How many of you hate ENT patients

Coke noses are often difficult to see

Ottawa. Treating patients with cocaine noses is of little use if the drug users continue to use cocaine. Especially with drug-related perforations of the nasal septum, it is important that the patient is clean before a reconstruction. However, many do not even mention their drug use.

In an analysis of British clinical data, more than a third of patients with cocaine harm who had claimed not to use cocaine were found to have drug use via urine and blood tests. However, the number of unreported cases is likely to be much higher, as the drug can only be detected in the blood and urine for a relatively short period of time, reports ENT doctors around Dr. Lisa Caulley from the clinic in Ottawa, Canada (Clin Otolaryngol 2020; online April 3).

Your analysis is based on evaluations of the medical records of the Guy’s and St. Thomas ‘Clinic in London. Patients who visited the clinic's rhinology department between 2017 and 2019 due to rhinitis symptoms, showed signs of cocaine-induced rhinitis, denied cocaine use in the past twelve months, but agreed to a routine blood and urine test for drugs, were taken into account.

Encrustations and scarring as an indication

The experts suspected cocaine-induced damage, for example, when rhinoscopy or nasal endoscopy revealed excessive crusting or scarring, a perforation of the septum or another destructive process. Patients with a known cause and those who admitted to using cocaine were not included.

That left 27 people who underwent a drug test, ten of them (37 percent) tested positive for cocaine, six were men, the average age was just under 38 years.

Ten percent of all British people have sniffed coke at one point or another

As the doctors around Caulley report, cocaine-induced rhinitis is not uncommon for ENT doctors in some cities. They point to data that more than ten percent of all Britons have sniffed coke, just under four percent of all men and two percent of all women within the past twelve months.

Nasal damage from cocaine ranged from irritation of the sinunasal mucosa to progressive destruction of nasal and pharyngeal tissue. The symptoms are often unspecific with a blocked or permanently runny nose, many patients present the picture of vasculitis with granulomatous polyangiitis, and anti-neutrophil cytoplasmic antibodies (ANCAs) can often be detected.

Cocaine consumption was only detectable in urine for a relatively short time

Without drug tests, it is difficult to prove the cause of the damage. However, doctors should not necessarily rely on such tests, as cocaine use can be detected in urine for a maximum of 72 hours, and up to eight days with repeated use of large amounts.

The ENT experts around Caulley therefore assume that the tests in their analysis did not convince all cocaine users. Some of the patients actually had vasculitis - they had already received immunosuppressants. Indications of cocaine use sometimes provide questions about leisure behavior: the drug is particularly widespread among regular bar and pub goers.

In order to rule out other causes of the nasal damage, a laboratory test with complete blood count, inflammation markers, autoantibodies, liver, creatinine and urea values ​​is recommended.

With cocaine users, withdrawal comes first, without this no surgical interventions should be carried out, if only because of the poor wound healing with continued use. Saline nasal sprays and creams with chlorhexidine and neomycin can help relieve rhinitis, the doctors report.