The Effect of Unilateral Cocaine Use on The Nose!

Two Images of the Same Patient: Dry and Infected Nasal Mucosa on the Right (Due to Cocaine) and Healthy and Wet Mucosa on the Left

cocaine nose dry bloody nasal mucosa
Image Description: A 36-year-old male patient was admitted to our clinic with the complaints of epistaxis and nasal dryness from the right nostril.  The patient stated that he had been using cocaine through his right nostril for about 2 years.  It was understood that the patient could not breathe through his left nostril due to severe nasal septum deviation, which almost completely covers the left nasal cavity, and therefore he did not use cocaine from this side.  Nasal septum deviation may have had a positive secondary effect.  In the photograph above, there are images obtained during the endoscopic examination of the patient's right nasal cavity and left nasal cavity at the same time.  This is a photo where you can easily see the changes that cocaine has made in the nose.  It is seen that the mucosa in the right nasal cavity is dry, bleeding and crusty, and there is almost no secretion.  It is seen that the left nasal cavity is almost completely closed with nasal septum deviation, the mucosa is quite pink and healthy, and there is normal nasal secretion. 

The fact that the patient had to use cocaine only unilaterally may have prevented the patient from fully perforating the nasal septum and the emergence of nasal septum perforation.

What's the Cocaine?

Cocaine or with its scientific name benzoylemethyl ecgonine is a crystallized tropane alkaloid obtained from the leaves of the coca plant.  It is a substance with a very strong local anesthetic and vasoconstrictor effect, previously used in otolaryngology operations.  It can offer bloodless and painless surgery options without the need for any injection when applied to the intranasal mucosa with a cotton swab with low-dose diluted solutions.  At the faculty I graduated about 20 years ago, we used to apply cocaine solutions to the cocoon with cotton wool before nasal surgeries, and we saw that there was a serious whitening of the nasal mucosa and no pain was felt by the patients immediately after the application. Cocaine is an inhibitor of dopamine, noradrenaline and serotonin reuptake, and it is addictive by affecting the mesolimbic pathway in these ways.  In other words, even if it is applied locally, it has an addictive side effect and another side effect is that it severely reduces the local circulation with a very strong vasoconstrictor effect.  Today, local anesthetic products with much less side effects and side effects are used instead of cocaine due to its high side effects and addictive effect.  Except for the medical use of cocaine, possession is not legal in the majority of production and distribution is prohibited in almost all countries around the world (source >> Kokain - Vikipedi (

Negative effect on a cocaine nose 

In patients with chronic nasal cocaine use, various symptoms such as nasal dryness and epistaxis, nasal congestion, chronic sinusitis, atrophic rhinitis, nasal septum perforation and columellar necrosis may occur due to atrophic changes in the nasal mucosa.

Long-term cocaine if used in the nose may occur following negative influences: 

- intranasal nasal mucosa in reduction of secretion decreases and secretion reduction in nasal mucosa circulation, nasal dryness.  

- nasal septum perforation, chronic mucosal changes and chronic mucosal inflammation in the nose.  

In the event of addiction, the frequency of use and the likelihood of the above negative effects may increase as it will increase.

The treatment plan of this patient

Simple intranasal care recommendations may not be sufficient for treatment in this patient! 

For the treatment of the patient, whose interior image is present in the photo above, which I have shared with you, he normally needs to stop using cocaine.  Even if cocaine use is terminated;  After months of intranasal care recommendations, it can be ensured that the intranasal mucosa becomes a moist and normal secretion-producing healthy mucosa.  The use of local cocaine causes a very strong decrease in the epidemic and deterioration of circulation in intranasal mycosis.  It takes a long time for the fairy tale mucosa, which has been exposed to this effect for years, to become healthy again.  The following recommendations were suggested for the normalization of the nasal mucosa and the treatment of nasal dryness and epistaxis in this patient: 

- immediate cessation of cocaine use.  In order for the mucosa in the nose to become moist again and to prevent infection, regularly spraying the nasal water containing sprays in the nose, using natural moisturizing sprays and drops in the nose, applying the antibiotic eye ointment in the nose for a few weeks.  

- living in humid areas, for example, if the patient lived near the ocean or the seaside, and if the patient applies natural sea / ocean water in the nose daily, the healing speed of the nasal mucosa may increase (maybe it is not easy for the patient to change the region where he lives, but if he has such an option). recovery can be accelerated).  

- salt restriction, reducing salt in foods can be beneficial for increasing marriage for the nose.  

- consumption of fruits and vegetables with a high water content.  

- ending the habits of picking the nose with fingers, mixing the inside of the nose with objects such as napkins or cotton swabs, which can dry the mucous membrane in the nose, and cleaning the nose with only salt water.

Link group where you can find detailed information about dry nose on this website >>

Video: Cocaine-related emergencies

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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