My name is Martin, and I have snorted too many drugs. I finally burned a hole in my nose, and it scared me enough to quit. I have been clean for a month now. My nose is messed up, very dry, lots of sneezing and lots of running. My question is: Is this something that will rejuvenate and heal on its own, or will I have problems forever? I plan on staying clean. It is much better. Please let me know what to expect.

Martin

Hi, Martin! Yes, you have thoroughly screwed up your nose. At one month, it is still too early to say what will become of your nose. It is certainly true that you have damaged all the tissues that make up the nasal interior. The fact that you developed a perforation indicates that you damaged the blood supply enough to cause the death of a portion of septal cartilage (the skeletal framework that makes up the partition between the two nasal cavities). The alternating dryness and watery drainage, with lots of sneezing, indicates that the lining of the nose (the mucosa) and the nerves that regulate the nasal environment are both traumatized.

Is this reversible, or not? Unfortunately, I can only give you the rather unsatisfying answer that time will tell. There are several things you can do to encourage recovery. First, many drug users also smoke cigarettes. Tobacco contains nicotine, a potent vasoconstrictor. In other words, nicotine (like cocaine and crack) constricts the small arteries that provide blood to the nasal tissues. Cigarette smoke is also harmful to nasal mucosa. Thus, if you smoke, stop. If you are around smokers, avoid secondhand smoke as much as possible.

You can try to keep your nose as clean and moist as possible by douching the nasal cavities two or three times per day with a saline solution. Your doctor can instruct you on this. If douching is unacceptable to you, then you could buy an over-the-counter saline spray. Ask your pharmacist to show you which spray to buy, because you do NOT want a spray that contains any medications. You only want salt water (saline).

If you have known allergies, try to manage them as best as possible. If, for example, you are allergic to house dust, then you should buy a HEPA air filter for your bedroom and vacuum your household regularly.

Finally, of course, you need to keep away from drugs.

What about the perforation? This may or may not be contributing to your symptoms. Perforations are interesting beasts. Very small and very large ones tend not to cause problems. Intermediate-sized perforations (about 1/3 inch to 1/2 inch in diameter) cause the most grief. Perforations can cause a whistling noise when you breathe through your nose. They may also crust and bleed periodically. They usually do not cause dryness, sneezing or a runny nose, which is what's bothering you.

Perforations can be closed with a little silicone "button." For patients who do not tolerate the button, there are operations that involve moving tissue within the nose to fill the defect. Needless to say, the one thing you do NOT need right now is an operation on your already-traumatized nose. Nevertheless, this is an option for the future, should your perforation prove very troublesome.