Chronic cocaine use can result in which of the following nasal findings?

• A. Ischemia and ulceration of the nasal mucosa
• B. Nasal polyps and increased mucous production
• C. Hyperemia with hyperplasia
• D. Improved nasal airflow

Answer: (A)

Chronic cocaine use causes powerful vasoconstriction of the nasal mucosa, driven by cocaine blocking norepinephrine reuptake and stimulating alpha-adrenergic receptors. This reduces blood flow to the mucosa, producing ischemia. Ongoing ischemia damages the mucosa and underlying tissue, leading to ulceration and, with progression, possible septal perforation and crusting. That tissue necrosis is the classic nasal finding associated with long-term cocaine use.

The other patterns don’t fit as well. Nasal polyps and increased mucous production are more typical of chronic inflammatory or allergic rhinitis. Hyperemia with hyperplasia would imply increased blood flow and tissue growth, not the ischemic damage seen with cocaine. Improved nasal airflow would be contrary to the obstructive and crusting processes that accompany chronic mucosal injury.