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Long ‐term experience with intranasal bevacizumab therapy
ConclusionsIntranasal bevacizumab injection is an effective treatment for most of the moderate and severe grades of HHT‐associated epistaxis. The duration of the effect of the treatment was variable. Primary and late resistance phenomena to the treatment were quite common. Level of Evidence4. Laryngoscope, 2018
Source: The Laryngoscope - February 22, 2018 Category: ENT & OMF Authors: Johan Steineger, Terje Osnes, Ketil Heimdal, Sinan Dheyauldeen Tags: Allergy/Rhinology Source Type: research

Pazopanib effective for bevacizumab ‐unresponsive epistaxis in hereditary hemorrhagic telangiectasia
We describe a patient with HHT with epistaxis recalcitrant to several endonasal procedures and six cycles of intravenous bevacizumab, for which he was dependent on iron infusions and packed red blood cells transfusions. He then started pazopanib at 100 mg with dramatic improvements in epistaxis and normalization of hemoglobin and iron levels, without replenishment needs for 12 months. This is the first report on the efficacy of pazopanib with high selectivity for abrogating VEGF receptor‐2 signaling in HHT, and needs to be explored further. Laryngoscope, 2018
Source: The Laryngoscope - February 16, 2018 Category: ENT & OMF Authors: Joseph G. Parambil, Troy D. Woodard, Omer N. Koc Tags: Allergy/Rhinology Source Type: research

Economic evaluation of floseal compared to nasal packing for the management of anterior epistaxis
ConclusionsPrior studies have demonstrated Floseal to be an effective treatment for anterior epistaxis. In the Canadian healthcare system, Floseal treatment appears to be a cost‐effective treatment option compared to nasal packing for anterior epistaxis. Level of Evidence2c Laryngoscope, 2018
Source: The Laryngoscope - January 4, 2018 Category: ENT & OMF Authors: Andre Le, Kednapa Thavorn, Andrea Lasso, Shaun J. Kilty Tags: Allergy/Rhinology Source Type: research

Nose blowing after endoscopic sinus surgery does not adversely affect outcomes
ConclusionNose blowing after ESS does not appear to measurably improve symptoms of nasal congestion or general sinonasal quality of life, nor does it seem to adversely affect the frequency or severity of postoperative epistaxis during the first postoperative week. Judicious nose blowing may be permissible immediately after uncomplicated ESS. Level of Evidence1b. Laryngoscope, 2017
Source: The Laryngoscope - October 25, 2017 Category: ENT & OMF Authors: Noel Ayoub, Wirach Chitsuthipakorn, Jayakar V. Nayak, Zara M. Patel, Peter H. Hwang Tags: Allergy/Rhinology Source Type: research

Osteonecrosis after intranasal injection with bevacizumab in treating hereditary hemorrhagic telangiectasia: A case report
Intranasal bevacizumab injections have been used in treating hereditary hemorrhagic telangiectasia (HHT)‐related epistaxis since 2009. It is believed to be a safe and effective treatment for a selected group of HHT patients in reducing frequency and intensity of epistaxis, with few or none adverse effects. In this case report, however, we will describe a patient who developed bilateral osteonecrosis in the knees while undergoing regular intranasal submucosal bevacizumab injections. Although osteonecrosis previously has been documented in patients receiving bevacizumab intravenously in oncologic doses, thus far it has not...
Source: The Laryngoscope - July 3, 2017 Category: ENT & OMF Authors: Johan Steineger, Else Merckoll, John Magnar Sl åstad, Erik Fink Eriksen, Ketil Heimdal, Sinan Dheyauldeen Tags: Allergy/Rhinology Source Type: research

Impact of liver disease on outcomes of patients hospitalized for epistaxis
ConclusionAmong patients hospitalized for epistaxis, LD resulted in greater morbidity and mortality. Clinicians should be aware of the particular risk that LD bears on the hospitalized epistaxis patient. Level of Evidence2C. Laryngoscope, 2017
Source: The Laryngoscope - May 29, 2017 Category: ENT & OMF Authors: Omar M. Mohamed, Aparna Govindan, Andrey Filimonov, Michael J. Sylvester, Michael Zaki, Soly Baredes, Jean Anderson Eloy Tags: Allergy/Rhinology Source Type: research

Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends
ConclusionCompared to embolization, ligation is associated with significantly decreased hospital charges and shorter hospital stay, without an increase in complication rates. Counterintuitively, ligation appears to be trending downward nationally in its use relative to embolization. Level of Evidence2C. Laryngoscope, 2016
Source: The Laryngoscope - December 22, 2016 Category: ENT & OMF Authors: Michael J. Sylvester, Sei Y. Chung, Luis A. Guinand, Aparna Govindan, Soly Baredes, Jean Anderson Eloy Tags: Allergy/Rhinology Source Type: research

Managing blocked foley catheter balloons when removing posterior nasal packs in epistaxis patients
Level of EvidenceNA Laryngoscope, 2016
Source: The Laryngoscope - June 26, 2016 Category: ENT & OMF Authors: Jonathan R. Abbas, Sanjeet Agrawal Tags: Allergy/Rhinology Source Type: research

Endoscopic endonasal greater palatine artery cauterization at the incisive foramen for control of anterior epistaxis
ConclusionsEndoscopic cauterization of the greater palatine artery at the incisive foramen is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Our case series corroborates the above. Level of Evidence4. Laryngoscope, 2015
Source: The Laryngoscope - October 5, 2015 Category: ENT & OMF Authors: Anna Butrymowicz, Adam Weisstuch, Alice Zhao, Jay Agarwal, Carlos D. Pinheiro‐Neto Tags: Allergy/Rhinology Source Type: research

The minimal important difference of the epistaxis severity score in hereditary hemorrhagic telangiectasia
ConclusionUsing both the anchor‐based and distribution‐based approaches, the estimated MID for the ESS in HHT is 0.71. Further implications include key metrics to help guide treatment responses in clinical care and essential information to calculate power and sample size for future clinical trials. Level of Evidence4. Laryngoscope, 2015
Source: The Laryngoscope - September 22, 2015 Category: ENT & OMF Authors: Linda X. Yin, Douglas D. Reh, Jeffrey B. Hoag, Sally E. Mitchell, Stephen C. Mathai, Gina M. Robinson, Christian A. Merlo Tags: Allergy/Rhinology Source Type: research

An evaluation of the severity and progression of epistaxis in hereditary hemorrhagic telangiectasia 1 versus hereditary hemorrhagic telangiectasia 2
ConclusionsHHT2 is associated with more severe epistaxis and a subsequent higher rate of interventions, requiring more aggressive therapy as compared to HHT1. Level of Evidence4 Laryngoscope, 2015
Source: The Laryngoscope - September 15, 2015 Category: ENT & OMF Authors: Benjamin N. Hunter, Benjamin H. Timmins, Jamie McDonald, Kevin J. Whitehead, P. Daniel Ward, Kevin F. Wilson Tags: Allergy/Rhinology Source Type: research

Cost of management in epistaxis admission: Impact of patient and hospital characteristics
ConclusionAlthough hospitalization costs are complex and multifactorial, we were able to identify patient and hospital characteristics associated with high costs in the management of epistaxis. Early identification and intervention, combined with implementation of targeted hospital management protocols, may improve outcomes and reduce financial burden. Level of Evidence2C. Laryngoscope, 2015
Source: The Laryngoscope - July 7, 2015 Category: ENT & OMF Authors: Erden Goljo, Rajan Dang, Alfred M. Iloreta, Satish Govindaraj Tags: Allergy/Rhinology Source Type: research

Relation of Mean platelet volume and red blood cell distribution width with epistaxis
ConclusionsThe results of this study showed a clinical finding of lower mean platelet volume and red blood cell distribution levels in epistaxis. These findings could be beneficial in new investigations into epistaxis mechanisms. Level of Evidence3b. Laryngoscope, 2014
Source: The Laryngoscope - October 24, 2014 Category: ENT & OMF Authors: Ozgur Kemal, Togay Müderris, Ergün Sevil, Gökhan Kutlar Tags: Allergy/Rhinology Source Type: research

Domiciliary floseal prevents admission for epistaxis in hereditary hemorrhagic telangiectasia
Laryngoscope, 2014
Source: The Laryngoscope - May 2, 2014 Category: ENT & OMF Authors: Laura Warner, Jane Halliday, Karen James, John de Carpentier Tags: Allergy/Rhinology Source Type: research

How to resolve the caudal septal deviation?: Clinical outcomes after septoplasty with bony batten grafting
ConclusionsEndonasal septoplasty using bony batten grafting for caudal septal deviation resulted in an improvement of nasal obstruction symptoms and acoustic rhinometry components. Level of Evidence3b Laryngoscope, 2013
Source: The Laryngoscope - December 9, 2013 Category: ENT & OMF Authors: Yong Soo Chung, Jeong‐Hun Seol, Jee‐Min Choi, Dong‐Hyuk Shin, Yong Won Kim, Jae Hoon Cho, Jin Kook Kim Tags: Allergy/Rhinology Source Type: research

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