Managing epistaxis in hereditary haemorrhagic telangiectasia: a comprehensive narrative review of therapeutic horizons.

Abstract

Background: Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disorder characterised by mucocutaneous telangiectasia, leading to recurrent epistaxis in nearly all affected individuals. Treatment strategies are broadly categorised into conservative, medical and surgical approaches. This study aimed to provide a concise summary of the existing literature on epistaxis associated with hereditary haemorrhagic telangiectasia.

Methods: The Medline/PubMed database was searched for relevant articles using the keywords 'hereditary haemorrhagic telangiectasia', 'Osler-Weber-Rendu' and 'epistaxis'.

Results: Out of 93 reviewed articles, 59 contained pertinent information. Interventions were categorised into self-delivered therapy, intravenous treatment, in-office procedures and surgical intervention.

Conclusion: A stepwise approach to managing epistaxis in patients with HHT involves a gradual escalation of treatments, starting with conservative measures and progressing to more invasive interventions as necessary. Topical oils can be efficient and intranasal bevacizumab injection shows promise, but more data are needed. Surgical options range from bipolar cautery and laser therapy to complete closure of the nasal cavity. Proper patient selection remains crucial.