title: Intranasal drug-induced fungal rhinopharyngitis.
abstract: BACKGROUND
  Intranasal drug abuse has long been recognized as an etiology of sinonasal pathology. However, the intranasal use of prescription and nonprescription drugs has surpassed the use of illicit drugs, and the pattern of presentation and required therapeutic intervention appears to be different. We report on our experience with these patients, along with a successful treatment algorithm for this disease process.
  
  
  METHODS
  Retrospective chart review of 9 consecutive patients who presented with rhinopharyngitis and a history of intranasal opioid and/or acetaminophen abuse, from 2007 to 2010, at a tertiary referral center.
  
  
  RESULTS
  Nine patients were found to have abused intranasal hydrocodone/acetaminophen, oxycodone/aceta-minophen, or acetaminophen and were diagnosed with rhinopharyngitis. Sinonasal pain and odynophagia were the most common chief complaints and 8 of 9 patients reported previous antibiotic failures. On endoscopy, all patients exhibited a thick, white, exudative process involving the nasal septum and lateral nasal mucosa. Five of 9 exhibited large septal perforations. Seven of 9 exhibited white, exudative pharyngitis. Seven of 9 patients had identifiable fungal organisms on culture, including 5 with species of Candida and 3 with Aspergillus. Two patients grew Staphylococcus aureus. Five patients were compliant with follow up. All 5 showed significant improvement in symptoms and examination, following treatment with oral and topical antifungal therapy and nasal irrigations.
  
  
  CONCLUSIONS
  Intranasal opioid and acetaminophen abuse is often associated with the development of fungal rhinopharyngitis. Recognizing that this process is primarily fungal in origin is paramount to successful treatment, as most patients respond well to antifungal therapy when compliant with treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0528, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Houlton
authors.forename: Angela M
authors.initials: AM
authors.lastname: Donaldson
authors.forename: Lee
authors.initials: L
authors.lastname: Zimmer
authors.forename: Allen
authors.initials: A
authors.lastname: Seiden
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000281:Administration, Intranasal; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000139:chemically induced; D005157:Facial Pain / Q000139:chemically induced; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009181:Mycoses / Q000139:chemically induced* / Q000188:drug therapy; D015508:Nasal Obstruction / Q000139:chemically induced; D009304:Nasopharyngitis / Q000139:chemically induced* / Q000188:drug therapy; D009761:Nystatin / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000150:complications; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000935:Antifungal Agents; D009761:Nystatin; D000082:Acetaminophen; D012965:Sodium Chloride; D015725:Fluconazole