Papillomas are common lesions of the larynx and other sites where ciliated and squamous epithelia meet Unlike oral papillomas, recurrent respiratory papillomatosis typically becomes symptomatic, with hoarseness that occasion- ally progresses over weeks to months These papillomas are almost always due to HPV types 6 and 11 Repeated laser vaporizations or cold knife resections via operative laryngoscopy are the mainstay of treatment Severe cases can cause airway compromise in adults and may require treatment as often as every 6 weeks to maintain airway patency Extension can occur into the trachea and lungs Tracheotomy should be avoided, if possible, since it introduces an additional squamociliary junction for which papillomas appear to have an affinity Interferon treatment has been under investigation for many years but is only indicated in severe cases with pulmonary involvement Rarely, cases of malignant transformation have been reported (often in smokers), but recurrent respiratory papillomatosis should generally be thought of as a benign condition Cidofovir (a cytosine nucleotide analog in use to treat cytomegalovirus retinitis) has been used with success as intralesional therapy for recurrent respiratory papillomatosis Because cidofovir causes adenocarcinomas in laboratory animals, its potential for carcinogenesis is being monitored The quadrivalent and new 9 serotype recombinant human HPV vaccines (Gardasil and Gardasil 9) offer hope for the eventual prevention of this benign, but terribly morbid, disease