What are the management options for epistaxis (nosebleed) associated with hereditary hemorrhagic telangiectasia (HHT)?

Updated: May 08, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Management of hereditary hemorrhagic telangiectasia (HHT) is palliative because the underlying defect is not curable. Options include coagulation with potassium-titanyl-phosphate (KTP) or neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers, septodermoplasty, embolization, and estrogen therapy. [29]

A study by Wirsching et al indicated that in patients with HHT, supplementing Nd:YAG laser therapy with temporary nasal occlusion with hypoallergenic tape can reduce the Epistaxis Severity Score by a significant amount over laser therapy alone. [30]

Research by Contis et al suggested that the beta blocker propranolol is effective against epistaxis in patients with HHT. In a retrospective study, the investigators found that the Epistaxis Severity Score significantly improved in nine out of 10 patients with HHT who received the drug, while in a second, prospective study, of 11 patients, they found that the median duration of epistaxis per month, as well as the monthly number of epistaxis episodes, significantly decreased after 3 months of propranolol therapy. [31]


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