Recurrent Respiratory Papillomatosis (RRP) is a condition where multiple warts grow within the airway and breathing passages. These warts are called papillomata and when they grow inside the voice-box (larynx) they result in hoarseness and an altered voice but more importantly can restrict breathing.
What is the cause?
RRP is caused by a viral infection. Human Papillomavirus (HPV) types 6 and 11 are the responsible viruses. The HPV virus is very common and about 25% of the population have this virus inside their bodies albeit without any sign of disease, though the proportion does vary with age.
The importance of HPV
Within the HPV virus family other members (types) can also cause cancer. The HPV types that cause cervical cancer in adults are HPV 16 and 18. The types that cause cancer are called high-risk. There are also low-risk HPV virus types which cause benign conditions such as skin warts and RRP, though the types that cause skin warts are different to RRP types. Skin warts do not cause RRP.
What is the cure?
Unfortunately, RRP has no cure. The management of the condition requires repeated removal of the papillomatous lesion under general anaesthetic and this may be necessary every 4-6 weeks initially. Numerous additional (adjuvant) therapies have been used in the UK and abroad however these have not been found to be curative. Mr Donne has performed laboratory research into the adjuvant therapies and has been awarded a PhD for his work. He actively continues to do research into RRP.
There is now a vaccine available against HPV 6 and 11. It might prevent RRP developing but it is not known to have an effect on the RRP condition once it is established. The effects of the vaccine on RRP prevalence is not yet known.
Mr Donne at Alder Hey is actively performing research to improve our understanding of RRP. His current research is looking into possible prognostic and therapeutic biomarkers for RRP. He is also the Chief Investigator for the UK arm of a major international study based in the USA looking at the genetics of RRP. It is thought that subtle genetic differences may affect the way different people fight HPV infection hence those that develop disease versus those that simple have the virus in their bodies with no ill effects.
Mr Adam Donne
Alder Hey Children's NHS Foundation Trust
0151 228 4811
Meet Tyler, a patient at Alder Hey who suffers with RRP
Tyler, aged 8, has Recurrent Respiratory Papillomatosis (RRP). This means he has condition where multiple warts grow within the airway and breathing passages. These warts are called papillomata and when they grow inside the voice-box (larynx) they result in hoarseness and an altered voice but more importantly can restrict breathing.
His Mum, Emma, said that last year she noticed Tyler had a hoarse voice, but Tyler was not complaining of a sore throat. When the hoarseness didn’t clear up Emma took Tyler to their local GP who referred Tyler to hospital.
Tyler was referred to Mr Donne at Alder Hey for specialist care where he was diagnosed with RRP. Mr Donne explained: “Tyler has papillomas (warts) that grow in his voice-box. These are caused by a virus. They affect Tyler’s voice making it weak and hoarse.”
When asked about his first visit to Alder Hey Tyler said: “Mr Donne looked in my throat and I was a little bit scared but everybody was friendly and I felt better.”
As there is currently no cure for this condition the main treatment requires repeatedly removing these papillomas as they regrow. Tyler has to go through operations to remove these papillomas on a regular basis. It only involves a day trip to Alder Hey so he visits our Day Case Ward (K1). Tyler is frightened of the Anaesthetic so he has his operations under Gas and Air. The anaesthetists are experts in administering anaesthetics to children. The surgeon and anaesthetist work as a team to allow breathing to occur spontaneously whilst allowing access to the voice-box to remove the papillomas with the use of endoscopes and microscopes.
During his visits, Tyler enjoys playing the most, and has drawn lots of great pictures and made a treasure box which he decorated with our Play Specialists on the wards. He doesn’t even mind when Mr Donne looks in his throat anymore!