Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique

  • Ryan L . Shelton
  • Ryan M. Nolan
  • Guillermo L. Monroy
  • Paritosh Pande
  • Michael A. Novak
  • Ryan G. Porter
  • Stephen A. BoppartEmail author
Research Article


Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child’s most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are pneumatic otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.

We have developed a technique based on low-coherence interferometry—a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum—to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.


otitis media biomechanics imaging middle ear effusion optical coherence tomography 



The authors thank Darold Spillman from the Beckman Institute for the helpful discussions, Deveine Toney from the Carle Research office for the study coordination, nursing staff from the otolaryngology department at Carle Foundation Hospital for the clinical support, and Eric Chaney from the Beckman Institute for the IRB support. This work was supported by a Bioengineering Research Partnership grant (R01 EB013723) from the NIH/NIBIB, the National Science Foundation (CBET 14-45111), as well as a grant from the University of Illinois Proof-of-Concept Fund.

Compliance with Ethical Standards

Conflict of Interest

R.L.S., R.M.N, and S.A.B. have a financial interest in PhotoniCare, Inc., a company commercializing technology related to this manuscript. PhotoniCare did not, however, sponsor this research.

Subjects for this study were recruited and enrolled under a protocol approved by the Institutional Review Boards (IRB) of the University of Illinois at Urbana-Champaign and Carle Foundation Hospital in Urbana, IL. Patients were recruited and imaged in the otolaryngology clinic at Carle Foundation Hospital, Urbana, Illinois.


  1. American Speech-Language-Hearing Association, Causes of Hearing Loss in Children. American Speech-Language-Hearing Association, Accessed 16 September 2015
  2. Armstrong WB, Ridgway JM, Vokes DE, Guo S, Perez J, Jackson RP, Gu M, Su J, Crumley RL, Shibuya TY, Mahmood U, Chen Z, Wong BJ (2006) Optical coherence tomography of laryngeal cancer. Laryngoscope 116:1107–1113CrossRefPubMedGoogle Scholar
  3. Cense B, Nassif NA, Chen TC, Pierce MC, Yun SH, Park BH, Bouma BE, Tearney GJ, de Boer JF (2004) Ultrahigh-resolution high-speed retinal imaging using spectral-domain optical coherence tomography. Opt Express 12:2435–2447CrossRefPubMedGoogle Scholar
  4. Costa RA, Skaf M, Melo LAS, Calucci D, Cardillo JA, Castro JC, Huang D, Wojtkowski M (2006) Retinal assessment using optical coherence tomography. Prof Retinal Eye Res 25:325–353Google Scholar
  5. Dirckx JJ, Decraemer WF (1991) Human tympanic membrane deformation under static pressure. Hear Res 51:93–106Google Scholar
  6. Djalilian HR, Rubinstein M, Wu EC, Naemi K, Zardouz S, Karimi K, Wong BJ (2010) Optical coherence tomography of cholesteatoma. Otol Neurotol 31:932–935CrossRefPubMedPubMedCentralGoogle Scholar
  7. Erickson-Bhatt SJ, Nolan RM, Shemonski ND, Adie SG, Putney J et al (2015) Real-time imaging of the resection bed using a handheld probe to reduce incidence of microscopic positive margins in cancer surgery. Cancer Res 75(18):3706–3712Google Scholar
  8. Gao SS, Xia A, Yuan T, Raphael PD, Shelton RL, Applegate BE, Oghalai JS (2011) Quantitative imaging of cochlear soft tissues in wild-type and hearing-impaired transgenic mice by spectral domain optical coherence tomography. Opt Express 19:15415–15428CrossRefPubMedPubMedCentralGoogle Scholar
  9. Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA, Fujimoto JG (1991) Optical coherence tomography. Science 254:1178–1181CrossRefPubMedPubMedCentralGoogle Scholar
  10. Hubler Z, Shemonski ND, Shelton RL, Monroy GL, Nolan RM, Boppart SA (2015) Real-time automated thickness measurement of the in vivo human tympanic membrane using optical coherence tomography. Quant Imag Med Surg 5(1):69–77. doi: 10.3978/j.issn.2223-4292
  11. Jones WS, Kaleida PH (2003) How helpful is pneumatic otoscopy in improving diagnostic accuracy? Pediatrics 112(3):510–513CrossRefPubMedGoogle Scholar
  12. Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al (2013) The diagnosis and management of acute otitis media. Pediatrics 131:964–999CrossRefGoogle Scholar
  13. Lim VY, Buellesfeld L, Grube E (2006) Images in cardiology. Optical coherence tomography imaging of thrombus protrusion through stent struts after stenting in acute coronary syndrome. Heart 92:409CrossRefPubMedPubMedCentralGoogle Scholar
  14. Linsk R, Blackwood A, Cooke J, Harrison V, Lesperance M, Hildebrandt HM (2013) University of Michigan Health System Otitis Media Guideline for Clinical Care. UMHS Otitis Media Guideline, Accessed 16 September 2015
  15. Monroy GL, Shelton RL, Nolan RM, Nguyen CT, Novak MA, McCormick DT, Boppart SA (2015) Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media. Laryngoscope 125(8):E276–E282. doi: 10.1002/lary.25141 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Monroy GL, Pande P, Shelton RL, Nolan RM, Spillman DR, Porter RG, Novak MA, Boppart SA (2016) Non-invasive optical assessment of viscosity of middle ear effusions in otitis media. J Biophotonics 10:394–403. doi:  10.1002/jbio.201500313.
  17. Muderris T, Yazici A, Bercin S, Yalciner G, Sevil E, Kiris M (2013) Consumer acoustic reflectometry: accuracy in diagnosis of otitis media with effusion in children. Int J Pediatric Otorhinolaryngology 77(10):1771–1774. doi: 10.1016/j.ijporl.2013.08.019 CrossRefGoogle Scholar
  18. Murakami S, Gyo K, Goode RL (1997) Effect of middle ear pressure change on middle ear mechanics. Acta Otolaryngol 117(3):390–395CrossRefPubMedGoogle Scholar
  19. Neerken S, Lucassen GW, Bisschop MA, Lenderink E, Nuijs TA (2004) Characterization of age-related effects in human skin: a comparative study that applies confocal laser scanning microscopy and optical coherence tomography. J Biomed Opt 9:274–281Google Scholar
  20. New York Times. (2012) Otitis Media With Effusion In-Depth Report. Accessed 16 September 2015
  21. Nguyen CT, Tu H, Chaney EJ, Stewart CN, Boppart SA (2010) Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear. Biomed Opt Express 1:1104–1116Google Scholar
  22. Nguyen CT, Jung W, Kim J, Chaney EJ, Novak M, Stewart CN, Boppart SA (2012) Noninvasive in vivo optical detection of biofilm in the human middle ear. Proc Natl Acad Sci USA 109:9529–9534Google Scholar
  23. Pitris C, Saunders KT, Fujimoto JG, Brezinski ME (2001) High-resolution imaging of the middle ear with optical coherence tomography: a feasibility study. Arch Otolaryngol Head Neck Surg 127:637–642CrossRefPubMedGoogle Scholar
  24. Shekelle P, Takata G, Chan LS, Mangione-Smith R, Corley PM, Morphew T, Morton S. (2003) Diagnosis, Natural History, and Late Effects of Otitis Media with Effusion: Summary. Evidence Report/Technology Assessment No. 55, AHRQ Publication No. 03-E023.Google Scholar
  25. Shelton RL, Jung W, Sayegh SI, McCormick DT, Kim J, Boppart SA (2014) Optical coherence tomography for advanced screening in the primary care office. J Biophotonics 7:525–533. doi: 10.1002/jbio.201200243 CrossRefPubMedGoogle Scholar
  26. Subhash HM, Nguyen-Huynh A, Wang RK, Jacques SL, Choudhury N, Nuttall AL (2012) Feasibility of spectral-domain phase-sensitive optical coherence tomography for middle ear vibrometry. J Biomed Opt 17:060505Google Scholar
  27. Takata GS, Chan LS, Morphew T, Mangione-Smith R, Morton SC, Shekelle P (2003) Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion. Pediatrics 112(6 Pt 1):1379–1387CrossRefPubMedGoogle Scholar

Copyright information

© Association for Research in Otolaryngology 2017

Authors and Affiliations

  • Ryan L . Shelton
    • 1
  • Ryan M. Nolan
    • 1
  • Guillermo L. Monroy
    • 1
    • 2
  • Paritosh Pande
    • 1
  • Michael A. Novak
    • 3
    • 4
  • Ryan G. Porter
    • 3
    • 4
  • Stephen A. Boppart
    • 1
    • 2
    • 5
    • 6
    Email author
  1. 1.Beckman Institute for Advanced Science and TechnologyUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  2. 2.Department of BioengineeringUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  3. 3.Department of Otolaryngology-Head and Neck SurgeryCarle Foundation HospitalUrbanaUSA
  4. 4.Department of SurgeryUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  5. 5.Department of Electrical and Computer EngineeringUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  6. 6.Department of Internal MedicineUniversity of Illinois at Urbana-ChampaignUrbanaUSA

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