title: Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia.
abstract: BACKGROUND
  Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment.
  
  
  METHODS
  This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding.
  
  
  RESULTS
  After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (-0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results.
  
  
  CONCLUSIONS
  This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT.
authors: Department of Otolaryngology - Head and Neck Surgery, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN.
authors: Holly
authors: H
authors: Boyer
authors: Department of Otolaryngology - Head and Neck Surgery, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN.
authors: Patricia
authors: P
authors: Fernandes
authors: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
authors: Chap
authors: C
authors: Le
authors: Department of Otolaryngology - Head and Neck Surgery, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN.
authors: Bevan
authors: B
authors: Yueh
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004844:Epistaxis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate
keywords: Osler-Weber-Rendu syndrome; epistaxis; hemorrhagic disorders; sclerotherapy; sodium tetradecyl sulfate
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