European annals of otorhinolaryngology, head and neck diseases · 2026
Necrotizing toxic laryngitis following combined polysubstance smoking of crack cocaine and heroin.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Asimakopoulos A D, Dulguerov N, Ciucchi L, Avagnina A
Аннотация
INTRODUCTION: Thermal injury of the upper aerodigestive tract related to inhalational drug abuse is uncommon but increasingly recognized. While airway injury associated with crack cocaine inhalation has been reported, the otolaryngologic manifestations of inhaled heroin vapor ("chasing the dragon") remain poorly described.
CASE SUMMARY: We report the case of a 39-year-old woman presenting with progressive dysphonia and dyspnea. She had a history of polysubstance smoking including tobacco, cannabis, crack cocaine, and heroin vapor inhalation. Flexible fiber-optic nasopharyngolaryngoscopy demonstrated extensive bilateral necrosis of the vocal fold mucosa with preserved vocal fold mobility and abundant carbonaceous debris within the laryngeal lumen. Histopathological analysis of expectorated fragments confirmed ischemic necrosis of squamous mucosa. The patient was managed conservatively with corticosteroids, antibiotics, and close outpatient follow-up, with partial clinical improvement.
DISCUSSION: Thermal injury from crack cocaine inhalation has been associated with supraglottic and laryngeal mucosal damage. In contrast, the effects of inhaled heroin vapor on the upper airway remain poorly documented. Combined inhalation of multiple substances may result in additive thermal and chemical mucosal injury, potentially explaining the extensive laryngeal necrosis observed in this case. This report highlights the need to consider polysubstance inhalational abuse in patients presenting with unexplained necrotizing laryngeal lesions.
CASE SUMMARY: We report the case of a 39-year-old woman presenting with progressive dysphonia and dyspnea. She had a history of polysubstance smoking including tobacco, cannabis, crack cocaine, and heroin vapor inhalation. Flexible fiber-optic nasopharyngolaryngoscopy demonstrated extensive bilateral necrosis of the vocal fold mucosa with preserved vocal fold mobility and abundant carbonaceous debris within the laryngeal lumen. Histopathological analysis of expectorated fragments confirmed ischemic necrosis of squamous mucosa. The patient was managed conservatively with corticosteroids, antibiotics, and close outpatient follow-up, with partial clinical improvement.
DISCUSSION: Thermal injury from crack cocaine inhalation has been associated with supraglottic and laryngeal mucosal damage. In contrast, the effects of inhaled heroin vapor on the upper airway remain poorly documented. Combined inhalation of multiple substances may result in additive thermal and chemical mucosal injury, potentially explaining the extensive laryngeal necrosis observed in this case. This report highlights the need to consider polysubstance inhalational abuse in patients presenting with unexplained necrotizing laryngeal lesions.