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LETTER TO EDITOR
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 36-37

Recurrent respiratory papillomatosis: The need for an Indian national registry


Associate Professor, Department of Otolaryngology, Chhatrapati Shahuji Maharaj Medical University, (King George Medical College), Lucknow, India

Date of Web Publication7-Feb-2011

Correspondence Address:
Anupam Mishra
Associate Professor, Department of Otolaryngology, Chhatrapati Shahuji Maharaj Medical University, (King George Medical College), Lucknow - 226003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.76137

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How to cite this article:
Mishra A, Singh D B, Verma V. Recurrent respiratory papillomatosis: The need for an Indian national registry. J Laryngol Voice 2011;1:36-7

How to cite this URL:
Mishra A, Singh D B, Verma V. Recurrent respiratory papillomatosis: The need for an Indian national registry. J Laryngol Voice [serial online] 2011 [cited 2022 Jan 21];1:36-7. Available from: https://www.laryngologyandvoice.org/text.asp?2011/1/1/36/76137

Dear Sir,

Recurrent respiratory papillomatosis (RRP) is a rare condition with unpredictable nature of disease behavior. Our institutional experience highlights the same and the importance of accumulating a large epidemiological data to characterize the disease in Indian context cannot be overemphasized. The existing registry needs to be strengthened by our fellow laryngologists through their enhanced participation and contribution of their experience. The salient features of the registry are discussed.


   Indian National Registry for RRP Top


Recurrent respiratory papillomatosis (RRP) is a condition characterized by small multiple warty growth in the respiratory tract, predominantly the upper and uncommonly the lower. The patient almost invariably presents to an otolaryngologist. There is no cure of RRP but (repeated) surgical excision is an accepted method of controlling the disease. The epidemiology of this disease has been reported to depend on the country and socioeconomic status of the population apart from other factors. [1] Data in the Indian subcontinent is sparse. Limited Indian data do exist on the incidence of human papillomavirus (HPV) in mothers attending antenatal clinic. This study actually reports an incidence of 28.14% positivity for HPV DNA. [2] Our experience with this disease reveals its rare occurrence and unpredictable/variable behavior. [3] This suggests the need for accumulating sufficient epidemiological data to characterize the disease as in Western countries.

A retrospective review of our index records of past four decades at the Department of Otolaryngology revealed only 55 cases of RRP. Our institute happens to be the biggest referral center in the state and despite draining a sizable patient load from adjoining states, the incidence of RRP seems to be unexpectedly low. We found its inconsistent behavior in terms of a wide variation in the duration of symptoms during the first presentation ranging from few months to several years. There is also an unpredictable recurrence seen in less than half of patients and that too, the frequency ranging from 1 to 8 times. The time to recurrence varied from few months to more than seven years while the rapidity of recurrence did not parallelize the frequency of recurrence, age or socioeconomic status. Finally, the need for tracheostomy (only 2%) did not correlate with any of the patient factors and neither with the frequency of recurrence.

The prognosis in terms of recurrences is quite unpredictable and the decreasing trends of incidence as observed by us remain unexplained with our limited epidemiological evidence. The existing adjuvant therapies may reduce the aggressive nature of the disease but are too expensive to be adapted routinely in the Indian scenario. The existing treatment options in India are guided by existing norms of the Western world and the possible racial, ethnical/biological differences in the disease behavior in our subcontinent are grossly neglected. Accordingly, it seems reasonable to accumulate sufficient data to better define the disease characteristics and improve overall prognosis. A nationwide registry of cases has proven to be of benefit in establishing the course of the disease in the United States. [4] Hence, there is a need to strengthen our existing national registry for RRP, which is likely to better facilitate our understanding of the disease in the Indian context. This would further enhance the research potential and refine health policy management guidelines.

An Indian national registry ( http://www.irrpregistry.in ) has been setup in this regard that initially aims to collect the relevant clinical data only. All otolaryngologists (of India) who are actively involved in the management of RRP either in government or private sectors are invited to help in strengthening this online registry. To use this free of cost registry, the surgeon has to initially sign up. The already registered surgeon can then login to enter the password-protected area, wherein patient details, disease details and subsequent follow-up findings can be documented. A single page disease information as per Coltrera/Derkay staging and severity scheme needs to be submitted online. [5] The time taken for filling up of a single case detail would hardly be a few minutes and hence time constraints are not likely to be bothersome for a busy laryngologist.

I hope that this registry can be adopted by all those involved in managing this disease so that it can be better characterized and thus help in making a national policy for its control.

 
   References Top

1.Larson D, Derkay C. Epidemiology of recurrent respiratory papillomatosis. APMIS 2010;118:450-4.  Back to cited text no. 1
    
2.Bandyopadhyay S, Sen S, Majumdar L, Chatterjee R. Human papillomavirus infection among Indian mothers and their infants. Asian Pac J Cancer Prev 2003;4:179-84.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Mishra A, Singh DB, Verma V. Recurrent Respiratory Pappillomatosis: National Registry. Indian J Otolaryng Head Neck Surg 2010.   Back to cited text no. 3
    
4.Reeves WC, Ruparelia SS, Swanson KI, Derkay CS, Marcus A, Unger ER. National registry for juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 2003;129:976.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Derkay CS, Malis DJ, Zalzal G, Wiatrak BJ, Kashima HK, Coltrera MD. A Staging System for Assessing Severity of Disease and Response to Therapy in Recurrent Respiratory Papillomatosis. Laryngoscope 1998;108:935-7.  Back to cited text no. 5
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This article has been cited by
1 Recurrent respiratory papillomatosis: The need for an Indian national registry
Anupam Mishra, DB Singh, Veerendra Verma
Journal of Laryngology and Voice. 2011; 1(1): 36
[Pubmed] | [DOI]



 

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