Ear, Nose and Oropharynx

Otitis Externa

Inflammatory reaction

Treatment

• Acetic acid [earcalm] for mild symptoms

• Paracetamol for pain

• Not getting better → Need to see GP and prescribed with Otomize [neomycin and dexamethasone]

Otitis Media

Common in children → self limiting and resolves by 3-7 days

Can be due to viral or bacterial infection

Symptoms

• ear pain

• irritability

• runny nose [rhinorrhoea]

• cough

• fever

Ear Wax → removal

• olive oil or almond oil [check for nut allergy]

• Sodium bicarbonate drops → could cause dryness in ear and cause irritation

Rhinitis

• Can be allergic or non-allergic [not caused by an allergy]

• Allergens → tree pollen, grass pollen

• Non-allergic → blocked/runny nose or sneezing

• Allergic → blocked/runny nose or itchy, watery/itchy eyes or scratchy throat

• Generally self limiting and gets better on its own

Treatment

• Saline nasal drops or spray for nasal congestion

• Warm most air or menthol and eucalyptus

• Mild allergic rhinitis → antihistamines or topical nasal corticosteroids

Nasal Corticosteroids

• Used for nasal polyps [soft painless growth inside the nose]

• DON’T USE CORTICOSTERIODS IN UNTREATED NOSE INFECTION [makes it worse]

Nasal Decongestants → Ephedrine

• Better than Oxymetazoline

• Only used for 7 days MAX → risk of rebound congestion if used longer

• Rebound congestion is where symptoms get worse because of long term use of nasal decongestants

• AVOID GIVING in UNDER 6 YEARS OLD

• only ONE pack sold to a patient at a time → MAX sold is 180mg

Ipratropium for Vasomotor Symptoms

• Used as chronic/long term

• Used if there is sneezing or watery discharge from the nose

• If you have a stuffy nose

Medication that can cause DRY MOUTH

[ASDAT]

What can dry mouth result in?

ASDAT

• Antimuscarinics like hyoscine or oxybutynin

• Salivary gland complications like infection, obstruction or cancer

• Diuretics

• Antipsychotics like quetiapine [newer ones]

• TCA → amitriptyline

Dry mouth can lead too…

• Increased dental caries → tooth decay

• Periodontal disease → infection of gums

• Dentures → harder to use

• Oral infections → candidiasis

Treatment for Dry Mouth

Other preparations

Frequent sips of water/cool drink

Artificial saliva → contains electrolytes

ACBs, Bioxtra, Glandosoane, Saliva orphans and Saliveze

Other Preparations

• Lozenges and Sprays → no evidence pf effectiveness

• Mouthwash, gargles and toothpaste

• Warm saline mouthwash → help with pain

• Hydrogen peroxide mouthwash [Peroxyl] → ulcerative gingivitis

• Fluoride toothpaste → prevent dental caries [tooth decays]

Chlorhexidine → Antiseptic

• Stop plaque formation and prevents candidiasis

• Won’t replace brushing but used with brushing and floss

• Comes as mouthwash, sprays and gels for mucosal ulcerations as well as for controlling gum disease

S/E

• REVERSIBLE brown staining of the teeth and tongue with prolonged use

Oral Ulceration and Inflammation

Buy in public

• Benzydamine HCL [difflam] → dilute mouthwash with same amount of water if it causes stinging pain

• Flurbiprofen lozenges → strefen honey and lemon ideal for sore throat

• Choline salicylate → gel

• Other preps: doxycycline

Oropharyngeal Infections [Inside Mouth] Treatment

Pericoronitis + Gingivitis → Metronidazole or Amoxicillin for 3 days

Abscess → amxoi or metron for 5 days

Periodontitis [inflammation in gums and structure supporting teeth] → metronidazole or doxycycline [tooth staining] if over 12

Sore Throat '[Acute]

• Viral → self limiting and would last 1 week]

• Bacterial → phenoxymethylpenicillin or clarithromycin for 5 days