The available evidence suggests that intranasal bevacizumab treatment does not have a significant effect on epistaxis in patients with HHT. There are several limitations that require further investigation to confidently rule out local bevacizumab as an effective therapy in HHT related epistaxis.

Background: A systematic review of the analgesic efficacy of selective cyclooxygenase-2 (COX-2) inhibitors in paediatric adenotonsillectomy based on subjective pain scores, adjunct analgesic requirements and time to recovery was performed. Additional analysis was performed of side effects to treatment and patient satisfaction. Methods: A systematic search was performed using the PubMed, MEDLINE and EMBASE databases. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies that measured the efficacy of selective COX-2 inhibitors were included for qualitative analysis. Results: Eight studies (seven randomised controlled trials and one prospective cohort study) were included for analysis of rofecoxib, parecoxib and celecoxib. Rofecoxib and parecoxib were shown to be largely effective analgesic agents for post-adenotonsillectomy pain. Results were conflicting for celecoxib. Conclusions: The available evidence suggests that COX-2 inhibitors offer some benefit in postadenotonsillectomy pain relief and are well tolerated. Paucity and heterogeneity of data make definitive conclusions difficult. Further research looking specifically at currently available oral agents in the postoperative setting will be of clinical relevance and potential benefit for this common paediatric procedure.