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Ketamine-snorting-induced nasal septum perforation.

A 23-year-old man presented with a 2-month history of nasal obstruction and intermittent nasal bleeding. He visited our clinic because of these symptoms, as well as urinary frequency, urgency, and suprapubic pain. He had no significant history of nasal trauma or surgery. He reported that he had been addicted for 2 years to ketamine powder in the form of nasal snorting through his right nostril.


An endoscopic sinus examination showed generalized mucosa necrosis and atrophy in the right nasal cavity, with a septum perforation measuring 2 x 1 cm that enabled direct visualization of the contralateral inferior turbinate (figure). The mucosa showing in the left nasal cavity (figure 1, A) was relatively normal compared to the right side (figure 1, B), which was consistent with his right-nostril-dependent ketamine snorting.

Ketamine, primarily used as an anesthetic agent for the induction and maintenance of general anesthesia, is commonly used at dance club venues or rave parties. (1) Ketamine causes vasoconstriction as a result of sympathetic stimulation; thus, long-term abuse leads to mucosal ischemia, atrophy and, ultimately, necrosis, followed by underlying cartilage or bone destruction. Ketamine abuse is also associated with severe urinary tract dysfunction such as chronic cystitis or bladder pain syndrome, (2) as shown in this case.

The patient declined surgical treatment for the defects. His nasal symptoms improved after he quit using ketamine and received regular intranasal rinses and endoscopic debridement during follow-up. However, the lower urinary tract symptoms remained.


(1.) Weir E. Raves: A review of the culture, the drugs and the prevention of harm. CMAJ 2000;162(13):1843-8.

(2.) Chen CH, Lee MH, Chen YC, Lin MF. Ketamine-snorting associated cystitis. J Formos Med Assoc 2011;110(12):787-91.

Keng-Kuang Tsai, MD; Chih-Hung Wang, MD, PhD

From the Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China (Dr. Tsai and Dr. Wang); and the Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital Songshan Branch, Taipei (Dr. Tsai).

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Author:Tsai, Keng-Kuang; Wang, Chih-Hung
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Date:Jul 1, 2016
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