The differential diagnosis of a nasal septal perforation includes trauma, surgery, inflammatory/granulomatous diseases, and cocaine abuse.
Cocaine abuse may lead to destructive changes of the nasal septum, paranasal sinuses, turbinates, and the hard palate.
Cocaine abuse may result in inflammatory and fibrotic changes that contribute to dacryocystitis.
Cocaine increases the activity of monoamine neurotransmitters (dopamine, norepinephrine, and serotonin) in the central and peripheral nervous systems by blocking the presynaptic reuptake transporter pumps. Dopaminergic effects have been proposed to account for euphoria and the addiction associated with cocaine use. Cocaine may be inhaled or administered intravenously. In the inhaled form, cocaine-induced vasoconstriction causes mucosal ischemia, which leads to necrosis and perforation with chronic use.
Nasal septal perforation 鼻中隔穿孔
The differential diagnosis of nasal septal perforation includes the consequence of prior operative interventions. Other causes include granulomatous/infectious processes, including granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), sarcoidosis, tuberculosis, and syphilis. Sinonasal malignancy such as lymphoma is another possible etiology. Necrosis and the destruction of sinonasal structures such as the ethmoid air cells, turbinates, maxillary walls, and the hard palate have also been described with cocaine abuse. Cocaine abuse may present as pansinusitis, and inflammation of the nasolacrimal sac (dacryocystitis) is also associated with abuse due to chronic obstruction of the nasolacrimal duct.