Cocaine is one of the most popular illicit drugs, and the most frequent route of administration is intranasal inhalation.1,2 Chronic consumption may be associated with the progressive destruction of the osteocartilaginous structures of the nose, paranasal sinuses, and palate.1,2 This clinical picture is also known as cocaine-induced midline destructive lesions (CIMDL). We describe a patient with CIMDL associated with erosion and widening of the eustachian tube. To our knowledge, this is the first documented case of eustachian tube erosion in a cocaine user.