Recurrent respiratory papillomatosis: From diagnosis to treatment

Recurrent respiratory papillomatosis (RRP) is a rare, benign, recurrent disease of the airway. Its warty lesions are associated with the Human papilloma virus (HPV) types 6 and 11, with a predisposition in the larynx. Because no curative treatment exists, some patients may require more than 100 surgical interventions. The primary aim of treatment is to prevent dyspnea and to minimize voice complaints. This thesis presents five studies on the diagnosis, clinical course, treatment, and the quality of life. The section on diagnosis shows that "Narrow band imaging" (NBI), a visualization technique to distinguish between healthy and unhealthy tissue, is simple, safe and fast in its use, and visualizes papillomata better during the operation, allowing for a better removal of the lesions. The section on clinical course shows differences in disease severity between RRP associated with HPV6 on the one hand, and HPV11 on the other hand. The section on treatment examines the side effects of a commonly used antiviral agent against HPV in RRP patients, and the immune response after therapeutic HPV vaccination in RRP patients. The last section investigates the impact on the voice of surgical intervention, and finds an improvement in voice-related problems after surgery. On the basis of the findings in this thesis, the RRP patient can be provided with a better understanding of the disease, and on the future prospects of this debilitating disease