title: The effects of epistaxis on health-related quality of life in patients with hereditary hemorrhagic telangiectasia.
abstract: BACKGROUND
  Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease mainly characterized by epistaxis in more than 96% of patients. Recently, a validated questionnaire known as the HHT Epistaxis Severity Score (ESS) was developed. However, little is known about the relationship between epistaxis and quality of life. We hypothesize that epistaxis severity is a major factor predicting health-related quality of life (HR-QoL) in HHT patients.
  
  
  METHODS
  This is a cross-sectional study. The ESS questionnaire and Medical Outcomes Study 36-item short form (SF-36) were administered to subjects through an Internet survey. All participants had a definitive diagnosis of HHT through Curaçao criteria or genetic testing. Demographic information, genetics, and extensive histories were also collected. Descriptive analyses were performed with calculations of means and standard deviations (SDs) for continuous variables and proportions for categorical variables. Linear regressions were then performed to assess the association between HR-QoL and ESS.
  
  
  RESULTS
  A total of 604 subjects participated between April and August 2008. All patients reported epistaxis, 285 (47.2%) had telangiectasias, and 545 (90.2%) had a family history of HHT; 167 (27.6%) patients had mild epistaxis (ESS <4), 285 (47.2%) reported moderate epistaxis (≥4 ESS <7), and 152 (25.2%) reported severe epistaxis (ESS ≥7). Patients with severe epistaxis had lower scores for both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of HR-QoL when compared to those with mild epistaxis (p < 0.001, p < 0.001).
  
  
  CONCLUSIONS
  The ESS is a major determinant of HR-QoL and should be considered as a measurement of treatment efficacy in HHT-related epistaxis.
authors.affiliation: Department of Medicine and Epidemiology, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
authors.forename: Linda X
authors.initials: LX
authors.lastname: Yin
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Hoag
authors.forename: Sally E
authors.initials: SE
authors.lastname: Mitchell
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Reh
mesh_terms: D003430:Cross-Sectional Studies; D004844:Epistaxis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000523:psychology*
keywords: Osler-Weber Rendu; epistaxis; hereditary hemorrhagic telangiectasia; quality of life; severity score