12: Ear, nose and oropharynx
Approved: 1 May 2013. Last amended: 9 May 2024.
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
Otigo®
Ear drops (lidocaine hydrochloride 40mg/g, phenazone 10mg/g)
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
Hydrocortisone 2.5mg
Mucoadhesive buccal tablet
Lidocaine 5%
Ointment
Choline Salicylate
Oromucosal gel
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