ENT, Hearing & Speech

Question 1

Ear wax

Answer 1

✓ The majority of patients with ear wax can be managed in primary care.
✓ Ear drops should be avoided in a suspected perforated tympanic membrane.
✓ Contraindications to ear irrigation include tympanic membrane perforation (in last 12 months), grommets, ear surgery, mucus discharge in the last 12months, Otitis Media in last 6 weeks, cleft palate (whether or not it has been repaired) and foreign body present.
✓ These patients should be managed in secondary care.
✓ Complications of ear irrigation include: failure of wax removal, Otitis Media/Externa, perforation, bleeding, vertigo or pain and exacerbation of tinnitus.

Question 2

Sinusitis

Answer 2

✓ Sinusitis is defined as inflammation of the lining of the paranasal sinuses, either acute (<12 weeks) or chronic (symptoms ongoing >12 weeks).
✓ It is usually triggered by viral upper respiratory tract infections and is occasionally complicated by bacterial infections (Steptococcus pneumoniae, Haemophilus and Moraxella).
✓ It is generally self-limiting and antibiotics are not required unless systemically unwell/high risk of complications. Acute sinusitis takes 2 - 3 weeks to resolve and advise that most people improve without antiobiotics with simple analgesia such as Paracetamol/Ibuprofen all that is required.
✓ If symptoms are severe or on-going for >10 days a trial of intranasal corticosteroids can be considered.
✓ If an antibiotic prescription is given (potentially delayed prescription), then first line is Phenoxymethylpenicillin 500 mg four times a day for 5 days. Doxycycline or Clarithromycin are alternatives if allergic to Penicillin. If systemically very unwell, at high risk of complications or signs of a serious condition then Co-amoxiclav is first line. For full guidance on when antibiotics are indicated see below resource.

Question 3

Use of nasal spray in children

Answer 3

Fluticasone nasal spray =>4 years Beclometasone=>6 years
Budesonide => 12 years
Flunisolide - discontinued