Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®)

Recurrent respiratory papillomatosis (RRP) is caused by a human papilloma virus (HPV). It is a rare, sometimes debilitating disease compromising voice and airway. RRP is characterized by a variable course of disease, potentially leading to frequent annual surgical procedures, the number of which may exceed a hundred during the life time. The therapy focuses on surgical removal of the mucosal lesions in order to keep the airway open and the voice satisfactory. Till now, there is no curative therapy for the virus infection in itself. As recurrent surgery alone has proven to be insufficient in many cases, adjuvant therapy is increasingly being used. One of the mainstays of adjuvant therapy is the administration of intralesional cidofovir (Vistide Ò). Cidofovir is an antiviral agent, registered for the treatment of cytomegalovirus (CMV) retinitis in patients wit

Change of Voice Handicap Index after treatment of benign laryngeal disorders

Voice disorders can have major impact on quality of life. Problems caused by these disorders can be experienced in different domains. The Voice Handicap Index (VHI) is a well-known voice-related quality of life instrument to measure physical, emotional and functional complaints. VHI change after treatment in seven separate benign laryngeal disorders was studied. In addition, correlation between the three domains was examined. VHI forms were completed before and 3 months after treatment. In a 5-year-period, 143 patients with seven specific diagnoses were retrospectively included. VHI improved for six diagnoses polyp (p <0.000), cyst (p = 0.001), unilateral paralysis (p = 0.001), Reinke edema (p = 0.016), papillomatosis (p = 0.001), nodules (p = 0.002). Sulcus glottidis did not change (p = 0.897). Mean VHI after treatment was higher for females (p = 0.021). The values of the three domains correlate statistically significant. For each diagnosis, the mean VHI after treatment remained higher than in subjects with a healthy voice. Because the domains are interdependent, their absolute values could not be compared. After treatment, VHI improved in six of the seven diagnoses. The scores on the physical, emotional, and functional domain are interdependent. Scores of the different domains cannot be compared

Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society

In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions

Narrow band imaging is a new technique in visualization of recurrent respiratory papillomatosis

Objectives/Hypothesis: Recurrent respiratory papillomatosis (RRP) is a rare, benign, wart-like disease for which no curative treatment exists. The goal of treatment is total surgical removal of the epithelial lesions to keep the airway open and the voice sufficient. Therefore, it is essential to visualize all papillomatous lesions. The present study aims to evaluate the sensitivity of additional use of narrow band imaging (NBI) in detecting RRP during microlaryngoscopy. Study Design: Prospective study. Methods: Between January 2011 and July 2011, patients with RRP underwent systematic inspection during microlaryngoscopy using conventional white light (WL) immediately followed by inspection with NBI. Consensus was achieved about the number of lesions and number of RRP suspect lesions. All lesions were subsequently excised and sent for histopathological examination. Results: Eighty-six excisional biopsies were taken in 24 microlaryngoscopies performed in 14 RRP patients. Eleven out of the 13 additional biopsies taken, induced by the second inspection with NBI, proved to be papillomata after histopathological examination. The sensitivity increased from 80% with WL up to 97% with WL + NBI (P <.01), whereas the specificity remained poor (32% and 28%, respectively). Conclusions: NBI is an additional diagnostic tool in increasing the sensitivity of visualizing papillomata during microlaryngoscopy. Laryngoscope, 201

Validation of the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis

Objective. There is no specific clinical tool for physicians to detect psychosocial and physical distress or health care need in patients with recurrent respiratory papillomatosis (RRP). The main aim of this study is to validate the RRP-adapted Distress Thermometer and Problem List (DT&PL). Study Design. Prospective cross-sectional questionnaire research. Setting. Academic tertiary care medical centers in Groningen, Netherlands, and Helsinki, Finland. Subjects and Methods. Ninety-one juvenile- and adult-onset RRP patients participated from the departments of otorhinolaryngology-head and neck surgery of the University Medical Center Groningen, Netherlands, and Helsinki University Hospital, Finland. The Hospital Anxiety and Depression Scale was used as the gold standard. Results. A DT cutoff score 4 gave the best sensitivity and specificity. Thirty-one percent of patients had significant distress according to the DT cutoff. Significantly more patients with a score above than under the cutoff had a referral wish. The PL appeared to be reliable. Patients' opinions on the DT&PL were largely favorable. Conclusion. The Dutch and Finnish versions of the DT&PL are valid, reliable screening tools for distress in RRP patients

Clinical course of recurrent respiratory papillomatosis:Comparison between aggressiveness of human papillomavirus-6 and human papillomavirus-11

Background. Recurrent respiratory papillomatosis (RRP) is mainly associated with human papillomavirus (HPV) 6 or HPV11. The purpose of this study was to compare clinical outcome, aggressiveness, and treatment response between HPV6- and HPV11-associated RRP. Methods. A retrospective cohort of 55 patients with RRP (1974-2012) was used. Surgical interventions (n = 814) were analyzed, and complications scored. HPV6/11-specific polymerase chain reaction (PCR) was performed on RRP biopsies. Results. Seventy-six percent of patients (42 of 55) were infected with HPV6 and 24% (13 of 55) with HPV11. The HPV11 group had anatomically more widespread disease. The expected number of surgical interventions was higher in the younger age ( Conclusion. Anatomically, HPV11-associated RRP behaves more aggressively. Younger patients with HPV11 and older patients with HPV6 experience a worse clinical course of RRP. (C) 2014 Wiley Periodicals, Inc