title: Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?
abstract: OBJECTIVE
  Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation.
  
  
  METHODS
  Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities.
  
  
  RESULTS
  Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery.
  
  
  CONCLUSIONS
  Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required.
authors: Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University School of Medicine, Japan. k-ichi@jichi.ac.jp
authors: Keiichi
authors: K
authors: Ichimura
authors: Hisashi
authors: H
authors: Kikuchi
authors: Shoichiro
authors: S
authors: Imayoshi
authors: Tomohiko
authors: T
authors: Yamauchi
authors: Kotaro
authors: K
authors: Ishikawa