Optical imaging technologies to identify residual cholesteatoma and improve ossiculoplasty outcomes

光学成像技术可识别残余胆脂瘤并改善骨成形术结果

• 批准号: 9899243
• 负责人: Brian E. Applegate
• 金额: $ 67.25万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9899243
• 关键词: Address; Adult; Affect; Animal Model; Auricular prosthesis; Basilar Membrane; Benign; Caring; Catheters; Child; Cholesteatoma; Chronic; Cicatrix; Clinic; Cochlea; Data Analyses; Development; Diagnosis; Diagnostic; Disease; Disease Management; Doctor of Philosophy; Ear; Ear Diseases; Etiology; Eustachian Tube; Excision; External auditory canal; Facial nerve structure; Growth; Health Care Costs; Hearing; Human; Image; Imaging Device; Imaging technology; Intervention; Joints; Language Development; Length; Lesion; Magnetic Resonance Imaging; Measures; Medical; Microscope; Morphology; Motion; Operating Rooms; Operative Surgical Procedures; Optical Coherence Tomography; Optics; Organ; Ossicular Prosthesis Implantation; Osteosclerosis; Otitis Media; Otologic Surgical Procedures; Outcome; Paper; Pathology; Patients; Perception; Performance; Pilot Projects; Prosthesis; Protocols documentation; Recurrence; Research; Residual state; Scientist; Second Look Surgery; Sensorineural Hearing Loss; Skin Abnormalities; System; Systems Development; Techniques; Time; Tissues; Trauma; Travel; Tympanostomy; Validation; Variant; Vertigo; Visit; Work; X-Ray Computed Tomography; base; bone erosion; clinical care; comorbidity; cost; hearing impairment; hearing restoration; high risk; imaging system; improved; instrumentation; meetings; middle ear; optical imaging; prediction algorithm; prosthesis fitting; response; signal processing; sound; technology development; temporal measurement

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.

中耳有许多疾病和病症会导致儿童和青少年听力损失， 成年人了在儿童中，加快干预以恢复听力尤为重要，因为这对儿童的听力有负面影响。 影响语言发展和学习成绩。一个例子是中耳炎，一种良性病变， 中耳的皮肤异常生长，这有助于骨的侵蚀，包括听小骨， 永久性损伤首选的手术方法具有相对较高的复发和复发风险。 残留病变（~10%）。虽然由于病变的大小，最初的诊断通常是直接的 当患者寻求医疗护理时，在初次切除后识别残留的中耳乳突瘤， 即使使用先进的MRI和CT技术也很难进行。因此，“第二次检查”手术 经常执行以验证中耳无损伤。成像解决方案能够识别 在临床上，中耳炎病变可以大大减少二次手术的数量， 相关费用和潜在的合并症（例如，感音神经性听力损失、眩晕和手术创伤， 面部神经）。 由于中耳瘤或其他病因（例如创伤、慢性中耳炎、 骨质疏松症）通常用听骨置换手术来治疗以恢复听力。可惜 结果差别很大。虽然这种变化还不完全清楚，但一个公认的影响因素是 假体长度的选择，松配合假体的性能明显优于紧配合假体 合适的假肢然而，目前还没有成像技术可以提供术前或术中成像。 最佳假体长度的定量指导。假体周围的疤痕组织形成也可以 对听力结果产生不利影响，并且没有可靠的方法来识别这个问题。因此如果 结果很差，通常很难确定原因以及是否需要进行翻修手术。 基于光学相干断层扫描（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，从而提供更好的诊断，导致更好的结果和更低的医疗保健 成本OCT具有测量形态特征的空间和时间分辨率， 耳朵的功能。利用OCT询问中耳空间的挑战是进入。 OCT可以穿透到组织中大约2 mm，因此必须通过OCT进入中耳进行成像。 耳道或耳咽管。这里提出的技术发展是针对克服访问 问题，并使全面的功能和形态成像的中耳空间。一组导频 研究将针对我们认为成像解决方案 可以迅速影响临床护理。