Sinonasal Symptomatic Outcomes following Laser Treatment of Epistaxis Related to Hereditary Hemorrhagic Telangiectasias

Objectives: (1) Characterize baseline sinonasal symptoms for hereditary hemorrhagic telangiectasia (HHT) patients. (2) Analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. Methods: Retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010, and December 31, 2013, in a tertiary academic medical center with an HHT Foundation-approved Center of Excellence. All HHT patients who had undergone one or more laser surgical treatments by 1 of 2 otolaryngologists were included in the analysis. Preoperative and all subsequent postoperative SNOT-22 scores were compared using unpaired t tests. Subgroup analysis was performed for patients who underwent more than 1 laser surgery. Results: A total of 21 consecutive HHT patients underwent laser surgery for recurrent epistaxis. Compared with preoperative scores, patients reported significantly improved (P < .05) SNOT scores at 2 weeks postoperatively for dizziness, difficulty falling asleep, waking up at night, getting a good night’s sleep, waking up tired, reduced concentration, feeling of frustration, and sadness. The same cohort reported significantly worse nasal obstruction at 2 weeks postoperatively. Patients who underwent more than one surgery experienced overall symptomatic improvement after the second surgery. Conclusions: HHT patients experienced a short-term improvement in sinonasal symptoms, especially those producing social and emotional consequences, following laser surgery for HHT-related epistaxis. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT.