Laser Treatment for Nosebleeds: When Is It Likely to Work?
Treatment of Disease: $5,000 Research Grant
Stanley Shapshay, M.D.
Elizabeth J. Mahoney Davis, M.D.
Over the years, a wide variety of treatments have been used to help manage nosebleeds in HHT patients including electro-cauterization, nasal packing, septodermoplasty (see article herein), arterial embolization, arterial ligation, and hormone therapy. While many of these interventions have achieved moderate success in the management of the HHT patient’s nosebleeds, recent attention has focused on the use of lasers for the treatment of intranasal telangiectases in patients with HHT.
Patient responses to therapy were evaluated. Patients were identified as a responder to the Nd-YAG laser treatment if they noted a 50% decrease in the severity and frequency of their nosebleeds for a period of greater than 6 months. Interestingly, vascular pattern I was most common, while vascular pattern III was least common. Patients with vascular pattern I uniformly demonstrated a good response to the Nd-YAG laser. Conversely, nearly all of the patients with vascular pattern II were poor responders to the Nd-YAG laser treatments. Finally, 80% of patients with pattern III demonstrated a good response to the Nd-YAG laser photocoagulation treatment.
In addition to correlating vascular pattern with response to Nd-YAG laser photocoagulation, vascular pattern classification was also correlated with disease severity. Patients with vascular pattern I tended to be most mildly impacted by HHT, while patients with vascular pattern II were more severely impacted. Those with pattern III were more broadly distributed over the range of disease severity.
These findings are important for physicians caring for HHT patients as they may help to predict response to laser therapy. For example, when a patient with HHT is noted to have isolated intranasal telangiectases, he or she can be counseled to anticipate a good response to Nd-YAG laser photocoagulation, while patients with a more diffuse vascular pattern almost uniformly have a sub-optimal response to their Nd-YAG laser treatments. For patients with patterns I and III, treatment with the Nd-YAG laser will typically provide an improvement in the intensity and frequency of epistaxis for a minimum of six months. The procedure is simple, requires only local anesthesia with sedation, and has few risks or side-effects. To conclude, the findings in this study will allow otolaryngologists to better counsel HHT patients and improve stratification for therapy.