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What to Do for Nasal Injuries

Samuel J. Romeo, MD; Christopher J. Hawley, MD; Michael W. Romeo, MD; Joseph P. Romeo, MD; with Patricia D. Mees

Practice Essentials Series Editors:
Kimberly G. Harmon, MD; Aaron Rubin, MD


Getting hit in the nose can be scary, especially if it starts bleeding a lot. Your nose is at risk in a collision with another player or piece of sporting equipment, and striking the bones in your face can be very painful. That's why wearing protective gear, like a helmet and a mouth guard, is so important when playing sports.

If you do get hit in the face, be sure to report it to the coach or team doctor right away.

Q. What should I do if I get a bloody nose?

A. The first step is to stop the bleeding and try to prevent swelling. Sit or lie down with your head and shoulders higher than your waist and legs. Tilt your head back slightly, and press on the bridge of your nose. If you can, place an ice pack on your nose and another ice pack on the back of your neck. Breathe through your mouth until the bleeding slows down. A nasal spray (the kind you use when you have a cold) may also help. You will not be allowed to return to play until the bleeding has completely stopped.

If the bleeding doesn't slow down in 10 minutes and stop in 1 hour, or if your mouth tastes salty, you will need to go to the emergency room or urgent care office.

Q. How do I know if my nose is broken?

A. If you heard a crunching sound (like biting into uncooked macaroni) when you got hit, your nose could be broken. It might still look OK, or it may look like it is pushed off to one side. If you're not sure, it's best to have a doctor check it anyway. It will probably swell up in an hour or two, so go to the doctor as soon as you can, so that he or she can see it before it swells.

Q. How can the doctor tell if my nose is broken?

A. The doctor will do an exam to see if any bones are broken. The best time to do this is before too much swelling occurs. Otherwise, you will have to wait 3 to 5 days for the swelling to go down before the doctor can tell what happened. X-rays are usually not needed, but your doctor will decide if they would be useful.

Q. How is a broken nose treated?

A. If the nose has been pushed out of place, it can usually be moved back into position, either within an hour (before it swells too much) or after the swelling goes down (after a week). You may also choose to have the repair done after the sports season or when the school year ends. If the nose is broken but still in place, you will not need surgery.

Q. When can I return to play?

A. If you are in a noncontact sport, like swimming, you may return as soon as the bleeding is completely stopped, you have no headache, and you can see clearly. If activity makes the bleeding start again, it's too soon to go back. If you can't see because the swelling blocks your vision, you need to wait until the swelling goes down. Applying ice for 20 minutes at a time may help.

If you play a contact sport, like soccer or hockey, you may be able to return in 1 or 2 weeks, but only if you wear a special protective mask. You might get hit in the nose again while playing, so a face mask is required. Your doctor will decide when it is safe for you to return to sports.

A displaced or broken nose can mask a more serious injury. A nose that doesn't heal properly may cause problems later in life. To prevent injury, always wear protective gear and play it safe.

Remember: This information is not intended as a substitute for medical treatment. If you have a medical concern, consult a physician.

Dr Samuel Romeo, Dr Hawley, and Dr Michael Romeo are family practice physicians at Romeo Medical Clinic in Turlock, California. They serve as team physicians for California State University, Stanislaus and directors of sports medicine at the Stanislaus family medicine residency program. Dr Joseph P. Romeo is a head and neck surgeon in Turlock. Dr Samuel Romeo and Dr Hawley hold certificates of added qualifications in sports medicine. Ms Mees is an assistant editor at THE PHYSICIAN AND SPORTSMEDICINE.

Disclosure information: Drs Romeo, Hawley, and Romeo disclose no significant relationship with any manufacturer of any commercial product mentioned in this article. No drug is mentioned in this article for an unlabeled use.

© 2005, by the McGraw-Hill Companies, Inc. Permission to photocopy is granted for educational purposes.

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