Ear, Nose and Oropharynx

Question 1

What are some examples of astringent/acidic preparations for use in the ear?

Answer 1

Acetic acid 2% ear spray

Question 2

What are some examples of antibiotic preparations for use in the ear?

Answer 2

Gentamicin 0.3% ear drops
Ciprofloxacin 2mg/ml ear drops

Question 3

What are some examples of combined corticosteroid and aminoglycoside antibiotic preparations?

Answer 3

Betnesol-N ear/eye/nose drops
Optomize ear spray

Question 4

What are some examples of corticosteroid preparations for the ear?

Answer 4

Prednisolone 0.5% ear/eye drops
Betamethasone 0.1% ear/eye/nose drops

Question 5

What is an example of an antifungal preparation for the ear?

Answer 5

Clotrimazole 1% solution with a dropper

Question 6

Acute Diffuse Otitis Externa

• Remove or treat any precipitating or aggravating factors.
• Prescribe or recommend a simple analgesic for symptomatic relief.
• Treat inflammation using a topical ear preparation for 7 days:
• Acetic acid 2% (EarCalm) spray can be used first-line.
• For more severe cases (pain, deafness, discharge), or if treatment with acetic acid for mild
  otitis externa is not effective, a topical antibiotic with or without corticosteroid should be used.
• Only consider adding an oral antibiotic for people with severe infection.

Answer 6

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Question 7

What is the first-line treatment for acute diffuse otitis externa?

Answer 7

Using a topical ear preparation for 7 days- acetic acid 2% (ear calm) spray

Question 8

Treatment Failure for Ear Infections

-Oral antibiotics are rarely indicated. If there are systemic signs of infection or if the infection is
spreading outside the ear canal, prescribe a 7 day course of an oral antibiotic (flucloxacillin or
erythromycin if penicillin sensitive; or clarithromycin if others contraindicated)

• If this is ineffective consider the possibility of a fungal infection and treat with topical antifungal
  such as clotrimazole 1% solution or flumetasone pivalate 0.02%/clioquinol 1% ear drops.

Answer 8

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Question 9

Oral antibiotics are rarely indicated for an ear infection. If there are systemic signs of an infection or the infection is spreading outside of the ear canal, which antibiotic/s should be prescribed for a 7 day course?

Answer 9

Flucloxacillin, or erythromycin if penicillin sensitive. Clarithromycin can be used if the other antibiotics are contraindicated.

Question 10

Chronic Otitis Externa

If mild to moderate fungal infection is suspected (signs of fungal growth in ear canal)
- A topical antifungal: clotrimazole 1% solution.
- Acetic acid 2% spray (unlicenced use)
- A topical preparation containing clioquinol and corticosteroid: flumetisone/clioquinol ear drops

• If the cause seems to be seborrhoeic dermatitis treat topically with antifungal-corticosteroid
  combination.
• If no cause is evident prescribe a 7 day course of topical preparation containing only a
  corticosteroid without antibiotic.
• Clinoquinol can also be considered as it possesses antibacterial and antifungal activities.
• If treatment needs to be continued beyond 2 or 3 months, seek specialist advice.

Answer 10

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Question 11

What are the first-line treatment options for a mild to moderate fungal ear infection?

Answer 11

A topical antifungal- clotrimazole 1% solution
Acetic acid 2% spray
A topical preparation containing clioquinol and corticosteroid, e.g. flumetisone/clioquinol ear drops

Question 12

What is first-line for a seborrhoeic dermatitis ear issue?

Answer 12

Treat topically with antifungal-corticosteroid combination

Question 13

Acute Otitis Media

Acute otitis media is the most common cause of severe aural pain in small children. Most uncomplicated cases resolve without antibacterial treatment and a simple analgesic, such as paracetamol, may be sufficient. Topical treatment of acute otitis media is ineffective and there is no place for drops containing a local anaesthetic.

Answer 13

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Question 14

Ear Wax

Self-care is recommended, and if unsuccessful then olive oil or sodium bicarbonate 5% ear drops may be purchased OTC.

Answer 14

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Question 15

Drugs Used in Nasal Allergy

-Beclometasone 50mcg/dose nasal spray
-Mometasone 50mcg/dose nasal spray
-Budesonide 64mcg/dose nasal spray
-Fluticasone furoate 27.5mcg nasal spray (Avamys)
-Fluticasone 400mcg/dose nasal drops

-Intranasal corticosteroids have similar clinical efficacy.
-For mild to moderate allergic rhinitis encourage patient to self-care. Treatment can be purchased
over the counter e.g., beclometasone nasal spray. Use mometasone first line if a prescription is
required.
-Dymista and Ryaltris are combination nasal sprays of fluticasone/azelastine and
mometasone/olopatadine, respectively, and are classified locally as GREY - for moderate to severe
allergic rhinitis (aged 12 years or over)

Question 16

What should be used first-line for nasal allergies if a prescription is required?

Answer 16

Mometasone 50mcg/dose nasal spray

Question 17

What treatment can be purchased OTC for nasal allergy?

Answer 17

Beclometasone

Question 18

Nasal congestion should be treated via self-care and OTC purchases. If these are innapropriate, what may be prescribed?

Answer 18

Ephedrine 0.5% nasal drops
Sodium chloride 0.9% nasal drops

Question 19

Non-Allergic Rhinitis

-Ephedrine & xylometazoline are only suitable for short term use (usually not longer than 7 days) and
are available OTC. They are of limited value because they can give rise to rebound congestion on withdrawal, due to a secondary vasodilation with a subsequent temporary increase in nasal congestion.
-Ephedrine nasal drops are the safest sympathomimetic preparation and can give relief for several hours, therefore the preferred choice locally.

Question 20

Why do ephedrine and xylometazoline nasal drops have limited value as nasal decongestants?

Answer 20

Give rise to rebound congestion on withdrawal, due to secondary vasodilation with subsequent temporary increase in nasal congestion.

Question 21

What is Naseptin cream used for?

Answer 21

For eradication of staphylococci from the nasal passage (nasal infection)

Question 22

Drugs for Oral Ulceration and Inflammation

For treatments of minor, short-term medical conditions such as mouth ulcers, patients are encouraged to self-care. Below treatments can be purchased over the counter from pharmacies.

-Hydrocortisone muco-adhesive buccal tablets 2.5mg
-Benzydamine, 300ml 0.15% oral rinse

-Prednisolone 5mg tablet (local advice- can be crushed and dispersed (off-label)) may be dissolved in 10-20mls of water and used as mouthwash up to 4 times a day for the off-label treatment of oral
lichen planus. Do NOT swallow the contents.

Answer 22

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Question 23

Oropharyngeal Anti-Infective Drugs

-Miconazole oral gel
-Nystatin suspension

-Oral fluconazole is effective for unresponsive infections or if a topical antifungal drug cannot be used or if the patient has dry mouth. Topical therapy may not be adequate in immunocompromised
patients.
-For treatments of minor, short-term medical conditions such as oral thrush patients are encouraged to self-care.
-Miconazole oral gel use in children under 4 months is off-licence because of the risk of choking if not
carefully applied.
-OTC miconazole (Daktarin) oral gel is contraindicated in patients taking warfarin. Patients
prescribed miconazole oral gel who are also taking warfarin should be monitored closely and seek
immediate medical attention if they experience any sign of bleeding.

Answer 23

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Question 24

OTC Miconazole (Daktarin) oral gel is contraindicated in warfarin patients.
True or False?

Answer 24

True

Question 25

Chlorhexidine Digluconate 0.2% Mouthwash

-GPs should not accept requests from dentists to prescribe medicines that the dentist can prescribe
themselves.
-GPs should not accept requests from patients to issue FP10 prescriptions for items prescribed on a
private prescription by their dentist during dental treatment as a private patient.
-Patients should be advised of self-care measures and signposted to purchase over the counter
remedies for dental conditions where appropriate

Answer 25

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Question 26

How can dry mouth be relieved?

Answer 26

Frequent sips of cool drinks or sucking pieces of ice or sugar-free pastilles.

Also can use Xerostem saliva substitutes, such as gels, pastilles and mouthwash

Saliveze spray

Question 27

What is otitis externa?

Answer 27

Inflammation of the external ear canal, primarily caused by bacterial infection.

Question 28

Acetic acid 2% can be used for otitis externa.

Question 29

What is acute otitis media?

Answer 29

A self-limiting coniditon that mainly affects children. Characterised by inflammation in the middle ear.

Symptoms include ear pain, fever, crying, poor feeding, cough

Question 30

Otitis Externa Antibacterial Therapy

-If pseudomonas suspected: Ciprofloxacin
-No penicillin allergy: Flucloxacillin
-Penicillin allergy or intolerance: Clarithromycin

Answer 30

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Question 31

Otitis Media Drug Treatment

-No penicillin allergy:
First line- amoxicillin
Second line (worsening symptoms despite 2-3 days of antibacterial symptoms- co-amoxiclav

Penicillin allergy:
- First-line: clarithromycin or erythromycin (in pregnancy)

Question 32

Drugs Used in Nasal Allergy

-Sodium chloride 0.9% solution
-Antihistamines
-Nasal corticosteroids- mometasone furoate and fluticasone.

Answer 32

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Question 33

What puts a patient at increased risk of oral thrush?

Answer 33

-Patients taking inhaled corticosteroids
-Chemotherapy
-Broad-spectrum antibacterials
-Patients with serious systemic disease

Question 34

What should be used to treat mild and localised oral thrush?

Answer 34

Miconazole oral gel

Oral nystatin is second-line if miconazole is unsuitable

Question 35

What antibacterial should be used for 3 days to treat gingivitis?

Answer 35

Metronidazole

Question 36

Which antibiotic should be used first-line to treat a sore-throat where there are severe systemic symptoms?

Answer 36

Phenoxymethylpenicillin (5-10 days treatment)