Recurrent Respiratory Papillomatosis (RRP) remains a problematic and challenging disease to manage for children, adolescents and adults. Newer, more refined and multi-modality surgical approaches assist in the successful treatment of the airway disease and enhance voice preservation. The use of adjuvant medication has taken on an increasingly important role in achieving durable remission. Innovative non surgical interventions are being aggressively studied including use of check point inhibitors and therapeutic DNA vaccines. This course will discuss the use of multi-modality surgical approaches including various lasers, including the newer "blue laser" as well as microdebrider, coblation and simple cup forceps for surgical debulking. The role of biopsy and typing will be addressed. Adjuvant injection therapies including Cidofovir and Avastin, as well as "alternative" therapies will be closely examined. Critical issues such as timing for initiation of adjuvant therapies (a philosophic departure from traditional thought) and intervals and dosing as well as voice, psychosocial and family concerns will be presented. Up to date research advances in therapeutic DNA vaccines, cell cultures and check point inhibitors will be discussed.