1c:I[419806,["/_next/static/chunks/bb923814e1f4d2e9.js","/_next/static/chunks/dd3ee9f5b7716ca6.js","/_next/static/chunks/4204a0ae82542ca8.js","/_next/static/chunks/30036bedc5269936.js","/_next/static/chunks/6e1aa89a642f40be.js","/_next/static/chunks/cd5e572bc3e4eb92.js","/_next/static/chunks/8ffd0b71567920d8.js","/_next/static/chunks/67ea6dfd21f16c5f.js","/_next/static/chunks/24eb4379f68013fd.js","/_next/static/chunks/b8cd775ffdf935bd.js","/_next/static/chunks/983103cd9eb7b428.js","/_next/static/chunks/d4ac9dcf27f6ff52.js","/_next/static/chunks/294b9525248c8e5f.js"],"default"] 1d:T42b,Abstract Recreational cocaine abuse via intranasal “snorting,” “free‐base” smoking, “body‐packing,” or intravenous injection can be lethal. Increasing illicit use of cocaine hydrochloride and the misuse of legal over‐the‐counter (OTC) nasal drugs are known causative agents of nasal septal perforation with loss of taste and smell. Although 2 to 3 mg/kg is the recommended maximum dose for topical anesthesia, cocaine snorters may use 1,000 mg or more daily on a “run.” Furthermore, the newer route of smoking the extracted volatile “free‐base” form of the adulterated street drug provides a plasma concentration producing the same physiological and subjective effects of intravenous cocaine. Presented are two cases exemplifying unusual complications of cocaine abuse: 1. total nasal septal bony and cartilaginous necrosis with resultant saddle‐nose deformity and osteolytic sinusitis secondary to chronic intranasal “snorting” and 2. tracheobronchial rupture with pneumomediastinum secondary to smoking “free‐base” cocaine.1e:T429,COCAINE is a naturally occurring alkaloid of the coca plantErythroxylon coca. Its psychopharmacological properties are due to stimulation of the central and sympathetic nervous systems by augmentation of the normal effects of the neurotransmitter norepinephrine. The Incas chewed coca leaves prior to 1000ADto "satisfy the hunger, provide the weary and fainting with new vigor and cause the unhappy to forget their miseries."¹ Recent increases in the production, trafficking, and use of cocaine have brought concomitant increases in associated medical problems.^2,3 The usual routes of illicit cocaine use are intranasal, intravenous, and inhalational. Each has unique medical hazards.^4,5We describe a patient with unusual ophthalmic and otolaryngologic complications related to long-term intranasal abuse of cocaine.

Report of a Case

A 43-year-old man was referred to the Neuro-ophthalmology Service with bilateral decreased visual acuity and asymmetric optic nerve head swelling. The patient had noticed progressive1f:T535,A questionnaire on cocaine-use patterns and associated adverse effects on the nasal passages was completed by 464 adolescents. The respondents were abusers of various nonintravenous drugs enrolled in seven modified outpatient treatment facilities for alcohol and other drug abuse in five geographic regions of the country. Three hundred thirty-six respondents (72%) noted that they had used cocaine one or more times prior to their entry into the treatment program. The 336 recovering cocaine users were divided into three groups: those who had used cocaine fewer than 25 times (203 [60%]); those who had used cocaine between 25 and 99 times (107 [32%]); and those who had used the drug daily plus at least 100 times total use of the drug (26 [8%]). Statistically, we found a highly significant difference between the first group and the other two groups for cocaine-associated symptoms, such as frequent sniffing, "sinus" problems, and diminished olfaction. Approximately 30% of those who had "snorted" cocaine at least 25 times but less than daily, vs 47% of those who used the drug daily, recalled that they had nasal membrane irritation with nasal crusts or scabs, recurrent nosebleeds, or both. The astute otolaryngologist should consider cocaine abuse as a cause of puzzling or recalcitrant rhinitis, even during teenage years.

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