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Objectives: 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. Study de: 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 and : 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.
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. Near total perforation of the nasal septum, post-debridement: This endoscopic photograph taken within….
Biopsy of involved nasal tissue. This high power magnified photomicrograph demonstrates extensive superficial…. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. Search: Search.
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Acute INHAA nasal manifestations of injury: The characteristic crusty, white exudate is noted overlying the necrotic and ulcerated mucosal surfaces. Figure 2 Near total perforation of the…. Figure 2 Near total perforation of the nasal septum, post-debridement: This endoscopic photograph taken within…. Near total perforation of the nasal septum, post-debridement: This endoscopic photograph taken within a week of initial debridement and cessation of INHAA demonstrates healing of mucosa and clear cessation of the soft tissue destruction.
Figure 3 Biopsy of involved nasal tissue. This high power magnified photomicrograph demonstrates extensive superficial exudates with What happens if you snort acetaminophen 500 mg granulation tissue. The deep tissue on the septum shows extensive fibrous proliferation with a mixed chronic inflammatory cell infiltrate. There is no vasculitis present. There is intimal proliferation of some obliterative vasculopathy.
There are scattered fragments of necrotic cartilage and focal osteonecrosis. See this image and copyright information in PMC. Sloan PA, Klimkina O. Sloan PA, et al. J Opioid Manag. PMID: Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications. Vosler PS, et al. Int Forum Allergy Rhinol. Epub Aug Complications of intranasal prescription narcotic abuse. Yewell J, et al. Ann Otol Rhinol Laryngol. Singla A, Sloan P. Singla A, et al. PMID: Review. Med Lett Drugs Ther.
No abstract available. See all similar articles. Lin Y, et al. Guenther SM, et al. Pain Med. The effects of opioids on the lung. Radke JB, et al. Clin Rev Allergy Immunol. Publication types Research Support, N. Administration, Intranasal Actions. Biopsy Actions. Drug Combinations Actions. Female Actions. Humans Actions. Male Actions. Necrosis Actions. Retrospective Studies Actions. Substances Analgesics, Opioid Actions. Acetaminophen Actions. Hydrocodone Actions. Show all 6 grants.
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