Sinus Issues & Drug Use: What Doctors Can & Cannot Detect

A routine sinus examination (anterior rhinoscopy, nasal endoscopy) cannot definitively determine intranasal drug use (snorting). Findings may include:

• Nasal mucosal atrophy, septal perforation, crusting, inflammation
• Foreign material, charring (from heated pipes)
• Secondary sinusitis, epistaxis

However, these signs are non‑specific—they also occur with chronic rhinosinusitis, autoimmune disease, occupational exposures, or excessive decongestant spray use.

Definitive detection requires:

• Toxicology screen (urine, blood, hair)
• Patient disclosure (confidential)
• Collateral history

Clinicians should maintain non‑judgmental approach; focus on treating nasal pathology and offering substance‑use resources if indicated.