Clinical course of recurrent respiratory papillomatosis in Danish children

Objective: To evaluate the clinical course of juvenile-onset recurrent respiratory papillomatosis (RP) with respect to age, disease duration, and maternal condylomas. Design: Inception cohort study Setting: All ear, nose, and throat departments in public Danish hospitals. Patients: Fifty-seven Danish children diagnosed with RP and born between 1974 and 1993 were observed for an average of 14 years after diagnosis. Main Outcome Measure: Removal of respiratory papillomas by knife biopsy, laser surgery, or cryotherapy. Results: Children younger than 5 years diagnosed with RP underwent an average of 4.1 surgeries in the first year of disease, the highest rate among all our patients. The overall surgery rate decreased over time after initial diagnosis but remained significantly higher for children with a younger age of onset for the first 4 years of disease (P < 001) and for children with a maternal history of condylomas in pregnancy for years 4 to 10 of the disease (P < 001). We also observed an independent and statistically significant (P < .001) decreasing surgery rate with increasing age and time from initial diagnosis. The trend for children with recurrent disease was a decreasing rate of surgical procedures (28 of 42 patients with recurrent disease); however, a third of patients (14/42) demonstrated a constant or increasing rate of surgical procedures over time. Conclusions: The clinical course of RP is characterized by a high frequency of surgeries soon after diagnosis that diminishes over time and with increasing age. Additional studies are warranted to identify factors associated with cases that do not conform to the usual disease course.