Nasal Septal Haematoma: Symptoms, Treatment and UK Advice

A nasal septal haematoma is a relatively uncommon but serious complication of nasal trauma. It occurs when small blood vessels within the nasal septum—the wall of cartilage and bone that divides your nostrils—rupture, causing blood to collect under the lining (the perichondrium). Unlike a simple bruise, this collection of blood places pressure on the delicate septal cartilage.

Because the cartilage in your nose relies on the overlying skin and membrane for its blood supply and nutrients, a haematoma acts as a barrier. If the blood is not drained, the cartilage can begin to die (necrosis) within 24 to 72 hours. In the UK, medical practitioners follow NICE clinical knowledge summaries which categorise this as an urgent concern requiring same-day specialist intervention to avoid permanent disfigurement or infection.

Physical Trauma

The vast majority of cases are caused by blunt force trauma. This includes sports injuries (common in rugby or boxing), motor vehicle accidents, accidental falls, or physical assaults. Even a relatively minor 'bump' to the nose can cause a haematoma, particularly in children whose nasal structures are more flexible.

Surgical Complications

Occasionally, a haematoma may develop as a complication of nasal surgery, such as a septoplasty or rhinoplasty. Patients recovering from these procedures are usually advised to monitor for sudden-onset blockage or new, severe pain.

Bleeding Disorders

Individuals taking anticoagulant medications (blood thinners like warfarin or apixaban) or those with underlying bleeding disorders are at a higher risk of developing a haematoma following even minor nasal irritation or trauma.

Identifying a nasal septal haematoma early is vital. The symptoms often appear shortly after an injury, but they can occasionally develop over 24 to 48 hours. Key signs to look for include:

• Nasal Obstruction: A sudden, often total blockage of one or both nostrils that does not improve by blowing your nose.
• Pain and Tenderness: The bridge or tip of the nose may feel excessively tender to the touch, often disproportionate to the visible bruising on the outside.
• Visible Swelling: If you look inside the nostril with a torch, you may see a red or purple 'boggy' swelling on the central wall. It often looks like a small balloon or grape.
• Change in Shape: In some cases, the nose may appear wider or slightly distorted from the front.
• Rhinorrhoea: A thin, watery discharge or persistent minor bleeding.

In the UK, healthcare professionals are trained to treat nasal septal haematomas as emergencies because the risks of 'waiting and seeing' are high. According to NHS guidance, the following complications can occur if the blood is not drained:

• Septal Abscess: The trapped blood is an ideal breeding ground for bacteria. An abscess can lead to severe pain, fever, and the rapid destruction of nasal tissue.
• Saddle Nose Deformity: If the cartilage dies due to lack of blood flow, the bridge of the nose can collapse. This results in a permanent 'saddle' shape that usually requires complex reconstructive surgery to fix.
• Septal Perforation: A hole may develop in the septum, leading to chronic crusting, whistling noises when breathing, and nosebleeds.

If you have suffered a nose injury and are experiencing persistent blockage or pain, you should seek a medical assessment. If you are unsure whether your symptoms constitute an emergency, you can speak to a GP online for an initial triage.

An online doctor can review your symptoms and, if you are able to provide a clear photograph or video of the inside of the nostril, they may be able to identify signs of a haematoma. However, because a physical examination (palpation of the swelling to check if it is soft or firm) is often necessary, the primary role of an online consultation in this context is to provide rapid advice on whether you need to attend an Urgent Treatment Centre or A&E immediately.

If you have recently had nasal surgery and develop these symptoms, your first point of contact should be your surgical team or the hospital where the procedure was performed.

Diagnosis is primarily clinical. A doctor will use a nasal speculum and a bright light to look inside the nose. They may use a small probe to feel the swelling; a haematoma is typically soft and fluctuates under pressure, unlike a deviated septum which is firm.

Incision and Drainage

Once confirmed, the patient is usually referred to an Ear, Nose, and Throat (ENT) specialist. The standard treatment involves making a small incision in the nasal mucosa to drain the accumulated blood. This is often done under local anaesthetic for adults, though children may require a general anaesthetic.

Nasal Packing and Aftercare

Following drainage, the nose is often 'packed' with sterile dressings for 24 to 48 hours. This applies pressure to the septum, preventing the blood from re-accumulating. Patients are typically prescribed a course of antibiotics to prevent infection. In the UK, follow-up appointments are standard to ensure the cartilage is healing correctly and no further swelling has occurred.