Topical Intranasal Treatments for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Systematic Review
- Journal
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Thomas Scharfenberger, Michelle Kwon, Ramzi Elased, Monica Louka, Jordan Rubenstein, David A Gudis, et al.
- PMID
- 42647059
- DOI
- 10.1002/ohn.70412
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 30 August 2026): Topical intranasal therapies for epistaxis in hereditary hemorrhagic telangiectasia
Abstract
OBJECTIVE: To characterize the landscape of topical intranasal therapies in hereditary hemorrhagic telangiectasia (HHT) associated epistaxis, evaluate comparative effectiveness versus placebo, and define their potential adjunctive role within evolving treatment paradigms. DATA SOURCES: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the WHO-ICTRP were searched through May 2025. REVIEW METHODS: English-language studies of adults with HHT treated with topical agents for epistaxis were included. Study selection and data extraction were performed using Covidence in accordance with PRISMA guidelines. Risk of bias was assessed using Joanna Briggs Institute (JBI) checklists. Due to study heterogeneity, results were synthesized narratively. RESULTS: Of 310 records, 20 studies met inclusion (n = 590). Within-group reductions in Epistaxis Severity Score (ESS) were frequently observed; however, no topical class demonstrated consistent superiority over placebo in randomized controlled trials. Bevacizumab showed the largest reduction in ESS among case series (mean -3.3, n = 26). Across all agents, adverse events were uncommon and primarily limited to mild localized irritation. CONCLUSIONS: Current evidence does not support durable or clinically meaningful efficacy of topical intranasal monotherapy beyond placebo for HHT-related epistaxis. However, this absence of definitive efficacy reflects a structural evidence gap rather than a lack of biologic plausibility or patient-centered benefit. Given the phenotypic heterogeneity of HHT and the biologic variability in treatment response, topical agents remain clinically relevant as frontline adjunctive options for otolaryngologists managing this condition before systemic therapies become necessary. This review provides a framework for evidence-informed agent selection in the context of multimodal HHT care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.