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In Vivo Optical Characterization of Middle Ear Effusions and Biofilms During Otitis Media

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Abstract

Otitis media (OM), a common ear infection, is characterized by the presence of an accumulated middle ear effusion (MEE) in a normally air-filled middle ear cavity. While assessing the MEE plays a critical role in the overall management of OM, identifying and examining the MEE is challenging with the current diagnostic tools since the MEE is located behind the semi-opaque eardrum. The objective of this cross-sectional, observational study is to non-invasively visualize and characterize MEEs and bacterial biofilms in the middle ear. A portable, handheld, otoscope-integrated optical coherence tomography (OCT) system combined with novel analytical methods has been developed. In vivo middle ear OCT images were acquired from 53 pediatric subjects (average age of 3.9 years; all awake during OCT imaging) diagnosed with OM and undergoing a surgical procedure (ear tube surgery) to aspirate the MEE and aerate the middle ear. In vivo middle ear OCT acquired prior to the surgery was compared with OCT of the freshly extracted MEEs, clinical diagnosis, and post-operative evaluations. Among the subjects who were identified with the presence of MEEs, 89.6% showed the presence of the TM-adherent biofilm in in vivo OCT. This study provides an atlas of middle ear OCT images exhibiting a range of depth-resolved MEE features, which can only be visualized and assessed non-invasively through OCT. Quantitative metrics of OCT images acquired prior to the surgery were statistically correlated with surgical evaluations of MEEs. Measurements of MEE characteristics will provide new readily available information that can lead to improved diagnosis and management strategies for the highly prevalent OM in children.

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Data Availability

The data that support the findings of this study are available upon reasonable request to the corresponding author and under a collaborative research agreement.

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Acknowledgements

The authors thank MaryEllen Sherwood and Christine Canfield from the Carle Research Office at Carle Foundation Hospital, Urbana, Illinois, for their help with IRB protocol management and subject recruitment. The authors acknowledge the nursing staff in the Department of Otolaryngology at Carle Foundation Hospital and Champaign Surgery Center at the Fields for their help in subject recruitment and clinical assistance.

Funding

This work was funded in part by grants from the National Institutes of Health (R01DC019412, R01EB028615, R01AI160671, P41EB031772) and in part by the McGinnis Medical Innovation Fellowship program.

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Authors and Affiliations

  1. Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA

    Jungeun Won & Stephen A. Boppart

  2. Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA

    Jungeun Won, Guillermo L. Monroy, Ronit Barkalifa, Eric J. Chaney, Edita Aksamitiene, Darold R. Spillman Jr. & Stephen A. Boppart

  3. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Pawjai Khampang, Wenzhou Hong & Joseph E. Kerschner

  4. Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL, 61801, USA

    Ryan G. Porter & Michael A. Novak

  5. Division of Otolaryngology and Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Joseph E. Kerschner

  6. Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA

    Stephen A. Boppart

  7. Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA

    Ryan G. Porter & Stephen A. Boppart

  8. NIH/NIBIB P41 Center for Label-free Imaging and Multiscale Biophotonics (CLIMB), University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA

    Stephen A. Boppart

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  1. Jungeun Won
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  2. Guillermo L. Monroy
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  5. Wenzhou Hong
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  12. Stephen A. Boppart
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Corresponding author

Correspondence to Stephen A. Boppart.

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Conflict of Interest

S. A. B. is co-founder and holds equity interest in PhotoniCare, Inc., which is commercializing the use of OCT for middle ear imaging. M. A. N. has equity interest and serves on the clinical advisory board of PhotoniCare, Inc. The remaining authors declare no conflict of interest.

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Won, J., Monroy, G.L., Khampang, P. et al. In Vivo Optical Characterization of Middle Ear Effusions and Biofilms During Otitis Media. JARO 24, 325–337 (2023). https://doi.org/10.1007/s10162-023-00901-6

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  • DOI: https://doi.org/10.1007/s10162-023-00901-6

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