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Video

Comprehensive Otolaryngology

(A210) Case Report and Literature Review of Oropharyngeal Frostbite Injury from Recreational Use of Nitrous Oxide

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Robert Gurevich, MD

    PGY4
    Tulane University
    New Orleans, Louisiana, United States

    • Co-Author(s)

  • Ajibola B. Bakare, MD/PhD

    Resident Physician
    University of Arkansas for Medical Science
    Little Rock, Arkansas, United States

  • JN

    Jonas Nielsen

    • Senior Author(s)

  • Katie Melder, MD

    Assistant Professor
    Louisiana State University Health Sciences Center New Orleans
    New Orleans, Louisiana, United States

Disclosure(s):
Robert Gurevich, MD: No relevant relationships to disclose.
Ajibola B. Bakare, MD/PhD: No relevant relationships to disclose.
Katie Melder, MD: No relevant relationships to disclose.


Introduction: We present a case report of an oropharyngeal mucosal injury secondary to nitrous oxide abuse requiring ICU admission with an accompanying review of the literature on upper airway injury due to volatile substances.

Methods: A systematic review was conducted across Pubmed, Embase and Google scholar focusing on English language articles on upper airway injury due to volatile substances.

Results: A previously healthy 24-year-old male presented to the emergency room of a level 1 trauma center 48 hours after abuse of N2O in a social setting. He complained of dysphagia, progressive dysphonia and shortness of breath. Flexible laryngoscopy revealed ulceration of the hard and soft palate, uvula and nasopharynx with sloughing pseudomembranes. The patient was admitted to the ICU on systemic steroids and clindamycin. After 24 hours, he showed continued symptomatic improvement and was discharged home. On reevaluation in 2 weeks, laryngoscopy showed near resolution of his upper airway frostbite injury.

In our literature review, we identified 7 published cases of upper airway injury associated with volatile substances. The median age was 26, all but one of the patients were males. The most common etiology was pressurized nitrous oxide. There was only 1 other case due to recreational use of whipped cream chargers, also known as whippets. Outcomes included same day discharge, ICU observation and emergent tracheotomy. Mean hospital stay was 3 days with 1 study not specifying the length of stay. Most cases administered systemic corticosteroids and empiric antibiotics. Additionally, it is advised to monitor for systemic effects of chronic N2O use.

Conclusions: Upper aerodigestive tract frostbite injury is a rare entity associated with N2O use and there are no established management strategies. In cases of widespread mucosal injury, it is important to observe for progressive airway edema and consider debridement of sloughing pseudomembranes. Additionally, it is important to keep a broad differential for systemic side effects such as myelopathy, megaloblastic anemia and thrombosis.