Recurrent respiratory papillomatosis (RRP) is a chronic, frequently debilitating, and potentially life-threatening disease. Therapy for RRP has evolved from simply inserting a tracheotomy to provide an airway and plucking out papillomata with cup forceps to provide some degree of voice to the present-day far more sophisticated approaches, along with preventative measures that may someday offer the potential dramatically to decrease disease prevalence. Family dynamics and support and intentional structuring of office protocols to accommodate the unique nature of RRP are as essential as any operative intervention for saving and prolonging life. This article reviews recent developments in the management of RRP and highlights palliative approaches to case management for those patients who are not easily cured with initial endoscopic interventions.