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 more rare instances be life-threatening. Management of epistaxis in HHT can 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 presentation of patient cases. The cases will demonstrate the preoperative evaluation, operating room setup, sclerosing solution preparation, and operative technique. Potential complications of sclerotherapy will be identified and discussed. 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.