What are the treatment options for a scratch and swelling inside the nose?

Treatment of Nasal Scratch and Swelling

For a scratch and swelling inside the nose, the primary treatment consists of nasal saline irrigation combined with topical lubricants or moisturizing agents, with the addition of topical intranasal corticosteroids if inflammation is significant. 1, 2

Initial Assessment and Management

The first priority is to determine if there is active bleeding or risk of bleeding from the scratch:

• Apply firm sustained compression to the soft part of the nose for 10-15 minutes if any bleeding is present, with the head tilted forward to prevent blood aspiration 3, 4
• Assess for signs of infection including fever, increasing pain, or purulent discharge that would require different management 3
• Evaluate whether the injury is superficial mucosal trauma versus deeper tissue involvement 3

First-Line Treatment Approach

Nasal Saline Irrigation

• Nasal saline irrigation is the cornerstone of treatment for intranasal injuries, as it promotes mucosal healing, improves clearance of debris, and maintains moisture 1, 2
• Perform irrigation 2-3 times daily by tilting the head forward over a sink, breathing through the mouth, and allowing solution to flow through the nasal passages 2
• This provides mechanical cleansing while preventing crust formation that can impede healing 3

Topical Lubricants and Moisturizing Agents

• Apply nasal lubricants such as aqueous gel, 25% glucose and glycerine drops, or honey ointment to keep the injured mucosa moist and facilitate healing 3
• These agents prevent drying and crusting that can delay healing and cause discomfort 3
• Apply 2-3 times daily, particularly after saline irrigation 3

Topical Intranasal Corticosteroids

• Add topical intranasal corticosteroids if significant swelling or inflammation is present, as they effectively reduce mucosal edema and inflammatory response 1, 2
• These are particularly useful when swelling is the predominant symptom 1
• Continue for 7-14 days depending on symptom resolution 1

Pain Management

• Use acetaminophen (Tylenol) for pain relief, as it does not increase bleeding risk 3
• Avoid aspirin and ibuprofen during the acute healing phase, as these medications can increase bleeding risk from the injured area 3

What NOT to Do

• Do not use topical decongestants beyond 3-5 days, as prolonged use can cause rebound congestion (rhinitis medicamentosa) and may impair healing 3, 5
• Avoid nose blowing during the initial healing period to prevent disruption of the injured tissue 3
• Do not apply nasal cautery unless there is persistent bleeding that cannot be controlled with conservative measures 3
• Antibiotics are not indicated unless there are clear signs of bacterial infection (fever, purulent discharge, worsening pain) 5, 6

Activity Restrictions During Healing

• Avoid straining, lifting over 10 pounds, bending over, and vigorous exercise that could increase nasal blood flow 3
• Sleep with the head slightly elevated to reduce swelling 3
• If sneezing occurs, sneeze with mouth open to reduce intranasal pressure 3

Warning Signs Requiring Reassessment

Seek immediate medical attention if any of the following develop:

• Return of bleeding that does not stop with 15 minutes of compression 3
• Fever over 101°F (38.3°C) 3, 6
• Increasing or severe pain 3
• Vision changes or swelling around the eyes 3
• Difficulty breathing 3
• Signs of septal perforation (whistling sound with breathing, visible hole) 3

Follow-Up and Expected Course

• Reassess after 7 days of treatment to evaluate healing progress and symptom resolution 1
• Most superficial nasal mucosal injuries heal within 7-14 days with appropriate conservative management 1
• Consider referral to otolaryngology if symptoms persist beyond 2 weeks, if there is concern for septal perforation, or if recurrent trauma occurs 3, 1

Common Pitfalls to Avoid

• Underutilizing simple saline irrigation, which is highly effective and has minimal side effects 2
• Prescribing antibiotics without evidence of bacterial infection, which exposes patients to unnecessary risks 5, 6
• Using topical decongestants for extended periods, leading to medication-induced rhinitis 3, 5
• Failing to provide adequate patient education about proper irrigation technique and the importance of maintaining nasal moisture 2