Sclerotherapy for Management of Epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT)

PROGRAM DESCRIPTION: Patients with hereditary hemorrhagic telangiectasia (HHT) frequently experience epistaxis that can substantially affect quality of life and, in rare instances, be life-threatening. Management of epistaxis in HHT can also be a challenging situation for the otolaryngologist. Many surgical techniques have been described for the management of epistaxis in HHT, including electrocautery, laser photocoagulation, coblation, septodermoplasty, nasal closure (Young’s procedure), local injection of bevacizumab, and sclerotherapy. The invasiveness, potential complications, and expected side effects of these procedures differ significantly and can influence personalized decision-making for HHT patients. Therefore, clear guidelines on surgical epistaxis management in HHT have remained elusive.

A growing body of literature has introduced sclerotherapy as an effective, minimally invasive, and safe approach to the management of epistaxis in HHT patients. This lecture will evaluate and describe the use of sclerotherapy, specifically with sodium tetradecyl sulfate (STS) solution, through the presentation of patient cases. The cases will demonstrate the preoperative evaluation, operating room setup, and operative technique. The concurrent use of electrocautery and/or coblation to maximize treatment effect will be explored. Finally, sclerotherapy will be compared to alternative procedures such as local injection of bevacizumab, septodermoplasty, and nasal closure.

HHT-related epistaxis impacts patients through decreased quality of life, comorbid anemia, and life-threatening blood loss. Sclerotherapy is an emerging technique that is effective and well-tolerated. This lecture will describe the personalized management of epistaxis in HHT patients with associated improvement in overall health.

OUTCOME OBJECTIVE 1: Understand the surgical options for management of epistaxis in HHT.

OUTCOME OBJECTIVE 2: Describe and evaluate the use of sclerotherapy as an effective and minimally invasive option for epistaxis management in HHT.

OUTCOME OBJECTIVE 3: Examine concurrent sclerotherapy with electrocautery or coblation to maximize treatment effect.

BACKGROUND STATEMENT: Epistaxis in HHT can be difficult to treat. This lecture will demonstrate sclerotherapy as an effective and minimally invasive management strategy. Better epistaxis control can translate to meaningful improvement in quality of life and overall health for HHT patients.