Care should be taken when working around the ears that oil or other medium, (even a trace amount) does not accidentally enter the ear canal. It can cause dizziness and possibly ear infection.

There is a nasya technique of putting five drops of an oil combination into the nose. A literal reading of the Standard would indicate that if a massage therapist performed this procedure, written consent would be indicated, although the therapist's fingers never touched the nose.

If the therapist is working for a medical professional who suggests the therapist massages this area, the therapist needs proper training. Such practice may be outside the scope of the massage license and of the therapist's insurance. Working with the ears and nose is a cause of particular concern since it is easy to create serious injury. Likewise, putting hard objects, even Q-tips, in the ear canal has been known to cause earache and infection which can also lead to perforation of the ear drum.