Clinical strategy in hereditary hemorrhagic telangiectasia.
BACKGROUND
Hereditary hemorrhagic telangiectasia (HHT) is a recurrent bleeding tendency caused by vascular malformations and preferentially involving the mucous membrane of the nose. The rhinological management of epistaxis is a challenge in which the frequency of bleeding has to be reduced without damage to the nasal mucosa, despite the fact that therapy necessarily has to be repeated.


METHODS
The clinical course in 30 patients with HHT was monitored prospectively. Nasal mucosal efflorescences underwent Nd:YAG laser therapy at individually defined intervals, and the effect on the frequency and duration of bleeding was documented, as were adverse effects.


RESULTS
No serious adverse effects (e.g., septal defects or synechiae) were observed as a consequence of therapy. During the course of laser therapy and ongoing compliance with nasal mucosal care instructions, the frequency of bleeding fell from "several times daily" to "every 2 weeks."


CONCLUSIONS
In conjunction with Nd:YAG laser therapy, ongoing and consistent care of the nasal mucosa is a proven and effective treatment regimen in HHT. As an integral element in an interdisciplinary strategy for diagnosis and therapy, this regimen yields satisfactory quality of life while avoiding local complications.
Kühnel
Thomas S
TS
Department of Otorhinolaryngology, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.
Wagner
Birgit H
BH
Schurr
Christian P
CP
Strutz
Jürgen
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000528:radiation effects; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*