In-Office Management of Eustachian Tube Dysfunction Secondary to Recurrent Respiratory Papillomatosis of the Nasopharynx: A Novel Approach to a Rare Condition

Recurrent respiratory papillomatosis (RRP) is characterized by benign papillomatous lesions of the respiratory tract, most commonly involving the larynx. Cases of RRP originating solely from the nasopharynx are rarely reported in the literature. To our knowledge, this is the first reported case of nasopharyngeal RRP causing secondary Eustachian tube dysfunction (ETD) managed by office-based laser excision. We describe a 68-year-old male with a history of nasopharyngeal RRP. The papilloma's location resulted in diminished hearing, tinnitus, and an intermittent ear-popping sensation, findings consistent with ETD. Flexible laryngoscopy revealed a papillomatous lesion on the right torus tubarius completely obstructing the Eustachian tube. Office-based flexible laryngoscopy with laser excision was performed without the need for sedation or operating room resources. Following excision, the patient experienced resolution of symptoms. This case demonstrates the feasibility of office-based laser excision for select cases of nasopharyngeal RRP involving the torus tubarius. Compared with operative management, this approach may offer potential advantages, including reduced healthcare costs, avoidance of general anesthesia, and the ability to perform real-time functional assessment. Further study is needed to evaluate the role of office-based techniques in the management of extralaryngeal RRP.