Osteolytic sinusitis and pneumomediastinum: Deceptive otolaryngologic complications of cocaine abuse

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.