{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:24:42Z","timestamp":1790011482913,"version":"4.0.1"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100003572","name":"American Academy of Otolaryngic Allergy Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100003572","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses guidelines were utilized to identify English\u2010language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse.<jats:italic>Laryngoscope<\/jats:italic>, 1767\u20131771, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27069","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T10:24:12Z","timestamp":1514370252000},"page":"1767-1771","source":"Crossref","is-referenced-by-count":5,"title":["Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review"],"prefix":"10.1002","volume":"128","author":[{"given":"Danielle A.","family":"Morrison","sequence":"first","affiliation":[{"name":"Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Wise","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"DelGaudio","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naweed I.","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5907-3421","authenticated-orcid":false,"given":"Joshua M.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"JonesCM.The Latest Prescription Trends for Controlled Prescription Drugs.National Institute of Health (NIH); National Institute on Drug Abuse.2015. 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