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Evidence-based management of epistaxis in hereditary haemorrhagic telangiectasia

Published online by Cambridge University Press:  04 March 2015

I Syed  and
V S Sunkaraneni
I Syed*
Affiliation:
St George's Hospital, Blackshaw Road, London, UK
V S Sunkaraneni
Affiliation:
Royal Surrey County Hospital, Guildford, UK
*
Address for correspondence: Mr I Syed, St George's Hospital, Blackshaw Road, London SW17 0QT, UK E-mail: irfan.syed@doctors.org.uk
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Abstract

Background:

There are currently no guidelines in the UK for the specific management of hereditary haemorrhagic telangiectasia related epistaxis. The authors aimed to review the literature and provide an algorithm for the management of hereditary haemorrhagic telangiectasia related epistaxis.

Method:

The Medline and Embase databases were interrogated on 15 November 2013 using the search items ‘hereditary haemorrhagic telangiectasia’ (title), ‘epistaxis’ (title) and ‘treatment’ (title and abstract), and limiting the search to articles published in English.

Results:

A total of 46 publications were identified, comprising 1 systematic review, 2 randomised, controlled trials, 27 case series, 9 case reports, 4 questionnaire studies and 3 in vitro studies.

Conclusion:

There is a lack of high-level evidence for the use of many of the available treatments for the specific management of epistaxis in hereditary haemorrhagic telangiectasia. Current management should be based on a multidisciplinary team approach involving both a hereditary haemorrhagic telangiectasia physician and an ENT surgeon, especially when systemic therapy is being considered. The suggested treatment algorithm considers that the severity of epistaxis merits intervention at different levels of the treatment ladder. The patient should be assessed using a reproducible validated assessment tool, for example an epistaxis severity score, to guide treatment. More research is required, particularly in the investigation of topical agents targeting the development and fragility of telangiectasiae in hereditary haemorrhagic telangiectasia.

Keywords

EpistaxisTelangiectasiaHereditary Haemorrhagic
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 5 , May 2015 , pp. 410 - 415
Copyright
Copyright © JLO (1984) Limited 2015 

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