What is the cause of nasal ulcers in a patient receiving oxygen (O2) therapy?

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Last updated: May 30, 2025View editorial policy

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From the Guidelines

Nasal ulcers in patients receiving oxygen therapy should be managed by reducing pressure points, applying water-based lubricants, and humidifying supplemental oxygen to prevent infection and promote healing. To manage nasal ulcers, first reduce pressure points by ensuring proper fit of nasal cannulas or masks, using padding at pressure points, and rotating device position when possible. Apply water-based lubricants like AquaphorⓇ or petroleum jelly to the nasal mucosa 2-3 times daily to maintain moisture, as recommended by recent guidelines 1. For established ulcers, consider mupirocin ointment applied to the affected areas three times daily for 5-7 days to prevent infection. Humidification of supplemental oxygen is essential - ensure humidifiers are properly filled and functioning, as high-flow nasal oxygen therapy has been shown to be beneficial in hospitalized patients with acute respiratory failure 1. Saline nasal sprays used 3-4 times daily can help maintain mucosal moisture. These interventions work by addressing the underlying causes of nasal ulceration: mechanical trauma, dryness, and reduced blood flow to compressed tissues. Regular assessment of the nasal mucosa is important, especially in patients requiring long-term oxygen therapy, as early intervention can prevent progression to more severe tissue damage. Some key points to consider when managing nasal ulcers in patients receiving oxygen therapy include:

  • Reducing pressure points to prevent mechanical trauma
  • Applying water-based lubricants to maintain moisture
  • Humidifying supplemental oxygen to prevent dryness
  • Using saline nasal sprays to maintain mucosal moisture
  • Regularly assessing the nasal mucosa to prevent progression to more severe tissue damage. The most recent and highest quality study 1 supports the use of high-flow nasal oxygen therapy in hospitalized patients with acute respiratory failure, which can help to reduce the risk of nasal ulcers.

From the Research

Nasal Ulcers in Patients with Oxygen Therapy

  • There is no direct evidence in the provided studies that links nasal ulcers with oxygen therapy 2, 3, 4, 5, 6.
  • However, oxygen therapy is known to accelerate healing and reduce healing times in general 2.
  • Nasal saline irrigation is a common treatment for upper respiratory conditions and may help with symptom relief, but its connection to nasal ulcers is not explicitly mentioned in the studies 3, 4, 5, 6.
  • The use of saline nasal irrigation has been shown to be beneficial in reducing symptom severity in pediatric acute upper respiratory infections, but its effect on nasal ulcers is not specified 6.
  • Further research is needed to determine the relationship between nasal ulcers, oxygen therapy, and nasal saline irrigation.

Possible Related Factors

  • Nasal saline irrigation has been shown to improve mucociliary clearance, reduce edema, and decrease antigen load in the nasal and sinus cavities, which may indirectly affect the development or healing of nasal ulcers 3, 4, 5.
  • The use of oxygen therapy may have an impact on the healing process of nasal ulcers, but more research is needed to confirm this 2.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Oxygen therapy: evidence base.

Journal of wound care, 2020

Research

Nasal saline irrigation: a clinical update.

International forum of allergy & rhinology, 2019

Research

Saline nasal irrigation for upper respiratory conditions.

American family physician, 2009

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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