Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Surgery or Not Surgery? Exploring the Dilemma of Epistaxis Management in Patients With HHT

Version 1 : Received: 12 February 2024 / Approved: 14 February 2024 / Online: 14 February 2024 (05:30:42 CET)

A peer-reviewed article of this Preprint also exists.

Passali, G.C.; Santantonio, M.; Vecchioli, N.; Sollazzo, M.; Rolesi, R.; Marotta, I.; Corina, L.; Riccioni, M.E.; Gaetani, E.; Galli, J. Surgery or No Surgery? Exploring the Dilemma of Epistaxis Management in Patients with HHT. Journal of Clinical Medicine 2024, 13, 1688, doi:10.3390/jcm13061688. Passali, G.C.; Santantonio, M.; Vecchioli, N.; Sollazzo, M.; Rolesi, R.; Marotta, I.; Corina, L.; Riccioni, M.E.; Gaetani, E.; Galli, J. Surgery or No Surgery? Exploring the Dilemma of Epistaxis Management in Patients with HHT. Journal of Clinical Medicine 2024, 13, 1688, doi:10.3390/jcm13061688.

Abstract

Epistaxis, particularly in Hereditary Hemorrhagic Telangiectasia (HHT) patients, is a common otolaryngological emergency, often requiring complex management. A hierarchy of increasingly invasive interventions, from external compression of the nasal pyramid to nostril closure, is typically proposed and applied. We conducted a retrospective study on HHT patients to assess the effectiveness and longevity of invasive procedures postoperatively. Data were collected using the Epistaxis Severity Score (ESS) questionnaire. The primary focus was on changes in the frequency and intensity of epistaxis, while the secondary focus was on the overall quality of life. The study found that invasive procedures initially improved the frequency and intensity of epistaxis in HHT patients. However, within one to 9 months postoperatively, these benefits often diminished, with hemorrhagic symptoms recurring at similar or worsened levels. Facial trauma further negated the advantages of these procedures. The findings suggest a need for a gradual and increasingly invasive approach to managing epistaxis in HHT patients. Highly invasive procedures should be reserved for cases where less invasive methods fail, due to their limited temporal effectiveness and the risk of causing anatomical-functional changes in the rhino-sinus area, complicating future management of severe epistaxis.

Keywords

hereditary hemorrhagic telangiectasia; rhinology; epistaxis

Subject

Medicine and Pharmacology, Otolaryngology

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