From the Guidelines
The most common causes of epistaxis (nosebleeds) in adolescents include digital trauma (nose picking), dry nasal mucosa, allergic rhinitis, upper respiratory infections, and nasal foreign bodies. According to the clinical practice guideline: nosebleed (epistaxis) 1, nasal masses, such as juvenile nasopharyngeal angiofibroma, can also cause nosebleeds in adolescents, particularly in males. This condition presents with unilateral, unprovoked, and typically profuse unilateral epistaxis in 60% to 76% of patients.
Some key points to consider:
- Digital trauma, such as nose picking, can damage the fragile blood vessels in the anterior nasal septum, specifically in Kiesselbach's plexus 1.
- Environmental factors, such as low humidity and heated indoor air, can contribute to drying and cracking of nasal mucosa, making vessels more prone to bleeding.
- Allergic rhinitis and upper respiratory infections can cause inflammation and increased vascularity of nasal tissues, leading to nosebleeds.
- Nasal foreign bodies are a common issue in children and can cause unilateral epistaxis, rhinorrhea, and foul smell 1.
- Management of nosebleeds typically involves direct pressure to the anterior portion of the nose, avoiding nose picking, using saline nasal sprays, and applying petroleum jelly to the inside of the nostrils.
It is essential to note that while these conditions are common causes of nosebleeds in adolescents, nasal endoscopy may be necessary to rule out underlying conditions, such as nasal masses or foreign bodies, especially if bleeding is severe, frequent, or difficult to control 1. The decision to proceed with nasal endoscopy should be discussed with the patient or caregiver, weighing the benefits against the risks.
From the Research
Common Causes of Epistaxis in Adolescents
The most common causes of nose bleeds (epistaxis) in adolescents include:
- Allergic rhinitis, which can lead to recurrent epistaxis due to nasal symptoms and an abnormality in the atopic state 2
- Dryness and picking of the nasal septum, trauma to the nose, and disorders of hemostatic mechanisms 3
- Sinus disease, colds, allergies, abrupt temperature changes, and dry heat, which can produce fragile and hyperemic nasal mucosa that bleeds easily 4
Associated Factors
Additional factors that may contribute to epistaxis in adolescents include:
- Ownership of pets, such as dogs or cats, especially in those with a positive skin test to that species 2
- Anticoagulation therapy, which can increase the risk of recurrent epistaxis 5
- Hypertension, atherosclerosis, and conditions that decrease platelets and clotting function, although these are more commonly associated with posterior epistaxis in the elderly 4
Treatment and Management
Treatment and management of epistaxis in adolescents may involve:
- Firm pressure, placement of a piece of cotton dipped in a vasoconstricting solution, and application of petrolatum 3
- Anterior nasal packing, and rarely, posterior packing 3
- Use of a nasal saline gel as monotherapy to treat recurrent epistaxis 5
- Control of epistaxis with well-aimed direct pressure for 10-15 minutes 6