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Is there still a role for nasal closure in hereditary haemorrhagic telangiectasia?

Published online by Cambridge University Press:  21 October 2024

Robert Bickerton Open the ORCID record for Robert Bickerton [Opens in a new window] ,
Benjamin Kennard ,
Nikita Mehtani ,
Elizabeth Bullock ,
Talisa Ross ,
Vikas Acharya  and
Catherine Rennie
Robert Bickerton*
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
Benjamin Kennard
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
Nikita Mehtani
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
Elizabeth Bullock
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
Talisa Ross
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK EvidENT Team, University College London, London, UK
Vikas Acharya
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
Catherine Rennie
Affiliation:
Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, UK
*
Corresponding author: Robert Bickerton; Email: r.bickerton1@nhs.net
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Abstract

Objective

Hereditary haemorrhagic telangiectasia (HHT) is characterised by recurrent, severe epistaxis. While nasal closure is a relatively well-established treatment for HHT patients with intractable epistaxis, recent studies highlight the efficacy of bevacizumab in this subgroup. We aim to evaluate the effectiveness of nasal closure for patients with contraindications to bevacizumab.

Methods

A case series of five patients with HHT and severe refractory transfusion-dependent epistaxis who were treated with nasal closure.

Results

All patients had subjective improvement in epistaxis. Haemoglobin concentrations increased in all patients, with none requiring transfusion for epistaxis post-operatively. Four patients experienced complete cessation in epistaxis. Four returned positive Glasgow Benefit Inventory scores.

Conclusion

Nasal closure appears to be a safe and effective option for the management of epistaxis in patients with severe, refractory HHT-related epistaxis. Treatment improved quality of life, reduced severity of epistaxis and increased haemoglobin concentrations. Nasal closure should be considered for HHT patients with severe, refractory epistaxis, particularly in cases where bevacizumab is contraindicated.

Keywords

bevacizumabepistaxishereditary haemorrhagic telangiectasiaHHTnasal closurequality of liferhinology

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 139 , Issue 2 , February 2025 , pp. 118 - 124
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Robert Bickerton takes responsibility for the integrity of the content of the paper

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