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Sinonasal papillomas are characterized by their potential for frequent recurrences and malignant progression. Currently, the role of human papillomavirus (HPV) infection in sinonasal papillomas is unclear. A study was conducted to elucidate the impact of HPV infection on recurrence and malignant progression of sinonasal papillomas. One hundred and seven patients with 151 tumors could be examined. One hundred and one patients suffered from benign papilloma, mostly inverted papillomas (IP); six patients suffered from carcinomas in situ and squamous cell carcinomas (SCC) ex‐IP. Recurrent IP were more often HPV‐positive than non‐recurrent tumors (38.8% vs. 60%–65%). Low‐risk (LR) HPV infection (especially HPV 6) increased the risk of tumor recurrences ( p = 0.0385 and p = 0.0556, respectively). IP and oncocytic papillomas (both lesions are known for their malignant potential) were more often high‐risk (HR) HPV‐positive (15.5% and 16.7%) than fungiform papilloma (which usually does not progress to carcinoma). CIS and SCC ex‐IP displayed higher HPV rates than benign IP (83.3% vs. 38.8%), especially higher rates of HR‐HPV (66.7% vs. 23.8%, p = 0.0415). Data from this study endorse the hypothesis that recurrence of sinonasal papillomas is promoted by LR‐HPV infection and that malignant progression of IP is promoted by HR‐HPV infection.

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