SignificanceCholesteatoma is an expansile destructive lesion of the middle ear and mastoid, which can result in significant complications by eroding adjacent bony structures. Currently, there is an inability to accurately distinguish cholesteatoma tissue margins from middle ear mucosa tissue, causing a high recidivism rate. Accurately differentiating cholesteatoma and mucosa will enable a more complete removal of the tissue.AimDevelop an imaging system to enhance the visibility of cholesteatoma tissue and margins during surgery.ApproachCholesteatoma and mucosa tissue samples were excised from the inner ear of patients and illuminated with 405, 450, and 520 nm narrowband lights. Measurements were made with a spectroradiometer equipped with a series of different longpass filters. Images were obtained using a red-green-blue (RGB) digital camera equipped with a long pass filter to block reflected light.ResultsCholesteatoma tissue fluoresced under 405 and 450 nm illumination. Middle ear mucosa tissue did not fluoresce under the same illumination and measurement conditions. All measurements were negligible under 520 nm illumination conditions. All spectroradiometric measurements of cholesteatoma tissue fluorescence can be predicted by a linear combination of emissions from keratin and flavin adenine dinucleotide. We built a prototype of a fluorescence imaging system using a 495 nm longpass filter in combination with an RGB camera. The system was used to capture calibrated digital camera images of cholesteatoma and mucosa tissue samples. The results confirm that cholesteatoma emits light when it is illuminated with 405 and 450 nm, whereas mucosa tissue does not.ConclusionsWe prototyped an imaging system that is capable of measuring cholesteatoma tissue autofluorescence.
SignificanceCerebrospinal fluid (CSF) rhinorrhea (leakage of brain fluid from the nose) can be difficult to identify and currently requires invasive procedures, such as intrathecal fluorescein, which requires a lumbar drain placement. Fluorescein is also known to have rare but significant side effects including seizures and death. As the number of endonasal skull base cases increases, the number of CSF leaks has also increased for which an alternative diagnostic method would be highly advantageous to patients.AimWe aim to develop an instrument to identify CSF leaks based on water absorption in the shortwave infrared (SWIR) without the need of intrathecal contrast agents. This device needed to be adapted to the anatomy of the human nasal cavity while maintaining low weight and ergonomic characteristics of current surgical instruments.ApproachAbsorption spectra of CSF and artificial CSF were obtained to characterize the absorption peaks that could be targeted with SWIR light. Different illumination systems were tested and refined prior to adapting them into a portable endoscope for testing in 3D-printed models and cadavers for feasibility.ResultsWe identified CSF to have an identical absorption profile as water. In our testing, a narrowband laser source at 1480 nm proved superior to using a broad 1450 nm LED. Using a SWIR enabling endoscope set up, we tested the ability to detect artificial CSF in a cadaver model.ConclusionsAn endoscopic system based on SWIR narrowband imaging can provide an alternative in the future to invasive methods of CSF leak detection.
Chronic-rhinosinusitis (CRS) is one of the most common conditions affecting ~14.2% (29.2-million) of US adults leading to estimated 18-22 million-physician office visits. It causes significant physical symptoms, negatively affects the quality-of-life and can substantially impair daily functioning. Various factors including microorganisms, allergies, and other inflammatory triggers play role in CRS. Lack of a universal marker and acknowledged difficulty in establishing the causes for the condition contributes to the poor treatment strategies and outcomes associated with CRS. Utilizing panel of sensitive markers associated with inflammatory responses in the nasal area can provide clinicians valuable information about the disease at the molecular level. The present study aims at identifying spectrochemical markers associated with the onset of CRS using data-driven Raman imaging. By combining high-resolution Raman imaging and machine learning we have developed a novel approach to obtain an integrated insight. Our findings are suggestive of differential changes in the biochemical composition of nasal tissues with CRS onset. A regression-based framework has been developed to link the inflammation score with spectral features. Support vector machine has been employed to explore the feasibility of classification. Successful recognition of these markers in nasal tissues will be helpful not only in designing automated diagnosis platforms but can also be used for identifying novel treatment strategies. Findings of this study will also serve as the foundation of our future research work on evaluating the applicability of nasal lavage for a minimally invasive method for objective CRS diagnosis.
Otitis media is one of the most common reasons for pediatrician visits, antibiotic prescription, and surgery in the pediatric population. Visible light pneumatic-otoscopy is considered the best currently available diagnostic tool for otitis media. However, it has various limitations e.g. the disposable speculum cannot create an adequate seal against the external auditory canal to obtain tympanic membrane movement. Also, lack of training for effective pneumatic-otoscopy for most clinicians is another factor. To overcome these limitations, we have recently developed an otoscope sensitive to shortwave infrared (SWIR) wavelengths of light. A SWIR otoscope could help identify middle-ear-effusions based on the strong light absorption by ear fluid. Due to a longer wavelength, light can penetrate deeper through tissue, enabling a better view behind the tympanic membrane. Here we present our preliminary findings on the feasibility of using video rate SWIR imaging in a pediatric population. A total of 74 ear video recordings were obtained in the study from 20 patients. There was an improvement in the ability to see through the tympanic membrane using the SWIR otoscope. Three patients with middle ear effusion, confirmed by pneumatic otoscopy, were all identified using both visible and SWIR otoscopy. The average contrast for visible otoscopy in the presence of middle ear effusion was 0.097 and for SWIR was 0.29. In tympanic membranes with myringosclerosis, neither technique was able to see through affected areas. However, the SWIR otoscope was able to see through dried blood, dried secretions and thin dry areas of cerumen overlying the tympanic membrane.
Otitis media, a range of inflammatory conditions of the middle ear, is the second most common illness diagnosed in children. However, the diagnosis can be challenging, particularly in pediatric patients. Otitis media is commonly over-diagnosed and over-treated and has been identified as one of the primary factors in increased antibiotic resistance. We describe the development of a short-wave infrared (SWIR) otoscope for objective middle ear effusion diagnosis. The SWIR otoscope can unambiguously detect the presence of middle ear fluid based on its strong light absorption in the SWIR. This absorption causes a stark, visual contrast between the presence and absence of fluid behind the tympanic membrane. Additionally, when there is no middle ear fluid, the deeper tissue penetration of SWIR light allows the SWIR otoscope to better visualize middle ear anatomy through the tympanic membrane than is possible with visible light. We demonstrate that in healthy, adult human ears, SWIR otoscopy can image a range of middle ear anatomy, including landmarks of the entire ossicular chain, the promontory, the round window niche, and the chorda tympani. We suggest that SWIR otoscopy can provide valuable diagnostic information complementary to that provided by visible pneumotoscopy in the diagnosis of middle ear effusions, otitis media, and other maladies of the middle ear.
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