Section 12: Ear, Nose and Oropharynx

Section Description

BNF 12.1.1

Otitis externa

BNF 12.1.2

Otitis media

BNF 12.1.3

Removal of ear wax

BNF 12.2

Drugs acting on the nose

BNF 12.2.1

Drugs used in nasal allergy

BNF 12.2.2

Topical nasal decongestants

BNF 12.2.3

Nasal preparations for infection and epistaxis

BNF 12.3.1

Drugs for oral ulceration and inflammation

BNF 12.3.2

Oropharyngeal anti-infective drugs

BNF 12.3.3

Lozenges and sprays

BNF 12.3.4

Mouthwashes, gargles and dentrifrices

BNF 12.3.5

Treatment of dry mouth

BNF 12.1.1 Otitis externa


Astringent preparations

 

 

Aluminium acetate 13% ear drops

 

 

 

 

 

Anti-inflammatory preparations

 

 

Betamethasone sodium phosphate 0.1% ear drops

 

Pack cost

Prednisolone sodium phosphate 0.5% ear drops

 

Pack cost

 

 

 

Anti-infective preparations

 

 

Clotrimazole 1% solution

 

Canesten®

Gentamicin 0.3%

 

Do not use in perforated ear drums.

 

 

 

Anti-infective + Anti-inflammatory preparations

 

 

Gentisone HC® (gentamicin + hydrocortisone)

 

Do not use in perforated ear drums.

Otomize® (neomycin, acetic acid + dexamethasone)

 

 

Predsol-N® (prednisolone + neomycin)

 

 

Sofradex® (framycetin, gramicidin + dexametasone)

 

 

Betnesol-N® (betamethasone + neomycin)

 

 

BNF 12.1.2 Otitis media


Acute Otitis Media – Viral

 

 

Simple analgesia e.g. paracetamol

 

 

 

 

 

Acute Otitis Media – Bacterial

 

 

Systemic antibiotic - see Antibiotic formulary

 

 

Simple analgesia e.g. paracetamol

 

 

BNF 12.1.3 Removal of ear wax

Olive oil

 

 

Sodium bicarbonate 5% ear drops

 

 

BNF 12.2 Drugs acting on the nose

How to use nose drops

To see an image of how to use nose drops please follow this link

Some points about nose drops

The above advice is general advice for most nose drops. You may be given specific instructions which may vary from the above.

© EMIS and PIP 2005   Updated: May 2005   CHIQ Accredited   PRODIGY Validated

How to use nasal spray

  1. 1. Shake bottle well
  2. 2. Look down
  3. 3. Using RIGHT hand for LEFT nostril, put nozzle just inside nose aiming towards outside wall
  4. 4. Squirt once or twice (as directed)
  5. 5. Change hands and repeat for other side
  6. 6. Do NOT sniff hard

To see an image of how to use nasal spray please follow this link

BNF 12.2.1 Drugs used in nasal allergy

 

Licensed age

ANTIHISTAMINES

 

Azelastine aqueous nasal spray

Twice daily

Fluticasone propionate / azelastine hydrochloride nasal spray (Dymista®)

> 12 years

ANTIMUSCARINICS

 

Ipratropium bromide nasal spray 0.03%

 

CORTICOSTEROIDS

 

Treatment of choice for nasal symptoms

 

TWICE DAILY Nasal Sprays

 

Beclometasone 50mcg / spray

> 6 years

ONCE DAILY Nasal Sprays

 

Mometasone 50mcg/ spray

> 3 years

Fluticasone furoate 27.5mcg/ spray  

> 12 years

BNF 12.2.2 Topical nasal decongestants

Sympathomimetics

Pack Cost

 

Ephedrine nasal drops 0.5% and 1%

 

For short-term use only.

Xylometazoline nasal drops 0.05% and 0.1%

 

For short-term use only.

Antimuscarinics

 

 

Ipratropium bromide nasal spray 0.03%

 

 

BNF 12.2.3 Nasal preparations for infection and epistaxis

Nasal Staphylococci – Patients without peanut allergy

 

Chlorhexidine + neomycin nasal cream

 

Naseptin®

Nasal Staphylococci – Patients with peanut allergy

 

Neomycin 0.5% cream - apply three times a day

 

 

For eradication of nasal carriage of MRSA

 

 

Mupirocin nasal ointment 2%

 

Bactroban Nasal®
Apply 3 times a day to the inner surface of each nostril for 5 days. Wait 2 days then re-swab.

Epistaxis

 

 

Bismuth subnitrate and iodoform paste (BIPP)

 

 

BNF 12.3.1 Drugs for oral ulceration and inflammation

Simple and Antiseptic Mouthwashes

 

 

see Section 12.3.4

 

Doxycycline 20mg tablets

   

Corticosteroids

 

 

Hydrocortisone oromucosal tablets 2.5mg

 

 

Local Anaesthetics

 

 

Benzydamine oral rinse 0.15%

 

 

Benzydamine oral spray 0.15%

 

 

Salicylates

 

 

Choline Salicylate 8.7% dental gel

 

 

BNF 12.3.2 Oropharyngeal anti-infective drugs

Fungal Infections

 

 

Miconazole sugar free oral gel 24mg/ml

 

Interaction with warfarin

Nystatin sugar-free oral suspension

 

 

BNF 12.3.3 Lozenges and sprays

There is no convincing evidence that antiseptic lozenges and sprays have a beneficial action and they sometimes irritate and cause sore tongue and lips.

Antiseptic

 

 

Merocet® lozenges

 

 

Antiseptic + Local Anaesthetic

 

 

Merocaine® lozenges

 

 

BNF 12.3.4 Mouthwashes, gargles and dentrifrices

Chlorhexidine gluconate 0.2% mouthwash

 

 

Hexetidine 0.1% mouthwash

 

Oraldene® not routinely stocked at RWHT

Mouthwash Solution Tablets

 

 

BNF 12.3.5 Treatment of dry mouth

Local Treatment
The following preparations may be prescribed for patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome. Please endorse FP10 prescription “ACBS”

Glandosane® aerosol spray

Neutral, lemon or peppermint flavour. Sugar-free

Saliveze® oral spray

Mint flavoured. Not routinely stocked at RWHT

BIOTÈNE ORAL BALANCE®

Restricted / Specialist Prescribing Only (hospital only). Maxillofacial or Speech and Language Therapy (SALT) recommendations Only

Systemic Treatment

 

Pilocarpine hydrochloride 5mg tablets

Salagen®