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oai:digital.library.adelaide.edu.au:2440/1377742024-07-25T05:01:52Zcom_2440_14759col_2440_14760

Wormald, Peter-John Vreugde, Sarah Megow, Anna Katharina Adelaide Medical School 2023 https://hdl.handle.net/2440/137774 This thesis encompasses research investigating topical therapies to improve the management of recalcitrant chronic rhinosinusitis (CRS). Chapter one of this thesis reviews the current literature pertaining to CRS including its aetiopathogenesis and the role of the sinonasal microbiome. It also outlines current management and factors leading to poor outcomes after surgery such as bacterial dysbiosis, inflammation and scarring. The use of two topical agents Chitogel®, a hydrogel composed of chitosan and dextran, and deferiprone, an iron chelating drug are reviewed for their potential to improve surgical outcomes. A review of sinonasal delivery devices for topical delivery of medication is presented with particular reference to intranasal nebulisers. The second chapter presents a double-blinded randomised controlled trial to investigate the effect that Chitogel has on the sinonasal microbiome and infections following endoscopic sinus surgery (ESS). Chitogel was found to significantly improved both the nasoendoscopic appearance of the sinuses and sinus ostial patency at 12 weeks postoperative. Significantly, Chitogel was also found to restore a healthier microbiome following ESS, resulting in an increase in the relative abundance of beneficial commensals Corynebacterium and Cutibacterium (Propionibacterium). In keeping with the improvement seen in the microbiome, a significant decrease in postoperative infections was noted following use of Chitogel. Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2023 en Topical therapies Recalcitrant Chronic Rhinosinusitis Topical Therapies for the Management of Recalcitrant Chronic Rhinosinusitis Thesis This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals.open.access