Severe cocaine use can cause damage well beyond a perforated nasal septum. Cases presented at the latest National Congress of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery, held in Madrid in October, included injuries to the palate, the skin of the nose, the eye socket and the base of the skull.
One case involved a man in his thirties, identified by the fictitious name Juan, who used cocaine daily. After perforating his nasal septum, the drug destroyed his palate and part of the bone separating the nose from the brain. Cerebrospinal fluid was leaking through the opening when he was admitted to intensive care with a serious neurological condition. Surgeons removed necrotic tissue and closed the defect, but the patient continued using cocaine and later died from aspiration pneumonia after substances that should have entered the digestive tract reached his lungs.
The damage begins with cocaine’s ability to constrict blood vessels, reducing the supply of oxygen and nutrients to tissues. Gonzalo Díaz Tapia, associate head of Otorhinolaryngology at Hospital General Universitario de Villalba, compared the process with what occurs during a heart attack or stroke, although in this case the affected tissues are in the nose. As the tissue dies, cartilage can be destroyed and perforations can develop.
Early deterioration may feel similar to a cold, but people affected rarely seek medical attention at that stage. According to Díaz Tapia, they generally reach a consultation only after a septal perforation has already formed. The extensive injuries described at the congress are uncommon and are associated with particularly heavy use, often practically daily consumption.
Spain’s EDADES survey, cited in the report, estimates that around 793,000 people aged between 15 and 64 used cocaine during the previous year, equivalent to 2.5% of that age group. The figure is roughly half when the question refers to use during the previous 30 days, an indicator of more frequent consumption.
When destruction reaches the palate, eating and speaking can become difficult. The opening creates a connection between the mouth and the nasal passages, allowing food and liquids to pass through. It can also alter the resonance of the voice, giving it a nasal quality.
Infections can further worsen the condition. Secretions may become trapped in the nasal cavities and paranasal sinuses, where they are difficult to clear. In the most serious cases, the damage can extend to the structures separating those cavities from the inside of the skull, as occurred in the patient with the cerebrospinal fluid leak.
Adulterants may add further risks. Cocaine is often cut with levamisole, a veterinary antiparasitic drug that can cause vascular problems and necrosis affecting the ears, fingers and other parts of the body.
Another congress communication described a woman who lost the sight of one eye and experienced pain that medication could not control. After several procedures to remove dead tissue from the nose and sinuses, surgeons performed an orbital exenteration, removing the eye and emptying the socket before reconstructing it with tissue from her own body.
Stopping cocaine use is the first requirement before attempting reconstruction. Díaz Tapia said that otherwise the tissue is unlikely to heal and could deteriorate again, while a failed operation may eliminate options that could be useful later. In his view, surgery should be considered when there is a realistic chance of success.
Sources: El País Sociedad.