Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Mar;39(2):159-168.
doi: 10.1177/19458924241308952. Epub 2024 Dec 29.

Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis

Ezer H Benaim  1 , Ethan M Kallenberger  2 , Yasine Mirmozaffari  1 , Cristine Klatt-Cromwell  1 , Charles S Ebert Jr  1 , Adam J Kimple  1 , Brent A Senior  1 , Raj S Kasthuri  3 , Brian D Thorp  1
Affiliations
Meta-Analysis

Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis

Ezer H Benaim et al. Am J Rhinol Allergy. 2025 Mar.

Abstract

Background: Epistaxis is one of the most common and debilitating symptoms of hereditary hemorrhagic telangiectasia (HHT), significantly impacting patients' quality of life. While various medical and surgical interventions exist for managing epistaxis in patients with HHT, patients with moderate to severe epistaxis are high health-care utilizers who frequently need surgical treatment.

Objective: To compare the efficacy, complications, and patient-reported outcomes for common surgical interventions utilized in treating epistaxis in patients with HHT.

Methods: Studies were identified in PubMed, Embase, Scopus, Redalyc, and LILACS databases and uploaded to Covidence. A systematic review following PRISMA guidelines was conducted on studies evaluating outcomes in adults with HHT with moderate to severe epistaxis who had undergone surgical interventions. We compared the respective outcomes for pre-operative and post-operative epistaxis severity/intensity, need for further interventions or transfusions, estimated blood loss, length of surgery, complications, and patient satisfaction.

Results: Twenty studies with a total of 546 patients were included. The most common surgeries studied were nasal closure and laser photocoagulation. Seven studies recorded the change in epistaxis severity score and observed a significant reduction postoperatively (3.91, [95% CI 2.73-5.09]). Eleven studies found a decrease in the number of transfusions and a rise in hemoglobin levels post-operatively. Common complications reported were partial dehiscence of a nasal closure, septal perforation, and continued bleeding requiring re-operation. Most patients report improved quality of life and satisfaction with surgical intervention.

Conclusion: Surgery can significantly reduce the severity of epistaxis in patients with HHT and improve quality of life. Further studies should focus on head-to-head comparisons of procedures and standardization of outcome measures.

Keywords: coagulation; complications; epistaxis severity score; hereditary hemorrhagic telangiectasia; laser therapy; nasal closure; quality of life; septodermoplasty; surgery; transfusion.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. This figure provides an overview of the study screening and selection process in accordance with PRISMA Guidelines.
Figure 2.
Figure 2.
ROBINS-I risk of bias assessment. This figure summarizes the sources of bias in non-randomized studies.
Figure 3.
Figure 3.
Meta-analysis using the random effects model of preoperative and postoperative Epistaxis Severity Scores (ESS) for 7 studies. The dots and solid lines represent odds ratios with 95% confidence intervals. The black solid diamond represents a significant mean difference in ESS scores following surgical intervention.
See this image and copyright information in PMC

References

    1. Shovlin CL, Guttmacher AE, Buscarini E, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu–Osler–Weber syndrome). Am J Med Genet. 2000;91(1):66–67. - PubMed
    1. Hasan Albitar HA, Van Houten H, Sangaralingham LR, et al. Healthcare utilization and costs associated with hereditary hemorrhagic telangiectasia patients in a large US claims database. Mayo Clin Proc Innov Qual Outcomes. 2021;5(1):55–64. - PMC - PubMed
    1. Hoag JB, Terry P, Mitchell S, Reh D, Merlo CA. An epistaxis severity score for hereditary hemorrhagic telangiectasia. Laryngoscope. 2010;120(4):838–843. - PubMed
    1. Geisthoff UW, Seyfert UT, Kübler M, Bieg B, Plinkert PK, König J. Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid—a double-blind placebo-controlled cross-over phase IIIB study. Thromb Res. 2014;134(3):565–571. - PubMed
    1. Al-Samkari H, Albitar HA, Olitsky SE, Clancy MS, Iyer VN. An international survey to evaluate systemic bevacizumab for chronic bleeding in hereditary haemorrhagic telangiectasia. Haemophilia. 2020;26(6):1038–1045. - PubMed

MeSH terms

LinkOut - more resources