Nose Injuries

Topic Overview

Nose injuries often occur during play, sports, accidents, fights, and falls. Pain, swelling, and bruising are common, even with minor injuries. Home treatment can usually help relieve your symptoms.

It may be hard to tell if your nose is broken. Swelling can make your nose look crooked even if it is not broken. When the swelling goes down after a few days, it is easier to tell if your nose is really crooked. Most doctors prefer to check an injured nose soon after the swelling has gone down. Sometimes, testing may be needed, such as an X-ray or computed tomography (CT) scan of the head, if other facial injuries or fractures are suspected. See a picture of a broken nose.

Seriousness of a nose injury

Whether or not your nose is broken, a nose injury is more serious when:

You have a nosebleed that you can't stop. See how to stop a nosebleed.
The skin of your nose is cut or punctured, especially if you think your nose may be broken. This increases your risk of infection.
A blood clot forms in the tissue that separates the nostrils (septum). This can create a hole (perforation) in the septum or cause the bridge of the nose to collapse (saddle nose deformity).
You think the injury may have been caused by abuse. Physical abuse often causes bruises, burns, fractures, head injuries, and other injuries. If you suspect abuse, seek help. You can call a local child or adult protective services agency, the police, a spiritual adviser, or a health professional such as a doctor, nurse, or counsellor.
You have persistent drainage from one or both nostrils. This may be caused by cerebrospinal fluid (CSF) draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears. There is a chance you may get a CSF infection, such as meningitis, which can affect the nervous system and be life-threatening.

Complications of a broken nose

Most broken noses heal without problems. When problems develop, they can include:

A change in the size or shape of the nose, or a crooked or bent nose. Multiple nose injuries, especially during childhood, increase the risk of damage to the tissues and structures in the nose. This can cause long-term problems.
Trouble breathing or nasal stuffiness.
An infection of the nose, sinuses, or bones in the face.
An abnormality in the tissue that separates the nostrils (deviated nasal septum).
A hole (perforation) in the septum.
Severe infection, such as meningitis or a brain abscess, or other CSF infection.

Treatment

Treatment of a simple fracture, when the bone is still in place, usually includes pain medicine and nasal decongestants. You may or may not need a nasal splint.

If your nose is broken and out of place, it may need to be set. Most doctors like to wait for any swelling to go down before setting a broken nose. Most swelling goes down after 2 or 3 days but may take as long as 7 to 14 days. After the nose is set, nasal packing may be inserted and a splint may be applied. You may be given antibiotics to help prevent infection if packing is used. Your doctor may want to recheck your nose and remove the packing in 2 to 3 days.

When you have a nose injury, it is important to look for other injuries to the head, face, and neck, such as a broken cheekbone, an eye injury, an injury to the mouth or teeth, or a cervical spine injury. If you think there are other injuries, use the topics in the Related Information section to evaluate these injuries.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Have you had a nose injury in the past 2 weeks?

Yes

Nose injury in past 2 weeks

How old are you?

Less than 4 years

4 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Do you have an eye injury?

Yes

Eye injury

Is there an object in your nose?

Yes

Object in nose

Did you pass out completely (lose consciousness)?

Yes

Lost consciousness

If you are answering for someone else: Is the person unconscious now?

(If you are answering this question for yourself, say no.)

Yes

Unconscious now

Are you back to your normal level of alertness?

After passing out, it's normal to feel a little confused, weak, or light-headed when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.

Yes

Has returned to normal after loss of consciousness

Did the loss of consciousness occur during the past 24 hours?

Yes

Loss of consciousness in past 24 hours

Do you have symptoms of shock?

The symptoms in an adult or older child are different than the symptoms in a young child.

Yes

Symptoms of shock

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Would you describe the breathing problem as severe, moderate, or mild?

The symptoms in an adult or older child are different than the symptoms in a young child or baby.

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Are there any symptoms of a skull fracture?

Yes

Symptoms of skull fracture

Have you had any new vision changes?

These could include vision loss, double vision, or new trouble seeing clearly.

Yes

New vision changes

Did you have a sudden loss of vision?

A loss of vision means that you cannot see out of the eye or out of some part of the eye. The vision in that area is gone.

Yes

Sudden vision loss

Do you still have vision loss?

Yes

Vision loss still present

Does your nose look swollen, crooked, or different than it did before the injury?

Yes

Nose looks swollen, crooked, or different than normal

Is there any swelling or bruising?

Yes

Swelling or bruising

Does the cheekbone or eye socket look different than it did before the injury?

For example, the cheekbone might look bent or out of place, and the eye socket may not be the same shape it was before.

Yes

Cheekbone or eye socket looks misshapen

Did you have swelling or bruising within 30 minutes of the injury?

Yes

Swelling or bruising within 30 minutes of injury

Does your nose have a cut or puncture wound?

Yes

Cut or puncture wound on nose

Is there any pain in or around the nose?

Yes

Pain in or around nose

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

Signs of pain in an adult or child are different than signs of pain in a baby or toddler.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Is the pain getting worse?

Yes

Pain is getting worse

Has the pain lasted for more than 2 days?

Yes

Pain for more than 2 days

Do you suspect that the injury may have been caused by abuse?

This is a standard question that we ask in certain topics. It may not apply to you. But asking it of everyone helps us to get people the help they need.

Yes

Injury may have been caused by abuse

Is your nose bleeding now?

If it is, try to stop the bleeding.

Yes

Nosebleed now

Would you describe the nosebleed as severe, moderate, or mild?

Severe

Severe nosebleed

Moderate

Moderate nosebleed

Mild

Mild nosebleed

Can you stop the bleeding?

Yes

Able to stop bleeding

Unable to stop bleeding

Have you kept the nose pinched shut for at least 20 minutes?

Yes

Has tried to stop nosebleed with direct pressure for at least 20 minutes

Do you feel light-headed or dizzy, like you are going to faint?

It's normal for some people to feel a little light-headed when they first stand up. But anything more than that may be serious.

Yes

Feels faint

Do you take a medicine that affects the blood's ability to clot?

This may include blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. These medicines can cause bleeding and can make it harder to control bleeding.

Yes

Takes medicine that affects blood's ability to clot

Have you had more than 1 nosebleed in the past 24 hours?

Yes

More than 1 nosebleed in past 24 hours

Have you had more than 4 nosebleeds in the past 24 hours?

Yes

More than 4 nosebleeds in past 24 hours

Do you think the nose may be infected?

Yes

Possible infection of nose

Do you think you may have a fever?

Yes

Possible fever

Do you have diabetes, a weakened immune system, or any surgical hardware in the area?

"Hardware" in the facial area includes things like cochlear implants or any plates under the skin, such as those used if the bones in the face are broken.

Yes

Diabetes, immune problems, or surgical hardware in affected area

Do you think you may need a tetanus shot?

Yes

May need tetanus shot

Do you have any other concerns about your nose?

Yes

Other concerns about nose

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

To stop a nosebleed:

Sit up straight, and tip your head slightly forward. (Do not tilt your head back. This may cause blood to run down your throat and make you vomit.)
Pinch the soft part of your nose shut with your thumb and index finger for 10 full minutes.
After 10 minutes, check to see if your nose is still bleeding. If it is, pinch it shut for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of pressure.

Symptoms of infection in the nose may include:

Increased pain, swelling, warmth, or redness around the nose.
Pus or smelly drainage from the nose.
Fever.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.

A nosebleed is severe if:

You have moderate to large amounts of blood even after you have pinched the nose shut for 10 minutes.
Your nose is still bleeding even after 20 full minutes of direct pressure.

A nosebleed is moderate if:

You have some bleeding, but direct pressure stops it within 20 minutes.
The nose bleeds small amounts of blood more than 3 times in 24 hours.

A nosebleed is mild if:

You have a little bleeding, but direct pressure stops it within 10 minutes.
The nose bleeds no more than 3 times in 24 hours, and each time the bleeding is mild.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

For a deep or dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
- You haven't had a tetanus shot in the past 5 years.
- You don't know when your last shot was.
- You have not received 3 doses of the tetanus vaccine series.
For a clean wound, you may need a shot if:
- You have not had a tetanus shot in the past 10 years.
- You don't know when your last shot was.
- You have not received 3 doses of the tetanus vaccine series.

Symptoms of a skull fracture may include:

Clear or bloody fluid draining from the ears or nose.
Bruising under the eyes or behind the ears.
Drooping of the face.
A dent anywhere on the head.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).

Severe trouble breathing means:

You cannot talk at all.
You have to work very hard to breathe.
You feel like you can't get enough air.
You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It's hard to talk in full sentences.
It's hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.
It's becoming hard to breathe with activity.

Severe trouble breathing means:

The child cannot eat or talk because he or she is breathing so hard.
The child's nostrils are flaring and the belly is moving in and out with every breath.
The child seems to be tiring out.
The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than usual.
The child has to take breaks from eating or talking to breathe.
The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.
The child seems a little out of breath but can still eat or talk.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or light-headed, like you may pass out.
Feeling very weak or having trouble standing.
Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Being very sleepy or hard to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
Acting confused. The child may not know where he or she is.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Eye Injuries

Objects in the Nose

Home Treatment

First aid measures are important after a nose injury.

Stop a nosebleed. Crying can make a nosebleed worse. If your child has a nosebleed and is crying, speak to the child in a quiet, relaxed manner. This will help reduce the child's fear. For more information, see the topic Nosebleeds.
If you think that the nose is broken, do not try to put a crooked nose back in place. This may increase bleeding or deformity or cause further injury.

Measures to reduce pain, swelling, and bruising

Use ice. Cold will reduce pain and swelling. Apply an ice or cold pack immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Always keep a cloth between your skin and the ice pack, and press firmly against all the curves of the affected area. Do not apply ice for longer than 20 minutes at a time, and do not fall asleep with the ice on your skin.
Keep your head elevated, even while you sleep. This will help reduce swelling.
Do not take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) or aspirin for the first 48 hours. Aspirin prolongs the clotting time of blood and may cause more nose or facial bleeding. Also, do not give aspirin to anyone younger than 18 because of the risk of Reye syndrome, a rare but serious disease.
Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.

Measures to relieve nasal stuffiness and promote sinus drainage

Drink plenty of fluids. Extra fluids help keep mucus thin and draining, which may help prevent blockage of the sinuses.
Try a non-prescription decongestant, such as Sudafed PE, or use saline nasal sprays or drops to relieve nasal stuffiness.
Use a humidifier to keep the air in your home moist. You may want to purchase a small humidifier to use in your bedroom while you sleep.
Inhale steam from a vaporizer, or take long, steamy showers. You may also try breathing the moist air from a bowl of hot water. Put a towel over your head and the bowl to trap the moist air.

Medicine you can buy without a prescription
Try a non-prescription medicine to help treat your fever or pain:
Acetaminophen, such as Tylenol Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, such as Advil or Motrin Naproxen, such as Aleve Aspirin (also a non-steroidal anti-inflammatory drug), such as Entrophen Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a non-prescription medicine:
Carefully read and follow all directions on the medicine bottle and box. Do not take more than the recommended dose. Do not take a medicine if you have had an allergic reaction to it in the past. If you have been told to avoid a medicine, call your doctor before you take it. If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to. Do not give aspirin to anyone younger than 18 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Eye or vision changes develop.
A skin infection develops.
A sinus problem develops.
Symptoms do not improve with home treatment.
Symptoms become more severe or frequent.

Prevention

While not all nose injuries can be prevented, you can take steps to help reduce your risk of a nose injury.

Wear a helmet and face guard to protect your head, face, and mouth during sports activities in which facial injuries may occur.
Always use car safety seats and seat belts to prevent or reduce nose and facial injuries during a car crash.
Wear a face shield when you work with power tools or when you do an activity that might cause an object to fly into your face.

Reduce your child's risk of injury

You can take steps to help reduce your young child's risk of a nose injury.

Never leave your child unattended in a high place, such as on a tabletop; in a crib with the sides down; on elevated porches, decks, and landings; or even on a bed or sofa.
Do not leave your child alone in any infant seat or sitting toy, such as a swing or jumper. Use all of the safety straps provided.
Use stair gates to block stairways. Install gates at the top and bottom of the stairs, and use the gates properly.
Baby walkers should not be used. They are not safe. Canada has banned baby walkers because many babies have been seriously injured while using them. It is illegal to manufacture, sell, advertise, or import new or used baby walkers. A stationary activity centre, with adult supervision, is a better choice.
Watch your child when he or she is outside. Uneven grass, sloping lawns, and hills may be difficult for your child to walk on.
Make your home safe from falls by removing hazards that might cause a fall, such as throw rugs.
Place your child in an approved child car seat when travelling in a car. Follow the manufacturer's directions for securing the seat in the car. Children should ride in the back seat for safety.
Have your children wear helmets when necessary, such as when they are passengers on a bike or are riding a tricycle or bicycle on their own. Be sure your child wears a helmet or protective clothing when he or she does sports activities to prevent sports injuries.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

What are your main symptoms? How long have you had your symptoms?
How and when did an injury occur? How was it treated?
Have you had a nose injury in the past?
- Was your injury checked by a doctor? What was the diagnosis?
- How was your injury treated?
- Do you have any continuing problems because of the previous injury?
What activities related to sports, work, or your lifestyle make your symptoms better or worse?
Do you think activities related to your job or hobbies caused your symptoms?
Was this injury intentionally caused by another person?
Was the use of alcohol or drugs involved in your injury?
What home treatment measures have you tried? Did they help?
What non-prescription medicines have you tried? Did they help?
Do you have any health risks?

Credits

Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
David Messenger MD