At Melbourne ENT, located in St Kilda East, Victoria, our skilled ENT surgeons, Dr Stephen Kleid and Dr Simon Braham, offer expert diagnosis and treatment for a wide range of ENT conditions. With decades of combined experience in ENT and head and neck surgery, our clinic is dedicated to providing comprehensive, patient-centred care for conditions like septal hematoma. Whether caused by trauma, surgery, or an underlying issue, our team ensures prompt and effective treatment to preserve nasal function and aesthetics. Our clinic is equipped with state-of-the-art diagnostic tools and a supportive team to guide patients from diagnosis to recovery.
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What is Septal Hematoma?
A septal hematoma is a collection of blood between the nasal septum (the cartilage dividing the nostrils) and its overlying mucosal lining. This condition typically results from blunt trauma to the nose – common in sports injuries, accidents, or post-operative complications. In some cases, minor trauma may go unnoticed initially, with symptoms developing over time. The trapped blood can obstruct airflow, cause discomfort, and if not addressed quickly, lead to serious complications including infection, septal abscess, cartilage necrosis, and permanent deformity of the nose.
A septal hematoma is considered a medical emergency due to the risk of compromising the blood supply to the septal cartilage. This makes early identification and intervention critical.
Common Symptoms of Septal Hematoma
Nasal Symptoms:
- Sudden nasal obstruction or blockage on one or both sides
- Swelling or tenderness inside the nostril
- Difficulty breathing through the affected side
- Redness or visible bulging within the nasal cavity
General Symptoms:
- Facial discomfort or pressure, especially over the nasal bridge
- Headache or sinus-like symptoms
- Fever or signs of systemic infection in advanced cases
Aesthetic Symptoms (if untreated):
- Nose may appear flattened or deformed over time
- Possible development of a “saddle nose” due to cartilage collapse
If any of these symptoms follow nasal trauma, urgent medical assessment is essential.
Who is Affected by Septal Hematoma?
Septal hematomas can affect anyone but are more common among:
- Children and adolescents: Their septal cartilage is softer and more susceptible to injury. They may also be less able to communicate discomfort, leading to delayed diagnosis.
- Athletes: Especially in high-contact sports such as rugby, AFL, boxing, and soccer.
- Post-operative patients: Following nasal surgeries like septoplasty, rhinoplasty, or sinus procedures.
- Individuals with bleeding disorders: Including those on blood thinners or with conditions like haemophilia.
- Patients with recent nasal infections: Increased vascular fragility may predispose to hematoma formation.
Awareness and early intervention in these groups can prevent complications.
Diagnosis and Evaluation at Melbourne ENT
At Melbourne ENT, our thorough evaluation process ensures timely and accurate diagnosis:
- Detailed medical history: Including the timing, mechanism, and severity of nasal trauma or surgery.
- Focused physical examination: Gentle inspection with a nasal speculum reveals swelling or fluctuation in the septal lining.
- Nasal endoscopy: A fibre-optic camera offers a detailed view of internal nasal structures to assess extent and side(s) affected.
- Imaging (when indicated): CT scans are used to rule out associated facial fractures or sinus injuries.
Our clinicians prioritise comfort during evaluation and explain each step of the process clearly.
Treatment Options for Septal Hematoma
Effective treatment of septal hematoma involves:
- Prompt surgical drainage: A small incision is made to release the accumulated blood and relieve pressure on the septum.
- Nasal packing or silicone splints: These help maintain septal alignment and prevent reaccumulation of fluid.
- Antibiotic therapy: Oral or intravenous antibiotics reduce the risk of septal abscess formation.
- Pain relief and anti-inflammatory medication: To manage discomfort and reduce swelling.
In some cases, particularly where the hematoma is large or recurrent, additional procedures may be needed to repair cartilage damage.
When is Surgery Recommended?
Surgical intervention is often the first-line treatment due to the urgency of decompressing the hematoma. Surgery is recommended when:
- The hematoma is confirmed through clinical examination or imaging
- There is significant nasal obstruction or asymmetry
- Signs of infection or abscess are present
- Conservative measures fail, or hematoma recurs after initial drainage
Our surgeons at Melbourne ENT perform these procedures with precision and care, using the latest techniques to minimise discomfort and maximise functional and cosmetic outcomes. Secondary corrective procedures, such as septoplasty or reconstructive rhinoplasty, may be discussed if there is cartilage damage or aesthetic concern post-recovery.
Recovery and Prognosis
Recovery from septal hematoma treatment is typically swift and uneventful with timely care:
- Initial recovery: Nasal packing is usually removed within 3-5 days, depending on the extent of surgery.
- Post-operative care: Includes saline nasal sprays, avoiding nose-blowing, and following antibiotic regimens.
- Monitoring for recurrence: Follow-up appointments allow assessment for healing and early detection of complications.
- Activity restrictions: Patients should avoid strenuous activity, trauma, or sports for at least 2 weeks.
With prompt and proper treatment, the long-term prognosis is excellent. Most patients regain full nasal function with no lasting deformity.
Risks or Complications if Left Untreated
Delaying treatment for a septal hematoma can lead to:
- Septal abscess: An infected hematoma can result in pus collection and spread to surrounding tissues.
- Cartilage necrosis: Blood supply loss causes cartilage death, compromising structural integrity.
- Nasal septum perforation: A permanent hole in the septum can result in whistling, crusting, and breathing difficulties.
- Saddle nose deformity: Aesthetic and functional deformity caused by collapse of the nasal bridge.
- Chronic nasal obstruction: Persistent blockage and sinus issues due to structural damage.
Early treatment at Melbourne ENT helps avoid these serious outcomes.
FAQs About Septal Hematoma
Can a septal hematoma heal on its own without treatment?
No, a septal hematoma typically does not resolve on its own. Without drainage, it can lead to infection, cartilage damage, and permanent nasal deformity.
What does a septal hematoma feel like from the patient’s perspective?
Many describe it as a blocked or stuffed nose that doesn’t improve with decongestants. It may feel tender or painful to the touch and often causes asymmetric nasal airflow.
How quickly after nasal trauma should I be concerned about a septal hematoma?
Symptoms can appear within hours of the injury. If nasal blockage or swelling develops, especially on one side, seek medical attention immediately.
Could a septal hematoma affect my sense of smell?
Yes. While not common, nasal blockage and inflammation can reduce airflow to the olfactory area, leading to a temporary loss or reduction in the sense of smell.
Is a septal hematoma ever related to sinus infections or colds?
While more often due to trauma, severe inflammation or infection can sometimes lead to mucosal bleeding and hematoma formation, though this is rare.
Can children get septal hematomas without obvious injury?
Yes. Minor unnoticed trauma, such as rough play or even a hard sneeze, can cause bleeding under the septal lining in young children. Their cartilage is more pliable and vulnerable.
What long-term follow-up is needed after treatment?
Most patients require at least one follow-up visit within a week to check healing. In cases with cartilage damage or aesthetic concerns, longer monitoring and potential future correction may be discussed.
Sources:
- Prevalence of nasal septal hematoma and vestibulitis in patients visiting the emergency department in Saudi Arabia
https://www.ijmdc.com/?mno=236073 - The occasional nasal septal hematoma management
https://journals.lww.com/cjrm/fulltext/2025/01000/the_occasional_nasal_septal_hematoma_management.8.aspx - Unmasking Nasal Septal Hematoma/Abscess: A Systematic Review
https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/abs/10.1002/oto2.174 - Evaluation of the management of nasal septal haematoma and abscess: A systematic review
https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/evaluation-of-the-management-of-nasal-septal-haematoma-and-abscess-a-systematic-review/52B50A97D53BA482CB550B61FD8366F8 - Nasal septal hematoma in children: Time to diagnosis and resulting complications
https://www.sciencedirect.com/science/article/abs/pii/S0165587621001270 - Post-traumatic interventricular septal hematoma in a dog (relevant for comparative pathology and trauma)
https://www.sciencedirect.com/science/article/pii/S1760273425000608 - Nasal Septal Hematoma – StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK470247/
Concerned About Septal Hematoma?
If you or someone you care for has suffered nasal trauma or is showing signs of nasal blockage, swelling, or discomfort, don’t wait. Septal hematomas require swift diagnosis and expert care to prevent long-term issues.
Book your consultation with our experienced team or Contact us at (03) 9038 1630 / (03) 9038 1311.
We are here to support your recovery, restore function, and protect the health and appearance of your nose.
Further Reading
- Read about Melbourne ENT’s Nose Anatomy for Nose Surgery Patients
- Read about Melbourne ENT’s Surgery For Nasal Obstruction Melbourne
- Read about Melbourne ENT’s Using the NOSE Scale Score to assess Nasal Obstruction
