Epistaxis occurs secondary to telangiectasias that develop on the nasal mucosa. Air passing through the nose leads to dryness and rupture of these fragile blood vessels. Epistaxis is the most common symptom among patients with HHT, occurring in 90 percent of patients, but it has a wide range of severity, even among affected family members. In some patients, it may be little more than a social nuisance; in others, it can be life threatening. Epistaxis tends to worsen with age, but 10 percent of patients with HHT will not have nosebleeds. These patients may mistakenly believe they do not have the disease, which could allow other manifestations of the disease to go undiagnosed.
- 90% of people with HHT have nosebleeds ranging from mild to severe.
- Transfusion dependent nosebleeds occur in about 20% of people with HHT.
- Skin grafts, hormonal therapy, other medical therapy, or a combination of these treatments can be helpful in these patients.
- Embolization of the blood vessels in the nose is helpful in emergent situations but is not durable for more than 4-6 weeks.
- Laser therapy can be helpful in individuals with moderate nosebleeds.
- The best therapy to date in those who are transfusion dependant is the application of skin grafts by the technique developed by Dr. William Saunders, of Ohio State University, which is referred to as the Saunder’s method.
- Hormonal and antifibrinolytic therapies are useful, but potentially dangerous in patients with untreated or partially treated PAVM.