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Current Question of the Week - August 23rd, 2023

A 5-year-old child presents to your clinic with a history of hoarseness, voice changes, and occasional respiratory distress. The parents report that the child's symptoms have been progressively worsening over the past few months. On examination, you observe small, pinkish, wart-like growths on the child's vocal cords. The rest of the physical examination is unremarkable. Which of the following treatment options is the most appropriate for managing the condition in this patient?

A.  Oral Corticosteroids

B. Antibiotics

C. Antiviral medications

D. Surgical excision

E. Over-the-counter antihistamines

  • Correct Answer: D

    Explanation: The presentation and physical findings described are consistent with juvenile recurrent respiratory papillomatosis (JRRP), also known as laryngeal papillomatosis. This condition is caused by human papillomavirus (HPV) infection and is characterized by the growth of wart-like papillomas in the larynx. Surgical excision is the primary treatment option for JRRP. The goal of surgery is to remove the papillomas and alleviate symptoms. Recurrences are common, and multiple surgeries may be necessary over time. Other options like oral corticosteroids, antibiotics, antiviral medications, and antihistamines are not considered the primary treatments for this condition.

    References: Seedat RY. Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management - A Developing Country Review. Pediatric Health Med Ther. 2020 Feb 4;11:39-46. doi: 10.2147/PHMT.S200186. PMID: 32099513; PMCID: PMC7007786. [Article Link]

    Image Credit: Harshad PL, Pujari V, Channappa NM, Anandaswamy TC. Anesthesia management in a child with laryngeal papilloma causing near complete airway obstruction. Saudi J Anaesth. 2015 Jan;9(1):86-8. doi: 10.4103/1658-354X.146322. PMID: 25558205; PMCID: PMC4279356. [Article Link]