Private nose injury & nosebleeds clinic in London, same-day ENT.

Why we do not X-ray a broken nose

The nose is mostly cartilage, which does not show up on X-ray, and knowing whether a small bone is cracked does not change what we do. What matters is how the nose looks and whether you can breathe through it. That is judged by examining the nose once the swelling has settled.

What is normal in the first week

• Pain, swelling and tenderness over the bridge.
• Bruising that slides downwards under one or both eyes after two to five days. Black eyes look alarming and are usually nothing more than gravity.
• A blocked nose, and a nose that looks a different shape while it is swollen.
• Small nosebleeds, especially in the first day or two.

Take paracetamol or ibuprofen at the dose on the packet. An ice pack — ice or frozen peas in a bag, wrapped in a damp towel — held on for about 10 minutes every two to four hours helps the swelling in the first couple of days. Never put ice straight against the skin.

If your nose bleeds again

1. Sit up and lean forward. Do not tip your head back — that sends blood down your throat and makes you feel sick.
2. Pinch the soft part of the nose, just below the bony bridge, firmly between finger and thumb. Breathe through your mouth.
3. Hold for a full 15 minutes without letting go to check. Releasing early is the commonest reason a nosebleed will not settle. Time it on a clock.
4. If it is still bleeding after 20 minutes of continuous pressure, get urgent medical help.

Once it has stopped: no blowing, picking or putting anything up the nose for 24 hours at least, and ideally for two to three days, while the clot is fragile. Avoid hot drinks, alcohol, hot baths and heavy lifting for the rest of the day. Do not take aspirin unless a doctor has prescribed it for you.

Once the swelling has gone down	No	Yes
Is your nose still noticeably swollen?
Has your nose changed shape, and would you want that corrected?
Has your nose felt permanently blocked since the injury?
Has clear fluid been running from your nose since the injury?

If you have answered no to all four, you do not need any further treatment. Your nose will settle on its own.

You need to be seen if the shape has changed and you want it corrected, if you cannot breathe through the nose, or if there is fluid leaking from it.

Looking after your nose while it heals

• A broken nose takes around four to six weeks to knit. Avoid anything that risks another knock during that time, including contact sports.
• Sleep with your head slightly raised for the first few nights to reduce swelling.
• If you wear glasses and the bridge is sore, rest them elsewhere or pad them for a week or two.