by Patrick Yang

Epistaxis, or bleeding from the nose, is only an intermittent nuisance for the majority of the population. However, for those with hereditary hemorrhagic telangiectasia (HHT), a disorder that results in the improper development of blood vessels, epistaxis can plague them up to two times a day. HHT affects roughly 1 in 5,000 people in the U.S., and the frequency of epistaxis is often a negative determinant in a patient’s quality of life. Doctors currently prescribe drugs to treat HHT, but there is no optimal treatment since their efficacies are still uncertain.

A recent study led by Dr. Kevin J. Whitehead from the University of Utah observed the effects of three prospective chronic epistaxis medications –bevacizumab, estriol, and tranexamic acid –against a saline placebo control. The 120 patients that participated in the study all met clinical criteria for HHT and were randomly administered a medication or placebo intranasally for 12 weeks. Epistaxis severity was measured as a composite score using a scale from 0-10 and gauged by weekly epistaxis frequency, duration, and symptoms.

Significant improvement in epistaxis severity was ubiquitous among 108 patients who experienced decreases in epistaxis severity scores of 5-6 to 3-4. All severity scores for epistaxis frequency and duration decreased by an approximate margin of 2. These improvements were consistent for all the patients; no matter what medicine or placebo was administered. The negligible differences between the medications and saline placebo suggest that drug treatment and saline treatment are identical in their ability to relieve chronic epistaxis. Although HHT-induced epistaxis is slightly different from the common nosebleed, further research could easily support the efficacy of saline spray for common use.

References:

1. K.J. Whitehead et al., Effect of topical intranasal therapy on epistaxis frequency in patients with hereditary hemorrhagic telangiectasia: a randomized clinical trial. The Journal of the American Medical Association 316, 943-951 (2016). doi:10.1001/jama.2016.11724.
2. Image retrieved from: http://www.public-domain-image.com/free-images/science/medical-science/unlike-the-flu-shot-the-nasal-spray-flu-vaccine-does-contain-live-viruses-however-the-viruses-are-attenuated.