Recurrent respiratory papillomatosis: pathogenesis to treatment.
OBJECTIVE
Recurrent respiratory papillomatosis remains a serious disease and is commonly treated by otolaryngologists. The goals of this review are to update physicians on current understandings regarding viral pathogenesis, patient risks, and current trends in treatment strategies.


RESULTS
Surgical debulking still remains the foundation of treatment; however, newer surgical approaches utilizing microdebriders are replacing laser ablation. Genetic studies have identified individuals with specific immune cell alleles to be at greater risk for persistent infection. Our understanding of the viral pathogenesis has increased by the identification of a viral mechanism to downregulate antigen expression in cells infected with human papillomavirus, thus possibly allowing decreased immune detection. Although the viral types responsible for recurrent respiratory papillomatosis have been identified, the mechanism by which they alter cellular growth has not been identified. Research studies investigating adjuvant medical therapies aimed at reducing required surgical therapy intervals and possibly helping cure the infection are being completed. A safe, effective adjuvant therapy is still currently not available.


CONCLUSIONS
Improved surgical approaches have slightly enhanced patient care; however, more research is needed to understand how human papillomavirus causes disease so that these therapies can be developed.
Lee
John H
JH
Department of Otolaryngology-Head and Neck Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA. john-h-lee@uiowa.edu
Smith
Richard J
RJ
D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D052140:Human papillomavirus 11 / Q000276:immunology; D052163:Human papillomavirus 6 / Q000276:immunology; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D053685:Laser Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D063065:Organophosphonates / Q000627:therapeutic use; D010212:Papilloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D030361:Papillomavirus Infections / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014765:Viral Vaccines
D000970:Antineoplastic Agents; D007211:Indoles; D016898:Interferon-alpha; D063065:Organophosphonates; D014765:Viral Vaccines; D003596:Cytosine; C016517:indole-3-carbinol; D000077404:Cidofovir