title: Topical application of timolol decreases the severity and frequency of epistaxis in patients who have previously undergone nasal dermoplasty for hereditary hemorrhagic telangiectasia.
abstract: OBJECTIVE
  Hereditary hemorrhagic telangiectasia (HHT) is widely known to cause bleeding that is difficult to control because of the associated vascular wall fragility. Although nasal dermoplasty results in decreased severity and frequency of nasal bleeding in patients with HHT, it does not eradicate epistaxis because this procedure cannot cover the entire nasal cavity. Residual bleeding warrants additional effective therapy. Preliminary reports on the use of β-adrenergic blockers for treating epistaxis in patients with HHT encouraged us to examine their effects in HHT patients who had previously undergone nasal dermoplasty but still complained of epistaxis.
  
  
  METHODS
  We performed a prospective topical timolol, a nonselective beta blocker, application study involving 12 HHT patients who had undergone nasal dermoplasty. The observation period lasted for 3 months.
  
  
  RESULTS
  There was one improperly enrolled case in which timolol administration was discontinued. The mean score of bleeding intensity and that of bleeding frequency were markedly reduced after treatment. Two patients who had required transfusions before treatment did not need them afterward, and patients were generally satisfied with the treatment.
  
  
  CONCLUSIONS
  Topical timolol application was effective in decreasing epistaxis. Although no adverse effects were observed in the properly selected patients, there are contraindications to timolol application that should be kept in mind when applying this treatment.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi 329-0498, Japan; Ishibashi General Hospital, Shimotsuke, Tochigi 329-0596, Japan. Electronic address: k-ichi@yushikai.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ichimura
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Imayoshi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Mari Shimada
authors.initials: MS
authors.lastname: Dias
mesh_terms: D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016038:Skin Transplantation; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000601:surgery*; D013999:Timolol / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D013999:Timolol
keywords: Epistaxis; Hereditary hemorrhagic telangiectasia; Nasal dermoplasty; β-blockers