Is Your Voice Changing? Understanding Recurrent Respiratory Papillomatosis (RRP)

A raspy voice, chronic coughing, or difficulty breathing can be more than just a passing symptom; it could be a sign of something more serious. If you or a loved one are experiencing these issues, it may be a good idea to learn about Recurrent Respiratory Papillomatosis (RRP). While RRP is a rare condition, understanding its symptoms and treatment is the first step toward managing it effectively. This guide will help you understand what RRP is and how to take action to get a proper diagnosis and care.

What Is Recurrent Respiratory Papillomatosis (RRP)?

Recurrent Respiratory Papillomatosis is a rare, non-cancerous disease caused by the Human Papillomavirus (HPV). It leads to the growth of warts, or papillomas, in the respiratory tract, most commonly on the vocal cords. These growths are typically benign, but they can be problematic. They can grow back, which is why the condition is called "recurrent," and in some cases, they can grow to be large enough to obstruct the airway, leading to serious breathing difficulties. While RRP can affect anyone, it is most common in children, which is known as juvenile-onset RRP, and adults, known as adult-onset RRP.

Recognizing the Symptoms of RRP

The symptoms of RRP often start subtly and can be mistaken for a common cold or other respiratory issues. Because the papillomas grow in the airways, the symptoms are often related to a change in the voice or breathing. Recognizing these signs early is key to getting a timely diagnosis and preventing the condition from becoming more severe. The most common symptoms include:


  • Hoarseness or a Weak Voice: This is often the first symptom to appear, especially in children. The papillomas on the vocal cords can prevent them from vibrating properly, leading to a hoarse or breathy voice.

  • Chronic Coughing: A persistent cough that doesn’t seem to go away can be a sign of papillomas irritating the throat or airways.

  • Stridor (High-Pitched Breathing Sound): As the papillomas grow and begin to obstruct the airway, you may hear a high-pitched, wheezing sound when breathing,which can be a serious symptom.

  • Difficulty Breathing (Dyspnea): In more advanced stages, the growths can cause significant airway obstruction, making it difficult to breathe, especially during physical activity.

  • Difficulty Swallowing: Although less common, large growths can sometimes make swallowing difficult.

Treatment Options for RRP

While there is no cure for RRP, there are effective treatments to remove the papillomas and manage the symptoms. The goal of treatment is to remove the growths, preserve the function of the vocal cords, and prevent airway obstruction. The main treatment approach is surgical, but new adjunctive therapies are also being used to reduce the frequency of recurrence. These treatments are often managed by a team of specialists, including an ear, nose, and throat (ENT) surgeon.


  • Surgical Removal: This is the primary treatment for RRP. The papillomas are removed using various techniques, often a laser or a microdebrider. The surgery is typically done through the mouth and does not require any incisions.

  • Adjuvant (Support) Therapies: Because RRP is recurrent, doctors often use additional therapies to help slow the regrowth of the papillomas. These can include:

    • Antivirals: Medications like Cidofovir can be injected into the papillomas to help slow their growth.

    • Immunotherapy: Treatments that stimulate the immune system to fight the virus, such as Interferon, are being explored and used in some cases.



The number of surgical procedures a patient needs can vary. Some may need them every few months, while others may only need them every few years. The goal is to reduce the number of surgeries and improve a person’s quality of life.

Are You Ready to Take Control of Your Health?

A persistent voice change or breathing issue should not be ignored. If you or a loved one are experiencing the symptoms of RRP, take the first step toward getting a diagnosis. A visit to a doctor or an ENT specialist can help you get the right care and find a treatment plan that works for you. By being proactive, you can manage the condition and live a more comfortable, confident life. Your health is worth it.