title: A natural obturator in hereditary haemorrhagic telangiectasia.
abstract: OBJECTIVE
  Most patients with hereditary haemorrhagic telangiectasia suffer with frequent episodes of epistaxis. The aim of this case report is to highlight the effect on epistaxis, occurring in hereditary haemorrhagic telangiectasia, when nasal airflow ceases.
  
  
  METHODS
  We present the interesting case of a patient with hereditary haemorrhagic telangiectasia who experienced cessation of her recurrent, refractory epistaxis through the development of coexisting polyp disease. The patient's enlarged, grade three nasal polyps were behaving as physiological obturators, limiting airflow through her nose. This reduced the intranasal trauma and subsequent frequency of her nosebleeds.
  
  
  CONCLUSIONS
  Epistaxis is a debilitating part of hereditary haemorrhagic telangiectasia, and poses a frequent management challenge. Our patient was more tolerant of her grade three nasal polyps than of her recurrent epistaxis. This case highlights the importance of reducing nasal airflow when treating patients with hereditary haemorrhagic telangiectasia.
authors.affiliation: Department of Otolaryngology, Manchester Royal Infirmary, UK. archanasj@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Soni-Jaiswal
authors.forename: T J
authors.initials: TJ
authors.lastname: Woolford
mesh_terms: D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015508:Nasal Obstruction; D009298:Nasal Polyps; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000628:therapy