septal perforation

septal perforation

Cocaine Effects On The Nose

5 Facts You Need To Know About Cocaine and Septal Perforation

1. What is Cocaine?

Cocaine is an addictive stimulant made from the leaves of the coca bush native to South America. It is used for medicinal purposes as an topical anesthetic and as a vasoconstrictor to control pain and bleeding, often in association with nasal surgery and ophthalmic procedures. Cocaine is also used as a recreational drug producing short-term euphoria. Users can be identified by hyperactivity, increased energy level and excessive chattiness. In addition cocaine use has potentially dangerous physical side effects such as arrhythmia (increased heart rate) and increased blood pressure as well as chronic nasal effects including septal perforation.

cocaine nose treatment

2. How Is Cocaine Use associated with Septal Perforations?


Powdered cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream. Inhalation of powdered cocaine is the primary cause of injury to the nasal septum which can lead to a septal perforation.

Other forms of inhalation include crack cocaine, which is a form of cocaine processed to make crystals “freebase cocaine” that can be smoked. The crack cocaine is heated to produce vapors that are inhaled and absorbed into the blood-stream primarily through the lungs. Smoking crack cocaine, also exposes the nasal passage mucosal lining to the inhalant trauma. The vapors from the heated crack cocaine act locally in the nasal passages causing trauma to the mucosa through the vasoconstrictive effects of cocaine on the delicate blood vessels in the nose which can lead to a septal perforation. In patients who use both crack and powdered cocaine a septal perforation would tend to occur faster and symptoms be more severe.


cocaine nose collapse treatment

Figure . Long-term effects on the nose from using powdered cocaine. Pictures show septal perforation and massive nasal collapse

3. What are the reasons someone would not be able to stop cocaine?

The intensity and duration of cocaine’s pleasurable effects depend on the way it is administered. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last only 5 to 10 minutes.

In order to sustain their high, people who use cocaine often use the drug in a binge pattern—taking the drug repeatedly within a relatively short period of time, at increasingly higher doses. This practice can easily lead to addiction. Some users will increase their dose in an attempt to intensify and prolong their high, but this increases the risk of addiction and deleterious side effects. The risk of acquiring a serious side effect, such as a septal perforation, would be increased with binge use and chronic addiction.

4. How Does Cocaine Affect The Brain, Keeping Patients Addicted Even With A Septal Perforation Present?

Even with a septal perforation present patients may continue to use cocaine. This is caused by cocaines long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction and poor judgment. With repeated use, especially binge using, tolerance to cocaine develops quickly; many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first experience. Once addicted to cocaine, the patients judgement is impaired and patients with septal perforations may continue to use cocaine even when the are aware of its current deleterious effects.

5. What Are the Other Health Effects of Cocaine That Can Worsen The Prognosis of Septal Perforation Treatment or Surgery?

Cocaine affects the body in a variety of ways. It constricts blood vessels and increases body temperature, heart rate, and blood pressure. It can also cause headaches, abdominal pain and nausea. Cocaine effects appetite, causing some chronic users to become malnourished.

Although the most serious complications of cocaine use are heart attacks and strokes, which may cause sudden death, nasal symptoms are much more common. Regular snorting of cocaine can lead to loss of smell, nosebleeds, a chronically runny nose, rebound nasal congestion, sinusitis, cellulitis, chondritis, nasal obstruction, turbinate hypertrophy, crusting, foul smelling nasal odors and septal perforation. Damage to the nose from cocaine can cause:

  • Epistaxis (nosebleeds)
  • Chronic Infections
  • Perforated Septum (hole in the nasal septum)
  • Nasal Collapse
  • Foul Smells
  • Anosmia (Loss of Smell)
  • Nasal Deformity
  • Allergy Exacerbation
  • Nasal Obstruction
  • Nose Whistling
  • Snoring
  • Social Isolation
  • Poor work performance from chronic nasal infection (missed days)
  • Low self-esteem
  • Anxiety

Typically, the cocaine user will have early signs that a septal perforation may be imminent but may be unaware of the immediate danger, because, early signs often mimic other benign nasal conditions such as; simple nosebleeds, nasal congestion, increase in nasal discharge (rhinorrhea), sinus infection, and common allergy symptoms. Although many cocaine users are clearly aware when they have a “full-blown” septal perforation, many miss the window of opportunity to reverse early damage before it leads to a septal perforation. Once a septal perforation is present it will never heal on its own. Damage to the nose caused by inhalation of powdered cocaine starts with small superficial ulcerations along the anterior nasal septum typically one side though both sides may show injury. A scab forms during the healing process which may be picked off by the patient which makes the ulceration slightly deep. This process repeats itself until a through-and-through septal perforation is present. The combination of late diagnosis, binge use, malnutrition and poor judgement with high often leads to septal perforation in an otherwise health person.

Figure. The perforated septum weakens the nasal septum eventually causing collapse of the nose. Image via

Figure. The perforated septum weakens the nasal septum eventually causing collapse of the nose. Image via

What Are My Options For Septal Perforation Treatment?

Septal Perforations can be treated and reversed only by a septal perforation specialist such as Dr. Hamilton. In the hands of a septal perforation specialist, the success rates of surgical repair are very good, however, with non-specialist nasal and plastic surgeons the success rates are very low.


How do I know if I’m seeing a qualified specialist?


surgery for nose hole

Figure. Perforated septum is a hole in the nasal septum that cause excessive drying of the nasal passages leading to nosebleeds, infections, foul smelling odors, and nasal collapse.

perforated septum

Figure a,b. Septal perforation (left) showing crusting, dry blood and a large opening through the nasal septum. Perforated septum repair (right) showing complete closure of the perforated septal defect with no evidence of disease.

perforated septum correction

Figure. Septal perforation repair showing restoration of normal airflow. It is important to seek treatment before the perforation gets so large as to cause a saddle nose. Treatment is complex and should be done only by a surgeon with extensive experience in nasal reconstruction.


A qualified septal perforation specialist such as Dr. Hamilton will have these attributes :

  • Dr. Hamilton manages several patients a week with septal perforations
  • Dr. Hamilton performs surgery weekly for septal perforations
  • Dr. Hamilton can successfully manage adults and children with septal perforations resulting from a variety of causes (i.e. septoplasty, nose picking, nasal fracture, decongestant over use, caustic burns, cocaine use, Wegener’s disease, etc.)
  • Dr. Hamilton has a septal perforation team experienced in coordinating care of the patient which includes septal perforation specialist, allergy and rhinology, pediatric ear nose and throat, head and neck/microvascular surgery, and anesthesia services
  • Dr. Hamilton has a success rate in the 99th percentile for large and small perforations not just small perforations
  • Dr. Hamilton has many patients/families that can attest to the competency of the physician and can speak with you about their personal experience with the physician and the success of their surgery

Are You Serious About Getting Help For Your Septal Perforation?

Learn More About Treatment of Septal Perforations and Cocaine

Contact Osborne Head & Neck Institute