title: Experience with recurrent respiratory papillomatosis in a developing country: impact of tracheostomy.
abstract: BACKGROUND
  The frequent relapses of recurrent respiratory papillomatosis (RRP) sometimes demand repeated surgical excision with tracheostomy. This situation plays a vital role in the management of RRP in developing countries such as ours because of late presentation. This study was conducted to evaluate our experience with RRP and to determine the incidence and impact of tracheostomy in the overall management and outcomes of our patients.
  
  
  METHODS
  The records of 59 patients with histologically confirmed RRP treated between 1994 and 2008 at our tertiary institution were reviewed. We collected data such as age at onset, tracheostomy frequency and duration, number of required surgical excisions, papilloma spread to the lower airways. Patients' characteristics and the course of the disease were compared between a juvenile-onset papillomatosis (JoRRP) group and an adult-onset group (AdRRP).
  
  
  RESULTS
  Overall, 68 % of our patients were in the JoRRP group (ages 2-11 years, mean 6 years). The other 32 % were 22-58 years of age (AdRRP group). Two cases of JoRRP continued into adult life. Multiple RRP dominated in the JoRRP group (93 %), whereas solitary papillomas predominated in the AdRRP group (63 %). Tracheostomy was performed because of upper airway obstruction in 42 % of our patients, with children accounting for 72 %. The mean duration of tracheostomy was 3.5 months, with 80 % lasting <4 months. Significantly more JoRRP patients had severe upper airway obstruction, required tracheostomy, and underwent multiple surgical excisions (p = 0.04, 0.02, and 0.009, respectively). Tracheobronchial spread occurred in a patient with prolonged tracheostomy.
  
  
  CONCLUSIONS
  Multiple laryngeal papillomatosis clearly followed a more severe and less predictable course than the solitary type in both groups. Although there was a high incidence of tracheostomy in this study, short-duration tracheostomies accounted for the low incidence of extralaryngeal spread.
authors.affiliation: Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria. tochiorji@yahoo.com
authors.forename: Foster Tochukwu
authors.initials: FT
authors.lastname: Orji
authors.forename: Ijeoma A
authors.initials: IA
authors.lastname: Okorafor
authors.forename: James O
authors.initials: JO
authors.lastname: Akpeh
mesh_terms: D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome