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Using cocaine by nasal insufflation about 1gm daily. Why am I getting these sticky and viscous chunks with mucus?

Answered by
Dr.
Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2584 Questions

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Posted on Fri, 23 Nov 2012 in Ear, Nose and Throat Problems
Question: I used cocaine by nasal insufflation about 1gram daily for 9 months and stopped for a month and a half. I started using again since a month and a half ago 1-1.5grams daily. I get these sticky and viscous chunks with my mucus and dried chunks of crust that sticks to my nasal membrane. My questions are:
1. What are these sticky and viscous chunks? Are they nasal tissue lining that's peeling?
2. Are these crusts also nasal tissues?
3. Can I pick my nose with my fingers to remove these chunks and crusts or will it cause further damage?
I use saline nasal spray, will it clean and remove the residues of cocaine that's trapped inside my nose?
4. Will the crusting go away if I stop using cocaine?
5. I have nasal pain on both sides of my nose bridge, what does this mean?
6. I never get dental plaques before, but since cocaine use I get them, what causes this and how to prevent it? Will it cause gingivitis?
7. After snorting cocaine, sometimes the cocaine goes down my throat, will that damage the throat?
doctor
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for your query.

1. The sticky and viscous chunks and nasal crusts are most probably dried mucus. Mucus secretions increase due to nasal irritation. This may not be nasal tissue unless there is a septal perforation.

2. Continued nasal crusting must be investigated with nasal examination and endoscopy. Cocaine is used medically as an excellent local anesthetic agent and powerful vasoconstrictor. These effects on the delicate nasal lining (mucosa) tend to cause septal perforations with chronic cocaine use. Sudden reduction of blood supply destroys the tissue. Normally septal injury will be preceded by warning signs such as dryness (it is good that you are using saline nasal washes), discomfort, pain, bleeding. However due to the anesthetic and vasoconstrictor action, these signs are minimal. Dilute hydrochloric acid may also be left behind in the nose after rapid absorption, adding to tissue damage. Additional damage probably occurs due to contaminants in adulterated or altered cocaine mixtures. That may partly explain this issue. Along with tissue damage and inflammatory response, there is a reflex vasodilation after some time, leading to excess secretions, which may explain the transparent and gelatinous fiber-like nasal discharge.

3. Pain on the nasal bridge may be due to injury and fibrosis caused due to chronic cocaine use. Picking your nose will cause further damage over time.

4. The simplest course of action will be to get a nasal examination and a nasal endoscopy done. If these are normal, only regular follow-up is required.

5. I must emphasize that you should stop any further intake of cocaine. You may continue saline nasal washes.

6. Dental plaques are probably due to gingivitis. Use a medicated mouthwash, brush and floss regularly.

7. Some amount of damage to the delicate lining of the throat is possible on sustained use.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 17 hours later
Thank you for your response Dr. Bhatti. I am worried about my nose :(
1. Given the amount of time and dosage I have been on cocaine, can it already damage my nose and lead to deviation or perforation? I know some people who took them daily for years and there's no nose damage like deformity.
2. So these crusts and white viscous sticky chunks are certainly not torn nasal tissues? But does this mean it's early sign of damage? Will it thin out my nasal membranes?
3. Can I remove the crusts and the white viscous sticky chunks that gets stuck on the wall inside my nose by picking them with my fingers? It is annoying. Or shall I just leave them alone? I pick my nose because I am afraid they might be cocaine residues and to let them sit inside my nose might rot it?
4. What are the early symptoms of damaged lining of the throat from cocaine use?
doctor
Answered by Dr. Sumit Bhatti 11 hours later
Hi,

Thank you for writing back.

1. The crusts are a sign of damage. The most well documented nasal injury is a septal perforation, which also causes increases crusting. It is difficult to comment on these other people without examining them.

2. The crusts are usually dried mucus. Continue your saline spray. The delicate nasal membranes are damaged.

3. Avoid picking your nose, Use a saline nasal wash.

4. Throat damage will make it more sensitive, scarred , dry and irritable. Hoarseness may also occur.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 18 hours later

Thank you for your answer Dr. Bhatti. I am still worried and still have some questions:
1. You said the pain on both sides of my upper nose bridge is fibrosis (correct me if I am wrong but I read the definition of fibrosis: formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process, does it mean new tissues are forming to repair the damaged tissues?
2. If the crusts are just dried mucus, how can the nasal membrane be damaged and what are the signs and symptoms? Will it heal?
3. I use saline drops to clean my nose but it does not get rid of the boogers and crusts stuck on my nasal walls. How do I remove them without picking my nose? And how can picking your nose cause damage?
4. Will breaking Vitamin E Perlecaps and rubbing the Vitamin E inside the nose prevent damage or help it heal?
Is it possible to get a reply from you soon or I have to wait 24 hours for each query submitted? Many Thanks,
doctor
Answered by Dr. Sumit Bhatti 16 minutes later
Hi,

Thank you for your writing back.

1. Fibrosis is a natural process of healing and the tissue never returns to it's original state. The fibrous tissue is not capable of performing the function of the repaired tissue. The damage is permanent and increases with each successive repair.

2. As explained earlier, loss of blood supply causes the lining to die. I quote from above again: XXXXXXX Cocaine is used medically as an excellent local anesthetic agent and powerful vasoconstrictor. These effects on the delicate nasal lining (mucosa) tend to cause septal perforations with chronic cocaine use. Sudden reduction of blood supply destroys the tissue. Normally mucosal injury will be preceded by warning signs such as dryness, discomfort, pain, bleeding. However due to the anesthetic and vasoconstrictor action, these signs are minimal (silent). Dilute hydrochloric acid may also be left behind in the nose after rapid absorption, adding to tissue damage. Additional damage probably occurs due to contaminants in adulterated or altered cocaine mixtures. The mucus glands are also damaged. Along with tissue damage and inflammatory response, there is a reflex vasodilation after some time, leading to excess secretions, which may explain the crusts, boogers and the sticky viscous the nasal discharge XXXXXXX

3. You should use a nasal saline was or a pressurized saline nasal spray, then gently clean the nose. It is a difficult task to clear the nose with sticky boogers and crusts. Picking the nose bruises the delicate nasal lining and breaks it down. These small injuries also undergo repair by fibrosis.

4. Vitamin E itself will not prevent damage to the nose. You must discontinue cocaine use. Previous damage will be irreparable.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 2 hours later
Thank you for your response Dr. Bhatti, please see my comments/questions below.

1. Fibrosis is a natural process of healing and the tissue never returns to it's original state. The fibrous tissue is not capable of performing the function of the repaired tissue. The damage is permanent and increases with each successive repair.
Does this mean each repair of nasal tissue will cause progressive damage of nasal tissues? So it means my nasal tissues will be permanently damaged and will progress damage even if I stop cocaine?

2. As explained earlier, loss of blood supply causes the lining to die. I quote from above again: XXXXXXX Cocaine is used medically as an excellent local anesthetic agent and powerful vasoconstrictor. These effects on the delicate nasal lining (mucosa) tend to cause septal perforations with chronic cocaine use. Sudden reduction of blood supply destroys the tissue. Normally mucosal injury will be preceded by warning signs such as dryness, discomfort, pain, bleeding. However due to the anesthetic and vasoconstrictor action, these signs are minimal (silent). Dilute hydrochloric acid may also be left behind in the nose after rapid absorption, adding to tissue damage. Additional damage probably occurs due to contaminants in adulterated or altered cocaine mixtures. The mucus glands are also damaged. Along with tissue damage and inflammatory response, there is a reflex vasodilation after some time, leading to excess secretions, which may explain the crusts, boogers and the sticky viscous the nasal discharge XXXXXXX
Will the died tissue lining and mucus glands repair if I stop cocaine?

3. You should use a nasal saline was or a pressurized saline nasal spray, then gently clean the nose. It is a difficult task to clear the nose with sticky boogers and crusts. Picking the nose bruises the delicate nasal lining and breaks it down. These small injuries also undergo repair by fibrosis.
Oh no! I have been picking my nose to remove the crusts and sticky boogers :( The saline nasal drops does not remove them. What shall I do to gently remove them? How can picking the nose to remove the crusts and sticky boogers bruise and break down the nasal lining? What are the symptpms?

4. Vitamin E itself will not prevent damage to the nose. You must discontinue cocaine use. Previous damage will be irreparable.
So you advise I shouldnt rub vitamin E inside my nose to heal it? How can I tell if there's already damage in my nose and please let me know if they can be repaired and how :(

I am really worried Doc, and thanks for your help and advice.
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your writing back.

1. The damage is progressive with continued cocaine use. Stopping the use of cocaine will prevent further damage.

2. There will be some healing and reversal with time but you cannot expect complete recovery.

3. Gentle, limited picking of the nose will be required till such time that stopping the use of cocaine will reduce the crusts and boogers. This will take many months. Pain, discomfort, dryness, bleeding are some of the signs of mucosal damage.

4. You have to get a nasal endoscopy done to assess the damage. Using Vitamin E will not harm you, but the benefit will be minimal if you do not stop using cocaine. You may need to use steroid sprays and saline nasal washes in the long term.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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