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New treatment helps Charles keep his chronic nosebleeds in check

Charles Horowitz, diagnosed with hereditary hemorrhagic telangiectasia, has suffered for years from chronic nosebleeds.
Hereditary hemorrhagic telangiectasia (HHT) is a genetic condition that affects blood vessels throughout the body—including the lungs, liver and brain. But it also causes chronic nosebleeds, which are sometimes so severe that patients faint or require blood transfusions.

For years, Charles Horowitz lived with a roll of paper towels nearby, ready for the moment his nose started to bleed uncontrollably.

Horowitz has a condition called hereditary hemorrhagic telangiectasia (HHT), which is found in one in 5,000 people. While the genetic disorder affects blood vessels throughout the body—including the lungs, liver and brain—its universal symptom is chronic nosebleeds, which are sometimes so severe that patients faint or require blood transfusions.

"People with HHT have learned to live with it, but there is always a risk that it will mess up our daily lives. It ranges from annoying to quite dangerous and you never know what to expect," said Horowitz. "You won't find many people in the HHT community wearing white shirts—because nosebleeds will show up too easily."

Traditionally, doctors treated the condition by cauterizing problematic blood vessels, and packing gauze into at patient's nostrils. Unfortunately, the process was painful, and temporary. The nosebleeds would often recur after the procedure.

University of Minnesota Health Otolaryngologist Holly Boyer, MD, wanted to find a better treatment. To do so, she modified a technique called sclerotherapy, which is commonly used to treat varicose veins and other internal bleeding.


During a sclerotherapy session, Boyer injects small amounts of solution into carefully selected blood vessels within the nose. The solution collapses the vessels, which forces blood to reroute through healthy veins. The process reduces bleeding. Eventually, the collapsed vessels disappear.

"This treatment has been around for years, but we were able to leverage existing sclerotherapy research and apply it to a new set of patients," Boyer said. "This treatment has great results, and patients can visit the clinic and leave the same day with little pain."

It's not a cure, but sclerotherapy research published in the International Forum of Allergy and Rhinology showed major improvements in controlling bleeding. Instead of routine visits, patients may only see Dr. Boyer once per year for the outpatient visit. In some cases, people can go longer than a year before returning for the treatment. Boyer has even started teaching the technique to other physicians from around the globe.

Last Chance

Sclerotherapy helped Horowitz when nothing else would. Horowitz, who is also a doctor, was at times forced to cancel his patients' appointments when his nose would bleed profusely. On a flight home from Milwaukee, he once passed out, forcing the pilot into an emergency landing. After seeing multiple specialists, he was eventually referred to Boyer for her pioneering treatment.

Find out more about our otolaryngology services at University of Minnesota Medical Center.

Since his first appointment, Horowitz has kept his bleeding nose in check. The paper towel roll he once kept near him is no longer a daily necessity and his quality of life has improved. He's grateful to have found Boyer, whom he sees just four times per year.

"Dr. Boyer's not one to boast about how her treatment is helping the HHT community," he said. "But this is a major advancement for patients. If people have severe HHT, this could be life changing."