title: Sinonasal quality of life outcomes following laser treatment of epistaxis related to hereditary hemorrhagic telangiectasia.
abstract: Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular disorder which manifests as recurrent, episodic, and potentially debilitating epistaxis. In this study, we aim to (1) characterize baseline sinonasal symptoms for HHT patients and to (2) analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. We performed a retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010 and December 1, 2015 at a tertiary academic medical center with an HHT Foundation-approved Center of Excellence. Preoperative and all subsequent postoperative SNOT-22 scores (short-term, <45 days and long-term, ≥45 days) were compared. Twenty consecutive HHT patients underwent 51 laser surgeries for recurrent epistaxis. Mean preoperative, short-term postoperative, and long-term postoperative SNOT-22 scores were 34.6 ± 5.4, 33.9 ± 5.5, and 18.8 ± 4.6, respectively. When analyzing subcategory scores, there was a significant improvement in the rhinologic domain from short-term to long-term postoperatively (13.5 vs. 7.3; p = 0.004), in the non-rhinologic otolaryngic domain from short-term to long-term postoperatively (2.8 vs. 1.7; p = 0.014), and in the psychological domain from preoperative and short-term postoperative to long-term postoperatively (12.2 and 10.0 vs. 6.0; p = 0.015 and 0.01, respectively). Following laser surgery for HHT-related epistaxis, patients' rhinologic symptoms worsened on the short run postoperatively but improved over time. The main benefit of laser treatment appears to be long-term improvement in psychological factors. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles (UCLA), 10833 Le Conte Ave, CHS 62-132, Los Angeles, CA, 90095, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Kuan
authors.affiliation: House Clinic, Los Angeles, CA, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Peng
authors.affiliation: Head and Neck Associates of Orange County, Mission Viejo, CA, USA.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Thompson
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles (UCLA), 10833 Le Conte Ave, CHS 62-132, Los Angeles, CA, 90095, USA.|The Hereditary Hemorrhagic Telangiectasia Center of Excellence at UCLA, Los Angeles, CA, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles (UCLA), 10833 Le Conte Ave, CHS 62-132, Los Angeles, CA, 90095, USA. mbwang@ucla.edu.|The Hereditary Hemorrhagic Telangiectasia Center of Excellence at UCLA, Los Angeles, CA, USA. mbwang@ucla.edu.
authors.forename: Marilene B
authors.initials: MB
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D004844:Epistaxis / Q000209:etiology*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008028:Light Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000601:surgery*
keywords: Epistaxis; Hereditary hemorrhagic telangiectasia; Laser; Osler-Weber-Rendu; Quality of life