Office‐based sclerotherapy for recurrent epistaxis due to hereditary hemorrhagic telangiectasia: a pilot study

Boyer, Holly; Fernandes, Patrícia Garani; Durán, Olga; Hunter, David W.; Goding, George S.

doi:10.1002/alr.20053

Cited by 21 publications

(37 citation statements)

References 48 publications

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“…26 Epistaxis can also be managed through surgical ligation of the feeding artery as well as endovascular embolization. [34][35][36] Intranasal and intravenous bevacizumab has been shown to be effective in reducing epistaxis frequency and severity in patients with HHT and is currently a focus of studies in these patients.…”

Section: Epistaxismentioning

confidence: 99%

Cerebrovascular Manifestations of Hereditary Hemorrhagic Telangiectasia

Brinjikji

Iyer

Sorenson

et al. 2015

Stroke

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Section: Epistaxismentioning

confidence: 99%

Cerebrovascular Manifestations of Hereditary Hemorrhagic Telangiectasia

Brinjikji

Iyer

Sorenson

et al. 2015

Stroke

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“…Many patients require iron supplementation to treat anemia. Various topical and oral regimens are also used, such as hormones, antifibrinolytics, and antiangiogenic agents . Recurrent or severe epistaxis may necessitate blood transfusions and referral to an otolaryngologist.…”

mentioning

confidence: 99%

“…More aggressive surgical options include septodermoplasty and complete nasal closure (Young's procedure). Arterial embolization is used for emergent severe bleeding . Yet none of these modalities provide complete relief from bleeding and can be associated with significant side effects, such as nasal crusting, foul odor, and septal perforation.…”

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confidence: 99%

Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia

Boyer

Fernandes

et al. 2015

Int Forum Allergy Rhinol

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Background Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. Methods This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. Results After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (−0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. Conclusion This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT.

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“…Submucosal bipolar radiofrequency causes submucosal sclerosis with preservation of the overlying mucosa, and a small pilot study showed a significant reduction in HHT-related epistaxis when applied to the nasal septum (100) . Submucosal injection of various sclerosants directly into septal and lateral nasal wall lesions has also been used with some success (28,38,101) , under both local and general anaesthesia.…”

Section: Other "Local" Surgical Treatmentsmentioning

confidence: 99%

“…However, visual loss has been reported after fibrin glue injections for HHT, so care must be taken and high pressure injections avoided (101) .…”

Section: Other "Local" Surgical Treatmentsmentioning

confidence: 99%

Hereditary haemorrhagic telangiectasia

Rimmer

Lund

2015

Rhin

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Background: Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. Methodology:The genetic basis and pathophysiology of the disease are discussed. Diagnostic criteria and the clinical course of the condition are considered. The current management options, both medical and surgical, are reviewed. Conclusions:Hereditary haemorrhagic telangiectasia requires specialist treatment for the problems it causes, and is best managed in specialist centres. Epistaxis is often the major symptom, significantly affecting patients' quality of life. An understanding of the available treatment options is therefore important for the otorhinolaryngologist.

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Office‐based sclerotherapy for recurrent epistaxis due to hereditary hemorrhagic telangiectasia: a pilot study

Abstract: This is the first clinical experience demonstrating that office-based sclerotherapy with STS is a safe, tolerable, and useful alternative for the treatment of epistaxis due to HHT.

Cited by 21 publications

References 48 publications

Cerebrovascular Manifestations of Hereditary Hemorrhagic Telangiectasia

Cerebrovascular Manifestations of Hereditary Hemorrhagic Telangiectasia

Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia

Hereditary haemorrhagic telangiectasia

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