions for histologic examination only if there is a change in growth pattern while one third send lesions with every surgery.
  
  
  CONCLUSIONS
  Recurrent respiratory papilloma continues to be a frustrating disease to treat and is associated with significant morbidity and mortality. There has been an evolution in the past decade toward the increased use of antiviral adjuvant therapy and the use of microdebrider techniques for surgical management.
authors.affiliation: Eastern Virginia Medical School and the Children's Hospital of the King's Daughters, Norfolk, VA 23507-1914, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Schraff
authors.forename: Craig S
authors.initials: CS
authors.lastname: Derkay
authors.forename: Bonnie
authors.initials: B
authors.lastname: Burke
authors.forename: Louise
authors.initials: L
authors.lastname: Lawson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001315:Australia; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000601:surgery; D008866:Microsurgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery; D009656:North America; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D010212:Papilloma / Q000188:drug therapy* / Q000601:surgery; D012142:Respiratory Tract Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir