Definition A haematoma is a collection of blood that occurs in tissue that separates 2 similar structures. A haematoma of the nasal septum refers to blood in the wall separating the 2 nostrils of the nose.
What is going on in the body? Septal haematoma of the nose is a swelling or collection of blood, usually clotted blood, that occurs in the wall that separates the nostrils. It can be the result of trauma, bleeding disorders, disease, or drug use.
What are the signs and symptoms of the disease? Symptoms of a haematoma of the nasal septum usually include:
What are the causes and risks of the disease? Most haematomas of the nasal septum occur as a result of trauma from being punched or hit in the nose. Other causes include:
collagen vascular diseases, which are disorders that cause weak arteries and thus easy bleeding
excessive nose picking
harsh nose blowing
medications that are used as anticoagulants, making blood less likely to clot
history of drug use where the drug is "snorted" through the nose
tumours
What can be done to prevent the disease? Sports safety guidelines for children, adolescents, and adults can prevent some injuries that lead to septal haematoma. Avoiding use of illegal drugs can eliminate haematomas caused by snorting. A person who is taking anticoagulants should have routine blood tests to check the ability of the blood to clot.
How is the disease diagnosed? A doctor can diagnose haematomas of the nasal septum by looking at the nose. Sometimes x-rays are done to view the nasal bones and facial structures to make sure there are no fractures. Cranial CT scans and cranial MRI scans can detect more serious injuries. If a person is on medication, blood tests will be done to check the ability of the blood to clot. A complete blood cell count, or FBC, will often be ordered to check for anaemia, or a low red blood cell count.
What are the long-term effects of the disease? Some of the long-term effects of haematomas of the nasal septum include decay of the septum, which would put a hole in the septum, and anaemia from blood loss. A hole in the nasal septum allows air to pass from side to side within the nostrils. Most people, however, have no problems once the haematoma has gone away.
What are the risks to others? Haematomas of the nasal septum are not contagious and cannot be spread from person to person.
What are the treatments for the disease? Treatment of haematomas of the nasal septum includes monitoring the haematoma and use of ice packs and non-steroidal anti-inflammatory drugs (NSAIDs). Sometimes a change in medication may be necessary to prevent or decrease the likelihood of bleeding. Some people require surgery to remove the haematoma and repair any damage to the nasal septum.
What are the side effects of the treatments? Surgery carries a risk of bleeding, infection, and allergic reaction to anaesthesia. The medications used, especially NSAIDs, can increase stomach irritation with bleeding and stomach upset.
What happens after treatment for the disease? Potential complications of treatment include disfigurement and difficulty breathing. Activity after recovering from surgery will usually be what the person can tolerate. Often a person will have gauze packing in the nose to decrease bleeding.
How is the disease monitored? Any new or worsening symptoms should be reported to the doctor.
Author: James Broomfield, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 10/05/2005 Contributors Potential conflict of interest information for reviewers available on request
