Deviated Septum from Drugs: Everything You Need to Know

A common question among drug users is “Can drugs cause a deviated septum?” This is especially the case among users of cocaine.

In this article we provide science-backed answers to your questions related to deviated septum from drugs.

Can Drugs Cause a Deviated Septum?

The short answer is yes.

Snorting (inhalation) of drugs such as cocaine, heroin, and opioids through the nose is a common form of drug abuse.¹Bakhshaee M, Khadivi E, Naseri Sadr M, Esmatinia F. Nasal Septum Perforation due to Methamphetamine abuse. Iran J Otorhinolaryngol. 2013;25(70):53‐56. Drugs such as cocaine and methamphetamine (also known as meth, blue, ice, and crystal) have been reported to cause deviated nasal septum.²Bakhshaee M, Khadivi E, Naseri Sadr M, Esmatinia F. Nasal Septum Perforation due to Methamphetamine abuse. Iran J Otorhinolaryngol. 2013;25(70):53‐56.³Colletti G, Autelitano L, Chiapasco M, et al. Comprehensive surgical management of cocaine-induced midline destructive lesions. J Oral Maxillofac Surg. 2014;72(7)

Can Cocaine Cause a Deviated Septum?

Cocaine is a potent vasoconstrictor (it can cause blood vessels to narrow). Repeated use of cocaine for recreational purposes can cause irritation and narrowing of the blood vessels present on the nasal mucosal lining (skin on nasal septum). These blood vessels are responsible for the nutritional and oxygen supply of the nasal septum.

Due to the narrowing of blood vessels, the oxygen supply to the septal lining (skin) is reduced, which leads to necrosis (cell death) of the septal lining and subsequently that of the underlying cartilage. This exposes the septum, which then becomes susceptible to infection. This is followed by perforation (formation of holes) in the septum. The size of the hole on the nasal septum expands with the increased use of cocaine.

Further destruction of the septum can cause the structure of the nose to be deformed, and the tip of the nose to tilt to one side. This is likely to be the side that is more frequently used for cocaine inhalation. Extensive damages can also cause deformities such as shortening of nose, exposure of nostrils, and bony hump appearance.⁴Guyuron B, Afrooz PN. Correction of cocaine-related nasal defects. Plast Reconstr Surg. 2008;121(3):1015‐1023.

Does Cocaine Make a Deviated Septum Worse?

Cocaine abuse among deviated septum patients can reduce the air intake while breathing, with one side doing most of the heavy lifting.

This, along with the presence of cocaine, can impair the mucociliary function of the nose, which defends against unwanted foreign particles. So, drug users are more likely to suffer from nasal congestion or stuffy nose. Over time, they may also experience sinusitis and other related infections.⁵Jang YJ, Myong N, Park KH, Koo TW, Kim H. Mucociliary Transport and Histologic Characteristics of the Mucosa of Deviated Nasal Septum. Arch Otolaryngol Head Neck Surg. 2002;128(4):421–424. doi:10.1001/archotol.128.4.421

The size and location of the perforation determine the severity of symptoms. More prominent symptoms are experienced in cases with larger perforations and those with perforations on the frontal part of the septum.

In cases of small perforations, the patient may experience discrete whistles and excessive mucus production and accumulation, causing a foul smell.⁶Businco LD, Lauriello M, Marsico C, Corbisiero A, Cipriani O, Tirelli GC. Psychological aspects and treatment of patients with nasal septal perforation due to cocaine inhalation. Acta Otorhinolaryngol Ital. 2008;28(5):247‐251.

Larger perforations cause the patient to experience bleeding from the nose, runny nose, heavy breathing, and presence of scabs (crust of hardened blood and broken skin formed as the wound heals). Some patients also experience severe nasal obstruction, nasal pain, and even a reduced sense of smell (cacosmia).⁷Fornazieri Marco Aurélio, Moreira Jemima Herrero, Pilan Renata, Voegels Richard Louis. Perfuração do septo nasal: etiologia e diagnóstico. Arquivos Int. Otorrinolaringol. (Impr.)  [Internet]. 2010 Dec; 14( 4 ): 467-471

The cosmetic deformity can also affect the psychological health of the individual.

Nasal perforation cannot heal on its own and requires professional intervention. If perforations are untreated, they may worsen the symptoms and lead to the collapse of the nose. 

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