The Effect of Combination Therapy with Alpha-interferon and Acyclovir in Reducing the Recurrence Rate and Severity of Laryngeal Papillomatosis in Children after CO2 Laser Surgery

Recurrent respiratory papillomatosis (RRP) is the most common benign laryngeal tumor and the second common cause for hoarseness in children. Despite its omplete benign histology, it has a great tendency to spread through the respiratory track and frequent recurrences may occur following surgery, possibly due to the virus survival in apparently healthy adjacent tissues. According to the most recent evident experiences, the treatment of choice for RRP disease is repetitive resections with CO2 laser. The present study evaluates the efficacy of adjuvant medical therapies for eradication of this disease in affected children. This was an experimental study with sequential control (self-control). The subjects were children who referred to ENT-H&N surgery dept. of Hazrat-e- Rasoul hospital in Tehran between Mar 1998 and Mar 2001 with chief complaint of hoarseness and respiratory obstruction. Among these children patients with confirmed diagnosis of RRP were selected as study samples and the effect of acyclovir and alpha-interferon combination in reducing the severity and recurrence of RRP was evaluated. Totally 18 patients entered this study (10 (55.5%) females and 8 (44.5%) males). The mean age of the patients was 6.5 and 94% of them were the first child of young mothers (under 25 years of age). The signs of respiratory obstruction in most of the cases with a mild to moderate severity was the main cause of referral in 45% of the subjects. Laryngeal lesions were mostly superficial and limited to glottis region. Severity and spread of RRP disease was greater in children under 3, which led to tracheotomy in 3 of them. The combined administration of alpha-interferon and acyclovir, made a significant reduction in disease severity and spread in 55.6% of the patients. The findings of this study indicated that combination of acyclovir and alpha-interferon can be effective in reducing RRP recurrences and severity. Nevertheless, because of small sample size(due to rarity of RRP), Further multi-institutional studies are required to obtain a greater sample size and more valid results.