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12: Ear, nose and oropharynx

Approved: 1 May 2013. Last amended: 5 Dec 2023.

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12.1 Drugs acting on the ear

12.1.1 Otitis externa

See Chapter 5 for treatment guidelines

12.1.1.1 Anti-infective preparations

Recommended

  • Acetic Acid 2%

    Spray (EarCalm®)

    • Specific Indication

  • Clotrimazole 1%

    Solution – confirmed fungal infection. Contains propylene glycol which causes hypersensitivity in 10% of patients.

  • Ciprofloxacin 0.2%

    Ear Drops

    • 12.1.1.2 Anti-infective plus corticosteroid

    Topical aminoglycoside antibiotics should only be used for a maximum of one week.

    Recommended

  • Dexamethasone 0.1% and neomycin 3250units/ml

    Spray (Otomize®)

    • Alternative

  • Betamethasone 0.1% and neomycin 0.5%

    Drops (Betnesol-N®)

  • Ciprofloxacin 0.3% and dexamethasone 0.1%

    Drops (Cilodex®)

    • Specific Indication

  • Flumetasone 0.02% and Clioquinol 1%

    Drops (Locorten Vioform®)
    Reserved for when recommended options are ineffective or unsuitable based on culture sensitivities

  • Hydrocortisone 1% and gentamicin 0.3%

    Drops (Gentisone HC®)
    Reserved for when recommended options are ineffective or unsuitable based on culture sensitivities

    • 12.1.1.3 Corticosteroids

    Recommended

  • Betamethasone 0.1%

    Drops (Vista-methasone®)

    • Alternative

  • Prednisolone 0.5%

    Drops (Predsol®)

    • 12.1.2 Otitis media

    See Chapter 5 for treatment guidelines

    12.1.3 Removal of ear wax

    Recommended

  • Sodium bicarbonate 5%

    Drops

    • Alternative

  • Olive oil drops
  • Cerumol® drops

    • 12.2 Drugs acting on the nose

    12.2.1 Drugs used in nasal allergy

    12.2.1.1 Antihistamines

    Recommended

  • Azelastine

    Nasal spray (Rhinolast®)

    • 12.2.1.2 Corticosteroids

    Alternatives and specific indications are for use in patients who experience adverse effects to recommended nasal preparations.

    Recommended

  • Beclometasone

    Nasal spray

  • Budesonide

    Nasal spray

  • Betamethasone 0.1%

    Drops (Vista-methasone®)

    • Alternative

  • Fluticasone furoate

    (Avamys®) nasal spray

    • Specific Indication

  • Dymista®

    (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.

  • Fluticasone propionate

    (Flixonase Nasule®) nasal drops – ENT only, for nasal polyps

    • 12.2.1.3 Cromoglicate

    Specific Indication

  • Sodium cromoglicate 4%

    (Rynacrom®) nasal spray - Resistant rhinitis

    • 12.2.1.4 Ectoin

    Specific Indication

  • Ectoin 2%

    Fusion Allergy® nasal spray

    (Red classification until listed in Drug Tariff)

    • 12.2.2 Topical nasal decongestants

    12.2.2.1 Sympathomimetics

    Specific Indication

  • Xylometazoline 0.1%

    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.

    • 12.2.2.2 Antimuscarinic

    Specific Indication

  • Ipratropium 0.03%

    Spray (Rinatec®) – for use in the elderly only

    • 12.2.3 Nasal preparations for infection and epistaxis

    12.2.3.1 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.

    Recommended

  • Chlorhexidine 0.1% & neomycin 0.5%

    Cream (Naseptin®)

  • Mupirocin 2%

    Nasal ointment (Bactroban Nasal®)

    • 12.2.3.2 Epistaxis

    Specific Indication

  • Bismuth subnitrate & iodoform

    Paste – ENT only

    • 12.3 Drugs acting on the oropharynx

    GHNHSFT Mouth Care Guideline

    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.

    Recommended

  • Benzydamine

    (Difflam®) oral rinse

  • Benzydamine

    (Difflam®) spray

  • Orabase®

    Paste

  • Hydrocortisone 2.5mg

    Mucoadhesive buccal tablet

  • Lidocaine 5%

    Ointment

  • Choline Salicylate

    Dental Gel, BP

    • Specific Indication

  • Gelclair®

    Gel – Radiotherapy / chemotherapy-induced painful oral lesions. Shared Care Guideline

  • Episil®

    Spray – Radiotherapy / chemotherapy-induced painful oral lesions where Gelclair® ineffective. Shared Care Guideline

  • Caphosol®

    Mouth Rinse – Prevention of oral mucositis caused by radiotherapy

    • 12.3.2 Oropharyngeal anti-infective drugs

    Recommended

  • Miconazole

    Oral gel (most cost-effective in primary care)

  • Nystatin

    Oral suspension (most cost-effective in secondary care)

    • Specific Indication

  • Fluconazole

    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

    Recommended

  • Chlorhexidine

    Mouthwash

    • Alternative

  • Chlorhexidine

    Dental gel

  • Chlorhexidine

    Oral spray

  • Hydrogen peroxide 6%

    Mouthwash

    • 12.3.5 Treatment of dry mouth

    Recommended

  • Saliveze®

    Spray

    • Alternative

  • BioXtra®

    Gel

  • BioXtra®

    Spray

  • Salivix®

    Pastilles (acidic – avoid in dentate patients)

    • Specific Indication

  • Pilocarpine

    5mg tablets – specialist use only

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    Key

    Hospital / Specialist only

    Specialist initiated / advised (with Shared Care Guideline)

    Specialist initiated / advised (without Shared Care Guideline)

    Non-specialist or Specialist

    Treatment Guidelines

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