title: Intranasal hydrocodone-acetaminophen abuse induced necrosis of the nasal cavity and pharynx.
abstract: OBJECTIVE
  Two million new users will abuse prescription narcotics this year, most commonly hydrocodone. The most commonly prescribed form is hydrocodone-acetaminophen (HA). Many individuals crush the tablets and snort the product to take advantage of the rapid transmucosal delivery of narcotics. The resultant pathology of intranasal hydrocodone acetaminophen abuse (INHAA) has been described only in a few case studies.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Two private and one academic otolaryngology practices in Kentucky searched their patient charts for patients with morbidity from intranasal abuse of hydrocodone acetaminophen tablets. We identified thirty-five patients who presented for treatment between 2004 and 2011.
  
  
  RESULTS
  The majority of patients will initially deny the behavior, frequently delaying diagnosis. Physical exam findings of white powder covering an underlying nasal mucosal necrosis are characteristic of this condition during active INHAA. Follow up was limited as only 26% returned for follow-up care. Patients commonly presented with orofacial-nasal pain (43%) and sino-nasal congestion and discharge (43%). Active necrosis or prior tissue loss was noted in 77% of patients. Fifty-one percent of patients presented with septal perforations, and 26% with palatal perforations. Two cases of invasive fungal sinusitis were clearly documented, with one resulting in death.
  
  
  CONCLUSIONS
  The vast majority of cases presented with characteristic physical findings that included acute necrosis of soft tissue, which can progress to destroy oronasal structures. In the absence of invasive fungal disease, the condition is self-limited after cessation of INHAA and performance of local nasal debridement and nasal hygiene.
authors.affiliation: Department of Otolaryngology, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0084, USA.
authors.forename: David
authors.initials: D
authors.lastname: Alexander
authors.forename: Keith
authors.initials: K
authors.lastname: Alexander
authors.forename: Joseph
authors.initials: J
authors.lastname: Valentino
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000633:toxicity*; D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D001706:Biopsy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage* / Q000633:toxicity*; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D009336:Necrosis; D009668:Nose Diseases / Q000139:chemically induced*; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology; D010608:Pharyngeal Diseases / Q000139:chemically induced*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone