Epistaxis Severity Score (ESS) for HHT
Hoag 2010 Epistaxis Severity Score for hereditary haemorrhagic telangiectasia (HHT): six questions about typical nosebleeds over the past 3 months, normalised to 0–10. Validated in HHT only — not a triage score for acute epistaxis.
Score interpretation
ESS 0–1: no significant HHT-related nosebleeds.
→ Nasal moisturising (saline spray, emollient gel); check haemoglobin and ferritin periodically.
ESS 1–4: mild epistaxis (Cure HHT categories).
→ Nasal moisturising; check haemoglobin and ferritin and treat iron deficiency; review at an HHT centre (Second International HHT Guidelines 2020).
ESS 4–7: moderate epistaxis.
→ As mild, plus consider oral tranexamic acid and ablative treatment (laser, radiofrequency, electrosurgery or sclerotherapy) by an ENT surgeon with HHT expertise; treat anaemia (Faughnan 2020).
ESS 7–10: severe epistaxis.
→ HHT centre: escalate — ablative therapy, systemic antiangiogenic therapy (e.g. intravenous bevacizumab), septodermoplasty or nasal closure for refractory bleeding; iron infusion or transfusion as needed (Faughnan 2020).
Interpretation bands for the HHT Epistaxis Severity. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Silver Nitrate · Chemical Cautery — Epistaxis
- Naseptin Nasal Cream · Nasal Decolonisation / Recurrent Epistaxis
- Mupirocin 2% Ointment · Topical antibiotic (pseudomonic acid)
- Chlorhexidine with neomycin · Topical nasal antiseptic/antibiotic
- Glucagon · Hypoglycaemia Antidote / Endocrine Agent
- Budesonide Nasal Spray · Intranasal corticosteroid
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
