Septal Hematoma: Causes, Symptoms, and Treatment Options

Introduction

A septal hematoma occurs when blood collects between the nasal septum (the wall dividing the nostrils) and the mucous membrane covering it. This condition is often caused by trauma, such as a sports injury, fall, or car accident. If left untreated, a septal hematoma can lead to serious complications, including infection, nasal deformity, or tissue death (necrosis) of the septum. This article provides a comprehensive overview of septal hematoma, covering risk factors, symptoms, diagnostic tests, treatment options, and home care tips. Understanding this condition helps patients take proactive steps for timely diagnosis and treatment, preventing long-term issues and ensuring full recovery.

What is a Septal Hematoma?

A septal hematoma occurs when blood pools in the nasal septum due to injury. This article will discuss risk factors, symptoms, diagnostic tests, medications, procedures, and home care strategies for managing the condition.

Description of Septal Hematoma

A septal hematoma forms when blood accumulates between the cartilage or bone of the nasal septum and the surrounding mucous membrane, typically due to trauma. When the septum is damaged, blood vessels rupture, leading to a hematoma (blood clot). If untreated, the pressure from the blood can restrict blood flow to the septal cartilage, potentially causing tissue death (necrosis) or infection.

Septal hematomas can progress quickly. Early symptoms include nasal congestion, difficulty breathing, and pain. As the condition worsens, infection may develop, leading to fever, increased pain, and more severe complications, such as abscesses or permanent nasal deformity. In some cases, untreated septal hematomas can cause a “saddle nose,” where the nasal bridge collapses.

Although septal hematomas are rare, they require immediate medical attention. Prompt diagnosis and treatment can prevent complications and ensure recovery. Studies show septal hematomas occur in about 1-5% of nasal trauma cases, emphasizing the need for vigilance after any nasal injury.

Risk Factors for Developing Septal Hematoma

Lifestyle Risk Factors

Certain lifestyle factors increase the risk of developing a septal hematoma. Individuals participating in contact sports like football, boxing, or martial arts are more likely to sustain nasal injuries that can lead to a septal hematoma. Activities with a higher risk of falls or accidents, such as cycling or skiing, also increase the risk. Wearing protective gear, such as helmets or face shields, can reduce the likelihood of nasal trauma.

Alcohol consumption is another risk factor. Alcohol impairs coordination and judgment, increasing the risk of falls, accidents, and injuries. Frequent alcohol consumption may make individuals more prone to accidents resulting in nasal trauma and, subsequently, a septal hematoma.

Medical Risk Factors

Medical conditions affecting blood clotting or increasing bleeding risk can also raise the likelihood of developing a septal hematoma. Individuals with bleeding disorders, such as hemophilia or von Willebrand disease, may be more susceptible to hematomas after minor nasal trauma. Patients taking blood-thinning medications, such as warfarin or aspirin, may experience prolonged bleeding after an injury, increasing the risk of a septal hematoma.

Chronic nasal conditions, such as frequent nosebleeds (epistaxis) or chronic sinusitis, can also elevate the risk. These conditions may weaken blood vessels in the nasal septum, making them more prone to rupture during an injury.

Genetic and Age-Related Risk Factors

Age plays a role in septal hematoma development. Children are particularly vulnerable to nasal trauma because their septal cartilage is softer and more prone to injury. Additionally, children may not always communicate symptoms clearly, delaying diagnosis and treatment. Parents should be vigilant if their child experiences nasal trauma, even if the injury seems minor.

Older adults are also at increased risk due to age-related changes in balance and coordination, which can lead to falls and injuries. Furthermore, older adults are more likely to take blood-thinning medications, exacerbating bleeding after nasal trauma.

While no direct genetic link to septal hematoma exists, individuals with a family history of bleeding disorders or conditions affecting blood clotting may be at higher risk. In such cases, it’s important to seek medical attention promptly if nasal trauma occurs.

Clinical Manifestations of Septal Hematoma

Nasal Obstruction (95% Occurrence)

Nasal obstruction is the most common symptom of a septal hematoma, affecting about 95% of patients. Blood collects between the layers of the nasal septum, causing swelling that blocks the nasal passages. This leads to difficulty breathing through the nose, which worsens if untreated. Nasal obstruction can affect one or both nostrils and may cause mouth breathing, especially during sleep, leading to throat dryness.

Nasal Pain (80% Occurrence)

About 80% of patients with septal hematoma report nasal pain. The pain results from the pressure of accumulated blood on nasal tissues, causing inflammation and irritation. Pain may worsen when touching the nose or during activities like blowing the nose or sneezing. In some cases, the pain radiates to other facial areas, increasing discomfort. If untreated, the pain intensifies as swelling increases.

Nasal Bleeding (60% Occurrence)

Nasal bleeding, or epistaxis, occurs in around 60% of patients with septal hematoma, often following trauma or recent nasal surgery. Damaged blood vessels in the nasal septum lead to blood accumulation. Bleeding can range from mild to severe, with some patients noticing blood clots or a constant trickle of blood. Persistent bleeding requires medical attention to prevent further complications.

Swelling of the Nasal Septum (100% Occurrence)

Swelling of the nasal septum is a hallmark symptom, occurring in 100% of septal hematoma cases. Blood collects between the septal layers, causing visible and palpable enlargement. This swelling can obstruct nasal passages, making breathing difficult. In some cases, the septum may appear bluish or purple. If untreated, swelling can lead to necrosis and infection, causing long-term nasal damage.

Difficulty Breathing (85% Occurrence)

Difficulty breathing is reported by about 85% of patients with septal hematoma. This symptom is closely linked to nasal obstruction, as septal swelling blocks airflow. Patients may struggle to breathe through their nose, especially when lying down or during physical activity. Severe obstruction can cause anxiety or panic, and some patients may develop sleep disturbances like snoring or sleep apnea.

Purulent Nasal Discharge (30% Occurrence)

Purulent nasal discharge, or pus-like drainage, occurs in about 30% of patients with septal hematoma, typically indicating infection. The discharge may be thick, yellow, or green, with an unpleasant odor. In some cases, the infection can spread to other facial areas, leading to more severe complications. If purulent discharge is present, medical attention is crucial, as antibiotics may be needed.

Fever (25% Occurrence)

Fever occurs in about 25% of patients with septal hematoma, usually due to infection. When blood in the septum becomes infected, the body raises its temperature to fight the infection. Fever may be accompanied by other infection signs, such as purulent discharge, facial pain, and general malaise. Prompt medical care is essential to prevent complications like abscess formation or sepsis.

Headache (35% Occurrence)

Headaches are reported by about 35% of patients with septal hematoma. These headaches result from pressure exerted by the swollen septum on surrounding facial structures. Pain may be localized to the forehead, temples, or behind the eyes, ranging from mild to severe. If the headache persists or worsens, consult a healthcare provider to rule out other causes.

Facial Pain (40% Occurrence)

Facial pain affects about 40% of patients with septal hematoma. Inflammation and swelling of the septum put pressure on surrounding facial structures, causing pain in the nose, cheeks, or forehead. Pain may worsen when touching the face or during activities like chewing or talking. Accurate diagnosis is important, as facial pain can be mistaken for sinusitis or other conditions.

Tenderness Over the Nasal Area (90% Occurrence)

Tenderness over the nasal area is common, affecting about 90% of patients with septal hematoma. Swelling and inflammation make the nose sensitive to touch. Patients may feel discomfort when pressing on the nose or wearing glasses. Tenderness may extend to the cheeks or forehead. Severe or persistent tenderness requires medical attention to prevent complications.

Diagnostic Evaluation of Septal Hematoma

Diagnosing septal hematoma involves patient history, physical examination, and diagnostic tests. A healthcare provider will ask about recent nasal trauma, such as a fall, sports injury, or surgery, and the onset and severity of symptoms. During the physical exam, the provider will inspect the inside of the nose using a nasal speculum or otoscope to check for swelling, discoloration, or blood collection in the septum. If a septal hematoma is suspected, additional tests may be ordered to confirm the diagnosis and assess the condition’s extent.

Nasal Endoscopy

Test Information

Nasal endoscopy is a diagnostic procedure that allows healthcare providers to visualize the nasal passages and septum in detail. A thin, flexible tube with a light and camera (endoscope) is inserted into the nostrils. The endoscope provides real-time images of the nasal structures, helping assess swelling, blood accumulation, and other abnormalities. Nasal endoscopy is typically performed in an outpatient setting and may involve a local anesthetic to minimize discomfort. This test is crucial for diagnosing septal hematoma, as it offers a clear view of the affected area, confirming blood collection between the septum layers.

Results that Indicate Septal Hematoma

During nasal endoscopy, the provider looks for signs of septal hematoma, such as swelling or bulging of the septum, discoloration (bluish or purple hue), and blood under the mucosal layer. If these findings are present, a septal hematoma diagnosis is likely. Signs of infection, such as pus or inflammation, may also be observed. If no signs of septal hematoma are found but symptoms persist, further testing may be recommended to rule out other conditions, such as nasal polyps or sinusitis.

Health Conditions with Similar Symptoms to Septal Hematoma

Nasal Fracture

A nasal fracture, commonly known as a broken nose, occurs when one of the nasal bones is cracked or broken, typically due to trauma from accidents, sports injuries, or physical altercations. Symptoms include pain, swelling, bruising around the nose and under the eyes, and difficulty breathing through the nose.

How to Know if You Might Have a Nasal Fracture vs. Septal Hematoma

Both nasal fractures and septal hematomas can cause nasal pain, swelling, and breathing difficulties. However, a nasal fracture often results in visible deformity or crookedness of the nose, which is uncommon with a septal hematoma. Bruising around the eyes (“raccoon eyes”) is more typical of nasal fractures, while septal hematomas present with a soft, swollen area inside the nose, particularly along the nasal septum, without external bruising.

A healthcare provider may perform a physical exam and order imaging tests, such as an X-ray or CT scan, to differentiate between the two. A nasal fracture will show a break or crack in the nasal bones, while a septal hematoma will appear as a blood collection within the nasal septum. Prompt medical attention is crucial to avoid complications from either condition.

Allergic Rhinitis

Allergic rhinitis, or hay fever, is an allergic reaction to airborne substances like pollen, dust, or pet dander. It causes sneezing, a runny or stuffy nose, itchy eyes, and postnasal drip, often occurring seasonally or after exposure to specific allergens.

How to Know if You Might Have Allergic Rhinitis vs. Septal Hematoma

Both allergic rhinitis and septal hematomas can cause nasal congestion and breathing difficulties. However, allergic rhinitis typically includes sneezing, itchy eyes, and a runny nose, which are absent in septal hematomas. Allergic rhinitis often affects both sides of the nose equally, while septal hematomas usually cause one-sided nasal obstruction.

Your healthcare provider may ask about your medical history and known allergies. Skin or blood tests may identify specific allergens. In contrast, a septal hematoma is diagnosed through a physical exam, revealing a swollen, soft mass inside the nasal septum. If you have a history of allergies and experience sneezing or itching, allergic rhinitis is more likely the cause.

Sinusitis

Sinusitis, or a sinus infection, occurs when the tissue lining the sinuses becomes inflamed, often due to infection or allergies. Symptoms include facial pain or pressure, nasal congestion, thick nasal discharge, and a reduced sense of smell. Sinusitis can be acute (short-term) or chronic (long-lasting).

How to Know if You Might Have Sinusitis vs. Septal Hematoma

Both sinusitis and septal hematomas can cause nasal congestion and breathing difficulties. However, sinusitis is more likely to cause facial pain or pressure, particularly around the forehead, cheeks, or eyes, which is uncommon in septal hematomas. Sinusitis also often presents with thick, yellow or green nasal discharge, while septal hematomas do not typically cause discharge.

Your healthcare provider may perform a physical exam and ask about your symptoms. Imaging tests, such as a CT scan, may be used to check for sinus inflammation or infection. A septal hematoma will appear as a blood-filled swelling inside the nasal septum, while sinusitis will show inflammation or fluid buildup in the sinuses. If you experience facial pain and thick nasal discharge, sinusitis is more likely the cause.

Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths that form on the lining of the nasal passages or sinuses due to chronic inflammation. They can cause nasal congestion, loss of smell, and breathing difficulties. Nasal polyps are often associated with conditions like allergies, asthma, or chronic sinusitis.

How to Know if You Might Have Nasal Polyps vs. Septal Hematoma

Both nasal polyps and septal hematomas can cause nasal congestion and breathing difficulties. However, nasal polyps usually develop gradually and are often associated with a loss of smell, which is not typical of septal hematomas. Additionally, nasal polyps are usually painless, while septal hematomas may cause significant pain and tenderness inside the nose.

Your healthcare provider may perform a nasal endoscopy, inserting a small camera into your nose to look for polyps or other abnormalities. Nasal polyps will appear as soft, fleshy growths, while a septal hematoma will appear as a swollen, blood-filled area along the nasal septum. If you have a history of chronic nasal congestion and loss of smell, nasal polyps may be the cause.

Foreign Body in the Nose

A foreign body in the nose occurs when an object, such as a small toy, bead, or food particle, becomes lodged in the nasal passages. This is more common in children but can happen to adults as well. Symptoms include nasal congestion, difficulty breathing, and sometimes a foul-smelling nasal discharge.

How to Know if You Might Have a Foreign Body in the Nose vs. Septal Hematoma

Both a foreign body in the nose and septal hematomas can cause nasal congestion and breathing difficulties. However, a foreign body is more likely to cause a foul-smelling nasal discharge, especially if the object has been lodged for some time. This is not a symptom of septal hematomas. Additionally, a foreign body may cause irritation or discomfort, but it is usually less painful than a septal hematoma.

A healthcare provider may use a nasal speculum or endoscope to look inside the nose. A foreign object will be visible in the nasal passages, while a septal hematoma will appear as a swollen, blood-filled area inside the nasal septum. If you or your child recently inserted something into the nose and are experiencing symptoms, a foreign body is more likely the cause.

Septal Perforation

A septal perforation is a hole or tear in the nasal septum, the cartilage and bone that separates the two nostrils. This can occur due to injury, surgery, or prolonged use of nasal sprays or drugs. Symptoms include nasal congestion, crusting, nosebleeds, and a whistling sound when breathing through the nose.

How to Know if You Might Have Septal Perforation vs. Septal Hematoma

Both septal perforation and septal hematomas can cause nasal congestion and breathing difficulties. However, a septal perforation is more likely to cause recurrent nosebleeds and a whistling sound when breathing, which are not typical symptoms of septal hematomas. Additionally, septal perforation may cause crusting inside the nose, while septal hematomas do not.

Your healthcare provider may perform a nasal examination using a speculum or endoscope. A septal perforation will appear as a hole or tear in the nasal septum, while a septal hematoma will appear as a swollen, blood-filled area. If you have a history of nasal surgery or frequent nosebleeds, septal perforation may be the cause of your symptoms.

Treatment Options for Septal Hematoma

Medications

Nasal Decongestants

Nasal decongestants reduce swelling in the nasal passages, making it easier to breathe. They work by constricting blood vessels in the nose, decreasing inflammation and mucus production.

These are typically used when a septal hematoma causes nasal congestion or breathing difficulties. They are often a first-line treatment to relieve symptoms, especially in the early stages. However, they should not be used for more than a few days, as prolonged use can lead to rebound congestion.

Patients can expect temporary relief from nasal congestion within minutes of using a nasal decongestant. However, the underlying hematoma will still require further treatment.

Analgesics

Analgesics relieve pain and range from over-the-counter options like acetaminophen to stronger prescription medications.

They are used to manage pain associated with a septal hematoma, especially after procedures like drainage. Mild analgesics are typically used first, with stronger options reserved for more severe pain.

Patients can expect pain relief within an hour of taking an analgesic. The duration of relief depends on the type of medication used.

Antibiotics

Antibiotics kill or inhibit the growth of bacteria and are used to prevent or treat infections.

In the case of a septal hematoma, antibiotics are prescribed if there’s concern about infection, particularly after drainage procedures. They may also be used if the hematoma has been present for some time, as this increases the risk of infection. Antibiotics are not typically a first-line treatment but are essential in preventing complications.

Patients can expect a reduction in infection risk and symptoms like fever or swelling within a few days of starting antibiotics. Full recovery from infection may take up to a week or more, depending on the severity.

Corticosteroids

Corticosteroids are anti-inflammatory medications that reduce swelling and suppress the immune system’s response.

These may be used in cases where inflammation is severe or if the septal hematoma is causing significant swelling and discomfort. Corticosteroids are not typically a first-line treatment but may be used when other medications or procedures have not been fully effective.

Patients can expect reduced swelling and discomfort within a few days of starting corticosteroids. However, these medications are generally used for short-term relief due to potential side effects.

Antihistamines

Antihistamines block the effects of histamine, a substance in the body that causes allergic symptoms like sneezing, itching, and swelling.

They may be used if a septal hematoma is associated with allergic reactions or if allergies are contributing to nasal congestion. They are not a primary treatment for the hematoma itself but can help manage symptoms that worsen the condition.

Patients can expect relief from allergy-related symptoms within an hour of taking antihistamines. However, these medications do not address the hematoma directly.

Saline Nasal Spray

Saline nasal sprays are saltwater solutions that help keep the nasal passages moist and clear of irritants.

These sprays are often recommended as part of aftercare following drainage procedures or to relieve nasal dryness and congestion. They are safe for long-term use and can be used alongside other treatments.

Patients can expect immediate relief from nasal dryness and mild congestion. Saline sprays also help promote healing by keeping the nasal passages clean.

Topical Vasoconstrictors

Topical vasoconstrictors are applied directly to the nasal tissues to constrict blood vessels and reduce swelling.

These medications may be used in cases of severe nasal swelling or bleeding. They are often used in a clinical setting before or after procedures like drainage to control bleeding and reduce swelling.

Patients can expect a reduction in swelling and bleeding within minutes of application. However, these medications are typically used for short-term relief under medical supervision.

Pain Relievers

Pain relievers, such as acetaminophen or ibuprofen, are commonly used to manage mild to moderate pain.

These medications are often recommended after procedures like drainage or incision to help control discomfort. They are typically used as needed and are available over the counter.

Patients can expect pain relief within 30 minutes to an hour, with effects lasting several hours depending on the medication used.

Antipyretics

Antipyretics reduce fever, such as acetaminophen or ibuprofen.

These medications may be used if a septal hematoma is associated with an infection that causes fever. They are not a primary treatment for the hematoma but help manage symptoms of infection.

Patients can expect a reduction in fever within an hour of taking an antipyretic. Fever control is important for managing overall comfort and preventing complications.

Procedures

Drainage

Drainage is a procedure where a doctor uses a needle or small incision to remove the blood accumulated in the septum.

This is the most common treatment for a septal hematoma and is typically performed as soon as the condition is diagnosed to prevent complications like infection or tissue death. Drainage is often done in a clinical setting under local anesthesia.

Patients can expect immediate relief from pressure and discomfort after drainage. However, follow-up care is essential to ensure the hematoma does not reoccur.

Incision and Drainage

Incision and drainage involve making a small cut in the septum to allow the blood to drain. This is a more invasive procedure than simple needle drainage.

This procedure is used when the hematoma is large or has been present for a longer period. It is typically performed under local anesthesia, and the incision may be left open temporarily to allow for continued drainage.

Patients can expect significant relief from symptoms after the procedure, though some discomfort may persist for a few days. Follow-up care, including packing the nose or using nasal sprays, is often required.

Improving Septal Hematoma and Seeking Medical Help

While medical treatment is essential for resolving a septal hematoma, several home remedies can support healing and improve comfort. Resting and avoiding strenuous activities can reduce the risk of further injury to the nose. Applying ice to the affected area can reduce swelling and discomfort, while elevating the head during sleep can help minimize pressure in the nasal passages.

Humidifying the air in your home and using saline nasal sprays can keep the nasal passages moist, promoting healing and reducing irritation. Staying hydrated is also important for overall recovery. Additionally, avoiding allergens and gently cleaning the nose can prevent further irritation and complications.

It is crucial to seek medical help if you suspect a septal hematoma. Telemedicine offers a convenient way to consult with a healthcare provider from the comfort of your home. Our primary care practice can assess your symptoms, recommend appropriate treatments, and guide you on the next steps, including whether an in-person procedure is necessary.

Living with Septal Hematoma: Tips for Better Quality of Life

Living with a septal hematoma can be uncomfortable, but with the right care, you can manage your symptoms and prevent complications. Following your doctor’s advice, including taking prescribed medications and attending follow-up appointments, is essential for a full recovery. Avoiding further trauma to the nose is critical, so take care during daily activities and sports.

Maintaining good nasal hygiene by using saline sprays and keeping the nasal passages moist can promote healing and prevent infections. If you experience any new symptoms, such as increased pain, fever, or difficulty breathing, seek medical attention promptly.

Conclusion

Septal hematoma is a condition that requires prompt medical attention to prevent serious complications like infection or tissue damage. Early diagnosis and treatment, including drainage and medications, are crucial for a full recovery. Home remedies such as rest, ice application, and nasal care can support healing, but medical intervention is often necessary.

If you suspect you have a septal hematoma, don’t wait. Our telemedicine practice offers a convenient way to consult with a healthcare provider and get the care you need. Early treatment can make all the difference in preventing complications and ensuring a smooth recovery.

James Kingsley

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