The minimal important difference of the epistaxis severity score in hereditary hemorrhagic telangiectasia

Yin, Linda X.; Reh, Douglas D.; Hoag, Jeffrey B.; Mitchell, Sally E.; Mathai, Stephen C.; Robinson, Gina; Merlo, Christian A.

doi:10.1002/lary.25669

Cited by 36 publications

(66 citation statements)

References 25 publications

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“…1 in the online version of this article). Nosebleeds often occur daily, and can be associated with acute hemodynamic disturbances 1,3,4,6,7 and reduced quality of life. [8][9][10][11][12] Treatments include surgically based therapies such as cauterization, laser photocoagulation, 13 septal dermoplasty, 14 and Young's procedure, 15 and medical therapies such as antioestrogens, 16 tranexamic acid, 17,18…”

Section: Introductionmentioning

confidence: 99%

Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia?

et al. 2016

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Objectives/HypothesisTo examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT).Study DesignSurvey evaluation of HHT patients, and a randomized control trial in healthy volunteers.MethodsNosebleed severity in response to iron treatments and standard investigations were evaluated by unbiased surveys in patients with HHT. Serial blood samples from a randomized controlled trial of 18 healthy volunteers were used to examine responses to a single iron tablet (ferrous sulfate, 200 mg).ResultsIron tablet users were more likely to have daily nosebleeds than non–iron‐users as adults, but there was no difference in the proportions reporting childhood or trauma‐induced nosebleeds. Although iron and blood transfusions were commonly reported to improve nosebleeds, 35 of 732 (4.8%) iron tablet users, in addition to 17 of 261 (6.5%) iron infusion users, reported that their nosebleeds were exacerbated by the respective treatments. These rates were significantly higher than those reported for control investigations. Serum iron rose sharply in four of the volunteers ingesting ferrous sulfate (by 19.3–33.1 μmol/L in 2 hours), but not in 12 dietary controls (2‐hour iron increment ranged from −2.2 to +5.0 μmol/L). High iron absorbers demonstrated greater increments in serum ferritin at 48 hours, but transient rises in circulating endothelial cells, an accepted marker of endothelial damage.ConclusionsIron supplementation is essential to treat or prevent iron deficiency, particularly in patients with pathological hemorrhagic iron losses. However, in a small subgroup of individuals, rapid changes in serum iron may provoke endothelial changes and hemorrhage.Level of Evidence4. Laryngoscope, 126:2468–2474, 2016

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Section: Introductionmentioning

confidence: 99%

Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia?

et al. 2016

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“…Overall, HHT patients with more nosebleeds tended to use iron supplements: the median ESS in the 38 non-iron users combined was 3. The difference in nosebleeds between the iron and non-iron using HHT cohorts substantially exceeded the minimal important difference for the epistaxis severity score (17), and corresponded to the difference between one nosebleed per week, typically lasting 1 to 5 minutes, and an average of one a day, typically lasting 6-15 minutes (16). For a male, the haemorrhageadjusted iron requirement (HAIR) (3 ) would increase from 9.1 to 35 mg/day, compared to the UK recommended nutrient intake (RNI) of 8.7 mg of iron per day (21).…”

Section: Resultsmentioning

confidence: 99%

“…All recruited participants recorded nosebleed severity by the validated Epistaxis Severity Score (ESS) (16). This rates nosebleed severity on a scale of 0-10, with the minimal important difference recently identified as 0.71 (17). Dietary supplement intake was assessed in an unbiased manner on the final page of the validated European Prospective Investigation into Cancer and Nutrition (EPIC) Food Frequency Questionnaire (18).…”

Section: Survey Methodologymentioning

confidence: 99%

Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia ‒ an observational study

Chamali

Finnamore

Manning

et al. 2016

IRDR

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“…According to Yin et al, a difference of ≥0.71 in ESS before and after treatment is the smallest value for which there is a clinical improvement in terms of quality of life (minimal important difference—MID). MID was measured for each patient.…”

Section: Methodsmentioning

confidence: 99%

Retrospective analysis of submucosal radiofrequency procedure for the treatment of nasal bleeding in 44 patients with hereditary haemorrhagic telangiectasia

Hochet

Achard

Maillard

et al. 2019

Clinical Otolaryngology

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The minimal important difference of the epistaxis severity score in hereditary hemorrhagic telangiectasia

Abstract: 4. Laryngoscope, 126:1029-1032, 2016.

Cited by 36 publications

References 25 publications

Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia?

Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia?

Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia ‒ an observational study

Retrospective analysis of submucosal radiofrequency procedure for the treatment of nasal bleeding in 44 patients with hereditary haemorrhagic telangiectasia

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