“Everybody must get stoned”

– Bob Dylan, Rainy Day Women # 12 & 35

Bob Dylan is one of the most popular Western musicians of the 1960s, and has been a songwriter and performer for more than 50 years. He has more than thirty studio albums and 50 singles to his name, among them Blowin' in the Wind and The Times They Are a-Changin'. Even though his popularity in modern times is not at the same level as it was earlier, he has recently published an album and given a live performance. His classic early sound involves vocals to a guitar accompaniment, with his singing sometimes alternating with a harmonica (mouth organ).

As a singer, his most important instrument is his voice. Singers need to nurture their voices so that they are able to give a good performance. There are various ways of taking care of the human voice, such as drinking plenty of fluids and going through a proper warm-up routine before singing. This makes reports that Dylan has a perforated nasal septum somehow rather ironic. In plain English, the nasal septum is the wall of cartilage that separates the two interior spaces of your nose. Without it, your nose would collapse, giving rise to a condition known as “saddle nose deformity” or simply “saddle nose”. A perforation in the septum therefore means that the cartilage has been broken or punctured.

The extent to which the septum is perforated depends on how the injury was caused. Symptoms vary from patient to patient, but common indications are a persistently bleeding nose, a stinking discharge, and a whistle when the sufferer breathes through their nose. Septum perforation is not the same thing as septum deviation, however. Septum deviation is merely the shifting or positioning of the septum in an asymmetrical fashion inside the nose, which happens naturally in many people and is not usually a problem.

Perforation can happen due to a number of possible causes. Excessive and vigorous nose-picking can injure the septum, but there are also many chemical causes. Regular exposure in industry to toxic, vapourising chemicals such as chromic acid can damage the septum. Corticosteroid nasal sprays can also cause damage if they are applied excessively. Sometimes the damage is the result of other medical procedures, such as the insertion of a tube into the nose or nasal surgery. And then there are some diseases which have septal perforation as a possible symptom. But in Dylan's case, the perforation is reported to have been caused by cocaine use.

Cocaine has three methods of use – injection of a cocaine solution, smoking in a solidified form known as “crack”, and snorting as a powder. The preferred method of the user may depend on the situation in which they are using the drug and their socialisation around its use. Lower-income or unemployed users may more commonly smoke crack or inject, but higher-income, more socially prestigious users are probably going to snort. Snorting does not create smoke or needle scars, and no specific equipment is required. People who snort cocaine usually do so through a rolled up bank note or a drinking straw. The user may therefore snort the powder at any convenient time during their daily routine. Cocaine costs more than other drugs, due probably to its restricted supply in the world, but it is powerful and easily forms an addiction in some people.

Perforation of the nasal septum is a common symptom of cocaine use. So are a constantly running or bleeding nose. These symptoms are awkward for anyone, but especially so for a singer. The pain of the perforation may be accompanied by the wheezing of the air passing through the perforation, and there may also be a constant discharge from the nose. For a professional singer, this is an impediment to performance, and socially it is a disadvantage for anyone. And yet many people who snort cocaine suffer from this type of nasal injury.

However, I am not trying to promote the use of cocaine by other methods. No-one should ever use cocaine, because nasal septum perforation isn't the only way in which the drug affects the user's health. Cocaine is easy to overdose on because it is so powerful. A cocaine overdose gives rise to serious health complications which require instant hospitalisation. The drug may also cause socially unacceptable behaviour. The traditionally cited advantages of using the drug, such as enhanced mood or more energy, need to be assessed in terms of the risks to physical health that the drug poses. If cocaine can cause damage to the cartilage in your nose, consider the effect that it may have elsewhere in your body. Cocaine is toxic and should never be used by anyone, especially because of the way that it is sold – as a white powder. It may therefore be mixed with other chemicals.

Bob Dylan is a better performer without cocaine, and so are you.

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