{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:44:52Z","timestamp":1782755092059,"version":"3.54.5"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Rhinol&amp;#65533;Allergy"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder with multiorgan manifestations, necessitating a multidisciplinary approach. Epistaxis is a common manifestation leading to significant morbidity. Current treatments are variable in efficacy, and adequate control of epistaxis remains a significant challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the cohort of patients treated at a dedicated multidisciplinary HHT clinic and to evaluate the efficacy of an HHT-related epistaxis treatment protocol at a multidisciplinary HHT clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included both retrospective and prospective cohorts of adult patients (\u2265 18 years) with confirmed HHT attending a tertiary multidisciplinary clinic. The retrospective cohort comprised patients managed prior to the establishment of the treatment protocol and contributed to baseline demographic and disease characteristics only. The prospective cohort of patients, recruited from September 2022 to September 2024, was managed using a tiered protocol progressing from topical treatment to surgical intervention to systemic therapy. Epistaxis severity score (ESS) was recorded longitudinally. Treatment efficacy was assessed by comparing ESS at baseline, pre-intervention, and post-intervention time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 62 patients, including 31 retrospective and 31 prospective patients, were identified with a mean age of 52.5\u2009\u00b1\u200917.4 years and female predominance of 62.9%. Baseline ESS scores were highest in patients in the \u201cBevacizumab\u201d group, followed by those in the \u201cSurgical treatment\u201d group, and lowest in patients in the \u201cTopical treatment only\u201d cohort (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.001). Within the prospective cohort, significant improvements in ESS were observed following surgery (\u0394ESS\u2009=\u20094.31,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.006) and bevacizumab (\u0394ESS\u2009=\u20094.74,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.005). Nearly half (48.4%) of patients in this clinic achieved satisfactory control with conservative measures alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A structured, multidisciplinary protocol enables effective management of HHT-related epistaxis, matching treatment intensity to disease severity to achieve satisfactory symptom control for patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19458924261459226","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:22:24Z","timestamp":1782480144000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation and Outcomes of a Structured Epistaxis Protocol in Hereditary Hemorrhagic Telangiectasia: An Observational Cohort Study from a Multidisciplinary Clinic"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7103-3634","authenticated-orcid":false,"given":"Niridu","family":"Peiris","sequence":"first","affiliation":[{"name":"Royal Prince Alfred Hospital"},{"name":"Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Hayler","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital"},{"name":"Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Le Marquand","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital"},{"name":"Institute of Precision Medicine and Bioinformatics, Sydney Local Health District, Camperdown, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0095-4459","authenticated-orcid":false,"given":"Pak Leng","family":"Cheong","sequence":"additional","affiliation":[{"name":"Institute of Precision Medicine and Bioinformatics, Sydney Local Health District, Camperdown, Sydney, Australia"},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5366-6083","authenticated-orcid":false,"given":"Lisa","family":"Worgan","sequence":"additional","affiliation":[{"name":"Institute of Precision Medicine and Bioinformatics, Sydney Local Health District, Camperdown, Sydney, Australia"},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Lau","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia"},{"name":"Royal Prince Alfred Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8958-736X","authenticated-orcid":false,"given":"Tsu-Hui (Hubert)","family":"Low","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital"},{"name":"Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia"},{"name":"Department of Otolaryngology Head and Neck surgery, faculty of Medicine and Health Sciences, Macquarie University Hospital, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2005.030833"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8628(20000306)91:1<66::AID-AJMG12>3.0.CO;2-P"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2005.035451"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.1320320302"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1443"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215111001733"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348948909800110"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-016-0116-8"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-016-0033-z"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-7-33"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-020-02415-7"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-015-0228-1"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25604"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25669"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.3025"},{"issue":"3","key":"e_1_3_2_17_2","first-page":"29","article-title":"TIMolol nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia (TIM-HHT)-A prospective, randomized, double-blind, controlled, cross-over trial","volume":"14","author":"Andorfer KEC","year":"2022","unstructured":"Andorfer KEC, Zeman F, Koller M, et al. 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Australian Society of Otolaryngology Head and Neck Surgery Annual Scientific Meeting (ASOHNS ASM). 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