Is it safe for a patient to blow their nose?

Is It Safe for a Patient to Blow Their Nose?

In general, patients should avoid blowing their nose if they have nasal packing in place, have recently had nasal surgery, or are experiencing a nosebleed. 1

When to Avoid Nose Blowing

After Nosebleeds

• Patients who have experienced a nosebleed should avoid blowing their nose as this can disrupt clot formation and cause rebleeding
• According to the Clinical Practice Guideline for Nosebleeds, patients should avoid straining activities that increase blood flow to the nose, which includes vigorous nose blowing 1
• This restriction is particularly important when nasal packing is in place

After Nasal/Sinus Procedures

• Following sinus augmentation procedures, patients should refrain from blowing their nose for at least 1 week 1
• After sinus procedures, patients should also avoid flying, diving, forceful sneezing, or playing wind instruments for at least 6 weeks 1
• For patients who have had nasal surgery or procedures involving the sinuses, nose blowing can disrupt healing and potentially cause complications

During Active Respiratory Infections

• For patients with COVID-19 or other respiratory infections, nose blowing can potentially generate aerosols, though this risk is less than with procedures like high-flow nasal oxygen 1

Normal Nose Blowing Patterns

• Research shows that healthy individuals without rhinitis typically blow their nose less than 4 times per day 2
• More frequent nose blowing (>4 times daily) may be indicative of rhinitis or other nasal conditions

Proper Technique When Nose Blowing Is Permitted

When nose blowing is appropriate and necessary:

• The European Position Paper on Rhinosinusitis and Nasal Polyps (2020) recommends blowing the nose prior to using nasal sprays to clear secretions 1
• Patients should avoid forceful nose blowing with both nostrils closed, as this generates significantly higher pressures (>900 daPa) that could potentially contribute to sinus problems 3
• Blowing one nostril at a time while keeping the other open generates lower pressures and is safer

Special Considerations

For Patients with Nasal Packing

• The Clinical Practice Guideline for Nosebleeds explicitly states: "In general, you should not try to blow your nose if you have packing in place" 1
• If a patient feels the need to sneeze while having nasal packing, they should sneeze with their mouth open to reduce pressure 1

For Patients with Epistaxis (Nosebleeds)

• After treatment for nosebleeds, patients should avoid activities that increase nasal blood flow, including nose blowing 1
• If nasal secretions need to be cleared, gentle irrigation may be preferable to blowing once acute bleeding has resolved

For Patients After Facial Fracture Repair

• Following treatment of zygomatic (cheek) fractures, advice on nose blowing varies widely among surgeons, ranging from no restrictions to avoiding nose blowing for up to 8 weeks 4
• This highlights the need for individualized guidance from the treating surgeon

Alternatives to Nose Blowing

• For patients who need to clear nasal secretions but should avoid blowing:
  • Nasal saline irrigation may be recommended once healing has progressed sufficiently
  • The American Academy of Otolaryngology recommends proper irrigation techniques rather than sprays for effectively expelling secretions 5
  • Gentle wiping of the nasal vestibule without blowing may be appropriate

Warning Signs

Patients should contact their healthcare provider if they experience:

• Return of blood from the nose or mouth
• Fever over 101°F
• Increasing pain
• Vision changes
• Shortness of breath
• Swelling of the face 1

In conclusion, while nose blowing is a normal activity for healthy individuals, it should be avoided in specific clinical situations, particularly after nosebleeds, with nasal packing in place, or following nasal/sinus procedures. Patients should follow the specific guidance of their healthcare provider regarding when it is safe to resume nose blowing.