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VOLUME 10 , ISSUE 1 ( January-April, 2018 ) > List of Articles

CASE REPORT

An Outpatient Approach to the Management of Recurrent Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia

Georgios Karatzias, Vasilios Chalkiadakis, Silvestros Boukouvalas, Maria Manitsopoulou, Konstantinos Papadopoulos

Keywords : Coblation, Epistaxis, Hereditary hemorrhagic telangiectasia, Rendu–Osler–Weber.

Citation Information : Karatzias G, Chalkiadakis V, Boukouvalas S, Manitsopoulou M, Papadopoulos K. An Outpatient Approach to the Management of Recurrent Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia. Int J Otorhinolaryngol Clin 2018; 10 (1):42-45.

DOI: 10.5005/jp-journals-10003-1288

License: CC BY-NC 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Patients with Rendu–Osler–Weber syndrome, a relatively common inherited vascular disorder, usually appear with epistaxis. Treatment is supportive and conducive to the prevention of complications. There are several ways to manage this condition, including conservative, medical, or surgical/ procedural approaches. Three cases of outpatients with hereditary hemorrhagic telangiectasia (HHT) are presented, who reported recurrent episodes of nasal bleeding. Furthermore, this study focuses on the approach to control episodes of epistaxis in our outpatient department, using radiofrequency (RF) energy in order to achieve coblation. Specifically, the clinical methodology aims to decrease the severity and frequency of nasal bleeding in the long term, with minimal local and general side effects. This will subsequently improve the quality of life in these patients.


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  1. Sharathkumar AA, Shapiro A. Hereditary haemorrhagic telangiectasia. Haemophilia 2008 Nov;14(6):1269-1280.
  2. Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJ, Kjeldsen AD, Plauchu H. Diagnostic criteria for hereditary hemorrhagic telangiectasia. Am J Med Genet 2000 Mar;91(1):66-67.
  3. van Gent MW, Velthuis S, Post MC, Snijder RJ, Westermann CJ, Letteboer TG, Mager JJ. Hereditary hemorrhagic telangiectasia: how accurate are the clinical criteria? Am J Med Genet A 2013 Mar;161A(3):461-466.
  4. Begbie ME, Wallace GM, Shovlin CL. Hereditary hemorrhagic telangiectasia: a view from the 21st century. Postgrad Med J 2003 Jan;79(927):18-24.
  5. Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, Spears J, Brown DH, Buscarini E, Chesnutt MS, et al.; HHT Foundation International— Guidelines Working Group. International guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. J Med Genet 2011 Feb;48(2):73-87.
  6. Kara N, Spinou C, Gardiner Q. Topical management of anterior epistaxis: a national survey. J Laryngol Otol 2009 Jan;123(1):91-95.
  7. Yaniv E, Preis M, Hadar T, Shvero J, Haddad M. Antiestrogen therapy for hereditary hemorrhagic telangiectasia: a double blind placebo controlled clinical trial. Laryngoscope 2009 Feb;119(2):284-288.
  8. Riss D, Burian M, Wolf A, Kranebitter V, Kaider A, Arnoldner C. Intranasal submucosal bevacizumab for epistaxis in hereditary hemorrhagic telangiectasia: a double blind, randomized, placebo controlled trial. Head Neck 2015 Jun;37(6):783-787.
  9. Olitsky SE. Topical timolol for the treatment of epistaxis in hereditary hemorrhagic telangiectasia. Am J Otolaryngol 2012 May-Jun;33(3):375-376.
  10. Jorgensen G, Lange B, Wanscher JH, Kjeldsen AD. Efficiency of laser treatment in patients with hereditary hemorrhagic telangiectasia. Eur Arch Otorhinolaryngol 2011 Dec;268(12): 1765-1770.
  11. Ting JY, Remenschneider A, Holbrook EH. Management of severe epistaxis after Young's procedure: a case report. Int Forum Allergy Rhinol 2013 Apr;3(4):334-337.
  12. Chin CJ, Rotenberg BW, Witterick IJ. Epistaxis in hereditary hemorrhagic telangiectasia: an evidence based review of surgical management. J Otolaryngol Head Neck Surg 2016 Jan;45:3.
  13. Gallione CJ, Repetto GM, Legious E, Rustgi AK, Schelley SL, Tejpar S, Mitchell G, Drouin E, Westermann CJ, Marchuk DA. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet 2004 Mar;363(9412):852-859.
  14. Johnson DW, Berg JN, Baldwin MA, Gallione CJ, Marondei I, Yoon SJ, Stenzel TT, Speer M, Pericak-Vance MA, Diamond A, et al. Mutations in the activin receptor-like kinase 1 gene in hereditary haemorrhagic telangiectasia type 2. Nat Genet 1996 Jun;13(2):189-195.
  15. Govani FS, Shovlin CL. Hereditary haemorrhagic telangiectasia: a clinical and scientific review. Eur J Hum Genet 2009 Jul;17(7):860-871.
  16. Haitjema T, Westermann CJ, Overtoom TT, Timmer R, Disch F, Mauser H, Lammers JW. Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu Disease): new insights in pathogenesis, complications, and treatment. Arch Intern Med 1996 Apr;56(8):714-719.
  17. Shovlin CL. Hereditary haemorrhagic telangiectasia: pathophysiology, diagnosis and treatment. Blood Rev 2010 Nov;24(6):203-219.
  18. Pau H, Carney AS, Murty GE. Hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu syndrome): otorhinolaryngological manifestation. Clin Otolaryngol Allied Sci 2001 Apr;26(2):93-98.
  19. Fuc h i zak i U, Miyamori H, K itagawa S, Ka neko S, Kobayashi K. Hereditary haemorrhagic telangiectasia (Rendu–Osler–Weber Disease). Lancet 2003 Nov;362(9394): 1490-1494.
  20. Geisthoff UW, Schneider G, Fischinger J, Plinkert PK. Hereditary hemorrhagic telangiectasia (Osler's disease): an interdisciplinary challenge. HNO 2002 Feb;50(2):114-128.
  21. Juares AJ, Dell'Aringa AR, Nardi JC, Kobari K, Gradim Moron Rodr ig ues VL, Perc hes Fi l ho RM. Rendu– Osler–Weber syndrome: case report and literature review. Bras J Otorhinolaryngol 2008 May-Jun;74(3):452-457.
  22. Folz BJ, Tennie J, Lippert BM, Werner JA. Natural history and control of epistaxis in a group of German patients with Rendu–Osler–Weber disease. Rhinology 2005 Mar;43(1):40-46.
  23. Wirsching KE, Kuhnel TS. Update on clinical strategies in hereditary hemorrhagic telangiectasia from an ENT point of view. Clin Exp Otorhinolaryngol 2017 Jun;10(2):153-157.
  24. Rotenberg B, Noyek S, Chin CJ. Radiofrequency ablation for treatment of hereditary hemorrhagic telangiectasia lesions: “how i do it”. Am J Rhinol Allergy 2015 May-Jun;29(3): 226-227.
  25. Joshi H, Woodworth BA, Carney AS. Coblation for epistaxis management in patients with hereditary haemorrhagic telangiectasia: a multicenter case series. J Laryngol Otol 2011 Nov;125(11):1176-1180.
  26. Mortuaire G, Boute O, Hatron PY, Chevalier D. Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia. Rhinology 2013 Dec;51(4):355-360.
  27. Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M. Tobacco smoking affects bacterial acquisition and colonization in oral biofilms. Infect Immun 2011 Nov;79(11): 4730-4738.
  28. Namiot Z, Namiot DB, Kemona A, Gołebiewska M, Bucki R. The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn 2000 Sep;104(3):569-574.
  29. Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med 2002 Mar;17(3):230-234.
  30. Lee WK, Ramanathan M Jr, Spannhake EW, Lane AP. The cigarette smoke component acrolein inhibits expression of the innate immune components IL-8 and human betadefensin 2 by sinonasal epithelial cells. Am J Rhinol 2007 Nov-Dec;21(6):658-663.
  31. Kamath PM, Shenoy VS, Mittal N, Sharma NK. Microbiological analysis of paranasal sinuses in chronic sinusitis—a south Indian coastal study. Egypt J Ear Nose Throat All Sci 2013 Nov;14(3):185-189.
  32. Bezerra TF, Pádna FG, Ogawa AI, Gebrim EM, Saldiva PH, Voegels RL. Biofilms in chronic rhinosinusitis with nasal polyps: pilot study. Braz J Otorhinolaryngol 2009 Nov- Dec;75(6):788-793.
  33. Hashemi M, Sadeghi MMM, Omrani MR, Torabi MA. Microbiology and antimicrobial resistance in chronic resistant rhino sinusitis with or without polyp after functional endoscopic sinus surgery. J Res Med Sci 2005;10(3):167-171.
  34. Farahani F, Youse Mashouf R, Hashemian F, Esmaeili R. Antimicrobial resistance patterns of aerobic organisms in patients with chronic rhinosinusitis in Hamadan, Iran. Avicenna J Clin Microb Infec 2014 Aug;1(2):e18961..
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