Nasal septum perforation

Dyspnea, cough, and wheezing were reported in two cases in which the subjects inhaled "massive amounts" of chromium(VI) trioxide. Marked hyperemia of the nasal mucosa without nasal septum perforation was found in both subjects upon physical examination (Meyers 1950). In a chrome plating plant where poor exhaust resulted in excessively high concentrations of chromium trioxide fumes,... 

Respiratory Effects. Occupational exposure to chromium compounds results in direct contact of mucocutaneous tissue, such as nasal and pharyngeal epithelium, due to inhalation of airborne dust and mists of these compounds. Such exposures have led to nose and throat irritation and nasal septum perforation. Because exposure is to airborne chromium, studies noting these effects are described in Section 2.2.1.2. 

CHRONIC HEALTH RISKS may cause severe allergic respiratory reaction with symptoms resembling asthma repeated or prolonged exposure may cause nasal septum perforation liver damage with yellow jaundice has been reported other long-term effects include kid-... 

Mailliez A, Baldini C, Van JT, Servent V, Mallet Y, Bonneterre J. Nasal septum perforation a side effect of bevacizumab chemotherapy in breast cancer patients. Br J Cancer 2010 103 772-5. 

Inhalation of dusts can cause metal fume fever (79,80), and ulceration or perforation of the nasal septum. Mild discomfort has been noted with workplace concentrations as low as 0.08 mg/m. The workplace standard (TLV) for copper dusts or mist is 1 mg/m and 0.2 mg/m for copper fume (81). 

The nose is usually the first site of contact in the respiratory tract for many airborne chemicals of environmental and occupational concern. Examples of human nasal effects include loss of olfactory function (e.g., anosmia and hyposmia), atrophy of the nasal mucosa, mucosal ulcers, perforated nasal septum, or sinonasal cancer related to exposure to certain metal dusts and vapors (Sunderman 2001). 

The irritant effects are probably due primarily to its alkalinity, but dehydrating and thermal effects also may be contributing factors. Strong nasal irritation was observed from exposure to a mixture of dusts containing calcium oxide in the range of 25mg/m but levels of 9-lOmg/m produced no observable irritation. Inflammation of the respiratory tract, ulceration and perforation of the nasal septum, and pneumonia have been attributed to inhalation of calcium oxide dust severe irritation of the upper respiratory tract ordinarily causes persons to avoid serious inhalation exposure. ... 

In an industrial plant in which the airborne chromic acid concentrations measured from 0.18 to 1.4mg/m/ moderate irritation of the nasal septum and turbinates was observed after 2 weeks of exposure, ulceration of the septum was present after 4 weeks, and there was perforation of the septum after 8 weeks. A worker exposed to an unmeasured concentration of chromic acid mist for 5 years developed jaundice and was found to be excreting significant amounts of chromium liver function was mildly to moderately impaired in four other workers with high urinary chromium excretion. ... 

Pneumoconiosis has been reported among workers exposed to nickel dust, but exposure to known fibrogenic substances could not be excluded. Nasal irritation, damage to the nasal mucosa, perforation of the nasal septum, and loss of smell have only occasionally been reported in workers exposed to nickel aerosols and other contaminants. ... 

Ammonium dichromate is an irritant to skin. Inhalation of dusts can cause pulmonary irritation, perforation of the nasal septum and chrome sores. Ingestion can cause ulceration. It is also a flammable salt. 

While chromium metal or trivalent chromium is not very toxic, hexavalent chromium (Cr +) is carcinogenic and moderately toxic. Cr + is corrosive to skin and causes denaturation and precipitation of tissue proteins. Inhalation of Cr6+ dust or mist can cause perforation of the nasal septum, lung irritation, and congestion of the respiratory passsages. Chronic exposure may produce cancer of the respiratory tract. 

Cocaine is a local vasoconstrictor, and snorting of cocaine intra-nasally reduces the amount of blood flow to the area, resulting in a reduced rate of drug absorption and slower onset of action. Often in cocaine abusers, the reduced blood supply to the nasal septum leads to the development of a perforation between the nasal passages. The effects of cocaine last approximately 40 minutes, while the effects of other stimulants usually last several hours, as each has a different half-life. 

Due to the extremely high boiling point of chromium, gaseous chromium is rarely encountered. Rather, chromium in the environment occurs as particle-bound chromium or chromium dissolved in droplets. As discussed in this section, chromium(VI) trioxide (chromic acid) and soluble chromium(VI) salt aerosols may produce different health effects than insoluble particulate compounds. For example, exposure to chromium(VI) trioxide results in marked damage to the nasal mucosa and perforation of the nasal septum, whereas exposure to insoluble(VI) compounds results in damage to the lower respiratory tract. 

Mouse (C57BL) 12 mo 2 d/wk 120 min/d Resp 1.81 F (emphysema, perforation) nasal septum Adachi 1987 Cr03 (VI)... 

Human 7.5 yr -avg (range 3-16 yr) Resp 0.004 M (epitaxis, rhinorrhea, nasal septum ulceration and perforation) Lucas and Kramkowski 1975 Cr03 (VI)... 

Phagocytosis and the reduction of nitroblue tetrazolium to formazan was impaired by chromium(III) but not chromium(VI). These effects represent a decrease in the functional and metabolic activity of the macrophage (Johansson et al. 1986a, 1986b). Mice exposed to chromium trioxide mist at concentrations of 1.81 and 3.63 mg chromium(VI)/m3 intermittently for i2 months developed perforations in the nasal septum, hyperplastic and metaplastic changes in the larynx, trachea, and bronchus, and emphysema (Adachi 1987 Adachi et al. 1986). 

Dermal Effects. Occupational exposure to airborne chromium compounds has been associated with effects on the nasal septum, such as ulceration and perforation. These studies are discussed in Section 2.2.1.2 on Respiratory Effects. Dermal exposure to chromium compounds can cause contact allergic dermatitis in sensitive individuals, which is discussed in Section 2.2.3.3. Skin burns, blisters, and skin ulcers, also known as chrome holes or chrome sores, are more likely associated with direct dermal contact with solutions of chromium compounds, but exposure of the skin to airborne fumes and mists of chromium compounds may contribute to these effects. 

Dermal Effects. Chromium compounds can produce effects on the skin and mucous membranes. These include irritation, burns, ulcers, an allergic type of dermatitis. Irritation of the nasal mucosa and other mucosal tissues of the respiratory system, and nasal septum ulcers, and perforation were considered under Respiratory Effects discussed above. Dermatitis is considered under Immunological Effects discussed below. 

Therapeutic uses Cocaine has a local anesthetic action that represents the only current rationale for the therapeutic use of cocaine-, cocaine is applied topically as a local anesthetic during eye, ear, nose, and throat surgery. While the local anesthetic action of cocaine is due to a block of voltage-activated sodium channels, an interaction with potassium channels may contribute to cocaine s ability to cause cardiac arrhythmias. [Note Cocaine is the only local anesthetic that causes vasoconstriction. This effect is responsible for the necrosis and perforation of the nasal septum seen in association with chronic inhalation of cocaine powder.]... 

Intranasal use causes mucosal vasoconstriction, anosmia and eventually necrosis and perforation of the nasal septum. 

When used as a nasal decongestant, phenylephrine can cause local nasal irritation and even perforation of the anterior nasal septum. 

A 69-year-old woman developed perforation of the nasal septum after overuse of a common over-the-counter nasal spray containing phenylephrine (6). 

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