11.

EAR, NOSE AND THROAT

Chapter 11
EAR, NOSE AND THROAT
11:1 Ear, nose and throat p. 422
11.1.1 Drugs used in Otitis externa p.423
11.1.2 Drugs used in Otitis media p.425
11.1.3 Removal of wax p.426
11.1.4 Drug used in Meniere’s disease p.427
11.2 Drugs acting on the nose p.427
11.2.1 Drugs used in nasal allergy p.427
11.2.2 Topical nasal decongestants p.429
11.2.3 Nasal preparations for the infection and epistaxis p.430
11.3 Drugs acting on the oropharynx p. 433
11.3.1 Drugs for oral ulceration and inflammation p. 433
11.3.2 Oropharyngeal anti infective drugs p. 433
11.3.3 Mouthwash and gargles p.435

11:1 EAR, NOSE AND THROAT humid climate of tropical and subtropical
countries. The cardinal features of
Otitis externa is the inflammation of ear otomycosis include intense itching, pain,
canal. Furuncle is a localized otitis watery discharge with a musty odour, and
externa, which is a staphylococcal ear blockage. Nystatin is effective
infection of the hair follicle. Patient usually against Candida. Other broad spectrum
presents with severe pain and tenderness antifungals include clotrimazole and
in the ear. Treatment consists of systemic betadine. 2 salicylic acid in alcohol is
antibiotics, analgesics and local heat. keratolytic. Antifungal treatment should be
continued for a week even after apparent
Diffuse otitis externa is commonly seen in cure to avoid recurrence. Ear must be
hot and humid climate. It is characterized kept dry.
by burning sensation in the ear followed Otitis externa haemorrhagica is a viral
by pain which is aggravated by infection characterized by formation of
movements of jaw. Ear starts oozing thin haemorrhagic blebs on the tympanic
serous discharge which later becomes membrane and deep meatus causing
thick and purulent. Common organisms severe pain in the ear and blood stained
responsible for otitis externa are Staph. discharge when the blebs rupture.
aureus, Pseud. pyocyaneus, B. proteus Treatment is directed to relief of pain with
and Esch. coli. But more often the analgesics and antibiotics for infection.
infection is mixed. Aural toileting is the Another viral infection, Herpeszoster
most important treatment. After thorough oticus is characterized by formation of
toileting a gauze wick soaked in antibiotic- vesicles on the tympanic membrane,
steroid preparation is inserted in the ear meatal skin, concha and post-auricalar
canal and patient is advised to keep it groove. Treatment consists of
moist by instilling the same drops twice or intravenous acyclovir as soon as
thrice daily then it can be substituted by possible.
ear drops. Broad-spectrum systemic
antibiotics are used when there is cellulitis Eczematous otitis externa is the result of
and acute lymphadenitis. Analgesics are hypersensitivity to infective organisms or
used for relief of pain. topical ear drops such as chloromycetin
Otomycosis is a fungal infection of the ear or neomycin. Intense irritation, vesicle
canal caused by Aspergillus niger, or formation, oozing and crusting in the
Candida albicans. It is seen in hot and canal characterize it. Treatment is

422
 11. EAR, NOSE AND THROAT

withdrawal of topical antibiotic causing Proprietary Preparations

sensitivity and application of steroid Eyebet (Incepta), Eye/Ear/Nose drops, 0.1 %,
cream. Tk. 30/5 ml
Methasol (Gaco), Eye/Ear/Nose drops, 0.1 %,
Seborrhoeic otitis externa is associated Tk. 31.80/5 ml
with seborrhoeic dermatitis of the scalp.
Itching is the main complaint. Greasy Betamethasone Sodium Phosphate with
yellow scales are seen in the external Neomycin sulphate
canal. Treatment consists of Aural Indications: Otitis externa and other
toileting, application of cream containing infective and inflammatory ear conditions.
salicylic acid and sulphur; and attention is Contraindications: Perforated ear drum,
to be given to the scalp. Application: apply 2 to 3 drops 2 or 3
Neurodermatitis is caused by compul-sive hourly.
Betamethasone Sodium Phosphate 0.1% +
scratching due to psychological factors.
Neomycin sulphate 0.5%
Main complaint is intense itching and may Proprietary Preparations
follow infection of raw area left by Aristobet-N (Aristo), Eye/Ear/Nasal drops,Tk.
scratching. Antibiotics can be given. Ear 32.30/5 ml
pack and bandage to the ear are helpful Betacin-N (Ibn Sina), Eye/ Ear /Nasal drops,
to prevent compulsive scratching. Tk. 35.00/15 gm
Betason-N(Reman), Eye/Ear/Nasal drops
Malignant or necrotising otitis externa is Tk.Tk 32.44/5ml
an inflammatory condition caused by Betricin-N(Nipa) ,Eye/ Ear /Nasal drops Tk.
Pseudomonas infection usually in the 35.00/5ml
elderly, diabetics or in those on Bn (Asiatic), Eye/Ear/Nasal drops,Tk.32/5ml
immunosuppressive drugs. Early Methasol-N (Gaco), Eye/ Ear /Nasal drops Tk.
manifestations are excruciating pain and 35.00/5ml
Optison-N (Opso Saline), Eye/Ear/Nasal
appearance of granulations in the meatus. drops, Tk. 22.86/5 ml
Treatment consists of high doses of
intravenous antibiotics such as DEXAMETHASONE [ED]
tobramycin, ticarcillin or third
generation cephalosporins such as (see also section 5.3)
moxalactum. Antibiotics are given for 6-8
weeks or longer. Diabetes should be Indications : eczematous otitis externa
controlled. Cautions : prolonged use must be
avoided
Contraindications : should not be used
11.1.1 DRUGS USED IN OTITIS
in untreated infection
EXTERNA
Side-effects : local sensitivity reactions
may occur
CORTICOSTEROID PREPARATIONS Preparations : ear drop / ointment
Application : apply 3-4 times daily
BETAMETHASONE SODIUM
PHOSPHATE[ED] Proprietary Preparations
(see section 5.3) Dexamethasone 0.1%
Acicot (ACI), Eye/Ear drops, Tk. 60/5 ml
Celudex(Drug Int.), Eye/Ear drops,Tk.60/5ml
Indications : eczematous otitis externa. Dexacort (Opso Saline),Eye/Ear drops, Tk.
Cautions : prolonged use must be 52.63/5 ml
avoided Dexadron(Reman), Eye/Ear drops,Tk.
Contraindications : should not be used 60.23/4ml
in untreated infection Dexamin (Jayson), Eye/Ear drops,
Tk.50.20/5ml
Side-effects : local sensitivity reactions Dexon (Ibn Sina), Eye/Ear drops,Tk. 70/5 ml
Preparations : drops for ear/eye/nose Dexonex(Square), Eye/Ear drops,Tk.60/5 ml
Applications : apply 2-3 drops every 2-3 Gludex (Kemiko), Eye/Ear drops,Tk. 70/5 ml
hours Inflavis (Beximco), Eye/Ear drops,Tk.60/5ml
Orbidex (Popular ), Eye/Eardrops,Tk.70/5ml

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11. EAR, NOSE AND THROAT

HYDROCORTISONE [ED] Supraphen plus (Gaco), Ear drops, Tk.

20.00/10ml
(see also Section 5.3)
CIPROFLOXACIN[ED]
Indications : eczematous otitis externa
Cautions : prolonged use must be (see also section1.1.5)
avoided
Contraindications : untreated infection Indications: Otitis externa, acute otitis
Side-effects : local sensitivity reactions media, chronic suppurative otitis media,
Preparations : ear drops and prophylaxis during otic surgeries
such as mastoid surgery.
Application : apply 2-4 drops into the ear
Contraindications: Known hypersen-
3-4 times daily
sitivity to ciprofloxacin.
Cautions: prolonged use may result in
Proprietary Preparations
Hydrocortisone 1% + Neomycine Sulphate+ overgrowth of non-susceptible organisms
0.5% + Polymyxine B Sulphate 10,000 units; including fungi. The drug should be
NPH (Reman), Eye/ Ear drpos, Tk 60.23/ 5ml discontinued if the sign of hypersensitivity
Otosporin (GSK),Eye/Ear Drpos,Tk. 60/5 ml reaction.
Polymix-H (Opso Saline), Eye/ Ear drpos, Side-effects :see section1.1.5
Tk.40/5 ml Application: Initially apply 2 to 3 drops
Hydrocortisone 1%+ Gentamicin 0.3%. every 2 to 3 hours; reducing the
Gentabac HC (Popular), Ear drops, Tk. frequency of instillation gradually as
51.04/10 ml
Gisin-H (Nipa), Ear drops, Tk. 50/10 ml
infection is controlled.
Recin HC (Reman,) Ear drops,Tk.50/10 ml
Proprietary Preparations
Ciflox (Reman), Eye/Ear Drops 0.3%, Tk.
TRIAMCINOLONE ACETONIDE 35.00/5 gm
(see notes above and section 11.2) Cip (Asiatic), Eye / Ear drops, 0.3%, Tk.
Ciprocin (Square), Eye/Ear drops, 0.3%,Tk.
ANTIMICROBIAL PREPARATIONS 40.15/5 ml
Ciprox (Opsonin), Eye/Ear drops 0.3%, Tk.
30.19/5 ml
CHLORAMPHENICOL[ED] Ciproxy (Opso Saline), Eye & Ear drops,
0.3%, Tk. 26.41/10 ml;
(see also section 1.1. 12)
Neofloxin (Beximco), Eye/Ear drops,
0.3%,Tk.40.00/5 ml
Indications : bacterial otitis externa Procin (Kemiko), Eye / Ear drops 0.3%, Tk.
Cautions : avoid prolonged use 50.00/10 ml
Side-effects : high incidence of Spectra (Jayson), Eye / Ear drops, 0.2%Tk.
sensitivity reactions 40.00/5 ml
Preparations : ear drops containing
Chloramphenicol 5% CLOTRIMAZOLE[ED]
Administration : apply 2-3 drops into the (see also section 12.2.2)
ear 2-3 times daily
Indications : fungal infection in External
Proprietary Preparations Auditory Canal
Opthacol (Drug Int), Eye / Ear drop ,  0.5%, Side-effects : occasional local irritation.
Tk. 30.00/10 ml
Ramphen (Kemiko), Eye/Ear drops,  0.5%, Tk. Preparations: clotrimazole 1% in
34.27/10 ml polyethylene glycol
SQ-Mycetin (Square), Eye/Ear drops, 0.5%,
Tk.34.40/10 ml
Applications : apply 2-3 times daily
Supraphen (Gaco), Ear Drops, 1%, Tk. continuing for at least 14 days after
19.00/10; 0.5%, Tk. 16.05/10 ml; disappearance of infections

Chloramphenicol 5%+ Lignocaine 1% Proprietary Preparations

Chlorphen (Nipa), Ear drops,Tk.20.23/10ml (see section 12.2)
Otophenicol (Reman), Ear drops,
Tk.25.00/10ml

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 11. EAR, NOSE AND THROAT

GENTAMICIN[ED] Symptoms of an allergic reaction include

(see also section 1.1.3) rash, itching, swelling or trouble breathing
Caution: prolonged use of ear drops may
Indications : bacterial otitis externa result in overgrowth of non-susceptible
Cautions : avoid prolonged use organisms and secondary infection
respectively.
Side-effects : local sensitivity
Preparation : ear drop
Proprietary Preparations
Application : apply 2-4 drops 3-4 times Obactin (Ibn Sina), Eye/Ear drops, 0.3%, Tk.
daily 85.00/5 ml
Vista (Aristo), Eye / Ear drops,0.3%,Tk.85/5ml
Proprietary Preparations
Gento (Gaco), Eye/Ear drops, 0.3%, Tk. 11.1.2 DRUGS USED IN OTITIS MEDIA
31.49/10 ml
Recin (Reman), Eye/Ear drops, 0.3%, Tk.
35.00 /10 ml Otitis media is an inflammation of middle
G-Gentamicin (Gonoshasthaya), Eye/Ear ear cleft. It is more common in infants
drops , 0.30% , Tk. 25.00/10 ml and children especially of lower socio-
Genacyn (Square), Eye/Ear drops, 0.30%, Tk. economic group. Infection enters via
32.02/10 ml eustachian tube. Most common
Gentamicin Sulphate0.3%+ +Hydrocortisone
organisms are Strept. preumoniae, H.
Acetate1%,
(see under Hydrocortisone) influenzae, Strept. pyogens, Staph.
aureus and Esch. coli. Otitis media with
LOMEFLOXACIN effusion is a condition characterized by
accumulation of non-purulent effusion in
(see also section 1.1.5)
the middle ear. The effusion is thick and
viscid but some times it may be thin and
Indications: Otitis externa, acute otitis
serous. The fluid is nearly always sterile.
media, chronic suppurative otitis media,
It is commonly seen in school going
and prophylaxis during otic surgeries
children. Antibacterial therapy is indicated
such as mastoid surgery.
in all cases of acute and chronic
Contraindications: Known hypersen-
suppurative otitis media. The drugs which
sitivity to lomefloxacin
are effective in acute otitis media are
Side effects: photosensitivity
penicillin, amoxicillin, cefaclor,
Application: Initially apply 2 to 3 drops
cotrimoxazole, erythromycin,
every 2 to 3 hours; reducing the
cefuroxime axetil or cefixime.
frequency of instillation gradually as
Antibacterial therapy must be continued
infection is controlled.
for minimum 10 days till tympanic
membrane regains its normal appearance
Proprietary Preparations
Lomecin (Reman) Ear/Eye drop, 0.3%, Tk and hearing returns to normal. Nasal
60/5 ml decongestant e.g. ephedrine,
Lumex (Gaco) Ear/Eye drop, 0.3%, Tk 60/5 ml oxymetazoline, xylometazoline should
be used to relieve eustachian tube
OFLOXACIN oedema and promote ventilation of middle
(see also section 1.1.5) ear. Analgesics and antipyretics such as
paracetamol or aspirin help to relief pain
Indications: It is indicated for the and temperature. If there is discharge in
treatment of external ear infections (otitis the ear, it is dry-mopped with sterile
external and certain middle ear infections cotton buds and a wick moistened with
(otitis media) antibiotic may be inserted. Dry local heat
Contraindications: Known hypersen- may help to relieve pain. Treatment of
sitivity to ofloxacin or any other otitis media with effusion can be given by
component of this preparation, topical decongestant in the form of nasal
Side effects: mild irritation or mild drops, sprays or systemic decongestants.
discomfort in the ear may occur. Antimicrobial prophylaxis can be given for
those having recurrent otitis media

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11. EAR, NOSE AND THROAT

associated with upper respiratory tract with a history of recurrent otitis externa, a
infection. In such cases, low dose long perforated ear drum, or previous ear
term antibiotic or sulphonamide can be surgery. Wax may be removed by
instituted. syringing with normal saline at body
Chronic suppurative otitis media (CSOM) temperature. Suction clearance under
is a long standing infection of a part or microscope is a better option. Some
whole of the middle ear cleft. Incidence of times, the wax is too hard and impacted
CSOM is higher in developing countries to be removed by syringing or
because of poor socio-economic instrumentations. It should be softened by
condition, poor nutrition and lack of health drops of 5% sodium bicarbonate in
education. It is the single most important equal parts of glycerine and water
cause of hearing impairment in rural instilled two or three times a day for
population. CSOM show multiple several days. Hydrogen peroxide, liquid
organisms like Ps. aerugenosa, B. paraffin or olive oil may also achieve
proteus, E. coli, Staph. aureus and some the same result. Commercial preparations
anaerobes include Bacteroids, B. fragilis containing ceruminolytic agents like
and Streptococci. It is characterized by paradichlorobenzine 2% can also be used
ear discharge, which is offensive or non and syringing can be tried again.
offensive, mucoid, mucopurulent, purulent
or blood stained and persistent or
intermittent according to the type of safe
or unsafe variety of CSOM. Aural toileting
can be done by dry mopping with
absorbent cotton buds, suction clearance
under microscope. Antibiotic ear drops
containing neomycin, polymixin,
chloramphenicol or gentamicin are
used. They are combined with steroids
which have local anti-inflammatory effect
(see also section 11.1.1). To use ear
drops, patients to be lied down with the
diseased ear up, antibiotic drops are
instilled and then intermittent pressure to
be applied on the tragus for antibiotic
solution to reach the middle ear. This
should be done 3-4 times a day. The
patient should be instructed to avoid
water entry into the ear during bathing,
swimming and hair washing. Many
attacks are viral in origin and need only
simple analgesic such as paracetamol
(See also section 7.5.2.1) for relief of
pain. Severe bacterial infection should be
treated with systemic antibiotics (See
also section 1.1). Surgical treatment is the
only option for unsafe variety of CSOM.

11.1.3 REMOVAL OF WAX

Treatment of wax consists of its removal

by syringing or instrumental manipulation.
Hard impacted wax may sometimes
require prior softening with wax solvents.
Syringing should be avoided in patients

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 11. EAR, NOSE AND THROAT

11.1.4 DRUG USED IN MEINERE’S isonicotine used as aerosols are very

DISEASE effective in controlling the symptoms.
Sodium cromoglycate stabilises the
mast cells. It is used as 2% solution for
BETAHISTINE
nasal drops or spray or as an aerosol
powder. In addition to these following Anti
Indications: it is commonly prescribed to histamine preprations are used in nasal
patients with balance disorders or to allergy:
alleviate vertigo symptoms associated Chlorpheniramine, diphenhydramine,
with Meniere’s disease. hydroxyzine, pheniramin,
Side effects: headache, insomnia, promethazine, Triprolidine.
nausea pseudoepedrine HCl, desloratadine,
Contraindications: for people with fexofenadine, levocetirizine,
pheochromocytoma, bronchial asthma loratadine, acrivastine and cetirizina
and peptic ulcer (see section 4.8.1)
Doses : ADULTS : 1 to 2 tablets three
times per day after meals. ANTIHISTAMINES USED FOR NASAL
ALLERGY
Proprietary Preparations (see section 4.8.1)
Menaril (Incepta), Tab., 8 mg, Tk. 2.00/Tab.
Merison (Square), Tab., 6 mg, Tk. 2.01/Tab.
Tiniril (Opsonin), Tab., 8 mg, Tk. 1.51/Tab. CORTICOSTEROID PREPARATIONS
Veserc (Unimed), Tab.,16 mg, Tk.5.00/Tab.; USED FOR NASAL ALLERGY
8mg, Tk. 3.00/Tab.
(see also section 4.2)
11.2 DRUGS ACTING ON THE NOSE BECLOMETHASONE DIPROPIONATE

11.2.1 DRUGS USED IN NASAL Indications : prophylaxis and treatment

ALLERGY of allergic and vasomotor rhinitis
Cautions : should be avoided in
It is an IgE-mediated immunologic untreated nasal infection and after nasal
response to nasal mucosa to air borne surgery till complete healing. It should
allergens and is characterized by watery also be avoided in pulmonary tuberculosis
nasal discharge, sneezing, nasal Side-effects : dryness, irritation of nose
obstruction and itching in the nose. and throat and epistaxis, raised intra-
Allergens e.g. house mite, pillow or ocular pressure. Smell and taste
mattress with plastic sheet, particular disturbances may occur
foods to which the patient is found Dose : 50-100 micrograms (1-2 sprays)
allergic, should be avoided. Drugs used in into each nostril twice daily in ADULT and
nasal allergy are antihistamines, they CHILD over 6 years
control rhinorrhoea, sneezing and
pruritus. Dose and type of antihistamines Proprietary Preparations
have to be individualized. If one is not Beclomet (Acme), Nasal Spray, 100 mcg/
effective, another may be tried from a Actuation, Tk. 120/200 MD
different class. Sympathomimetic drugs Beconase (G.S.K), Nasal Spray, 50 mcg/
such as phenylephrine, oxymetazoline Spray, Tk. 207.21/100 ml
Becospray (Square), Nasal Spray, 50 mcg /
and xylometazoline are often used to
spray, Tk. 125.47/200 Puffs
relieve nasal obstruction. Oral cortico- Decomit (Beximco), Nasal Spray, 50 mcg/
steroids are very effective in controlling Spray, Tk. 146.00/200 MD
the symptoms of allergic rhinitis. Topical BUDESONIDE
steroids such as beclomethasone
dipropionate, budesonide and
Indications : prophylaxis and treatment
flunisolide acetate, fluticasone,
of allergic and vasomotor rhinitis; nasal
mometasone, dexamethasone
polyps

427
11. EAR, NOSE AND THROAT

Cautions : see under Beclomethasone MOMETASONE FUROATE

Dipropionate
Side-effects: see under Beclomethasone Indications : prophylaxis and treatment
Dipropionate of allergic rhinitis
Dose : ADUL and CHILD over 12 years Cautions : see under Beclomethasone
200 micrograms (2 spray) into each Side-effects : see under
nostril daily in the morning or 100 Beclomethasone
microgram (1 spray) into each nostril Dose : ADULT and CHILD over 12 years
twice daily. 100 micrograms in to each nostril once
daily, increased to twice daily if required;
Proprietary Preparations maximum total 200 microgram daily.
Budenide (ACI), Nasal Spray, 100 mcg/spray,
Tk. 250.00/120 Spray When control achieved reduce to 50
Budicort (Incepta), Nasal Spray, 100 micrograms. CHILD upto 6-11 years, 50
mcg/spray,Tk. 250.00/120 MD microgram in to each nostril once daily.
Pulmicort (Opsonin), Nasal Spray, 1 mg/1 ml,
Tk. 187.97/120 MD
Proprietary Preparations
Momeson (Incepta), Nasal Spray, 50 mcg/
FLUTICASONE PROPIONATE Spary, Tk. 250.00/120 dose;
Metaspray (Square), Nasal Spray, 50 mcg/
Indications : prophylaxis and treatment Spary, Tk. 250.94/120 dose;
Nasomet (Beximco), Nasal Spray,  50 mcg/
of allergic rhinitis Spray, Tk. 250.00/120 MD
Cautions : see under Beclomethasone Nasonex (Opsonin), Nasal Spray,  50 mcg/
Dipropionate Spary, Tk. Tk.219.92/120 MD
Side-effects : see under Beclometha-
sone Dipropionate TRIAMCINOLONE ACETONIDE
Dose: ADULT and CHILD over 12 years,
100 micrograms in to each nostril once Indications : prophylaxis and treatment
daily, increased to twice daily if required; of allergic rhinitis
maximum total 400 microgram daily. Cautions : see notes above
CHILD upto 4-11 years, 50 microgram Side-effects : see notes above
into each nostril once daily, increased to
Dose : for ADULT apply 110 micrograms
twice daily if required; maximum total 200
(2 spray) in to each nostril once daily;
microgram daily
CHILD upto 6-12 years half of the adult
dose.
Proprietary Preparations
Flixonase (GSK), Nasal Spray,
50mcg/metered dose, Tk. 275/120 MD Proprietary Preparations
Flonaspray (Square), Nasal Spray, 50 mcg / Cenolon (Incepta), Nasal Spray, 550 mcg/ml,
spray, Tk. 250.94/120 Spray Tk. 200.00/120 Spray
Fluticon (Acme), Nasal Spray, 50mcg/metered Cortefin (ACI),Nasal Spray, 55 mcg/ml, Tk.
dose Tk. 250.00/120 MD 200.00/120 spray
Fluvate (Opsonin), Nasal Spray,  0.005%, Tk. T-cort (Opsonin), Nasal Spray, 550 mcg/ml,
187.97/120 MD Tk. 150.38/120 spray
Fluvent (ACI), Nasal Spray, 50mcg/spray , Tk. Trispray (Square), Nasal Spray, 550 mcg/ml,
250.00/120 Spray Tk. 200.75/120 metered dose
Lutisone (Incepta),Nasal Spray,  0.05%, Tk.
250.00/120 MD MAST CELL STABILIZERS FOR
Perinase (Beximco), Nasal Spray,  50 NASAL ALLERGY
mcg/Actuation, Tk. 250.00/120 MD
Fluticason furoate
Avamys (GSK), Nasal Spray,27.5mcg/spray OLOPATADINE
Tk. 354.38/120 MD
Indications :seasonal allergic rhinitis
Side-effects : epistaxis, nasal ulceration,
and nasal septal perforation

428
 11. EAR, NOSE AND THROAT

Dose : ADULT:two sprays per nostril limited value because they can give rise
twice daily. CHILD over 6 years of age to rebound congestion on withdrawal,
one spray per nostril twice daily. which is due to a secondary
vasodilatation with a subsequent
Proprietary Preparations temporary increase in nasal congestion.
Alercon (Acme), Nasal Spray ,  0.6%, Tk. This in turn makes habits for further use
400.00/120 doses;  of the decongestant and that leads to a
Lopadine (Incepta), Nasal Spray,  0.6%, Tk. vicious cycle of events. An ephedrine
400.00/120 doses
Olopan (Beximco), Nasal Spray,  0.6%, Tk. nasal drop, the sympathomimetic
400.00/120 doses.  preparation can be used as nasal
decongestant. It can give relief of nasal
SODIUM CROMOGLYCATE congestion for several hours.
Oxymetazoline and xylometazoline are
more potent sympathomimetic nasal
Indications: prophylaxis for allergic decongestant but are more likely to cause
rhinitis a rebound effect. All of these preparations
Side-effects: local irritation should not be used concomitantly with
Dose : 4% aqueous nasal spray ADULT monoamino-oxidase inhibitor because it
and CHILD, apply 1 puff into each nostril may cause hypertensive crisis.
2-4 times daily Ipratropium bromide responds well to
the treatment of non-allergic watery
Proprietary Preparations rhinorrhoea. Inhalation of warm moist air,
Aristocrom (Aristo) Eye/Nasal drops, 2%,Tk.
65.00/10ml
compounds containing volatile
G-Cromo (Gonoshasthaya), Eye /Nasal substances such as menthol and
drops,  2%, Tk. 50.00/10 ml eucalyptus are also useful.
Icrom (ACI), Eye drops, 2%, Tk. 65.25/10 ml
Nacromin(Square), Nasal drops, 2%, Tk. EPHEDRINE HYDROCHLORIDE
66.25/15 ml
Nasochrom (Drug Int.), Eye /Nasal drops,
2%, Tk. 60.00/10 ml Indications : nasal congestion
Opsocrom (Opso Saline), Eye / Nasal Drops, Caution : excessive or prolonged use
2%, Tk. 48.87/10 ml
must be avoided. If should not be used for
infants under 3 months. If irritation occurs
11.2.2 TOPICAL NASAL it may cause narrowing of nasal passage
DECONGESTANTS
Side-effects : local irritation, tolerance
Atmospheric temperature and humidity may develop after excessive use;
may cause nasal congestion because Rebound congestion is another important
nasal mucosa is sensitive to it. The nasal side-effect
sinuses produce huge amount of mucus Administration : instill 4-5 drops in to
in a day and most of it passes into the each nostril up to 3-4 times daily
stomach through the nasopharynx. 0.9% Proprietary Preparation
Sodium chloride solution given as Remadrin (Reman), Nasal drops,
nasal drops may relieve nasal congestion 0.5%,Tk. 45.52/10ml
by liquefying mucus secretions.
Decongestant nasal drops contain IPRATROPIUM BROMIDE
sympathomimetic drugs relieve
symptoms of nasal congestion associated Indications : rhinorrhoea associated with
with vasomotor rhinitis and common cold. allergic and non allergic rhinitis
Use of these drugs must be for short
term, usually not longer than 7 days. Cautions : glaucoma, prostatic hyper-
These drugs exert their effect by trophy, pregnancy
vasoconstriction of the mucosal blood Contraindication: avoid spraying near
vessels, which in turn reduces oedema of eyes
the nasal mucosa. These drugs are of

429
11. EAR, NOSE AND THROAT

Side-effects: nasal dryness and Administration: ADULT: Instill 4-5 drops

epistaxis of 0.1% in to each nostril 2-3 times daily
Administration : apply 2 puffs into each when required. Maximum duration 7days
nostril 2-3 times daily, CHILD under 12 CHILD: Over 3 months instill 2-3 drops of
years not recommended 0.05% in to each nostril 2-3 times daily
when required. Maximum duration 7 days.
Proprietary Preparation
Rinase (ACI), Nasal Spray, 21mcg/spray, Proprietary Preparations
Tk.150.00/120 Spray; Antazol (Square), Nasal drops, 0.05%, Tk.
11.01/15 ml
Antazol (Square), Nasal drops, 0.10%, Tk.
OXYMETAZOLINE HYDROCHLORIDE 11.51/15 ml
G-Xylometazoline (Gonoshasthaya), Nasal
Indications: nasal congestion drops, 0.1%, Tk. 11.25/15 ml
Cautions: see under ephedrine Rhinozol (Acme), Nasal drops,  0.05%, Tk.
hydrochloride 11.01/15 ml
Rhinozol (Acme), Nasal drops, 0.1%, Tk.
Side-effects: see under ephedrine 11.51/15 ml
hydrochloride Xylomet (Opsonin), Nasal drops, 0.1%, Tk.
Administration: see under 8.99/15 ml
xylometazoline hydrochloride Xylovin (Opso Saline), Nasal drops, 0.1%, Tk.
5.47/10 ml;  0.05%, Tk. 5.47/10 ml
Proprietary Preparations Sodium Cromoglycate 2.6mg + Xylometazoline
Afrin (Aristo), Nasal drops, 0.05%,Tk.45/10 ml; HCl 0.0325mg
0.025%, Tk. 40.00/10 ml Nacromin (Square), Nasal Spray, Tk.
Azolin (Acme), Nasal drops, 0.05%, Tk. 110.41/120 metered dose
45.00/10 ml; 0.025%, Tk. 40.00/10 ml Xylo Plus (Incepta), Nasal Spray, Tk.
Confree (Asiatic), Nasal drops,  0.05%, Tk. 110.00/120 metered dose
45.00/10 ml; 0.025%, Tk. 40.00/10 ml
G-Con (Kemiko), Nasal drops, 0.05%, Tk. 11.2.3 NASAL PREPARATIONS
45.00/10 ml; 0.025%, Tk. 40.00/10 ml FOR THE INFECTION AND
Nasalox(General), Nasal drops,  0.025%, Tk. EPISTAXIS
40.00/10 ml; 0.05%, Tk. 45.00/10 ml
Natazol (Ibn Sina), Nasal drops, 0.025%, Tk.
10.00/10 ml; 0.05%, Tk. 45.00/10 ml Infection of the nasal skin (cellulitis) is
Nazolin (Beximco), Nasal Spray, 0.025%, Tk. usually invaded by Streptococci or
130.00/200 doses Staphylococci leads to a red, swollen and
Nocon (Square), Nasal drops, 0.05%, Tk. tender nose. Infection can be treated with
45.00/10 ml antibiotics, hot compression and
Oxymet(Opso Saline), Nasal drops,  0.025%,
analgesics. An acute infection of the hair
Tk. 30.08/10 ml.; 0.05%, Tk. 33.83/10 ml
Oxynex (Opsonin), Nasal drops,  0.025%, Tk. follicle by the Staphylococcus aureus is
30.08/10 ml; 0.05%, Tk. 33.83/10 ml.; Nasal called furuncle or boil. The lesion is small
Spray,  0.05%, Tk. 60.15/200 MD but extremely painful and tender. The
Rynex (Incepta), Nasal drops, 0.05%, Tk. furuncle may rupture spontaneously in the
45.00/10 ml;  0.025%, Tk. 40.00/10 ml; Nasal nasal vestibule. Treatment consists of
Spray  0.05%, Tk. 80.00/200doses warm compression, an analgesic to
relieve pain, and topical and systemic
XYLOMETAZOLINE HYDROCHLORIDE antibiotics directed against
staphylococcus.
Indications : nasal congestion. Vestibulitis is diffuse dermatitis of nasal
Cautions: see under ephedrine vestibule. Causative organism is Staph.
hydrochloride aureus. Treatment consists of cleaning
Contraindication: CHILD under 3 the nasal vestibule of all crusts and
months scales with cotton applicator soaked in
Side-effects: see under ephedrine Hydrogen peroxide and application of
hydrochloride antibiotic steroid ointment. Treatment
should always be continued for a few

430
 11. EAR, NOSE AND THROAT

more days even after the apparent cure, Antibiotics help to clear nasal infection
as the condition is likely to relapse. and concomitant sinusitis.
Septal abscess mostly results from Nasal polyps are non-neoplastic masses
secondary infection of septal haematoma. of oedematous nasal or sinus mucosa.
Systemic antibiotic should be started and Nasal stuffiness leading to total nasal
continued at least for 10 days. obstruction, partial or total loss of smell,
Acute rhinitis can be viral, bacterial or headache due to associated sinusitis,
irritatant type. Viral rhinitis is known as sneezing and watery nasal discharge due
common cold (coryza). The infection is to associated allergy, Polyp protruding
usually acquired through air borne from the nostril may be the presenting
droplets. Several viruses such as symptom. Conservative treatment may
adenovirus, rhinovirus, coxsackie virus include antihistamines and control of
are responsible. There is burning allergy. A short course of steroid nasal
sensation at the back of the nose soon drop or spray is often helpful to produce
followed by nasal stuffiness, rhinorrhoea significant shrinkage in the early stages of
and sneezing. Patient feels chilly and polyp. The reduction of the oedema can
there is low-grade fever. Initially nasal be maintained by the continuing treatment
discharge is watery and profuse but may with the same spray. If the condition does
become mucopurulent due to secondary not respond to medical therapy,
bacterial invasion. Secondary invaders endoscopic clearance of the polyp should
include Strep. haemolyticus, be carried out immediately.
Pneumococcus, Staphylococcus, H. Acute inflammation of the sinus mucosa
influenzae, Kleb. pneumoniae and M. is called acute sinusitis. Most common
catarrhalis. Treatment consists of bed cause of acute sinusitis is viral rhinitis
rest, which is essential to cut down the followed by bacterial invasion. Sinus
course of illness. Plenty of fluids are mucosa is the continuation of nasal
encouraged. Symptoms can be easily mucosa and infections from nose can
controlled with antihistamines and nasal travel directly. Infected water can enter
decongestants. Analgesics are useful to the sinuses through their ostia during
relieve headache, fever and myalgia. swimming and diving. Trauma may permit
Antibiotics are only required when direct infection of sinus mucosa. Infection
secondary infection supervenes. from the molar or premolar teeth or their
Bacterial rhinitis may be primary which is extraction may be followed by acute
seen in children and is usually the result sinusitis. Sinusitis is common in cold and
of infection with Pneumococcus, Strepto- wet climate. Atmospheric pollution,
coccus or Staphylococcus. A grayish smoke, dust and overcrowding also
white tenacious membrane may form in predispose to sinus infection. The
the nose. Secondary bacterial rhinitis is bacteria most frequently responsible for
the result of bacterial infection acute suppurative sinusitis are Strep.
supervening acute viral rhinitis. pneumoniae, H. Influenzae, Moxacella
catarrhalis, Strep. pyogens, Staph.
Irritant rhinitis is the form of acute rhinitis, aureus and Kleb. pneumoniae. Anaerobic
caused by exposure to dust, smoke or organisms and mixed infections are seen
irritating gases such as ammonia, in sinusitis of dental origin. Constitutional
formalin, acid fumes etc. Treatment symptoms and signs consist of fever,
includes particular attention to sinuses, headache, pain, tenderness, redness and
tonsils, adenoids, allergy, and smoky or oedema of chick and nasal discharge.
dusty surroundings. Nasal irrigation with Conservative treatment includes
alkaline solution help to keep the nose antimicrobial drugs such as ampicillin,
free from viscid secretions and also amoxycillin, erythromycin, doxycycline
remove superficial infection. Nasal or cotrimoxazole, sparfloxacin etc.
decongestants help to relieve nasal Nasal decongestant drops such as 1%
obstruction and improve sinus ventilation. ephedrine or 0.1% xylo- or
oxymetazoline are used as nasal drops

431
11. EAR, NOSE AND THROAT

or sprays. Steam inhalation with steam PREPARATIONS FOR NON-INFECTED

alone or medicated with menthol or INFLAMMATORY NASAL CONDITIONS
tincture benzoin provides symptomatic
relief and encourages sinus drainage.
BETAMETHASONE SODIUM
Paracetamol can be given for the relief of
PHOSPHATE
pain and headache. Local heat to the
affected sinus is often soothing and helps
in the resolution of inflammation. Most Indications : non-infected inflammatory
cases of acute maxillary sinusitis respond conditions of the nose
to medical treatment. Surgical treatment Cautions : should be avoided in the
is done only when medical treatment fails. presence of untreated nasal infection and
also after nasal surgery. Should also be
Bleeding from inside the nose is called avoided in pulmonary tuberculosis
epistaxis. It is fairly common and is seen Side-effects : dryness and irritation of the
in all age groups and often presents as an nose
emergency. It is the sign and not a Preparation : drops (for nose, eye, ear)
disease so attempt should be made to Betamethasone sodium phosphate 1%
find out any local or constitutional cause. Application : 2-3 drops into each nostril
Causes are trauma, infections, foreign 2-3 times daily
bodies, neoplasm of nose, atmospheric
changes such as high altitude, Proprietary Preparations
hypertension, arteriosclerosis, mitral (see section 11.1.1)
stenosis, aplastic anemia, leukemia,
PREPARATION FOR NASAL
purpura, hemophilia, scurvy, vitamin K
INFECTION & EPISTAXIS
deficiency etc. Most of the times, bleeding
occurs from the Little’s area and can be
easily controlled by pinching the nose BETAMETHASONE SODIUM
with thumb and index finger for about 10 PHOSPHATE & NEOMYCIN
minutes. This compresses the vessels of SULPHATE
the Little’s area. If the bleeding is profuse
or site of bleeding is difficult to localize Indications: nasal infection and epistaxis
then packing should be done. For this, Application: apply 2-3 drops in to nostril
use ribbon gauze soaked with liquid 2-3 times daily
paraffin. One or both cavities may need to
be packed. Pack can be removed after 24 Proprietary Preparations
hours if bleeding has stopped. Some see section 11.1.1
times it has to be kept for 2-3 days.
Systemic antibiotics should be given to 11.3 DRUGS ACTING ON THE
prevent sinus infection (see section1.1). OROPHARYNX
Bismuth idoform paraffin paste (BIPP)
pack is used for packing cavities after 11.3.1 DRUGS FOR ORAL
surgery and epistaix as mild disinfectant ULCERATION AND
and astringent. INFLAMMATION

AMOXYCILLIN The causes of ulcers of the oral cavity are

(see section 1.1.1.3) trauma, (physical, chemical or thermal).
Infection, (viral, bacterial, fungal), immune
AMPICILLIN disorders, (aphthous ulcer), neoplasm,
(see section 1.1.1.3) skin disorders, blood disorders, nutritional
deficiencies, gastrointestinal diseases
and drug therapy. First of all diagnosis
PHENOXYMETHYL PENICILLIN
must be made because majority of these
(see section 1.1.1.2) conditions require specific treatment
along with the local treatment. Mouth
ulcer for more than 3 weeks duration

432
 11. EAR, NOSE AND THROAT

need urgent diagnosis and treatment to recurrent herpes labialis. Acute ulcerative
exclude carcinoma. Aim of local treatment gingivitis is also called Vincent’s infection
is to give protection to the ulcerated area, caused by Borrelia vincenti. Treatment is
relieving pain and reducing inflammation. systemic antibiotics (penicillin see
A saline or compound thymol glycerin section 1.1.1 or erythromycin see
mouthwash may relieve pain. Antiseptic section 1.1.4 and metronidazole (see
mouthwashes such as chlorhexidine or section 1.1.8). Frequent mouth washes
povidone iodine mouth wash is (with sodium bicarbonate solution) and
beneficial for healing of recurrent apthous attention are to be given to dental
ulcer. Topical corticosteroid therapy hygiene.
may be useful for some form of oral Moniliasis (Candidiasis) is caused by C.
ulceration. It is most effective in the albicans, and occur in the form of thrush
treatment of apthous ulcer, thrush or and chronic hypertrophic candidiasis. The
other types of candidiasis. Amelexanox condition is seen in infants and children.
paste is also used in the treatment of Adults are also affected when they are
apthous ulcer. suffering from malignancy and diabetes
Systemic corticosteroid must be or taking broad-spectrum antibiotics,
reserved for severe conditions such as cytotoxic drugs, steroid or radiation.
pemphigus vulgaris. To relieve pain Thrush can be treated by topical
lidocaine (lignocaine) 5% ointment or application of nystatin or clotrimazole.
lozenges are applied to the ulcer, but Hypertrophic form usually requires
care must be taken not to use this before excision surgery.
meals as this might lead to choking. Acute pharyngitis is also very common.
Carbenoxolone gel or mouthwash may Streptococcal pharyngitis is treated with
be of some value. Carmellose gelatin penicillin.
paste may relieve some discomfort Diphtheria is to be treated with diphtheria
arising from ulceration by protecting the antitoxin and penicillin or erythromycin.
ulcer site. For mild oral and perioral lesion Gonococcal pharyngitis responds to
salicylates may be used. conventional doses of penicillin or
Benzydamine mouth wash or spray may tetracycline.
be useful in palliating the discomfort Fungal pharyngitis of the oropharynx can
associated with a variety of ulcerative occur as an extension of oral thrush;
condition. It has also been found to be nystatin is the drug of choice.
effective in reducing the discomfort of Aphthous ulcer is an autoimmune
post irradiation mucositis. process that may be caused by nutritional
deficiency (Vitamin B12, folic acid and
11.3.2 OROPHARYNGEAL ANTI iron), viral infection, hormonal changes or
INFECTIVE DRUGS stress. Treatment consists of topical
application of steroids and cauterization
Viral infection is most common. These are with 10% silver nitrate. In severe cases
herpes simplex. Herpangina is a 250 mg of tetracycline dissolved in 50 ml
coxsackie viral infection mostly affecting of water is given as mouth rinse and then
children. They usually persist for about a to be swallowed, four times a day. Local
week. Herpetic gingival stomatitis is also pain can be relieved with lignocaine
known as orolabial herpes, is caused by viscous.
herpes simplex virus. It may be primary Oral mucosal lesions (erythema
and secondary. Primary infection affects multiforme) consist of vesicles or bullae
children and secondary or recurrent which may involve lips, buccal mucosa
herpes mainly affects adults. Most and tongue. The disease is self-limiting
commonly it involves the vermilion border and management is mainly supportive.
of the lip which is known as herpes Steroid preparations are used to treat the
labialis. Treatment is mostly symptomatic. severe cases.
Acyclovir, 200 mg, five times a day for 5
days helps to cut down the course of Proprietary Preparations
Erythromycin (see Section 1.1.5)

433
11. EAR, NOSE AND THROAT

Nystatin (see Section 1.2.1) MICONAZOLE GEL[ED]

Penicillin (see Section 1.1.1)
Tetracycline (see Section 1.1.6) See sectopm 12.2.2

Indications: Oropharyngeal candidiasis.

ACYCLOVIR[ED]
Dose 5-10 ml after food 4 times a day.
(see section 1.4.) Retain near oral lesions before
swallowing. Continue treatment until 48
Indications: Herpes simplex and hours until lesions have healed.
varicella-zoster
Cautions: renal impairment, pregnancy, Proprietary Preparations
breast-feeding; adequate hydration must Miconazole oral gel 2% 
be maintained with infusion A-Migel (Acme), Oral Gel, Tk. 52/15 g
Side-effects: rashes, gastrointestinal Candoral (Beximco), Oral Gel, Tk. 52/15g
disturbances, increased bilirubin and liver Dakrin (General, Oral Gel, Tk. 60/15 g
enzymes, increases blood urea and Fungidal (Square), Buccal Tab. 10 mg, Tk.
creatinine 5.01/Tab.
Dose: Tab. 200 mg 5 times daily for 5 Gelora (Square), Oral Gel, Tk. 60/15 gm
Micoderm (Drug Int.), Oral Gel, Tk. 50/15 g
days. Child under 2 years, half of adult Micosina (Ibn Sina), Oral Gel, Tk. 60/15 g
dose. For streptococcal infections, Myco (Parmasia), Oral Gel, Tk. 50/15 gm
required systemic penicillin Mycon (Aristo), Oral Gel, Tk. 60/15 gm
Oragel-M (Unimed), Oral Gel, Tk. 50/15 gm
Proprietary Preparations Oramic (Alco), Oral Gel,  Tk. 50/10 gm
(see Section 1.4.) Oroconazol (Incepta), Oral Gel,Tk. 50/15gm
Orogurd (Eskayef), Oral Gel, Tk. 50/15gm
PENICILLIN
11.3.3 MOUTHWASH AND
(see section 1.4.)
GARGLES
Indications: Acute ulcerative gingivitis
(Vincent’s infection) responds to systemic Mouthwash freshens the mouth and it has
metronidazole (see section 1.1.8) got a mechanical cleansing action.
Sodium chloride and thymol glycerins
are also very useful mouthwash.
DRUGS USED IN OROPHARYNGEAL
Hydrogen peroxide is an oxidizing agent
ULCERS
and is very much useful in the treatment
(see also Dental Practitioner’s Formulary) of acute ulcerative gingivitis (Vincent’s
infection). Since the organisms involved
FOR APHTHOUS ULCER in these cases are anaerobes,
mouthwashes containing hydrogen
AMLEXANOX peroxide are useful. It produces a
mechanical cleansing action due to
Indications: aphthous ulcers in people frothing when it comes in contact with oral
with normal immune systems. debris. A Chlorhexidine mouthwash may
be used for oral infection or when tooth
Proprietary Preparations brushing is not possible. chlorhexidine
Apsol (Square), Oral Paste, 5%,Tk.75.28/5 gm has a specific effect for inhibition of the
Amlex (ACI), Oral Paste, 5%, Tk. 75/5 gm formation of plaques on teeth. For
Sorex (Eskayef), Oral Paste, 5%,Tk.75/5 gm mucosal infection povidone iodine
(see also Dental Practitioner’s Formulary) mouthwash may be used. As significant
amount of iodine may absorb so it should
FOR FUNGAL INFECTION not be used for not more than 14 days.
Thymol mouthwash to be used as mouth
Amphotericin (see section 1.2), wash.
Nystatin (see section 12.2.2&1.2.3)
CHLORHEXIDINE GLUCONATE[ED]

434
 11. EAR, NOSE AND THROAT

Indications: oral hygiene and plaque Lister Total Care Anticavity Mouthwash
inhibition (General), Tk. 75.00/120 ml; Tk. 140/250 ml
Caution: If desquamation occurs then it Listoral Cool Mint (ACI), Mouth Wash, Tk.
75.28/120 ml; Tk. 140.53/250 ml
must be discontinued Listoral Original (ACI), Mouth Wash, Tk.
Side-effects: mucosal irritation., 75.28/120 ml; Tk. 140.53/250 ml
reversible brown staining of teeth and Orostar Cool Mint (Square), Mouth wash, Tk.
parotid gland swelling may occur 75.00/120 ml; Tk. 140.00/250 ml
Dose: rinse mouth with 10 ml, for about 1 Orostar Original (Square), Mouth wash, Tk.
minute twice daily. 75.00/120 ml; Tk. 140.00/250 ml
Orostar plus (Square), Mouth wash,Tk.
Preparations: chlorhexidine gluconate
85.00/120 ml; Tk. 150.00/250 ml
0.2% mouth wash
Thymol 0.063gm + Eucalyptol 0.091gm +
Proprietary Preparations Menthol 0.042gm /100ml
ORAL-C(Unimed), Mouthwash, 0.2%,Tk. Lister Zero Mouthwash (General),
75.00/125 ml Mouthwash, Tk. 80.00/120 ml
Oralon(ACI), Mouthwash, 0.2%, Tk.35.13/100 Lister Total Care Anticavity Mouthwash
ml (General), Mouthwash, 0.063gm + 0.091gm +
0.042gm /100ml, Tk. 145.00/250 ml
POVIDONE IODINE[ED]

Indication : oral hygiene

Cautions : pregnancy and breast-feeding
Contraindications : patients with thyroid
disorders or those receiving lithium
therapy
Side-effects: idiosyncratic mucosal
irritation and hypersensitivity reactions.It
may interfere with thyroid function tests
and with tests for occult blood

Proprietary Preparations
Povidone Iodine 1%
Arodin (Aristo), Gargle & Mouthwash , Tk.
35.00/100 ml;
Betadine (Mundipharma), Gargle &
Mouthwash, Tk. 60.00/50 ml; Tk. 95/100 ml
Cleanser(General), Gargle & Mouthwash, Tk.
25/100 ml
Povisep (Jayson), Gargle & Mouthwash, Tk.
35/100 ml
Povin (Opsonin), Gargle & Mouthwash, Tk.
18.86/100 ml
Viodin (Square), Gargle & Mouthwash, Tk.
30/100 ml

MENTHOL, THYMOL , EUCALYPTOL,

METHYL SALICYLATE

Indications : antiseptic mouth wash

Menthol 0.042 gm + Thymol 0.064 gm +

Eucalyptol0.092gm + Methyl Salicylate
0.060gm/100m;
Lister Coolmint Antiseptic Mouthwash
(General), Tk. 145.00/250 ml; Tk. 80/120 ml
Lister Original Antiseptic Mouthwash
(General), Tk 140.00/ml; Tk. 80.00/120 ml

435