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.

中耳中有许多疾病和状况会导致两个儿童听力损失，并且 成年人。在儿童中，加快干预措施恢复听力尤其重要，因为它负面 影响语言发展和学习成绩。一个例子是胆瘤，良性病变应得 中耳异常的皮肤生长，促进骨骼的侵蚀，包括耳囊，导致 永久损坏。首选的手术方法具有反复发生的相对较高的风险 残留病变（〜10％）。而初始诊断通常是由于病变的大小而直接的 当患者寻求医疗服务时，在最初切除后识别残留的胆汁淤积瘤 即使使用高级MRI和CT技术，执行也很困难。因此，“第二张看”手术是 经常预先验证中耳无病变。成像解决方案可以识别 诊所中的胆汁脱瘤病变可以大大减少第二次外观手术的数量及其 相关成本和潜在的合并症（例如，感觉性听力损失，眩晕和手术创伤 面神经）。 胆汁脱蛋白瘤或其他病因引起的骨链破坏（例如创伤，慢性中耳炎， 骨硬化）通常接受骨化替代手术以恢复听力。不幸的是， 结果差异很大。虽然差异尚未完全理解，但公认的促成因素是 选择宽松的假肢的假肢长度的选择要比紧密 安装假肢。但是，目前尚无成像技术可以提供前手术前或外科手术 最佳假体长度的定量指南。牙齿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此问题。因此，如果是 结果很差，通常很难确定原因以及是否指示修订手术。 基于光学连贯性层析成像（OCT）的高级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，从而带来更好的结果并降低医疗保健 费用。 OCT具有空间和临时分辨率，以衡量形态学特征和 耳朵的功能。使用OCT询问中耳空间的挑战是访问。 OCT可以将大约2 mm穿透到组织中，因此必须通过 耳道或尤斯塔克式管。这里提出的技术开发旨在克服访问 发出并实现中耳空间的全面功能和形态成像。一组飞行员 研究将解决我们对特定病理的方法的验证，我们相信成像解决方案 可以迅速影响临床护理。