Long-term outcomes of blue light laser therapy for epistaxis in patients with hereditary hemorrhagic telangiectasia within a multimodal treatment concept

Hereditary hemorrhagic telangiectasia (HHT) is a genetically inherited vascular disorder transmitted in an autosomal dominant manner. It is defined by the presence of arteriovenous malformations in the nasal mucosa, resulting in severe recurrent epistaxis. This study investigates the long-term efficacy and safety of blue light laser therapy for managing epistaxis in patients with HHT. A retrospective analysis was conducted on 71 patients treated between 09/2017 and 02/2023 at the Department of Otorhinolaryngology, University Hospital Regensburg. All patients underwent endonasal treatment using a pulsed diode laser at 445 nm as part of a structured stepwise protocol including nasal care. Of the 86 patients initially treated, 17.4% were excluded due to uncontrollable epistaxis requiring surgery under general anesthesia or concomitant medication. A total of 351 laser treatments were administered, with no reported occurrences of nasal septal perforation. A modified Epistaxis Severity Score (ESS, range 0–10) decreased by an estimated mean difference of –0.66 (95% CI = –1.05, –0.27). Subgroup analyses revealed that patients with moderate to severe baseline ESS experienced a significant reduction of –1.53 (95% CI = –2.11, –0.95), achieving the minimal important difference (MID) of 0.71. Patients’ satisfaction with their nasal bleeding, measured by the Numeric Rating Scale (0–10), improved significantly from 5.08 to 6.67 (p < 0.001). Our study indicates that blue light laser therapy plus mucosal care is associated with reduced nosebleed severity, improved patient satisfaction and a favorable safety profile, supporting its use as a long-term treatment option for managing HHT in patients with mild to moderate epistaxis.