Longitudinal Voice Handicap in Adult Recurrent Respiratory Papillomatosis Under Stepwise Treatment

To characterize longitudinal trajectories of patient-reported voice handicap during stepwise treatment for recurrent respiratory papillomatosis (RRP) and determine if total voice handicap index (VHI) or its domains best represent subjective outcomes compared to endoscopically documented disease regression.

A longitudinal analysis of 15 adults with severe RRP managed by sequential surgical debulking and adjuvant bevacizumab. We assessed VHI-30 (total and functional, physical, and emotional domains) and objective endoscopic papilloma burden (Derkay scale) across 3 to 6 visits per patient. Individual trajectories were summarized using Theil-Sen estimators.

Mean total VHI decreased significantly from 81.2 at baseline to 54.8. Total VHI showed the most statistically robust improvement (median slope -1.65; 78.6% of patients with negative slopes; P = 0.03). Functional and physical subscales exhibited comparable but non-significant monotonic declines (median slopes -0.80 and -0.77, respectively). Conversely, the emotional domain showed minimal change (median slope -0.25; P = 0.61), reflecting delayed psychosocial recovery despite pronounced anatomical regression (Derkay slopes < -1.00; P < 0.001).

Stepwise endoscopic treatment yields pronounced anatomical disease control, while patient-reported voice handicap improves more gradually. Total VHI is the most sensitive global subjective outcome measure. However, domain-level analysis reveals that emotional and physical recovery often lags behind structural and functional gains. Serial VHI alongside clinical grading provides a necessary dual endpoint in RRP management.