Is cryotherapy (cryosurgical treatment) safe for use on the nose?

Cryotherapy on the Nose: Safety and Efficacy

The usefulness of cryotherapy (ice) for managing conditions on the nose is unknown and lacks sufficient supporting evidence for routine clinical use. 1

Safety Considerations for Nasal Cryotherapy

• Current evidence does not support recommendations for using cryotherapy as a first aid intervention for nasal conditions such as epistaxis (nosebleeds) 1
• No serious adverse events have been reported with cryotherapy for nasal conditions, but common complications include epistaxis and nasal obstruction 2
• Application methods for nasal cryotherapy in studies have been inconsistent, with ice applied to various locations including the forehead, mouth, neck, feet, or combinations of sites, but rarely directly to the nose itself 1
• The American Heart Association and American Red Cross do not recommend cryotherapy for epistaxis management due to insufficient evidence 1

Evidence on Efficacy

• Studies examining cryotherapy effects on nasal blood flow and volume show mixed results:

  • One randomized crossover study (16 adults) reported significant decrease in nasal mucosal blood flow (23% vs 5%) with ice packs inside the mouth compared to forehead application 1
  • Another randomized crossover study (13 adults) found lower nasal submucosa temperature with ice cubes compared to forehead ice packs 1
  • However, an observational study (56 healthy adults) showed no change in nasal mucosal blood flow after applying ice packs around the neck 1
  • Another study (15 healthy adults) reported no significant change in nasal blood volume after 10-minute ice collar application to the neck 1

• For chronic rhinitis treatment, cryotherapy has shown some promise:

  • A 2024 systematic review and meta-analysis found improvements in nasal symptom scores and quality of life measures after cryotherapy for chronic rhinitis 3
  • Cryotherapy showed effectiveness for nasal obstruction in 61% of patients and for rhinorrhea in 52% of patients with complete relief 3

Clinical Application

• For epistaxis (nosebleeds):

  • The recommended first-line approach is to have the person sit with head slightly forward and pinch the nostrils for 10-15 minutes 1, 4
  • Seek medical attention if bleeding doesn't stop after 15 minutes of continuous pressure 1
  • Patients taking anticoagulants or antiplatelet medications should seek medical care unless bleeding has stopped 1, 4

• For chronic rhinitis:

  • Office-based cryotherapy procedures targeting the posterior nasal nerve region have shown promising results in symptom reduction 5
  • Both allergic and non-allergic rhinitis patients may benefit from cryotherapy treatment 2, 5

Common Pitfalls and Caveats

• Gray literature recommendations for cryotherapy in epistaxis management are likely based on theory rather than evidence 1
• The theory that cryotherapy induces vasoconstriction in nasal mucosa lacks sufficient clinical validation 1
• Application times for cryotherapy varied between studies, making standardized recommendations difficult 1
• There is a significant knowledge gap regarding cryotherapy for nasal conditions, with the American Heart Association highlighting the need for clinical research studies 1

Conclusion for Clinical Practice

• For epistaxis management, rely on proven methods like nasal pressure rather than cryotherapy 1, 4
• For chronic rhinitis, professionally administered cryotherapy may be considered when medical treatments fail, but should be performed by specialists 2, 5
• The evidence base for nasal cryotherapy remains limited, with more high-quality randomized controlled trials needed 6, 3