Optical imaging technologies to identify residual cholesteatoma and improve ossiculoplasty outcomes

中耳有许多疾病和状况会导致儿童和儿童听力损失 成年人。在儿童中，尤其重要的是加快干预以恢复听力，因为它对听力有负面影响 影响语言发展和学业成绩。胆脂瘤就是一个例子，这是一种良性病变 中耳皮肤异常生长，促进包括听小骨在内的骨骼的侵蚀，导致 永久性的损害。首选的手术方式具有相对较高的复发和 残留病变(~10%)。虽然最初的诊断通常是直接的，因为病变的大小 当患者就医时，在初次切除后发现残留的胆脂瘤 即使使用先进的MRI和CT技术也很难进行。因此，“第二眼”手术是 经常进行检查，以验证中耳无病变。一种成像解决方案能够识别 胆脂瘤的临床病变可以大大减少二次手术的数量和他们的 相关成本和潜在的并存(例如，感觉神经性听力损失、眩晕和手术创伤 面部神经)。 因胆脂瘤或其他原因(如创伤、慢性中耳炎、 骨质疏松症(骨质疏松症)通常通过听骨置换手术恢复听力。不幸的是， 结果千差万别。虽然这种变化并不完全被理解，但一个公认的促成因素是 松装假体的长度选择明显好于紧固假体 安装假肢。然而，目前还没有成像技术可以在手术前或手术中提供 最佳假体长度的定量指导。假体周围形成的疤痕组织也可以 对听力结果有不利影响，而且没有可靠的方法来确定这个问题。因此，如果 预后不佳，通常很难确定原因以及是否需要进行翻修手术。 基于光学相干层析成像(OCT)的先进光学成像工具可以在很大程度上填补这一空白 成像技术因此提供了改进的诊断，导致更好的结果和更低的医疗保健 成本。OCT同时具有空间和时间分辨率来测量图像的形态特征和图像特征 耳朵的功能。利用OCT来询问中耳间隙的挑战是进入。 OCT可以穿透组织大约2毫米，因此进入中耳成像必须通过 耳道或咽鼓管。这里提出的技术开发旨在克服 发布并实现中耳空间的全面功能和形态成像。一套领航员 研究将解决我们的方法对特定病理的验证，在我们相信成像解决方案的情况下 会迅速影响临床护理。

There are a number of diseases and conditions in the middle ear that cause hearing loss in both children and adults. In children it is particularly important to expedite interventions to restore hearing since it negatively impacts language development and academic performance. An example is cholesteatoma, a benign lesion due to abnormal skin growth in the middle ear which facilitates erosion of bone, including the ossicles, causing permanent damage. The preferred surgical approach comes with a relatively high risk of both recurrent and residual lesions (~10%). While the initial diagnosis is typically straight forward because of the size of the lesion when the patient seeks medical care, identifying residual cholesteatoma after the initial resection has been performed is difficult even using advanced MRI and CT techniques. Consequently, “second look” surgeries are frequently preformed to verify that the middle ear is lesion free. An imaging solution able to identify cholesteatoma lesions in the clinic could substantially reduce the number of second look surgeries and their associated costs and potential co-morbidities (e.g. sensorineural hearing loss, vertigo and surgical trauma to the facial nerve). Disruption of the ossicular chain due to cholesteatoma or other etiologies (e.g. trauma, chronic otitis media, osteosclerosis) is commonly treated with ossicular replacement surgery to restore hearing. Unfortunately, the outcomes vary greatly. While the variation is not entirely understood, an accepted contributing factor is the choice of the length of the prostheses with loose fitting prostheses performing significantly better than tight fitting prostheses. However, there is currently no imaging technology that can provide pre- or intra-surgical quantitative guidance on optimal prosthetic length. Scar tissue formation around the prosthesis can also adversely affect hearing outcomes, and there is no reliable way to identify this problem. Therefore, if the outcome is poor it is often difficult to determine the cause and whether a revision surgery is indicated. Advanced optical imaging tools based on Optical Coherence Tomography (OCT) can largely fill this gap in imaging technology thus providing improved diagnostics, leading to better outcomes and lower health care costs. OCT has both the spatial and temporal resolution to measure the morphological features and the function of the ear. The challenge with utilizing OCT for interrogating the middle ear space is access. OCT can penetrate roughly 2 mm into tissue, hence access to the middle ear for imaging must be made via the ear canal or Eustachian tube. The technology development proposed here is directed at overcoming the access issue and enabling comprehensive functional and morphological imaging of the middle ear space. A set of pilot studies will address validation of our approach for specific pathologies where we believe an imaging solution can swiftly impact clinical care.