title: Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.
abstract: CONCLUSIONS
  Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis.
  
  
  OBJECTIVE
  HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT.
  
  
  METHODS
  Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy.
  
  
  RESULTS
  Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.
authors.affiliation: a Department of Head and Neck Surgery , Saitama Medical University International Medical Center , Hidaka , Saitama , Japan ;
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Minami
authors.affiliation: b Department of Communication Science and Disorders, Faculty of Health and Welfare , Prefectural University of Hiroshima , Mihara , Hiroshima , Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Haji
mesh_terms: D000281:Administration, Intranasal; D004844:Epistaxis / Q000188:drug therapy / Q000209:etiology*; D004964:Estriol / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D030342:Genetic Diseases, Inborn / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*
chemical_list: D004967:Estrogens; D004964:Estriol
keywords: Hereditary hemorrhagic telangiectasia; epistaxis severity score; hormonal therapy; topical estrogen