Is routine cocaine testing justified in patients with septal perforation?

Nasal septal perforation occurs when both mucoperichondrial layers surrounding the septal cartilage are compromised. While richly vascularized, this tissue is particularly vulnerable to ischaemic injury caused by intranasal cocaine use. Cocaine inhibits catecholamine reuptake, leading to vasoconstriction, tissue necrosis, and, ultimately, septal damage. Furthermore, the adulterant levamisole, present in up to 80% of seized cocaine in Germany, is a known trigger for vasculitis, compounding this effect.