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Goon P, Sauzet O, Schuermann M, Oppel F, Shao S, Scholtz LU, Sudhoff H, Goerner M. Recurrent Respiratory Papillomatosis (RRP)-Meta-analyses on the use of the HPV vaccine as adjuvant therapy. NPJ Vaccines 2023; 8:49. [PMID: 37005390 PMCID: PMC10067830 DOI: 10.1038/s41541-023-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
Recurrent Respiratory Papillomatosis(RRP) is a rare disease with severe morbidity. Treatment is surgical. Prevailing viewpoint is that prophylactic HPV vaccines do not have therapeutic benefit due to their modus operandi. Studies on HPV vaccination alongside surgery were meta-analysed to test effect on burden of disease. Databases were accessed Nov and Dec 2021 [PubMed, Cochrane, Embase and Web of Science]. Main outcome measured was: Mean paired differences in the number of surgeries or recurrences per month. Analyses was performed using: Random effect maximal likelihood estimation model using the Stata module Mataan(StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX:StataCorp LLC.) Our results found n = 38 patients, suitable for syntheses with one previous meta-analyses (4 published, 2 unpublished studies) n = 63, total of n = 101 patients. Analyses rendered an overall reduction of 0.123 recurrences or surgeries per month (95% confidence interval [0.064, 0.183]). Our meta-analyses concludes that HPV vaccine is a beneficial adjunct therapy alongside surgery.
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Affiliation(s)
- Peter Goon
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Departments of Dermatology & Otolaryngology, National University Health System, Singapore, Singapore.
| | - Odile Sauzet
- Bielefeld School of Public Health and Department of Business Administration and Economics, University of Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Matthias Schuermann
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Felix Oppel
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - SenYao Shao
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Lars-Uwe Scholtz
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Holger Sudhoff
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Martin Goerner
- Dept of Haematology, Oncology and Palliative Medicine, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
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Sibeko SR, Seedat RY. Adult-onset Recurrent Respiratory Papillomatosis at a South African Referral Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:5188-5193. [PMID: 36742562 PMCID: PMC9895704 DOI: 10.1007/s12070-022-03110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/09/2022] [Indexed: 02/07/2023] Open
Abstract
Objective The aim of this study was to describe the clinical presentation and outcome of patients with adult-onset recurrent respiratory papillomatosis (AoRRP) in a developing country with the challenges of poor health care access and high prevalence of HIV infection. Materials and methods This was a retrospective study of patients diagnosed with AoRRP who were managed in the Department of Otorhinolaryngology at Universitas Academic Hospital in Bloemfontein, South Africa over a 10 year period. Results There were a total of 41 patients, of which 26 (63.4%) were male. The age at diagnosis ranged between 16.4 and 67.4 years (mean 39.4 ± 14.9 years). All patients presented with a hoarse voice, with three patients also having upper airway obstruction. Eight (19.5%) patients were HIV positive. HPV typing was performed in 29 patients; 14 had HPV11 disease, 12 had HPV6 disease and in 3 patients HPV DNA was not detected. There was no significant difference in initial presentation or outcome between HIV negative and HIV positive patients, or between patients with HPV6 and HPV11 disease. Two patients had malignant transformation of the papillomas. In both these patients, HPV was not detected in the papillomas. Conclusions HPV type and HIV infection did not appear to influence the clinical presentation and outcome in patients with AoRRP. There is a risk of malignant transformation in patients in which HPV is not detected in the papillomas.
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Affiliation(s)
- Samukelisiwe R. Sibeko
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, P.O. Box 339, 9300 Bloemfontein, South Africa
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Riaz Y. Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, P.O. Box 339, 9300 Bloemfontein, South Africa
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
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3
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RY Seedat, FG Dikkers. Global epidemiology of HPV-associated recurrent respiratory papillomatosis and effect of vaccination. Future Virol 2022. [DOI: 10.2217/fvl-2021-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- RY Seedat
- Department of Otorhinolaryngology, Universitas Academic Hospital & University of the Free State, Bloemfontein, 9301, South Africa
| | - FG Dikkers
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
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HPV and Recurrent Respiratory Papillomatosis: A Brief Review. Life (Basel) 2021; 11:life11111279. [PMID: 34833157 PMCID: PMC8618609 DOI: 10.3390/life11111279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a rare but severe manifestation of human papillomavirus (HPV). As our knowledge about HPV infections has expanded, it has become possible to understand the course of RRP disease and unravel plausible efficient methods to manage the disease. However, the surge in reports on HPV has not been accompanied by a similar increase in research about RRP specifically. In this paper, we review the clinical manifestation and typical presentation of the illness. In addition, the pathogenesis and progression of the disease are described. On the other hand, we discuss the types of treatments currently available and future treatment strategies. The role of vaccination in both the prevention and treatment of RRP will also be reviewed. We believe this review is essential to update the general knowledge on RRP with the latest information available to date to enhance our understanding of RRP and its management.
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Carvalho AMAS, Brito DSD, Cunha APA, Monteiro PDM, Ferreira MB, Assis DSFRD, Bentivi JO, Andrade MSD, Vidal FCB, Salgado Filho N. Recurrent respiratory papillomatosis: clinical characteristics and viral genotyping in a Brazilian population. Rev Inst Med Trop Sao Paulo 2021; 63:e63. [PMID: 34406288 PMCID: PMC8376275 DOI: 10.1590/s1678-9946202163063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
This study presents 25 cases of recurrent respiratory papillomatosis (RRP) that occurred in Sao Luis, Maranhao State, Northeast region, Brazil, between January 2007 and December 2018. Sociodemographic and clinical profile of patients as well as human papillomavirus (HPV) infection status were evaluated. Clinical and histopathological data were collected from the patients' medical records. For the HPV infection analysis, DNA was extracted and subjected to amplification by a nested polymerase chain reaction. Viral genotyping was performed by automated sequencing. The median age of patients was 12.40 ± 12.6. years, and the juvenile form of the disease (68%) was the predominant form of disease. Female participants were predominant (60%), and they were from cities located in the interior of the State (60%). The most common clinical manifestation was dysphonia; recurrence was observed in most cases (56%), and tracheostomy was necessary in seven patients (26.9%). When comparing the RRP forms, patients in the juvenile-RRP group had higher recurrence rates and need of tracheostomy than those in the adult-RRP group. The viral genotyping analysis revealed that 47.8% of patients had low-risk HPVs, whereas 13.1% had high-risk HPVs, and in 39.1% of patients the viral genotype was not obtained. HPV-6 was the most prevalent type and Juvenile-RRP was more prevalent in our population. HPV was present at a high rate, and HPV-6 was the predominant genotype. This study serves as the basis for further studies to be conducted in the Brazilian population. Our findings aid the better understanding of RRP, possibly suggesting some prognostic factors associated with the disease aggressiveness.
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Affiliation(s)
| | | | - Ana Paula Almeida Cunha
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil
| | | | | | | | | | - Marcelo Souza de Andrade
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Fisiologia, São Luís, Maranhão, Brazil
| | - Flávia Castello Branco Vidal
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Farmácia, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Morfologia, São Luís, Maranhão, Brazil
| | - Natalino Salgado Filho
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Medicina I, São Luís, Maranhão, Brazil
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Oh JK, Choi HY, Han M, Jung YS, Lee SJ, Ki M. Estimated incidence of juvenile-onset recurrent respiratory papillomatosis in Korea. Epidemiol Health 2021; 43:e2021019. [PMID: 33906285 PMCID: PMC8189843 DOI: 10.4178/epih.e2021019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/10/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11 and is potentially preventable through vaccination. This study estimated the incidence of juvenile-onset RRP before the implementation of the national HPV vaccination program in Korea. METHODS We conducted a cohort study using claims data provided by a mandatory insurance program to estimate the incidence of RRP and associated healthcare use. Patients with juvenile RRP were defined as those aged ≤12 years with ≥2 admissions or ≥2 outpatient visits during which they received the International Classification of Diseases, 10th revision code for benign neoplasms of the larynx (D14.1). RESULTS During 2002-2014, 123 children (74 boys and 49 girls) were diagnosed with RRP. The patients had a mean of 6.5 person-years of follow-up. The incidence was estimated at 0.30/100,000 person-years. The median age at diagnosis was 4.0 years (mean, 4.3). Thirty-six (29.3%) patients underwent surgery, including 23 patients (18.7%) who underwent 2 or more surgical procedures. Severe disease, measured by more frequent surgical procedures and shorter time intervals between consecutive operations, was associated with a younger age at diagnosis. CONCLUSIONS The estimated incidence of juvenile-onset RRP in Korea was similar to that reported in other countries. The RRP burden should continue to be monitored using National Health Insurance Service claims data.
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Affiliation(s)
- Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Cancer Risk Appraisal and Prevention Branch, National Cancer Center, Goyang, Korea
| | - Hwa Young Choi
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Department of Health Sciences, Hanyang University, Seoul, Korea
| | - Minji Han
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Yuh-Seog Jung
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Department of Otorhinolaryngology, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Joon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
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Uloza V, Kuzminienė A, Palubinskienė J, Balnytė I, Ulozienė I, Valančiūtė A. An Experimental Model of Human Recurrent Respiratory Papillomatosis: A Bridge to Clinical Insights. Laryngoscope 2020; 131:E914-E920. [PMID: 32894613 DOI: 10.1002/lary.29093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the growth pattern of recurrent respiratory papilloma (RRP) implants on chicken embryo chorioallantoic membranes (CAMs) and to evaluate possible associations between the clinical course of the disease and the behavior of experimentally implanted RRP tumors. STUDY DESIGN Experimental study. METHODS Fresh 172 RRP tissue samples from 12 patients were implanted onto chick embryo CAMs. Morphological and morphometric analysis of the experimental CAM and chorionic epithelium was performed. The microvascular network of the CAM with the RRP implant was investigated under the effect of fluoresceinated anionic dextran. The peculiarities of the clinical course of the disease were evaluated. RESULTS The implanted RRP tissue samples survived on CAMs in 86% of cases, retaining their essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM and the chorionic epithelium, but none of the RRP implants crossed the basement membrane of the hosting CAM. A "crawling film" of acellular material with newly formed papilloma sprouts located on the outer chorionic epithelium of the CAM was detected. Direct association between a recurrence rate of RRP and the number of newly formed papilloma sprouts around the implanted tumor on CAMs was revealed. CONCLUSION The chicken embryo CAM-based model is appropriate for investigations of RRP and facilitates the understanding of tumor biology and the clinical course of the disease, thus providing the basis for further research and acceleration of the identification and development of new specific therapeutic compounds that limit the spread and recurrence of RRP. LEVEL OF EVIDENCE N/A Laryngoscope, 131:E914-E920, 2021.
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Affiliation(s)
- Virgilijus Uloza
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alina Kuzminienė
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolita Palubinskienė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ingrida Balnytė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ingrida Ulozienė
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Angelija Valančiūtė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Seedat RY. Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management - A Developing Country Review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:39-46. [PMID: 32099513 PMCID: PMC7007786 DOI: 10.2147/phmt.s200186] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/14/2020] [Indexed: 01/04/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is a condition caused by human papillomavirus (HPV), usually HPV types 6 and 11, which is characterized by recurrent papillomas of the respiratory tract, mainly the larynx. Patients usually present between the ages of 2 and 6 years. The initial presenting symptom is progressive dysphonia, followed by stridor and respiratory distress. Treatment consists of repeated microlaryngoscopic procedures to remove the papillomas as there is no cure. The poor availability and accessibility of appropriate healthcare services in developing countries are barriers to the early diagnosis and appropriate management of patients with juvenile-onset recurrent respiratory papillomatosis (JoRRP), requiring many patients to have a tracheostomy. The introduction of prophylactic vaccines that include HPV6 and HPV11 is necessary in order to reduce the incidence of JoRRP.
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Affiliation(s)
- R Y Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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9
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Laryngopharyngeal Reflux Is a Potential Risk Factor for Juvenile-Onset Recurrent Respiratory Papillomatosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1463896. [PMID: 30881982 PMCID: PMC6387692 DOI: 10.1155/2019/1463896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Introduction Human papillomavirus (HPV) causes juvenile-onset recurrent respiratory papillomatosis (JORRP). Although HPV is common in children, the prevalence of JORRP is low. It is likely that other factors contribute to the pathogenesis of JORRP, during either activation or reactivation of a latent HPV infection. There is evidence that laryngopharyngeal reflux (LPR) might be such a risk factor for adult-onset recurrent respiratory papillomatosis. This study investigated if LPR might also be a risk factor for JORRP. Materials and Methods Children with JORRP of the larynx that required microlaryngoscopy at a tertiary referral hospital were included in this prospective case-series study from November 2015 to November 2017. Using immunohistochemistry, HPV infection and pepsin associated with LPR were diagnosed from laryngeal biopsies. Results Eleven children (aged 4-14 years) were analyzed. No patient had a history of immunodeficiency or tobacco smoke exposure. All patients underwent at least three previous surgeries due to JORRP and had been vaccinated against HPV in the past. Five children were treated using antivirotics and immunomodulators. The only known maternal risk factor was that three mothers were primiparous. All 11 samples were infected with HPV (type 6 or 11). Pathologic LPR was diagnosed in 5/11 children (45.5%). Conclusion LPR may be a risk factor for JORRP, contributing to its development by activating or reactivating a latent HPV infection. Results are in accordance with those from our previous study in adults.
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Matinhira N, Soko ND, Bandason T, Jenson RG, Dzongodza T, von Buchwald C, Chidziva C. Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe. Int J Pediatr Otorhinolaryngol 2019; 116:147-152. [PMID: 30554686 DOI: 10.1016/j.ijporl.2018.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting. METHODS We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types. RESULTS A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed. CONCLUSION HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.
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Affiliation(s)
- Naboth Matinhira
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe.
| | - Nyarai D Soko
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Ramon G Jenson
- Department of ORL, H&N Surgery, Rigshospitalet and University of Copenhagen, Denmark
| | - Titus Dzongodza
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Clemence Chidziva
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
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Seedat R, Schall R. Age of diagnosis, incidence and prevalence of recurrent respiratory papillomatosis-A South African perspective. Clin Otolaryngol 2017; 43:533-537. [DOI: 10.1111/coa.13016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- R.Y. Seedat
- Department of Otorhinolaryngology; Faculty of Health Sciences; University of the Free State; Bloemfontein Free State South Africa
| | - R. Schall
- Statistical Consultation Unit; Department of Mathematical Statistics and Actuarial Science; University of the Free State; Bloemfontein Free State South Africa
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San Giorgi MRM, van den Heuvel ER, Tjon Pian Gi REA, Brunings JW, Chirila M, Friedrich G, Golusinski W, Graupp M, Horcasitas Pous RA, Ilmarinen T, Jackowska J, Koelmel JC, Ferran Vilà F, Weichbold V, Wierzbicka M, Dikkers FG. Age of onset of recurrent respiratory papillomatosis: a distribution analysis. Clin Otolaryngol 2016; 41:448-53. [PMID: 26460806 DOI: 10.1111/coa.12565] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Distribution of age of onset of recurrent respiratory papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately 5 years and 30 years. This assumption has never been scientifically confirmed, and authors tend to refer to an article that does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. The objective of this study was to determine the distribution of age of onset of RRP in a large international sample. DESIGN Cross-sectional distribution analysis. PARTICIPANTS Laryngologists from 12 European hospitals provided information on date of birth and date of onset of all their RRP patients treated between 1998 and 2012. Centers that exclusively treated either patients with juvenile onset RRP or patients with adult onset RRP, or were less accessible for one of these groups, were excluded to prevent skewness. MAIN OUTCOME MEASURES A mixture model was implemented to describe distribution of age of onset. The best fitting model was selected using the Bayesian information criterion. RESULTS Six hundred and thirty-nine patients were included in the analysis. Age of onset was described by a three component mixture distribution with lognormally distributed components. Recurrent respiratory papillomatosis starts at three median ages 7, 35 and 64 years. CONCLUSIONS Distribution of age of onset of RRP shows three peaks. In addition to the already adopted idea of age peaks at paediatric and adult age, there is an additional peak around the age of 64.
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Affiliation(s)
- M R M San Giorgi
- Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R E A Tjon Pian Gi
- Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W Brunings
- Department of Otorhinolaryngology/Head & Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Chirila
- Department of Otorhinolaryngology/Head & Neck Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - G Friedrich
- Department of Phoniatrics, Speech and Swallowing, Ear, Nose and Throat University Hospital, Medical University of Graz, Graz, Austria
| | - W Golusinski
- Department of Otorhinolaryngology, Greater Poland Cancer Centre, Poznań, Poland
| | - M Graupp
- Department of Phoniatrics, Speech and Swallowing, Ear, Nose and Throat University Hospital, Medical University of Graz, Graz, Austria
| | - R A Horcasitas Pous
- Pediatric Otolaryngology, Hospital Infantil del Estado de Chihuahua, Chihuahua, Mexico
| | - T Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - J Jackowska
- Department of Otolaryngology - Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - J C Koelmel
- Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum-Stuttgart, Stuttgart, Germany
| | - F Ferran Vilà
- Consulta d'ORL, foniatria i logopèdia, Hosp. Gral de Catalunya (Sant Cugat del Vallès), Barcelona, Spain
| | - V Weichbold
- Department for Hearing Speech and Voice Disorders, Medical University Innsbruck, Innsbruck, Austria
| | - M Wierzbicka
- Department of Otolaryngology - Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - F G Dikkers
- Department of Otorhinolaryngology/Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands.
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