12: Ear, nose & oropharynx
Approved: 1 May 2013. Last amended: 4 Mar 2015.
12.1 Drugs acting on the ear
12.1.1 Otitis externa
126.96.36.199 Anti-infective preparations
Acetic Acid 2%
Solution – confirmed fungal infection. Contains propylene glycol which causes hypersensitivity in 10% of patients.
Drops – ENT consultant request only. As there isn’t a licensed ciprofloxacin eardrop preparation, ciprofloxacin eye drops are used.
188.8.131.52 Anti-infective plus corticosteroid
Topical aminoglycoside antibiotics should only be used for a maximum of one week.
Dexamethasone 0.1% and neomycin 3250units/ml
Flumetasone 0.02% and Clioquinol 1%
Betamethasone 0.1% and neomycin 0.5%
Hydrocortisone 1% and gentamicin 0.3%
Drops (Gentisone HC®)
12.1.2 Otitis media
12.1.3 Removal of ear wax
Sodium bicarbonate 5%
Olive oil drops
12.2 Drugs acting on the nose
12.2.1 Drugs used in nasal allergy
Nasal spray (Rhinolast®)
Alternatives and specific indications are for use in patients who experience adverse effects to recommended nasal preparations.
(Avamys®) nasal spray
(azelastine/fluticasone propionate) nasal spray
- patients who are already using this combination in separate nasal sprays.
- patients for whom the maximum tolerated dose of intranasal corticosteroid is insufficient.
(Flixonase Nasule®) nasal drops – ENT only, for nasal polyps
Sodium cromoglicate 4%
(Rynacrom®) nasal spray - Resistant rhinitis
12.2.2 Topical nasal decongestants
Drops or spray – only where non-pharmacological measures have failed. Max. 7 day duration.
Ephedrine 0.5%, 1%
Nasal drops – only where non-pharmacological measures have failed. Max. 7 day duration.
Spray (Rinatec®) – for use in the elderly only
12.2.3 Nasal preparations for infection and epistaxis
184.108.40.206 Nasal staphylococci
- For MRSA treatment, Mupirocin 2% nasal ointment is the recommended choice.
- Please refer to your Organisation’s MRSA policy for further information on the treatment of MRSA.
Chlorhexidine 0.1% & neomycin 0.5%
Nasal ointment (Bactroban Nasal®)
Bismuth subnitrate & iodoform
Paste – ENT only
12.3 Drugs acting on the oropharynx
12.3.1 Drugs for oral ulceration and inflammation
Note: A saline mouthwash may relieve the pain of traumatic ulceration. Dissolve half a teaspoon of salt in a glass of warm water.
(Difflam®) oral rinse
Mucoadhesive buccal tablet
Dental Gel, BP
Gel – Radiotherapy / chemotherapy-induced painful oral lesions. Shared Care Guideline
Spray – Radiotherapy / chemotherapy-induced painful oral lesions where Gelclair® ineffective. Shared Care Guideline
12.3.2 Oropharyngeal anti-infective drugs
Oral gel (most cost-effective in primary care)
Oral suspension (most cost-effective in secondary care)
50mg capsules – oral candidiasis in radiotherapy
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 sore lips. Some of these preparations also contain local anaesthetics which relieve pain but may cause sensitisation.
12.3.4 Mouthwashes, gargles, and dentifrices
Hydrogen peroxide 6%
12.3.5 Treatment of dry mouth
Pastilles (acidic – avoid in dentate patients)
5mg tablets – specialist use only