Share This Article:

Impediments to clinical diagnosis and management of juvenile-onset recurrent respiratory papillomatosis in Ilorin, Nigeria

Abstract Full-Text HTML Download Download as PDF (Size:143KB) PP. 127-132
DOI: 10.4236/ojped.2013.32023    3,408 Downloads   4,907 Views   Citations

ABSTRACT

Background: To report the impediments to the diagnosis and management of children with JuvenileOnset Recurrent Respiratory Papillomatosis as seen in a teaching hospital in West Africa. Methods: Retrospectively analysed study of participants requiring surgical intervention for histologically confirmed juvenile onset recurrent respiratory papillomatosis managed at the Department of Otorhinolaryngology, University of Ilorin Teaching Hospital, Ilorin over a 10-year period (2002-2011) using prospectively collated database. Results: Juvenile-Onset Recurrent Respiratory Papillomatosis constituted 8.8% of 307 laryngeal pathologies seen during the study period. 18 (66.7%) were males and 9 (33.3%) females with a sex ratio (M:F) of 2:1. Age ranged from 1 year 4 months to 12 years with a mean age of 6.1 years (SD = 2.78), with the 6 - 10 age group constituting the largest categories in 51.9% of patients seen. Patients from low socioeconomic class constituted slightly over half of the patients studied (51.9%). 55.5% of the patients presented late (>13 months). All patients presented with hoarseness, stridor and difficulty in breathing. Misdiagnosis made by the referring clinician included Asthma, Laryngo-tracheo-bronchitis, Foreign body aspiration and Laryngomalacia. Involvement of the glottis occurred in 70.4% of cases seen, while bilateral involvement was present in 91.3% of cases operated. Recurrence was seen in 63.0% of the patients and the best attendance at follow-up clinic was during the first three months post surgical extirpation. Emergency tracheostomy was done to relieve airway obstruction in 17 (63.0%) patients. Conclusion: Impediments to diagnosis and management of JORRP are multifactorial. Misdiagnosis, late presentation and poor follow-up clinic attendance of patients with JORRP is still a common occurrence among the physicians. Recommendations on how to improve management and outcome of JORRP were made.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Adebola, S. and Dunmade, A. (2013) Impediments to clinical diagnosis and management of juvenile-onset recurrent respiratory papillomatosis in Ilorin, Nigeria. Open Journal of Pediatrics, 3, 127-132. doi: 10.4236/ojped.2013.32023.

References

[1] Terry, R.M., Lewis, F.A., Griffiths, S., Wells, M. and Bird, C.C. (1987) Demonstration of human papillomavirus type 6 and 11 in juvenile laryngeal papillomatosis by in-situ DNA hybridization. Journal of Pathology, 153, 245-248. doi:10.1002/path.1711530308
[2] Zawadzka-Glos, L., Jakubowska, A., Chmielik, M., Bieliaka, A. and Brzewski, M. (2003) Lower airway papillomatosis in children. International Journal of Pediatric Otorhinolaryngology, 67, 1117-1121. doi:10.1016/S0165-5876(03)00191-5
[3] Larson, D.A. and Derkay, C.S. (2010) Epidemiology of recurrent respiratory papillomatosis. APMIS, 118, 450-454. doi:10.1111/j.1600-0463.2010.02619.x
[4] Chadha, N.K. and James, A. (2010) Adjuvant antiviral therapy for recurrent respiratory papillomatosis. Cochrane Database of Systematic Reviews, Article ID: CD00-5053.
[5] Derkay, C.S. and Wiatrak, B. (2008) Recurrent respiretory papillomatosis: A review. Laryngoscope, 118, 1236-1247. doi:10.1097/MLG.0b013e31816a7135
[6] Derkay, C.S. (1995) Task force on recurrent respiratory papillomas. A preliminary report. Archives of Otolaryngology, Head and Neck Surgery, 121, 1386-1391. doi:10.1001/archoto l.1995.01890120044008
[7] Snoeck, R., Wellens, W., Desloovere, C., Van Ranst, M., Naesens, L., De Clercq, E., et al. (1982) Treatment of severe laryngeal papillomatosis with intralesional injections of cidofovir [(S)-1-(3-hydroxyl-2-phosphonylmethoxypropyl) cytosine]. Journal of Medical Virology, 79, 5425-5429.
[8] Stamataki, S., Nikolopoulos, T.P., Korres, S., Felekis, D., Tzangaroulakis, A. and Ferekidis, E. (2007) Juvenile recurrent respiratory papillomatosis: Still a mystery disease with difficult management. Head & Neck, 29, 155-162. doi:10.1002/hed.20491
[9] Oyedeji, G.A. (1985) Socio-economic and cultural background of hospitalized children in Ilesha. Nigerian Journal of Paediatrics, 12, 111-117.
[10] Fasunla, A.J. and Lasisi, O.A. (2009) Diagnostic challenges of laryngeal papillomatosis and its implications among children in developing country. International Journal of Pediatric Otorhinolaryngology, 73, 593-595. doi:10.1016/j.ijporl.2008.12.009
[11] Shykhon, M., Kuo, M. and Pearman, K. (2002) Recurrent respiratory papillomatosis. Clinical Otolaryngology and Applied Sciences, 27, 237-243.
[12] Parikh, S., Brennan, P. and Boffetta, P. (2003) Meta-analysis of social inequality and the risk of cervical cancer. International Journal of Cancer, 105, 687-691. doi:10.1002/ijc.11141
[13] Wiatrak, B.J., Wiatrak, D.W., Broker, T.R. and Lewis, L. (2004) Recurrent respiratory papillomatosis: A longitudinal study comparing severity associated with human papilloma viral types 6 and 11 and other risk factors in a large pediatric population. Laryngoscope, 114, 1-23. doi:10.1097/01.mlg.000148224.83491.0f
[14] Leung, R., Hawkes, M. and Campisi, P. (2007) Severity of juvenile onset recurrent respiratory papillomatosis is not associated with socioeconomic status in a setting of universal health care. International Journal of Pediatric Otorhinolaryngology, 71, 965-972. doi:10.1016/j.ijporl.2007.03.009
[15] Gissmann, L., Diehl, V., Schultz-Coulon, H.-J. and zur Hansen, H. (1982) Molecular cloning and characterization of human papillomavirus DNA derived from a laryngeal papilloma. Journal of Virology, 44, 393-400.
[16] Silverberg, M.J., Thorsen, P., Lindeberg, H., Grant, L. and Shah, K.V. (2003) Condyloma in pregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstetrics & Gynecology, 101, 645-652. doi:10.1016/S0029-7844(02)03081-8
[17] Coope, G. and Connett, G. (2006) Juvenile laryngeal papillomatosis. Primary Care Respiratory Journal, 15, 125-127. doi:10.1016/j.pcrj.2006.02.004
[18] Zacharisen, M.C. and Conley, S.F. (2006) Recurrent respiratory papillomatosis in children: Masquerader of common respiratory diseases. Pediatrics, 118, 1925-1931. doi:10.1542/peds.2006-1555
[19] Olaosun, A.O., Bello, T.O., Aremu, A.A., Sogebi, O.A. and Tobih, J.E. (2007) The hypoplastic maxillary antrum: A pitfall for the unwary. The Internet Journal of Otorhinolaryngology, 6. doi:10.5580/10df
[20] Pasquale, K., Wiatrak, B., Woolley, A. and Lewis, L. (2003) Microdebrider versus CO2 laser removal of recurrent respiratory papillomas: A prospective analysis. Laryngoscope, 113, 139-143. doi:10.1097/00005537-200301000-00026
[21] Ilmrinen, T., Nissila, H., Rihkanen, H., Roine, R., Pietarinen-Runtti, P., Pitkaranta, A. and Aaltonen, L. (2011) Clinical features, health-related quality of life, and adult voice in juvenile-onset recurrent respiratory papillomatosis. Laryngoscope, 121, 846-851.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.