Abscess in the Nose

What is a nose abscess?

An abscess is the body's way of walling off an infection. White blood cells, dead tissue and bacteria collect into a pocket of pus surrounded by inflamed tissue. In the nose this happens in three main places:

The most common by far is the nasal furuncle, which is a boil inside the nostril. It often follows nasal vestibulitis, a milder infection of the skin at the nostril opening.

Symptoms of an abscess in the nose

• a red, swollen, shiny bump inside or on the nose
• throbbing pain and marked tenderness, so even touching the tip of the nose hurts
• a yellow or white point (head) as pus collects
• swelling and redness of the nose tip or upper lip
• blocked nose on the affected side, or both sides with a septal abscess
• fever, tiredness and feeling unwell in larger infections
• crusting, discharge or minor bleeding from the nostril

A septal abscess is easy to miss. It usually appears 2 to 7 days after a nose injury, with increasing nasal blockage, pain across the nose and sometimes fever. Inside both nostrils a soft, red swelling bulges from the septum.

Causes and risk factors

Staphylococcus aureus lives harmlessly in the nostrils of about a third of people. It causes infection when it gets into broken skin or a hair follicle. Triggers include:

• nose picking or vigorous nose blowing
• plucking or trimming nasal hairs
• nose piercings
• a cold or allergies that cause constant wiping and cracked skin
• a nose injury that leaves a blood clot in the septum (septal hematoma)
• recent nasal surgery

You are more at risk if you have diabetes, a weakened immune system, eczema around the nose, or carry MRSA, a strain of staph resistant to common antibiotics.

The danger triangle of the face

The area from the corners of the mouth to the bridge of the nose drains blood through veins that connect with the cavernous sinus, a large vein at the base of the brain. These veins have no valves, so infection can rarely travel backward.

Possible serious complications include:

• Spreading cellulitis of the face
• Orbital or periorbital cellulitis: infection around the eye
• Cavernous sinus thrombosis: an infected blood clot near the brain, causing severe headache, eye swelling, double vision and high fever. This is rare but life-threatening
• Meningitis or brain abscess: very rare

With a septal abscess there is another risk: pus cuts off the blood supply to the septal cartilage, which can die within days. This can cause a hole in the septum or collapse of the nasal bridge (saddle nose deformity). That is why a septal abscess is drained urgently.

This is why you should never squeeze or pick at a boil in or near the nose.

How it is diagnosed

A doctor can usually diagnose a nose abscess by looking inside the nostril with a light and a small speculum. They will check for spreading redness, eye involvement and fever. Tests may include:

• a swab of any pus, to identify the bacteria and check for MRSA
• blood tests if you have fever or appear unwell
• a CT scan if a septal abscess, spread to the eye socket or sinus involvement is suspected

Treatment

Small nasal furuncles

• Warm compresses: a clean, warm, damp cloth held to the nose for 10 to 15 minutes, 3 to 4 times a day, helps the boil come to a head and drain on its own.
• Antibiotic ointment applied inside the nostril, such as mupirocin, which needs a prescription in the US.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Hands off: do not squeeze, pick or pop it.

Larger or spreading abscesses

• Oral antibiotics that cover staph, chosen to also cover MRSA if it is common in your area or you have had it before. Finish the full course.
• Incision and drainage: a doctor numbs the area and makes a small cut to let the pus out. This gives fast relief and is often needed if the abscess is large or not improving after 48 hours.
• Hospital admission and intravenous antibiotics if there is spreading cellulitis, eye involvement, high fever, or a weak immune system.

Septal abscess

This needs same-day care from an ear, nose and throat (ENT) specialist. The abscess is drained through a small cut inside the nose, the nostrils may be packed or splinted, and antibiotics are given. Prompt drainage usually saves the cartilage.

Preventing nose abscesses

• Avoid picking your nose or plucking nasal hairs. Trim them with rounded scissors or a trimmer instead.
• Wash your hands often, and keep nails short.
• Treat cracked, crusty skin at the nostrils with a bland ointment such as petroleum jelly.
• See a doctor promptly after a nose injury that causes blockage of both sides, to check for a septal hematoma.
• If you get repeated boils, ask your doctor about decolonization: a short course of antiseptic body wash and nasal ointment to reduce staph carriage.

Frequently asked questions

How do I know if I have an abscess in my nose?

Look for a very tender, red, swollen bump inside the nostril or on the nose, often with a yellow or white head and throbbing pain. The nose tip may be swollen and painful to touch. Fever, spreading redness or swelling near the eye mean you need to see a doctor quickly.

Can a nose abscess go away on its own?

A small boil at the nostril edge may drain and heal on its own within a week with warm compresses. Larger abscesses, those with fever or spreading redness, and any septal abscess need medical treatment with antibiotics and often drainage.

Should I pop a boil in my nose?

No. Squeezing a boil in the nose can push bacteria deeper into the tissue and into veins that connect to the area around the brain. Use warm compresses and let it drain naturally, or have a doctor drain it under sterile conditions.

Why is a nose infection called dangerous?

The nose sits in the danger triangle of the face, where veins drain toward the cavernous sinus near the brain. In rare cases infection spreads along them and causes a clot or meningitis. Prompt treatment of nose abscesses makes this very unlikely.

How long does a nose abscess take to heal?

With proper treatment, most nasal furuncles improve within 2 to 3 days and heal within 1 to 2 weeks. After drainage of a larger abscess, pain eases quickly, and the wound usually heals within a week or two.