Silent Choke!

That night, the emergency room turned chaotic.

A 4-year-old boy arrived in critical condition—his face turning blue, his chest heaving rapidly, eyes wide open in panic, desperately searching for air. His voice was gone, replaced only by a harsh, heartbreaking breath. The nurses quickly administered oxygen. The doctors gathered, ready to perform intubation.

“Quick! He’s about to collapse!”

The tube was inserted through his mouth, the scope glided into the airway—and suddenly, everyone froze.

“I can’t see the vocal cords at all… it’s all covered with growths!” said the doctor holding the laryngoscope, sweat dripping from his brow.

This was not an ordinary inflammation—the child’s airway was completely obstructed by wart-like masses at the level of the vocal cords.

Intubation was impossible!

The boy was weakening. His pulse was dropping. Time stood still.

There was no time for general anaesthesia. In a split-second, the team made a drastic decision—emergency tracheostomy under local anaesthesia. The child, still semi-conscious and silently crying, was swiftly prepped.

With steady hands, the doctor made a small incision in his neck. As the tracheostomy tube was inserted into the windpipe, the air began to flow. Slowly, the child’s breathing returned.

His life was saved—for now.

But the question remained: What was this disease that almost stole his breath—and his life?

What is Recurrent Respiratory Papillomatosis?

Recurrent Respiratory Papillomatosis (RRP) is a condition caused by infection with the human papillomavirus (HPV)—mainly types 6 and 11. It leads to the growth of wart-like tumors along the respiratory tract, most commonly on the vocal cords.

In children, it is known as Juvenile-Onset RRP, often presenting before the age of 5.

Although the growths are non-cancerous (benign), they are dangerous because they can obstruct the airway, as happened to the child in the story.

How Do Children Get It?

JORRP is usually transmitted from mother to child during childbirth, especially if the mother has active genital HPV. Not all exposed babies develop the disease, but some will show symptoms months or years later.

Warning Signs and Symptoms

Persistent hoarseness (the most common early sign)
Stridor (a harsh, high-pitched breathing sound)
Difficulty breathing, especially during activity or crying
Frequent respiratory infections or coughing
Noticeable changes in the child’s voice

Treatment and Outlook

Unfortunately, there is no complete cure for RRP yet. Treatment focuses on:

Surgical removal of the growths, usually through microlaryngoscopy with a laser or microdebrider
Tracheostomy, in severe cases
Adjuvant therapies, such as cidofovir injections or anti-VEGF agents like bevacizumab, to slow regrowth

Children often need repeated surgeries, sometimes every few weeks or months, depending on the aggressiveness of the disease.

Prevention: A Real Hope

The HPV vaccine has been proven to reduce the risk of HPV types 6 and 11 infections. Countries with comprehensive vaccination programs have seen a decline in new cases of juvenile RRP. Prevention is our strongest weapon.

A Message for Parents

If your child has persistent hoarseness, strange breathing sounds, or seems to struggle for breath, don’t wait. See an ENT specialist early. Timely intervention could save a life.

Final Words

This disease may be rare, but its impact can be devastating if left undiagnosed. Let’s raise awareness, promote vaccination, and act early. Every breath our child takes is precious.

To make an appointment to see me, kindly click here for Sunway Velocity Medical Centre or here for Columbia Setapak Hospital! Or, if you prefer the old-school way, give a ring at 03-41313771 to book your appointment at Klinik ANDA Wangsa Melawati