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Old 09-17-2019, 06:45 AM
Eva Luna is online now
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Broke my nose yesterday. What questions do I need to ask the ENT?


Yesterday morning I tripped and face-planted on the sidewalk while rushing to get to work on time and broke my nose 2 blocks from my office. Because I work in the same building as a large health insurance company, a family physician saw me fall and helped me deal with the aftermath (I did manage to talk her into hailing me a taxi instead of calling me an ambulance, and am forever grateful that my GP always gets me in the same day if I need it).

Apparently the fracture is severe enough that the X-ray tech's first reaction was "so you always wanted a nose job, right?" (I didn't and still don't). So I have an ENT consult this morning. Other than "is your proposed treatment covered," what other questions should I be asking?

(If I do need surgery, I will definitely ask about dealing with polyps at the same time. A different ENT told me 20+ years ago that removing them would help my sinus issues, but I never did anything about it because I didn't want surgery and couldn't have dealt with it at the time, anyway.)

Also, is there anything I can do in the near term to make it less painful to wear glasses? That's the biggest immediate issue - it actually doesn't really hurt unless I'm touching it. The problem is that I pretty much need them to read, and my job basically entails reading all day. I've never had contacts - my eyes are too sensitive to deal with them. It literally took me years even to be ale to wear eyeliner, and the eye doctor always has a hard time doing the puff test.
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Old 09-17-2019, 09:40 AM
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:: bump :: no thoughts? I have to leave the house for the doc in a bit.
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Old 09-17-2019, 10:10 AM
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I'm sorry you got hurt.

I think you've got a solid list of questions for the doc. I would add asking him what all the treatment options are, and what the outcomes are likely to be for each.
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Old 09-17-2019, 10:13 AM
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"Don't let my appearance fool you, you should see the other guy." My concern would be postoperative pain management.
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Old 09-17-2019, 11:59 AM
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Update: tentatively he doesn't think it looks that bad and won't require surgery, but he won't know for sure until the swelling goes down. In the meantime, though, the radiology report came back, and I also fractured my orbital bone. Which also doesn't require surgery, but wow, I really did a number on myself!

Also, he didn't see any polyps, so at least there's that!
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Old 09-17-2019, 12:52 PM
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Ouch!

Healing regimen: What you need to do to help it heal straight and well. What you need to avoid. Any foods that will help or hinder?

Pain management: Ask about non-opioid options. Things like alternating tylenol (or another acetaminophen) and ibuprofen (or another NSAID).

Miscellaneous problems: Ask how to deal with drainage problems. Can you safely blow your nose without making things worse? Does the swelling affect your sleep too much?

Also, I recommend seeing an eye doctor to make sure your vision hasn't been affected.

And, if you can afford it, see a neurologist. Can't be too careful with your brain. You might want to discuss with them exactly how you fell.

Get and be well.
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Old 09-17-2019, 12:54 PM
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Ouchy. No surgery is good. I had a eff-ed up face due to a car accident. I sympathise. I couldn't wear contacts for over a year. And glasses were painful in lots of places. There's no easy answer, I'm afraid. Good luck.
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Old 09-17-2019, 12:59 PM
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I have no advice, but damn, you sure did do a number on yourself!

I wish you good healing.
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Old 09-17-2019, 01:01 PM
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"Will I ever be able to play the nose harp again?"
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Old 09-17-2019, 01:07 PM
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You may want to talk to your eye doctor - there are magnifiers, computer screen reading software and apps, and other low-vision devices that could help you with reading until your nose heals well enough to use your glasses again.
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Old 09-17-2019, 01:24 PM
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Fractures of the nose are pretty common due to falls and fights. Most of them are NOT really bad. If the nose absorbs the shock, more sensitive areas were probably spared. Internet advice never substitutes for seeing a qualified doctor, though.

That said, the first question is whether the brain and other bones were affected. If after 24h you donít have any confusion, headache, visual changes or unusual symptoms chances are any damage was mild. Even breaking a facial bone may not be a big deal if undisplaced. You should be able to open your mouth easily and chew without much pain. Dental work is sometimes necessary.

The worst case scenarios are high grade LeFort fractures where the nose is separated from the skull. More common is the broken nose is not very displaced or can be pulled into acceptable position by yanking on the end of the nose. Youíll know if it looks crooked after the swelling goes down in three days or so, this is best corrected early on. Pain medicines may be needed.

Vision testing is reasonable, and if there are visual changes these should be checked out. There usually arenít. Any heavy bleeding is a concern, and you would want to make sure the sinuses are clear as these bones can sometimes be broken too. Since the nose consists of cartilage and a bit of bone, stitches may be required and glasses are sometimes (but not always) painful to wear.

Surgery may be needed if the fracture is complex, or if the eyes or sinuses or facial bones are affected, depending on the specifics. With any facial injury, you need to make sure the neck is okay, and generally people are allowed to sleep but should be woken every hour or two for the first 24 hours after the injury.

Glad to hear surgery does not sound necessary and I wish you a speedy recovery.
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Old 09-17-2019, 01:32 PM
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You should also not have double vision when you look upwards, and your peripheral vision should be unaffected. A good doctor would specifically test for both these things.

As for pressure from glasses, I would try inserting a cotton puff or piece of gauze. If that doesnít help, perhaps a glasses strap (like some use for swimming) would take some pressure off. A pain medicine might help - acetaminophen (Tylenol) is a good starting point; naproxen works better but may increase bruising or bleeding. Putting on something cold might give a little comfort and probably wouldnít reduce the swelling much. This typically goes down after 3 days, but canít be precisely predicted. Bruising can last 4-6 weeks of severe.
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Old 09-17-2019, 02:46 PM
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Update on some of the points mentioned: luckily vision, neck, teeth, etc. seem to be unaffected. (My primary doc did test my vision, and the ENT looked at teeth, jaw, ears, etc.) No headaches, though apparently I was anxious about needing surgery, because my BP was crazy high at the ENT's office even after checking 3 times, so much that my GP had me come in to have it checked. Luckily by then it was basically back to normal. The facial bruising isn't too bad; I think it will basically be gone in a few days. The nose basically doesn't hurt at all if I don't touch it, and there wasn't much bleeding (and it stopped entirely within a few minutes). 400 mg of ibuprofen seems to be working fine, with ice to reduce swelling.

I asked the ENT about the glasses, and his immediate response was to tape the bridge of them to my forehead with Scotch tape so that they aren't resting directly on my nose. Super sexy! We'll see how well it works with progressive lenses, or maybe even with an old single-vision backup pair that I keep by my computer at home...

ETA: my glasses aren't so much for magnification as for astigmatism, so we'll see how that goes (or not). I am typing without glasses right now, but I don't know that my eyes can handle that for an 8+ hour workday.

Last edited by Eva Luna; 09-17-2019 at 02:48 PM.
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Old 09-17-2019, 03:40 PM
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Do you smell alright now?

Hyuk hyuk. I don't know anyone who has had surgery for nose trauma, but I and a handful of people I know have had their septums straightened. Recovery from that just sucks. Short of pain management you're just uncomfortable for about a week. Sounds like you're not going in that direction, so good. And props on what sounds like an epic faceplant. The orbit fracture was a nice touch. Get well soon.
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Old 09-19-2019, 10:52 PM
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OUCH!!!!!!!!!!!!!

I am amazed I have not done the same to myself (yet) becaue I am a major klutz.

My SIL did much as you described a few months back; she tripped when she and some friends were walking across some rough sidewalk.

She looked like hell the next day. IIRC, she did see an ENT, who (like you) said "we'll see how it looks when the swelling goes down". She did not have to have surgery.

Re glasses: I suppose you could try to get the insurance pony up for Lasik "Really, the doc says I can't wear glasses!!". I imagine any Lasik surgeon wouldn't touch you right now, though (and for good reason).

Last edited by Mama Zappa; 09-19-2019 at 10:53 PM.
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Old 09-21-2019, 10:06 PM
Eva Luna is online now
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Quote:
Originally Posted by Mama Zappa View Post

Re glasses: I suppose you could try to get the insurance pony up for Lasik "Really, the doc says I can't wear glasses!!". I imagine any Lasik surgeon wouldn't touch you right now, though (and for good reason).
I'm not interested in Lasik, anyway; does it even do anything for astigmatism?

The slightly more worrying issue at the moment is that I have felt a tad woozy and lethargic all week. I stayed home from work (which was totally awesome to have to do 3 months into a new job, but I wouldn't have been any use anyway and couldn't face walking 2 blocks to the bus stop, let alone an hour-plus public transportation commute each way and an 8+ hour workday).

The doc thinks I may have a mild concussion, though I didn't have the frequent symptoms of blurred vision, nausea, headaches, etc. I basically spent the entire week napping on the couch with the cats, though I did manage to remain upright long enough to make some spaghetti sauce last night.

I am feeling somewhat better now and sure as hell hope I can drag myself to work on Monday! If not, the doc wants me to call him back and discuss a possible head CT or MRI.

So basically for the moment I am treating myself like I do have a concussion...the general consensus seems to be to rest, avoid bright lights, visual/mental stimuli, strenuous activity or even thinking too hard.

Who here has been through something like this, and what was your experience? I never lost consciousness or anything like that and passed all the visual and cognitive tests in the immediate aftermath, so it must not have been too horrible, but well, I did whack my head pretty damn hard...
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