Background: Recently, there have been intense discussions whether HPV infections can promote development and recurrence of sinonasal papillomas. Although there is a high rate of HPV-positive sinonasal papillomas (roughly 30%), there are only few studies that try to discriminate between colonization and "true" infection with HPV. As a first step to address this question, a monocentric case control study was set up.

Methods: The rates of HPV DNA detection in patients with sinonasal papillomas and matched controls were investigated. Smoking status was recorded as a possible confounder/promoter.

Results: Up to date, 43 patients with sinonasal papillomas (with 43 matched controls) were enrolled. Patients with sinonasal papillomas were positive for HPV DNA more than twice as often as the controls (23.3 vs. 11.6%). Male gender is a known risk factor for development of sinonasal papillomas. In this study, male participants were more often HPV-positive than female ones: ratio 9:1 in HPV-positive papillomas and 4:1 in HPV-positive controls (ratio in HPV-negative patients = 2.2-2.8:1). Patients with HPV-positive papillomas were younger than patients with HPV-negative papillomas (49.9 vs. 56.2y, n.s.). This difference was not seen in control patients. The rate of smokers was significantly higher in patients with HPV-positive papillomas than in HPV-negative papilloma patients and non-significantly higher than in controls (RR 3.9 bis 6.25), indicating reciprocal reinforcement of HPV and smoking.

Discussion: Initial data from this study suggests that the high rate of HPV-positive sinonasal papillomas is rather due to infection than due to colonization. In the future, this will be further investigated by searching for E5, E6, and E7 mRNA as markers of integration / "true" infection.

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