Respiratory Papillomatosis Research Articles

Laryngeal papillomatosis Rare but disabling pathology

Recurrent respiratory papillomatosis is a common benign epithelial tumor of the respiratory tract, caused by the human papillomavirus HPV 1.

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Clinico-pathological Factors in Malignant Transformation of RRP.

Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.

Laryngeal papillomatosis in an adult patient: managed with micolaryngeal surgery and CO2 laser

The most prevalent benign laryngeal tumour, squamous papilloma, typically affects the vocal folds and/or epiglottis. It is often associated with human papillomavirus (HPV) infection and can present as a single or multiple lesions. We describe a case of a 24-year-old male who presented with hoarseness and dysphonia for six to eight months. Laryngoscopy revealed exophytic, papillary lesion on the right true vocal fold with creating contact lesion on opposite side. The lesion was excised using carbon dioxide (CO2) laser and histopathology confirmed the diagnosis of squamous papilloma. The patient had no recurrence or complications at six months follow-up. This case illustrates the clinical features, diagnosis, and management of squamous papilloma of the true vocal fold in an adult patient.

Public health impact and cost-effectiveness of switching from bivalent to nonavalent vaccine for human papillomavirus in Norway: incorporating the full health impact of all HPV-related diseases

AimThe objective of this study was to estimate and compare the cost-effectiveness of switching from a bivalent to a nonavalent human papillomavirus (HPV) vaccination program in Norway, incorporating all nonavalent vaccine-preventable HPV-related diseases and in the context of the latest cervical cancer screening program.MethodsA well-established dynamic transmission model of the natural history of HPV infection and disease was adapted to the Norwegian population. We determined the number of cases of HPV-related diseases and subsequent number of deaths, and the economic burden of HPV-related disease under the current standard of care conditions of bivalent and nonavalent vaccinations of girls and boys aged 12 years.ResultsCompared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of recurrent respiratory papillomatosis (RRP) over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. Total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3–9.4 billion NOK [€915–925 million] for bivalent vaccination). A switch to nonavalent vaccination had a higher vaccination cost (4.4 billion NOK [€433 million] vs. 2.7 billion NOK [€266 million] for bivalent vaccination) but resulted in a savings of 627–694 million NOK [€62–68 million] in treatment costs. A switch to nonavalent vaccination demonstrated an incremental cost-effectiveness ratio of 102,500 NOK (€10,086) per QALY versus bivalent vaccination.ConclusionsUsing a model that incorporated the full range of HPV-related diseases, and the latest cervical cancer screening practices, we found that switching from bivalent to nonavalent vaccination would be considered cost-effective in Norway.

Environmental Sustainability: Waste Audit Comparison Operating Roomand In-Office Laryngeal Surgery.

With vast improvements in imaging and endoscopic technology, there has been a massive shift towards in office procedures for various laryngeal disorders with significant health system and patient benefits. Another benefit which has yet to be investigated is the potential environmental effects and waste reduction of in-office laryngeal procedures over traditional operating room surgery. The purpose of this study is to perform a waste audit and compare the results between operating room and in-office laser laryngeal surgery. Ten cases of in-office and operating room laser laryngeal surgery, performed for recurrent respiratory papillomatosis, were subjected to a waste audit with four waste streams identified. Recyclable, general waste, anesthesia source and sharps. All waste was included from the time of case preparation to termination. The cases were extremely homogeneous in the waste produced. The mean waste total produced for the operating room laser surgery was 2972 g of which 18% was recoverable/recyclable. Contamination rate was very low. Recycling was performed very well by nursing/prep staff; however, anesthesia was not recovering 13% of potential materials. The in-office waste produced was approximately one tenth of the operating room waste with almost all delegated into general waste. Potentially divertible/recyclable materials accounted for 38% of the waste in-office procedures. In-office laryngeal procedures produce 13% of waste compared to surgery performed for similar pathology. These procedures are cost effective, safe and have been demonstrated to enhance environmental sustainability. NA Laryngoscope, 134:803-806, 2024.

Anaesthetic Challenges in Recurrent Respiratory Papillomatosis with Unyielding Lesion

Abstract Recurrent respiratory papillomatosis (RRP) is one of the most common laryngeal lesions in children. A 14-year-old female presented with complaints of a change in voice and noisy breathing. She underwent excision of laryngeal papillomatosis thrice before. Fibreoptic laryngoscopy revealed that the lesion was occluding the entire glottic chink except for a small opening through which she was breathing. As there was a risk of seeding of the distal airway following tracheostomy, the initial plan of tracheostomy was deferred. Anaesthesia was induced with sevoflurane. C-MAC™ laryngoscopy revealed that the entire glottic chink was occupied with the papillomatous lesion, and no opening was visualised. The lesion could not be negotiated with a 4 mm endotracheal tube and started bleeding. Immediately, surgeon was asked to perform a tracheostomy. With each recurring incidence of RRP, the probability of the papilloma’s non-yielding nature may increase, making the negotiation of the lesion impossible.

Laryngeal Papillomatosis: A Non-traditional Flexible Endoscopic Approach

To evaluate the efficacy of flexible endoscopic laryngeal surgery (FELS) using unconventional tools in the treatment of laryngeal papillomatosis (LP). We applied FELS using forceps, diathermy snare, and Nd:YAG laser for 47 patients with LP. In 38 cases (81%), surgeries were performed under topical anesthesia with spontaneous respiration and in seven cases we used general anesthesia with superimposed high-frequency jet ventilation. In two cases, both types of anesthesia were used in different sessions. In 22 cases (46.8%), the interventions were performed as outpatient procedures. The Nd:YAG laser was used in the majority (89.4%) of cases. The expected result (complete eradication of the visible lesion) was obtained in all treated patients without procedure complications. Disease recurrence was established in 16 cases (34%) that led to repeated surgeries. FELS, using Nd:YAG laser as a main tool, is a safe and effective approach that can be a feasible alternative to the conventional approach in the treatment of LP due to possibility to avoid repeated general anesthesia with its associated risks; applicability for the patients, who have contraindications for general anesthesia and transoral microsurgery; possibility to perform the intervention in an outpatient setting that leads to essential reduction of medical costs; economy of time. Nd:YAG laser ablation, preceded by diathermy snare resection, allows reducing the time of the intervention and thermal injury of the adjacent tissues, compared to using laser alone, and can be used in bulky and obstructive lesions that present a limitation for nonablative techniques.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022.

For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.

Malignancy Associated with Low-Risk HPV6 and HPV11: A Systematic Review and Implications for Cancer Prevention.

High-risk human papillomavirus (HPV) is etiologically related to cervical cancer, other anogenital cancers and oropharyngeal carcinomas. Low-risk HPV, especially HPV6 and HPV11, cause genital warts and laryngeal papillomas. However, the accumulating data suggests that HPV6 and HPV11 may cause malignant lesions at non-cervical anatomic sites. This review aims to estimate the proportions of single and dual HPV6/11 infections in multiple cancers reported in the last 10 years in the Cochrane, Embasa and PubMed databases. Secondly, the genomes of HPV6/11 were compared with the most common high-risk genotype, HPV16, to determine the similarities and differences. A total of 11 articles were selected, including between one and 334 HPV+ cancer patients. The frequencies of single or dual HPV6/11 infections ranged between 0-5.5% for penile and 0-87.5% for laryngeal cancers and were null for vulvar, vaginal and oral cancers. The genomic similarities between HPV6/11 and HPV16 mainly involved the E7 gene, indicating a limited ability to block cell differentiation. The presence of single or dual HPV6/11 infections in variable proportions of penile and laryngeal cancers support the vaccination strategies that cover these genotypes, not only for preventing genital warts but also for cancer prevention. Other risk factors and co-carcinogens are likely to participate in epithelial carcinogenesis associated with low-risk HPV.

Intralesional Cidofovir: A Systematic Review of Administration Protocols and Long-term Recurrence Rates in Adult and Juvenile Recurrent Respiratory Papillomatosis

This is a systematic review aimed to explore Cidofovir administration protocols, recurrence rates, and long-term effectiveness for severe cases of recurrent respiratory papillomatosis (RRP). The primary goal was to identify current practices, determine the preferred protocol, and assess the adjuvant therapy's ability to prevent long-term papilloma recurrence in juvenile and adult-onset disease. The following databases were searched: Pubmed, Google Scholar (pages 1-10), EMBASE, Scopus, ISI (clarivate), Cochrane Library, and Journal Storage from 1996 to June 2022. Articles that reported the use of intralesional Cidofovir in RRP and reported remission/recurrence rates with follow-up were included in the review. The systematic review was registered through PROSPERO and contains the detailed protocol for the conduction of the review. A total of 389 records were identified, 126 titles and abstracts screened, 45 studies fully read, and 30 studies met the inclusion criteria. Two hundred and fourteen adult-onset RRP (AORRP) and 126 juvenile-onset RRP (JORRP) cases were treated with Cidofovir across the included studies. There was no universal protocol for administering Cidofovir, with variations in concentration, treatment period, number and interval of injections, and follow-up duration. Most lesions showed human papilloma virus types 6 and 11. Recurrence rates varied, and other outcomes reported included remission rates, lesion reduction, surgical intervals, and side effects. Some studies demonstrated significant improvements in disease severity and extended intervals between recurrences after Cidofovir administration. The analysis of 30 studies reveals the need for greater consistency in reporting treatment parameters and outcomes. The use of recurrence-free period as an outcome measure and the potential benefits of a concentration of 7.5mg/mL are identified. Additionally, the importance of viral typing within papilloma lesions is emphasized. To further enhance understanding and establish optimal protocols, future research should focus on uniform reporting, including severity, dosage, interval, treatment duration, functional outcome, and related procedures. PROSPERO CRD42022299549.

Public health impact of 2-, 4-, and 9-valent HPV vaccination in females on cervical and noncervical diseases in men and women under different coverage scenarios in China: A simulation study

ABSTRACT The high prevalence of human papillomavirus (HPV) infection in China suggests there would be a substantial positive health impact of widespread vaccination against HPV. We adapted a previously described dynamic transmission model of the natural history of HPV infection and related diseases to the Chinese setting to estimate the public health impact in China of 2-valent (with and without cross-protection), 4-valent, and 9-valent HPV vaccination strategies. The model predicted the incidence and mortality associated with HPV-related diseases, including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP), based on the various vaccination coverage rate (VCR) scenarios, over a 100-year time horizon. The public health impact of the 4 vaccination strategies was estimated in terms of cases and deaths averted compared to a scenario with no vaccination. Under the assumption of various primary and catch-up VCR scenarios, all 4 vaccination strategies reduced the incidence of cervical cancer in females and noncervical cancers in both sexes, and the 4-valent and 9-valent vaccines reduced the incidence of genital warts and RRP in both sexes. The 9-valent vaccination strategy was superior on all outcomes. The number of cervical cancer cases averted over 100 years ranged from ~ 1 million to ~ 5 million while the number of cervical cancer deaths averted was ~ 345,000 to ~ 1.9 million cases, depending on the VCR scenario. The VCR for primary vaccination was the major driver of cases averted.

Thuja as an adjuvant medical management of juvenile recurrent laryngeal papillomatosis: our experience

A subgroup of recurrent respiratory papillomatosis, which is a larger clinical entity, is laryngeal papillomatosis. The vocal folds produce recurrent papillomata, which is a hallmark of the condition. The two most prevalent strains of human papillomavirus have been linked to the development of laryngeal papillomas, types 6 and 11. Distinctive presence of warty lesion on endoscopy is basis for clinical diagnosis. Surgery is the foremost treatment possibility, combined with adjuvant therapy such antiviral medications and immunomodulators. Thuja occidentalis, a tree whose leaves and leaf oil have anti-oxidant,antiviral,anti tumoral,anti inflammatory, antibacterial and antifungal properties. It has been extensively utilized to treat warts and condylomatous skin lesions. In this article, we go through the results of using Thuja as an adjuvant therapy for laryngeal papillomatosis in a 16-year-old female.

A Case of Inverted Papilloma in the False Vocal Fold Coexisting With Fungiform Papillomas of the True Vocal Fold

Inverted papilloma is a pathologic subtype of papilloma that mainly occurs in the sinonasal tract. Laryngeal inverted papilloma is extremely rare, and only a few cases have been reported so far. A 78-year-old male visited our clinic complaining of voice change that lasted five months. The rigid laryngoscopy showed multiple exophytic papillomatous masses in both vocal folds, and the left false vocal fold showed slight protruding appearance without a definite mass shadow. We performed laryngeal microsurgery with CO&lt;sub&gt;2&lt;/sub&gt; laser. While the masses in both true vocal folds were pathologically diagnosed as fungiform papillomas, the left false vocal fold was diagnosed as an inverted type. We report this very rare and unique case of laryngeal papilloma with a relevant literature review.

Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement.

Pulmonary papillomatosis is a rare but severe manifestation of recurrent respiratory papillomatosis (RRP). Efficacy data of systemic bevacizumab for pulmonary RRP are limited. This study's objective was to characterize disease response of pulmonary RRP to systemic bevacizumab. A retrospective review was performed to identify patients with pulmonary RRP seen at three medical institutions. Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. Disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. Of the 12 pulmonary RRP patients treated with systemic bevacizumab, 4 (33.3%) were male, and 11 (91.7%) were juvenile-onset RRP patients. All presented with laryngeal, tracheal, and pulmonary RRP. The median (range) age at first bevacizumab infusion was 48.1 (19.5-70.2) years. Progression to pulmonary malignancy was identified in 3 (25.0%) patients, 2 before initiation of and 1 after complete cessation of bevacizumab therapy. Clinical symptoms such as dyspnea (75.0% vs. 25.0%; p = 0.01) and dysphagia and/or odynophagia (33.3 vs. 0.0%; p = 0.03) were significantly decreased following bevacizumab therapy. Compared with pre-treatment baseline, 9 (75.0%) patients experienced a stable-to-partial response in the lungs to systemic bevacizumab, and 10 (83.3%) experienced partial-to-complete responses in the larynx and trachea. Systemic bevacizumab is effective in stabilizing progression in even the most severe cases of RRP, with both a dramatic reduction in laryngeal and tracheal disease as well as a stable-to-partial response of pulmonary involvement in a majority of patients. 4 Laryngoscope, 134:577-581, 2024.

Recent Developments in Human Papillomavirus (HPV) Vaccinology.

Human papillomavirus (HPV) is causally associated with 5% of cancers, including cancers of the cervix, penis, vulva, vagina, anus and oropharynx. The most carcinogenic HPV is HPV-16, which dominates the types causing cancer. There is also sufficient evidence that HPV types 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 cause cervical cancer. The L1 protein, which, when assembled into virus-like particles, induces HPV-type-specific neutralising antibodies, forms the basis of all commercial HPV vaccines. There are six licensed prophylactic HPV vaccines: three bivalent, two quadrivalent and one nonavalent vaccine. The bivalent vaccines protect from HPV types 16 and 18, which are associated with more than 70% of cervical cancers. Prophylactic vaccination targets children before sexual debut, but there are now catch-up campaigns, which have also been shown to be beneficial in reducing HPV infection and disease. HPV vaccination of adults after treatment for cervical lesions or recurrent respiratory papillomatosis has impacted recurrence. Gender-neutral vaccination will improve herd immunity and prevent infection in men and women. HPV vaccines are immunogenic in people living with HIV, but more research is needed on the long-term impact of vaccination and to determine whether further boosters are required.

A case of malignant transformation of recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a rare, difficult to treat benign tumor disease of the respira­tory tract with a progressive course caused by human papillomavirus and most often occurs in the larynx in the form of papillomas. They may be present at any age, but most often between the ages of 1 and 4. They can recur after treatment, undergo malignant transformation, and spread to the vocal cords, trachea, or lungs.&#x0D; Objective — to present our own observation of the malignant transformation of RRP in a young man of 23 years old, who was diagnosed and treated at the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine».&#x0D; Materials and methods. Prior to this non-systematic review, information was searched in MEDLINE/PubMed for systematic reviews, meta-analyses, and randomized controlled trials published in the past 5 years using such terms as human papillomavirus, recurrent respiratory papillomatosis, and malignant transfor­mation.&#x0D; Results and discussion. Patient H. 23 years old. From the anamnesis, it is known that the diagnosis of RRP was made at the age of 4, since then he regularly noticed the appearance of dry wheezing, shortness of breath, hoarseness, and sometimes its disappearance. Since childhood, the patient has been under the supervision of a pediatric otolaryngologist. The papillomas were localized on the vocal cords. It is known that more than 100 procedures were performed to remove papillomas using electrocoagulation under general anesthesia. For morphological verification of the diagnosis, it was decided to perform a video-assisted thoracoscopic surgery of the right lung.Pathological examination findings: «Respiratory papillomatosis with a tendency to malignant transforma­tion». The biopsy material was sent for the immunohistochemical examination. Findings: «G2 Non-keratinizing squamous cell lung carcinoma. There are signs of lymphovascular, perineural invasion, there are signs of pleural invasion, the immunohistochemical study shows that tumor cells are positive for p40, which allows to confirm the diagnosis». After that, the patient was consulted by an oncologist and an immunologist. A 2-component chemotherapy with Carboplatin and Paclitaxel was prescribed.&#x0D; Conclusions. RRP is a rare disease that can become malignant in case of untimely diagnosis and inadequate screening. Great attention should be paid to complementing of the surgical treatment with vaccination and immunotherapy.

Role Of CO2 Laser & Microdebrider In The Treatment Of Juvenile Onset Recurrent Respiratory Papillomatosi.

To compare the efficacy of two main treatment modalities of microdebrider and carbon dioxide laser excision for juvenile onset recurrent respiratory papillomatosis. The retrospective study was conducted in May 2021 at the Combined Military Hospital, Kharian, Pakistan, and comprised data from July 1, 2007, to January 31, 2020, of patients of either gender aged 2-12 years who were treated for juvenile onset recurrent respiratory papillomatosis either with microdebrider excision in group A or carbon dioxide laser excision in group B. Extent and severity of disease was documented as per the Derkay-Coltrera grading system. Data was analysed using SPSS 20. Of the 39 patients, 23(59%) were girls and 16(41%) were boys. The overall mean age at the time of procedure was 6.62±2.06 years. Group A had 22(56.4%) subjects; 15(68.2%) girls and 7(31.8%) boys, while group B had 17(43.6%) cases; 8(47%) girls and 9(53%) boys. The mean operative time for group A was 40.91±11.50 minutes and for group B it was 60.59±19.51 minutes. Postoperative breathing and oedema status was better for group A (p<0.05), while there was no significant difference regarding postoperative pain, residual disease and repeat surgeries (p>0.05). Microdebrider was found to be superior to carbon dioxide laser excision in the treatment of juvenile onset recurrent respiratory papillomatosis.

Human papillomavirus prevalence and type distribution in Chinese juvenile-onset recurrent respiratory papillomatosis patients

Objective: To evaluate HPV prevalence and type distribution in Chinese juvenile-onset recurrent respiratory papillomatosis (JoRRP) patients. Methods: We searched China National Knowledge Infrastructure, Wanfang data, China Biology Medicine disc, PubMed, Embase, and the Cochrane Library for studies assessing HPV infection of Chinese JoRRP patients up to 1 October, 2022. Two authors independently performed literature selection, data extraction, and quality assessment. HPV prevalence and HPV type-specific prevalence were pooled using a random effects model after Freeman-Tukey double arcsine transformation. All analyses were performed with R 4.1.3 software. Results: Nineteen publications investigating HPV infection of JoRRP patients were included in the final analyses. Of these, 16 studies reported HPV prevalence with a sample size of 1 528 patients, and 11 studies reported HPV6 prevalence and HPV11 prevalence with a sample size of 611 patients. All studies were graded as medium quality. In Chinese JoRRP patients, the synthesized HPV prevalence was 92.0% (95%CI:86.0%-96.6%, I2=87%), HPV6 prevalence was 42.4% (95%CI:34.9%-50.1%, I2=61%), and HPV11 prevalence was 72.3% (95%CI:59.0%-83.9%, I2=87%). All the pooled prevalence persisted in subgroup analyses stratified by publication year, sample size, and specimen type (P>0.05). There was no evidence of publication bias. In Chinese JoRRP patients, HPV16, 18, 31, 33, 52, and 58 prevalence was very low. Conclusions: Our findings suggested high HPV prevalence in Chinese JoRRP patients, and the most common HPV types were HPV6 and HPV11.

Recurrent Respiratory Papillomatosis –An Updated Review in 2023–

Recurrent Respiratory Papillomatosis –An Updated Review in 2023–