Presented at the Annual Meeting of the Norwegian Society of Otorhinolaryngology Head and Neck Surgery, Oslo, Norway, October 27–28, 2011.
Article first published online: 7 MAY 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 6, pages 1210–1214, June 2012
How to Cite
Dheyauldeen, S., Østertun Geirdal, A., Osnes, T., Vartdal, L. S. and Dollner, R. (2012), Bevacizumab in hereditary hemorrhagic telangiectasia-associated epistaxis: Effectiveness of an injection protocol based on the vascular anatomy of the nose. The Laryngoscope, 122: 1210–1214. doi: 10.1002/lary.23303
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 1 JUN 2012
- Article first published online: 7 MAY 2012
- Accepted manuscript online: 22 MAR 2012 10:19AM EST
- Manuscript Accepted: 22 FEB 2012
- Manuscript Revised: 20 FEB 2012
- Manuscript Received: 15 NOV 2011
- Osler disease;
- hereditary hemorrhagic telangiectasia;
- local treatment;
- treatment technique;
- vascular anatomy of the nose;
- quality of life;
- Level of Evidence: 4
To evaluate the effectiveness of a standardized intranasal bevacizumab injection in treating hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis.
Prospective pilot study.
A total dose of 100 mg bevacizumab (25 mg/mL Avastin) was injected submucosally, 50 mg on each side. A total of 0.5 mL was injected in the sphenopalatine area, upper part of bony septum, upper part of the later nasal wall, and the anterior part of nasal floor. No cauterizations or laser therapy were done during or after the procedure. The hemoglobin level and grades of epistaxis were recorded before and monthly after the procedure. The IFT grading system (intensity [I], frequency [F] of epistaxis, and the amount of blood transfusion [T]) and epistaxis severity score (ESS) for hereditary hemorrhagic telangiectasia system were used. Quality of life (QoL) was evaluated before and 4 weeks after the procedure using the Short Form-36 Health Survey questionnaire, Cantril's Self-Anchoring Ladder questionnaire, and Slotosch disease-specific QoL questionnaire.
A significant improvement was found in IFT grading (P = .007), ESS grading (P = .001), and hemoglobin level (P = .01). The QoL differences were statistically not significant.
The four-injection site technique of intranasal administration of bevacizumab is an effective treatment option in HHT-associated epistaxis, at least on the short-term effect. Long-term and comparative studies are needed to further evaluate the significance of this treatment modality. Laryngoscope, 2012