Intranasal Acetaminophen Abuse and Nasal, Pharyngeal, and Laryngotracheal Damage

Abstract

A young adult female originally presented with necrosis of the nasal cavity mucosa and septum after sniffing crushed acetaminophen. She underwent endoscopic sinus surgery and debridement but continued to use acetaminophen intranasally. Four months later, the destruction had extended to include the posterior pharyngeal wall and subglottis. The diagnosis was confirmed by polarizable talc found on biopsy of the subglottis. While nasal insufflation of cocaine and hydrocodone-acetaminophen has been well-documented, intranasal abuse of exclusively acetaminophen is not well understood. This case demonstrates the destructive potential of intranasal acetaminophen use and may help physicians recognize unusual signs and symptoms of intranasal drug abuse.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Similarly, prescription narcotics, antidepressants, anticholinergics, and psychostimulants can be abused by intranasal administration 78,92 . Tissue necrosis has also been associated with intranasal opioid and acetaminophen abuse 93–95 . Possible mechanisms of injury include hyperosmotic conditions, vasculitic‐like inflammation, or direct injury secondary to talc 95,96 …”

“…Tissue necrosis has also been associated with intranasal opioid and acetaminophen abuse 93–95 . Possible mechanisms of injury include hyperosmotic conditions, vasculitic‐like inflammation, or direct injury secondary to talc 95,96 …”