title: Juvenile recurrent respiratory papilloma: variable intersurgical intervals.
abstract: OBJECTIVE
  To analyze the patterns of surgical frequency in pediatric patients undergoing surgery with CO(2)  laser ablation for juvenile onset recurrent respiratory papillomatosis (JORRP). The hypothesis is that over time there is a high variability in surgical frequency independent of the use of an adjuvant therapy.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  All pediatric patients treated surgically with the CO(2)  laser for JORRP by two senior surgeons at a tertiary pediatric hospital over an 11-year period were evaluated. Regression analysis was performed. An online survey was conducted of the American Academy of Pediatric Otolaryngology membership on their practice patterns regarding JORRP.
  
  
  RESULTS
  Twenty-nine patients were identified, and of those, 20 were included in regression analysis. Several distinct patterns were noted. Only five of the 20 patients (25%) had a constant rate of procedures throughout the observation period. Three (15%) of the patients had continual decrease and one (5%) of the patients had a continual increase in the surgical rate throughout the study period. Eleven (55%) had a fluctuation in the pattern of their recurrences. When queried on how they approach when to repeat intervention for JORRP patients, more than 16 responses were given, and the most common determinants included standard set interval, previous operative findings, and previous interval.
  
  
  CONCLUSIONS
  The natural fluctuation in intersurgical intervals without the use of any adjuvant therapy confounds the use of intersurgical interval as an outcome measure for the success of adjuvant therapy. Accelerations and decelerations were noted but cannot be explained.
authors: Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA. julinao@bcm.edu
authors: Julina
authors: J
authors: Ongkasuwan
authors: Ellen M
authors: EM
authors: Friedman
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D053685:Laser Therapy / Q000379:methods* / Q000706:statistics & numerical data; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology