# Contemporary management of recurrent respiratory papillomatosis: a survey of Australian otolaryngologists

## TL;DR

This survey explores how Australian otolaryngologists currently assess and manage a rare respiratory condition called recurrent respiratory papillomatosis.

## Contribution

The study identifies the influence of laryngology fellowship training on management practices and highlights contemporary trends in RRP care.

## Key findings

- Laryngology-trained doctors manage more RRP patients and use advanced techniques like stroboscopy and lasers more frequently.
- Adjuvant therapies and HPV vaccination are commonly recommended, especially by fellowship-trained specialists.
- Management practices align with international trends, except for in-office procedures which are less common in Australia.

## Abstract

To assess current experiences and practices in assessment and management of recurrent respiratory papillomatosis (RRP) in Australian Otolaryngologists, with a secondary aim to determine the impact of Laryngology fellowship training on these outcomes.

An online survey was developed and emailed to practicing Australian Otolaryngologists, determined by membership and registration status with the Australian Society of Otolaryngology Head and Neck Surgeons (ASOHNS).

Seventy-four of 507 ASOHNS members completed the survey. Only 20.3% completed Laryngology fellowships (n=15/74). Those who saw <2 individual RRP patients/year were excluded, leaving 46 respondents. The majority (n=29/46) only operated on <5 patients per year, typically adults (n=37/46). Lasers overall were the most common instrument used in adult patients (n=17/37), whilst the microdebrider in those who managed juvenile disease (n=9/17). Adjuvant therapy was used in 74.4%, stroboscopy in 58.1% and voice therapy in 86.1%. Laryngology-trained respondents saw more patients, used stroboscopy, recommended vaccination, used laser and adjuvant therapy more than other respondents.

Our findings reflect the current trends of pre-operative, intraoperative and post-operative management of RRP amongst Australian Otolaryngology consultants. Many of these practices are consistent with findings from international literature, except for in-office procedures. Despite being a relatively rare disease, RRP presents a significant disease burden to the global population emphasising the importance of how it is managed. In recent decades, contemporary management options such as new ablative and angiolytic lasers and adjuvant options such as intralesional bevacizumab and the HPV vaccination have changed the way we manage RRP, particularly amongst the laryngology fellowship trained subspecialty population.