title: Age of onset of recurrent respiratory papillomatosis: a distribution analysis.
abstract: OBJECTIVE
  Distribution of age of onset of recurrent respiratory papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately 5 years and 30 years. This assumption has never been scientifically confirmed, and authors tend to refer to an article that does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. The objective of this study was to determine the distribution of age of onset of RRP in a large international sample.
  
  
  METHODS
  Cross-sectional distribution analysis.
  
  
  METHODS
  Laryngologists from 12 European hospitals provided information on date of birth and date of onset of all their RRP patients treated between 1998 and 2012. Centers that exclusively treated either patients with juvenile onset RRP or patients with adult onset RRP, or were less accessible for one of these groups, were excluded to prevent skewness.
  
  
  METHODS
  A mixture model was implemented to describe distribution of age of onset. The best fitting model was selected using the Bayesian information criterion.
  
  
  RESULTS
  Six hundred and thirty-nine patients were included in the analysis. Age of onset was described by a three component mixture distribution with lognormally distributed components. Recurrent respiratory papillomatosis starts at three median ages 7, 35 and 64 years.
  
  
  CONCLUSIONS
  Distribution of age of onset of RRP shows three peaks. In addition to the already adopted idea of age peaks at paediatric and adult age, there is an additional peak around the age of 64.
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: M R M
authors.initials: MR
authors.lastname: San Giorgi
authors.affiliation: Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: E R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: R E A
authors.initials: RE
authors.lastname: Tjon Pian Gi
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Brunings
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Chirila
authors.affiliation: Department of Phoniatrics, Speech and Swallowing, Ear, Nose and Throat University Hospital, Medical University of Graz, Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Friedrich
authors.affiliation: Department of Otorhinolaryngology, Greater Poland Cancer Centre, Poznań, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Golusinski
authors.affiliation: Department of Phoniatrics, Speech and Swallowing, Ear, Nose and Throat University Hospital, Medical University of Graz, Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Graupp
authors.affiliation: Pediatric Otolaryngology, Hospital Infantil del Estado de Chihuahua, Chihuahua, Mexico.
authors.forename: R A
authors.initials: RA
authors.lastname: Horcasitas Pous
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Ilmarinen
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Jackowska
authors.affiliation: Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum-Stuttgart, Stuttgart, Germany.
authors.forename: J C
authors.initials: JC
authors.lastname: Koelmel
authors.affiliation: Consulta d'ORL, foniatria i logopèdia, Hosp. Gral de Catalunya (Sant Cugat del Vallès), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ferran Vilà
authors.affiliation: Department for Hearing Speech and Voice Disorders, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Weichbold
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Wierzbicka
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. f.g.dikkers@umcg.nl.|Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands. f.g.dikkers@umcg.nl.
authors.forename: F G
authors.initials: FG
authors.lastname: Dikkers
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001499:Bayes Theorem; D002648:Child; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000453:epidemiology*