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

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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Media Gallery

Posterior epistaxis from the left sphenopalatine artery.
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
Nasal speculum.
Vaseline gauze packing.
Expandable (Merocel) packing (dry).
Nasal vascular anatomy

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Author

Quoc A Nguyen, MD Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Phi Beta Kappa, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa;Proforma;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

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