In juvenile respiratory papillomatosis, HPV types 6 and 11 passed from mother to baby around birth cause benign wart-like growths in the airway, mostly on the vocal cords. The growths keep coming back and can narrow the airway, so many children need repeated surgery.
Key symptoms
- Hoarse or weak voice or cry that slowly worsens
- Noisy breathing (stridor)
- Chronic cough or repeated chest infections
- Trouble swallowing in some children
What you find on exam
- Hoarse voice and stridor on breathing in, or in both phases
- Work of breathing: retractions, nasal flaring, breathing rate
- Oxygen saturation
- Ask about maternal genital warts during pregnancy
Tests
- Flexible laryngoscopy to see the papillomas
- Direct laryngoscopy and bronchoscopy under anesthesia with biopsy
- HPV typing of the biopsy
- Chest imaging if spread to the lungs is suspected
Treatment basics
- Surgical removal with microdebrider or laser, repeated as needed
- Bevacizumab as add-on therapy in severe, frequently returning disease
- Avoid tracheostomy when possible
- HPV vaccination of young people to prevent the infections behind this disease
Red flags
- Stridor at rest or increasing breathing effort
- Low oxygen or bluish color
- Child unable to speak, cry or swallow saliva
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.