A concise summary of the ear, nose and oropharynx intended to facilitate preparation for the GPhC registration exam. These notes can also be used as a quick reference guide or a resource to refresh general clinical pharmacy knowledge, perfect for pre-registration pharmacists, medical students, and ...
Drug Summaries – Humza Ibrahim
The nasal mucosa is sensitive to changes in
Chapter 12 atmospheric temperature and humidity and these
alone may cause slight nasal congestion. Sodium
Ear, Nose, and chloride 0.9% may relieve nasal congestion by helping
to liquefy mucous secretion. Alternatively
Oropharynx decongestant nasal preparations include ephedrine
and xylometazoline.
1 EAR
Otis externa
3 OROPHARYNX
Infection of the ear canal, a topical anti-infective such Dry mouth
as neomycin or clioquinol may be used, but for only Often caused by antimuscarinic drugs and diuretics.
about a week. Acetic acid 2% (EarCalm) acts as an May be relieved by simple measures such as frequent
antifungal and antibacterial in the external ear canal, sips of cool drinks or sucking pieces of ice or sugar-
and may be used to treat mild cases. In more severe free fruit pastilles. Sugar-free chewing gum stimulates
cases an anti-inflammatory preparation with or salivation in patients with residual salivary function.
without an anti-infective drug is required. Artificial saliva can provide useful relief of dry mouth.
Otitis media Oral hygiene
Most common cause of severe ear pain in small There is no convincing evidence that antiseptic
children. Many infections are caused by viruses, and lozenges and sprays have a beneficial action, they can
uncomplicated cases resolve without antibacterial irritate and cause sore tongue and sore lips.
treatment. In children without systemic features,
antibacterial treatment (amoxicillin) may be started A warm saline mouthwash is ideal for superficial
after 72 hours if no improvement. infections, and can be prepared by dissolving half a
teaspoonful of salt in a glassful of warm water.
Removal of earwax Hydrogen peroxide, may be useful in the treatment of
Wax provides a protective film on the ear canal, and acute ulcerative gingivitis. Chlorhexidine is an
only needs to be removed if it causes hearing loss. effective antiseptic which has the advantage of
Wax can be softened using olive or almond oil, or ear limited inhibition of plaque formation on the teeth.
drops; ear drops are also effective, but may cause Fluoride toothpaste is used in the prophylaxis of
dryness of the ear canal. If necessary, wax may be dental caries.
removed by irrigation with warm water.
Ulceration and inflammation
Important to establish the diagnosis, as each case will
2 NOSE require specific management. Unexplained mouth
ulcer of more than 3 weeks requires urgent referral to
Allergic rhinitis is self-limiting but can be controlled hospital to exclude oral cancer.
with antihistamines (e.g. azelastine), or nasal
corticosteroids (e.g. beclomethasone, mometasone). Preparations include saline mouthwash, chlorhexidine
Sodium cromoglicate is an alternative, but may be less mouthwash, oral corticosteroids, benzydamine,
effective. If necessary, a pregnant woman can use flurbiprofen (sore throat), and choline salicylate.
nasal beclometasone, budesonide, fluticasone, or
Bacterial infections
sodium cromoglicate.
The most common cause of a sore throat is a viral
Bacterial sinusitis may require treatment with infection which does not benefit from anti-infective
antibacterials (amoxicillin or doxycycline). There is no treatment. Bacterial infections may require systemic
evidence that topical anti-infective nasal preparations penicillin or metronidazole therapy.
have any therapeutic value in rhinitis or sinusitis.
Fungal infections
However, Naseptin and Bactroban are licensed for the
Most common is oral thrush and is treated with local
eradication of nasal carriage of staphylococci.
nystatin or miconazole; miconazole is licensed in
Nasal polyps can be treated with short-term use of children aged 4 months and over.
corticosteroid (e.g. beclomethasone, mometasone).
Chapter 12 – Pg 1
Compiled using the British National Formulary
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