Ear, Nose and Oropharynx
Removal of ear wax
Drugs used in nasal allergy – antihistamines
Drugs used in nasal allergy - corticosteroids
Drugs used in nasal allergy - cromoglicate
Topical nasal decongestants
Topical nasal decongestants - antimuscarinic
Infections of the ear, nose and oropharynx - Please refer to the ‘Treatment of infections in Primary Care’ section
Drugs used for oral hygiene, plaque inhibition, oral candidiasis, gingivitis, management of aphthous ulcers
Treatment of dry mouth
Updated: 27.08.2009
Preparations used for the removal of ear wax
Drug
Indication
Formulation
Notes
Sodium
Softening of ear
Sodium bicarbonate
May cause dryness of the ear canal.
bicarbonate
wax
5% ear drops
Softening of ear
Olive oil
Olive oil ear drops
wax
Softening of ear
Almond oil
Almond oil ear drops
wax
Drugs used in nasal allergy – antihistamines
Drug
Indication
Formulation
Notes
Azelastine
Azelastine
140mcg/dose nasal
(Rhinolast®)
Allergic rhinitis
spray
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Drugs used in nasal allergy - corticosteroids
Corticosteroids should be avoided in untreated nasal infections or pulmonary tuberculosis.
Systemic absorption may occur from nasal administration particularly if high doses are used or if treatment is prolonged. The risk of systemic
effects is more with nasal drops than sprays.
CSM: the height of children should be monitored in those receiving prolonged treatment, and referred to a paediatrician if growth is slowed.
For information on preservative contents, please refer to the current BNF.
Drug
Indication
Formulation
Notes
Prophylaxis and
Beclometasone
treatment of allergic
Beclometasone
50mcg/dose nasal
and vasomotor
spray
rhinitis
Prophylaxis and
Fluticasone
treatment of allergic
50mcg/dose nasal
Fluticasone
rhinitis and
spray
perennial rhinitis;
nasal polyps
Mometasone
Prophylaxis and
50mcg/dose nasal
Mometasone
treatment of allergic
spray
rhinitis; nasal poyps
Drugs used in nasal allergy - cromoglicate
For information on preservative contents, please refer to the current BNF.
Drug
Indication
Formulation
Notes
Sodium
Prophylaxis of
Sodium cromoglicate
cromoglicate
allergic rhinitis
4% nasal spray
Topical nasal decongestants
For information on preservative contents, please refer to the current BNF.
Drug
Indication
Formulation
Notes
Sodium chloride 0.9%
Sodium chloride
Nasal congestion
3 drops into each nostril 3-4 times a day
nasal drops
Topical sympathomimetic nasal decongestants should be used for short-term
Ephedrine 0.5% &
use only (no longer than 7 days) as they can cause rebound congestion.
Ephedrine
Nasal congestion
1% nasal drops
All can cause hypertensive crisis if used with a monoamine-oxidase inhibitor
including mocolobomide.
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Topical nasal decongestants - antimuscarinic
For information on preservative contents, please refer to the current BNF.
Drug
Indication
Formulation
Notes
Rhinorrhoea
Ipratripium
associated with
Ipratropium
21mcg/dose nasal
allergic and non-
spray
allergic rhinitis
Oral hygiene, plaque inhibition, oral candidiasis, gingivitis, management of aphthous ulcers.
Drug
Formulation
Notes
Duration of treatment
Not compatible with some ingredients in toothpaste; leave an interval of at
Mouthwash should not
least 30 minutes between using mouthwash and toothpaste.
Chlrohexidine
Mouth wash
be used continuously
for more than 1 month
Can cause reversible brown staining of teeth.
Treatment of dry mouth
Please review patients’ medication to identify iatrogenic causes of dry mouth.
Frequent sips of cool drinks or sucking pieces of ice or sugar-free pastilles should be advised before prescribing artificial saliva.
Drug
Indication
Formulation
Notes
Advice from ACBS (Advisory Committee for Borderline Substances): Saliveze
Artificial saliva
is reserved for dry mouth during and post radio therapy or patients suffering
[Luborant®
Dry mouth
Oral spray
from Sicca syndrome.
Saliveze®]
Luborant may be difficult to obtain.
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References:
•
Joint Formulary Committee. British National Formulary. 54th Ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain. 2007.
•
Clinical Knowledge Summaries. Otitis media and externa. SCHIN Ltd. Centre for Health Informatics at Newcastle. Available from: http://www.cks.library.nhs.uk/otitis
externa Accessed 26/02/08
•
Summary of Product Characteristics. Gentisone HC®, Locorten-Vioform® , Daktarin oral gel® Available from: www.medicines.org.uk. Accessed 26/02/08.
•
Bart’s and the London and Tower Hamlets PCT. ENT guidelines for general practionners. June 2002. Available from:
http://10.148.22.35/commissioningandmodernisation/policies%20protocols%20%20guidelines/ent%20management%20%26%20referral%20guidelines.doc
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