Letter to the Editor: The United Nations Office on Drugs and Crime reports a continuing rise in cocaine use, especially over the past decade. Widespread adulteration of cocaine and higher purities are producing more extensive local destruction and increasing systemic complications beyond the simple nasal perforations historically seen. These guidelines reflect the Irish Rhinologic Society's recognition of the increasing prevalence of cocaine-related disease, but also the expanding associated clinical complexity and demonstrating our commitment to improving its timely recognition and accurate diagnosis.