Comparison of electrosurgical plasma coagulation and potassium-titanyl-phosphate laser photocoagulation for treatment of hereditary hemorrhagic telangiectasia-related epistaxis.
BACKGROUND
Potassium-titanyl-phosphate (KTP) laser photocoagulation is commonly used for treatment of hereditary hemorrhagic telangiectasia-related epistaxis (HHT-RE). Electrosurgical plasma coagulation (EPC), also known as coblation, has not been rigorously evaluated for HHT-RE.


METHODS
Patients seeking treatment for HHT-RE between September 2010 and September 2012 were prospectively randomized (1:1) to KTP or EPC in a single blind prospective cohort study. Length of surgery and estimated blood loss (EBL) were recorded. Epistaxis severity scores (ESSs) and 10-cm visual analogue scale (VAS) scores for HHT-RE-related symptoms were administered at enrollment and at 3, 6, 12 months following surgery. Statistical analysis used Friedman's and Pearson's chi-square tests.


RESULTS
Eleven HHT patients were prospectively enrolled and followed. Six patients underwent EPC treatment while 5 underwent KTP. Three patients in the KTP subgroup and 2 patients in the EPC subgroup requested additional surgical treatment within 12 months (p > 0.999). There were no significant differences in terms of EBL (p = 0.126) and length of surgery (p = 0.429) between treatment groups. Mean ESSs were not significantly different between groups at any follow-up point (KTP, p = 0.896; EPC, p = 0.159). Compared to KTP, mean ESSs were higher in the EPC subgroup at baseline and lower at all other time points. Mean nasal obstruction VAS scores were significantly lower in the EPC subgroup at all follow-up points.


CONCLUSIONS
EPC is a viable alternative to KTP laser photocoagulation for epistaxis control in patients with HHT. Subjectively, patients experience less nasal obstruction following EPC as compared to KTP treatment. A multicentered, well-powered study is warranted to better determine treatment outcomes.
Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
Lauren
L
Luk
Jess C
JC
Mace
Naveen D
ND
Bhandarkar
Nathan B
NB
Sautter
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004598:Electrosurgery; D004844:Epistaxis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008028:Light Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011188:Potassium; D011446:Prospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
D011188:Potassium
epistaxis; hereditary hemorrhagic; lasers; light coagulation; telangiectasic