Hereditary Hemorrhagic Telangiectasia (HHT) is a disease that presents with blood-vessel-malformation morbidity, such as the membranes of the entire body, the skin, internal organs, and the central nerves. HHT causes severe recurrent epistaxis. Though several treatments have been attempted to achieve hemostasis, epistaxis by HHT can recur many times after the cessation of treatment. Here, we report a case of HHT treated with radiation therapy. An 81-year-male exhibited recurrent epistaxis over a long period of time. In spite of several treatments, being performed in previous hospital, such as Argon plasma coaggulation therapy and electrocoaggulation, frequent blood transufusions were required for uncontrollable epistaxis. We attempted external radiation therapy in this case. External radiotherapy was performed to optimally spare the surrounding normal tissue. We administered 50Gy in 25 fractions of 2Gy delivered over 5 weeks (5 days per week), and the therapy continued uninterrupted for five weeks. Two weeks after the last radiation function the patient’s nasal dressing could be removed without any problems. The abnormal blood vessel that existed in the nasal mucosa almost disappeared. Epistaxis has not reccuerd and a blood transfusion has not been required for eight months following the radiation therapy treatment. External radiation therapy may be effective for recurrent epistaxis in HHT.

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Background: Allergic rhinitis refractory to medical treatment requires surgical intervention. Although several surgical procedures have been proposed, their indications are still controversial. We developed modified selective endoscopic resection of the peripheral branches of the posterior nasal nerve (PNN) with submucosal inferior turbinate conchotomy, and studied the efficacy of this new surgical procedure.
Patients and Methods: Twenty-six consecutive patients with severe allergic rhinitis refractory to medical treatment were enrolled in this study. The PNN diverges into two main branches near the sphenopalatine foramen. Each main branch diverges into several peripheral branches that terminate in the nasal glands distributed in the inferior turbinate mucosa. After inferior turbinate conchotomy, all these branches were endoscopically identified, ablated with electrocautery, and resected. Results were evaluated using Practical Guidelines for the Management of Allergic Rhinitis in Japan (2009).
Results: Substantial improvements in the scores for sneezing, rhinorrhea, nasal obstruction, and interference with daily life were observed and maintained for one year in most patients (P<0.01). Although there were several minor temporal complications, no major bleeding was observed.
Conclusions: The present results indicated that this modified selective endoscopic resection of the peripheral branches of the PNN with submucosal inferior turbinate conchotomy is a relevant surgical intervention for the treatment of refractory allergic rhinitis.

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We performed a survey using the JRQLQ and RQLQJ of patients diagnosed with perennial allergic rhinitis and compared the results. The responses to the two questionnaires showed significant correlations in all areas and the total score. The correlation was particularly strong concerning nasal symptoms. A significant correlation was also noted in sleep, which differed most notably between the two questionnaires. The relationships of nasal obstruction, which is the most frequent complaint of perennial rhinitis patients, with sleep and daily life were evaluated. Both questionnaires indicated increasing disturbance of sleep and daily life with the exacerbation of nasal obstruction. The statistical comparison is difficult, but the RQLQJ scores of perennial rhinitis patients were generally lower than those of pollinosis patients previously reported by Okuda et al. This study showed significant correlations between the results of the JRQLQ and RQLQJ, and suggested that the JRQLQ is simpler, more useful, and more appropriate for evaluation of the state of perennial allergic rhinitis than the RQLQJ.

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