BNF for Children 2011-2012

534 BNFC 2011–201212 Ear, nose, and oropharynx12 Ear, nose, and oropharynx12.1 Drugs acting on the ear 53412.1.1 Otitis externa 53412.1.2 Otitis media 53712.1.3 Removal of ear wax 53712.2 Drugs acting on the nose 53812.2.1 Drugs used in nasal allergy 53812.2.2 Topical nasal decongestants 54112.2.3 Nasal preparations for infection 54212.3 Drugs acting on the oropharynx54312.3.1 Drugs for oral ulceration andinflammation 54312.3.2 Oropharyngeal anti-infectivedrugs 54512.3.3 Lozenges and sprays 54612.3.4 Mouthwashes and gargles 54612.3.5 Treatment of dry mouth 548This chapter also includes advice on the drug managementof the following:allergic rhinitis, p. 538nasal polyps, p. 538oropharyngeal infections, p. 545periodontitis, p. 54312.1 Drugs acting on the ear12.1.1 Otitis externa12.1.2 Otitis media12.1.3 Removal of ear wax12.1.1 Otitis externaOtitis externa is an inflammatory reaction of the liningof the ear canal usually associated with an underlyingseborrhoeic dermatitis or eczema; it is important toexclude an underlying chronic otitis media before treatmentis commenced. Many cases recover after thoroughcleansing of the external ear canal by suction or drymopping.A frequent problem in resistant cases is the difficulty inapplying lotions and ointments satisfactorily to therelatively inaccessible affected skin. The most effectivemethod is to introduce a ribbon gauze dressing orsponge wick soaked with corticosteroid ear drops orwith an astringent such as aluminium acetate solution.When this is not practical, the ear should be gentlycleansed with a probe covered in cotton wool and thepatient encouraged to lie with the affected ear uppermostfor ten minutes after the canal has been filled witha liberal quantity of the appropriate solution.Secondary infection in otitis externa may be of bacterial,fungal, or viral origin. If infection is present, a topicalanti-infective which is not used systemically (such asneomycin or clioquinol) may be used, but for onlyabout a week because excessive use may result in fungalinfections that are difficult to treat. Sensitivity to theanti-infective or solvent may occur and resistance toantibacterials is a possibility with prolonged use. Aluminiumacetate ear drops are also effective againstbacterial infection and inflammation of the ear. Chloramphenicolmay be used, but the ear drops containpropylene glycol and cause hypersensitivity reactions inabout 10% of patients. Solutions containing an antiinfectiveand a corticosteroid (such as Locorten-Vioform c ) are used for treating children when infectionis present with inflammation and eczema. Clotrimazole1% solution is used topically to treat fungal infection inotitis externa.In view of reports of ototoxicity in patients with aperforated tympanic membrane (eardrum), manufacturerscontra-indicate treatment with a topical aminoglycosideantibiotic in those with a tympanic perforation.However, many specialists do use these dropscautiously in the presence of a perforation in childrenwith otitis media (section 12.1.2) and when other measureshave failed for otitis externa.A solution of acetic acid 2% acts as an antifungal andantibacterial in the external ear canal and may be usedto treat mild otitis externa. More severe cases requiretreatment with an anti-inflammatory preparation with