1
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Won J, Monroy GL, Khampang P, Barkalifa R, Hong W, Chaney EJ, Aksamitiene E, Porter RG, Novak MA, Spillman DR, Kerschner JE, Boppart SA. In Vivo Optical Characterization of Middle Ear Effusions and Biofilms During Otitis Media. J Assoc Res Otolaryngol 2023:10.1007/s10162-023-00901-6. [PMID: 37253962 DOI: 10.1007/s10162-023-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
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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Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Pawjai Khampang
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ronit Barkalifa
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Wenzhou Hong
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Eric J Chaney
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Edita Aksamitiene
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Ryan G Porter
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL, 61801, USA
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Michael A Novak
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Darold R Spillman
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Division of Otolaryngology and Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Stephen A Boppart
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA.
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- NIH/NIBIB P41 Center for Label-free Imaging and Multiscale Biophotonics (CLIMB), University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
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Porter RG, Nolan RM, Novak M, Youakim JP, Shelton RL. Use of Optical Coherence Tomography Otoscopy to Overcome Cerumen and other View Obstructions during Ear Examination and Assessment. Transl Biophotonics 2022. [DOI: 10.1002/tbio.202200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ryan G. Porter
- Carle Health Urbana Illinois United States
- Carle Illinois College of Medicine Urbana Illinois United States
| | | | - Michael Novak
- Carle Health Urbana Illinois United States
- Carle Illinois College of Medicine Urbana Illinois United States
| | - Jon Paul Youakim
- Carle Health Urbana Illinois United States
- Carle Illinois College of Medicine Urbana Illinois United States
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3
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Monroy GL, Won J, Shi J, Hill MC, Porter RG, Novak MA, Hong W, Khampang P, Kerschner JE, Spillman DR, Boppart SA. Automated classification of otitis media with OCT: augmenting pediatric image datasets with gold-standard animal model data. Biomed Opt Express 2022; 13:3601-3614. [PMID: 35781950 PMCID: PMC9208614 DOI: 10.1364/boe.453536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
Otitis media (OM) is an extremely common disease that affects children worldwide. Optical coherence tomography (OCT) has emerged as a noninvasive diagnostic tool for OM, which can detect the presence and quantify the properties of middle ear fluid and biofilms. Here, the use of OCT data from the chinchilla, the gold-standard OM model for the human disease, is used to supplement a human image database to produce diagnostically relevant conclusions in a machine learning model. Statistical analysis shows the datatypes are compatible, with a blended-species model reaching ∼95% accuracy and F1 score, maintaining performance while additional human data is collected.
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Affiliation(s)
- Guillermo L. Monroy
- Beckman Institute for Advanced
Science and Technology, 405 N Mathews Ave, Urbana, IL
61801, USA
| | - Jungeun Won
- Beckman Institute for Advanced
Science and Technology, 405 N Mathews Ave, Urbana, IL
61801, USA
- Department of Bioengineering,
University of Illinois at Urbana-Champaign,
1406 W Green St, Urbana, IL 61801, USA
| | - Jindou Shi
- Beckman Institute for Advanced
Science and Technology, 405 N Mathews Ave, Urbana, IL
61801, USA
- Department of Electrical and Computer
Engineering, University of Illinois at
Urbana-Champaign, 306 N Wright St, Urbana, IL 61801,
USA
| | - Malcolm C. Hill
- Carle Foundation
Hospital, 611 W Park St., Urbana, IL 61801, USA
| | - Ryan G. Porter
- Carle Foundation
Hospital, 611 W Park St., Urbana, IL 61801, USA
- Carle Illinois College of Medicine,
University of Illinois at Urbana-Champaign,
506 S. Mathews Ave., Urbana, IL 61801, USA
| | - Michael A. Novak
- Carle Foundation
Hospital, 611 W Park St., Urbana, IL 61801, USA
- Carle Illinois College of Medicine,
University of Illinois at Urbana-Champaign,
506 S. Mathews Ave., Urbana, IL 61801, USA
| | - Wenzhou Hong
- Department of Otolaryngology and
Communication Sciences, Medical College of
Wisconsin, Milwaukee, WI 53226, USA
| | - Pawjai Khampang
- Department of Otolaryngology and
Communication Sciences, Medical College of
Wisconsin, Milwaukee, WI 53226, USA
| | - Joseph E. Kerschner
- Department of Otolaryngology and
Communication Sciences, Medical College of
Wisconsin, Milwaukee, WI 53226, USA
- Division of Otolaryngology and Pediatric
Otolaryngology, Medical College of
Wisconsin, Milwaukee, WI 53226, USA
| | - Darold R. Spillman
- Beckman Institute for Advanced
Science and Technology, 405 N Mathews Ave, Urbana, IL
61801, USA
| | - Stephen A. Boppart
- Beckman Institute for Advanced
Science and Technology, 405 N Mathews Ave, Urbana, IL
61801, USA
- Department of Bioengineering,
University of Illinois at Urbana-Champaign,
1406 W Green St, Urbana, IL 61801, USA
- Department of Electrical and Computer
Engineering, University of Illinois at
Urbana-Champaign, 306 N Wright St, Urbana, IL 61801,
USA
- Carle Illinois College of Medicine,
University of Illinois at Urbana-Champaign,
506 S. Mathews Ave., Urbana, IL 61801, USA
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4
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Won J, Monroy GL, Dsouza RI, Spillman DR, McJunkin J, Porter RG, Shi J, Aksamitiene E, Sherwood M, Stiger L, Boppart SA. Handheld Briefcase Optical Coherence Tomography with Real-Time Machine Learning Classifier for Middle Ear Infections. Biosensors (Basel) 2021; 11:bios11050143. [PMID: 34063695 PMCID: PMC8147830 DOI: 10.3390/bios11050143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
A middle ear infection is a prevalent inflammatory disease most common in the pediatric population, and its financial burden remains substantial. Current diagnostic methods are highly subjective, relying on visual cues gathered by an otoscope. To address this shortcoming, optical coherence tomography (OCT) has been integrated into a handheld imaging probe. This system can non-invasively and quantitatively assess middle ear effusions and identify the presence of bacterial biofilms in the middle ear cavity during ear infections. Furthermore, the complete OCT system is housed in a standard briefcase to maximize its portability as a diagnostic device. Nonetheless, interpreting OCT images of the middle ear more often requires expertise in OCT as well as middle ear infections, making it difficult for an untrained user to operate the system as an accurate stand-alone diagnostic tool in clinical settings. Here, we present a briefcase OCT system implemented with a real-time machine learning platform for middle ear infections. A random forest-based classifier can categorize images based on the presence of middle ear effusions and biofilms. This study demonstrates that our briefcase OCT system coupled with machine learning can provide user-invariant classification results of middle ear conditions, which may greatly improve the utility of this technology for the diagnosis and management of middle ear infections.
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Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Guillermo L. Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Roshan I. Dsouza
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - Jonathan McJunkin
- Department of Otolaryngology, Carle Foundation Hospital, Champaign, IL 61822, USA; (J.M.); (R.G.P.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Ryan G. Porter
- Department of Otolaryngology, Carle Foundation Hospital, Champaign, IL 61822, USA; (J.M.); (R.G.P.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Jindou Shi
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Edita Aksamitiene
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
| | - MaryEllen Sherwood
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL 61801, USA; (M.S.); (L.S.)
| | - Lindsay Stiger
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL 61801, USA; (M.S.); (L.S.)
| | - Stephen A. Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (G.L.M.); (R.I.D.); (D.R.S.J.); (J.S.); (E.A.)
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Correspondence:
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5
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Meade ZS, Porter RG. Blastomyces Induced Otomastoiditis With Local Soft Tissue Invasion: A Case Report. Ear Nose Throat J 2021:1455613211006001. [PMID: 33866867 DOI: 10.1177/01455613211006001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this report is to document a very rare case of Blastomycosis dermatitidis mastoiditis with extension into the retromastoid soft tissue and surrounding muscle. Blastomycosis dermatitidis is a dimorphic fungus of endemic areas which classically infiltrates the lungs; however, dissemination presenting as otomastoiditis is exceedingly rare. The patient was an immunocompetent 27-year-old male with no significant preexisting health conditions. He had significant work exposure to dust and soil and was referred to our department for evaluation of otalgia with headaches, hearing loss, and intermittent facial paralysis. Initially, the extent of the infection was unknown. Based on extensive disease on magnetic resonance imaging, the patient was scheduled for urgent tympanoplasty and mastoidectomy. Postoperative treatment with itraconazole resolved any further manifestations and halted further soft tissue invasion. It is important to consider uncommon fungal infections in the workup of persistent otalgia, especially when presenting with facial paralysis and a history of environmental exposure to soil and dust. This type of infection should be considered regardless of immunodeficiency status. Early detection may prevent hearing loss and local invasion into surrounding structures.
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Affiliation(s)
| | - Ryan G Porter
- Carle Illinois College of Medicine, Champaign, IL, USA.,Department of Otolaryngology-Head & Neck Surgery, Carle Health, Urbana, IL, USA
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6
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Won J, Porter RG, Novak MA, Youakim J, Sum A, Barkalifa R, Aksamitiene E, Zhang A, Nolan R, Shelton R, Boppart SA. In vivo dynamic characterization of the human tympanic membrane using pneumatic optical coherence tomography. J Biophotonics 2021; 14:e202000215. [PMID: 33439538 PMCID: PMC7935452 DOI: 10.1002/jbio.202000215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 05/05/2023]
Abstract
Decreased mobility of the human eardrum, the tympanic membrane (TM), is an essential indicator of a prevalent middle ear infection. The current diagnostic method to assess TM mobility is via pneumatic otoscopy, which provides subjective and qualitative information of subtle motion. In this study, a handheld spectral-domain pneumatic optical coherence tomography system was developed to simultaneously measure the displacement of the TM, air pressure inputs applied to a sealed ear canal, and to perform digital pneumatic otoscopy. A novel approach based on quantitative parameters is presented to characterize spatial and temporal variations of the dynamic TM motion. Furthermore, the TM motions of normal middle ears are compared with those of ears with middle ear infections. The capability of noninvasively measuring the rapid motion of the TM is beneficial to understand the complex dynamics of the human TM, and can ultimately lead to improved diagnosis and management of middle ear infections.
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Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois
| | - Ryan G. Porter
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, Illinois
| | - Michael A. Novak
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, Illinois
| | - Jon Youakim
- Department of Pediatrics, Carle Foundation Hospital, Urbana, Illinois
| | - Ada Sum
- Department of Pediatrics, Carle Foundation Hospital, Urbana, Illinois
| | - Ronit Barkalifa
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois
| | - Edita Aksamitiene
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois
| | | | | | | | - Stephen A. Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois
- PhotoniCare, Inc., Champaign, Illinois
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
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7
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Won J, Hong W, Khampang P, Spillman DR, Marshall S, Yan K, Porter RG, Novak MA, Kerschner JE, Boppart SA. Longitudinal optical coherence tomography to visualize the in vivo response of middle ear biofilms to antibiotic therapy. Sci Rep 2021; 11:5176. [PMID: 33664323 PMCID: PMC7933323 DOI: 10.1038/s41598-021-84543-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Studying the impact of antibiotic treatment on otitis media (OM), the leading cause of primary care office visits during childhood, is critical to develop appropriate treatment strategies. Tracking dynamic middle ear conditions during antibiotic treatment is not readily applicable in patients, due to the limited diagnostic techniques available to detect the smaller amount and variation of middle ear effusion (MEE) and middle ear bacterial biofilm, responsible for chronic and recurrent OM. To overcome these challenges, a handheld optical coherence tomography (OCT) system has been developed to monitor in vivo response of biofilms and MEEs in the OM-induced chinchilla model, the standard model for human OM. As a result, the formation of MEE as well as biofilm adherent to the tympanic membrane (TM) was longitudinally assessed as OM developed. Various types of MEEs and biofilms in the chinchilla model were identified, which showed comparable features as those in humans. Furthermore, the effect of antibiotics on the biofilm as well as the amount and type of MEEs was investigated with low-dose and high-dose treatment (ceftriaxone). The capability of OCT to non-invasively track and examine middle ear conditions is highly beneficial for therapeutic OM studies and will lead to improved management of OM in patients.
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Affiliation(s)
- Jungeun Won
- grid.35403.310000 0004 1936 9991Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Wenzhou Hong
- grid.30760.320000 0001 2111 8460Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI USA
| | - Pawjai Khampang
- grid.30760.320000 0001 2111 8460Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI USA
| | - Darold R. Spillman
- grid.35403.310000 0004 1936 9991Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Samuels Marshall
- grid.30760.320000 0001 2111 8460Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI USA
| | - Ke Yan
- grid.30760.320000 0001 2111 8460Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI USA
| | - Ryan G. Porter
- grid.413441.70000 0004 0476 3224Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Michael A. Novak
- grid.413441.70000 0004 0476 3224Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Joseph E. Kerschner
- grid.30760.320000 0001 2111 8460Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI USA ,grid.30760.320000 0001 2111 8460Division of Otolaryngology and Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Stephen A. Boppart
- grid.35403.310000 0004 1936 9991Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL USA ,grid.35403.310000 0004 1936 9991Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL USA
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8
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Monroy GL, Won J, Dsouza R, Pande P, Hill MC, Porter RG, Novak MA, Spillman DR, Boppart SA. Automated classification platform for the identification of otitis media using optical coherence tomography. NPJ Digit Med 2019; 2:22. [PMID: 31304369 PMCID: PMC6550205 DOI: 10.1038/s41746-019-0094-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
The diagnosis and treatment of otitis media (OM), a common childhood infection, is a significant burden on the healthcare system. Diagnosis relies on observer experience via otoscopy, although for non-specialists or inexperienced users, accurate diagnosis can be difficult. In past studies, optical coherence tomography (OCT) has been used to quantitatively characterize disease states of OM, although with the involvement of experts to interpret and correlate image-based indicators of infection with clinical information. In this paper, a flexible and comprehensive framework is presented that automatically extracts features from OCT images, classifies data, and presents clinically relevant results in a user-friendly platform suitable for point-of-care and primary care settings. This framework was used to test the discrimination between OCT images of normal controls, ears with biofilms, and ears with biofilms and middle ear fluid (effusion). Predicted future performance of this classification platform returned promising results (90%+ accuracy) in various initial tests. With integration into patient healthcare workflow, users of all levels of medical experience may be able to collect OCT data and accurately identify the presence of middle ear fluid and/or biofilms.
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Affiliation(s)
- Guillermo L Monroy
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Jungeun Won
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Roshan Dsouza
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Paritosh Pande
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Malcolm C Hill
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Ryan G Porter
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Michael A Novak
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Darold R Spillman
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Stephen A Boppart
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA.,3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA.,5Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL USA
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9
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Dsouza R, Won J, Monroy GL, Hill MC, Porter RG, Novak MA, Boppart SA. In vivo detection of nanometer-scale structural changes of the human tympanic membrane in otitis media. Sci Rep 2018; 8:8777. [PMID: 29884809 PMCID: PMC5993811 DOI: 10.1038/s41598-018-26514-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/11/2018] [Indexed: 01/25/2023] Open
Abstract
Otitis media (OM) is a common ear infection and a leading cause of conductive hearing loss in the pediatric population. Current technologies such as otoscopy, pneumatic otoscopy, tympanometry, and acoustic reflectometry are used to diagnose OM, which can reasonably diagnose the infection with a sensitivity and specificity of 50-90% and 60-90%, respectively. However, these techniques provide limited information about the physical architecture of the tympanic membrane (TM), or what may lie behind it. Here, we report the detection of nanometer-scale structural changes of the TM using nano-sensitive optical coherence tomography (nsOCT). In total, an image dataset from 65 pediatric subjects from three different groups (normal, acute OM, and chronic OM) and with longitudinal image-based analysis of ear infections were included in this study. The nsOCT data were correlated with physician diagnosis and with OCT thickness measurements and were found to be in good agreement with these results. We report that nsOCT detects in vivo structural deformations of the TM earlier than OCT alone, and enhances the detection sensitivity of OCT measurements. This unique technique for early detection of nano-scale structural modifications in the TM has the potential to aid in our understanding of microbiological effects, and possibly for early diagnosis and more effective treatment of OM.
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Affiliation(s)
- Roshan Dsouza
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jungeun Won
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Malcolm C Hill
- Department of Pediatrics, Carle Foundation Hospital, Urbana, Illinois, USA
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan G Porter
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Michael A Novak
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
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10
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Monroy GL, Hong W, Khampang P, Porter RG, Novak MA, Spillman DR, Barkalifa R, Chaney EJ, Kerschner JE, Boppart SA. Direct Analysis of Pathogenic Structures Affixed to the Tympanic Membrane during Chronic Otitis Media. Otolaryngol Head Neck Surg 2018; 159:117-126. [PMID: 29587128 DOI: 10.1177/0194599818766320] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective To characterize otitis media-associated structures affixed to the mucosal surface of the tympanic membrane (TM) in vivo and in surgically recovered in vitro samples. Study Design Prospective case series without comparison. Setting Outpatient surgical care center. Subjects and Methods Forty pediatric subjects scheduled for tympanostomy tube placement surgery were imaged intraoperatively under general anesthesia. Postmyringotomy, a portable optical coherence tomography (OCT) imaging system assessed for the presence of any biofilm affixed to the mucosal surface of the TM. Samples of suspected microbial infection-related structures were collected through the myringotomy incision. The sampled site was subsequently reimaged with OCT to confirm collection from the original image site on the TM. In vitro analysis based on confocal laser scanning microscope (CLSM) images of fluorescence in situ hybridization-tagged samples and polymerase chain reaction (PCR) provided microbiological characterization and verification of biofilm activity. Results OCT imaging was achieved for 38 of 40 subjects (95%). Images from 38 of 38 (100%) of subjects observed with OCT showed the presence of additional microbial infection-related structures. Thirty-four samples were collected from these 38 subjects. CLSM images provided evidence of clustered bacteria in 32 of 33 (97%) of samples. PCR detected the presence of active bacterial DNA signatures in 20 of 31 (65%) of samples. Conclusion PCR and CLSM analysis of fluorescence in situ hybridization-stained samples validates the presence of active bacteria that have formed into a middle ear biofilm that extends across the mucosal layer of the TM. OCT can rapidly and noninvasively identify middle ear biofilms in subjects with severe and persistent cases of otitis media.
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Affiliation(s)
- Guillermo L Monroy
- 1 Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Wenzhou Hong
- 3 Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ryan G Porter
- 4 Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Michael A Novak
- 4 Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Darold R Spillman
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Ronit Barkalifa
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Eric J Chaney
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | | | - Stephen A Boppart
- 1 Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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11
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Won J, Monroy GL, Huang PC, Dsouza R, Hill MC, Novak MA, Porter RG, Chaney E, Barkalifa R, Boppart SA. Pneumatic low-coherence interferometry otoscope to quantify tympanic membrane mobility and middle ear pressure. Biomed Opt Express 2018; 9:397-409. [PMID: 29552381 PMCID: PMC5854046 DOI: 10.1364/boe.9.000397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 05/20/2023]
Abstract
Pneumatic otoscopy to assess the mobility of the tympanic membrane (TM) is a highly recommended diagnostic method of otitis media (OM), a widespread middle ear infection characterized by the fluid accumulation in the middle ear. Nonetheless, limited depth perception and subjective interpretation of small TM displacements have challenged the appropriate and efficient examination of TM dynamics experienced during OM. In this paper, a pneumatic otoscope integrated with low coherence interferometry (LCI) was adapted with a controlled pressure-generating system to record the pneumatic response of the TM and to estimate middle ear pressure (MEP). Forty-two ears diagnosed as normal (n = 25), with OM (n = 10), or associated with an upper respiratory infection (URI) (n = 7) were imaged with a pneumatic LCI otoscope with an axial, transverse, and temporal resolution of 6 µm, 20 µm, and 1 msec, respectively. The TM displacement under pneumatic pressure transients (a duration of 0.5 sec with an intensity of ± 150 daPa) was measured to compute two metrics (compliance and amplitude ratio). These metrics were correlated with peak acoustic admittance and MEP from tympanometry and statistically compared via Welch's t-test. As a result, the compliance represents pneumatic TM mobility, and the amplitude ratio estimates MEP. The presence of a middle ear effusion (MEE) significantly decreased compliance (p<0.001). The amplitude ratio of the OM group was statistically less than that of the normal group (p<0.01), indicating positive MEP. Unlike tympanometry, pneumatic LCI otoscopy quantifies TM mobility as well as MEP regardless of MEE presence. With combined benefits of pneumatic otoscopy and tympanometry, pneumatic LCI otoscopy may provide new quantitative metrics for understanding TM dynamics and diagnosing OM.
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Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1304 W. Springfield Avenue, Urbana, IL 61801, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Guillermo L. Monroy
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1304 W. Springfield Avenue, Urbana, IL 61801, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Pin-Chieh Huang
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1304 W. Springfield Avenue, Urbana, IL 61801, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Roshan Dsouza
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Malcolm C. Hill
- Carle-Illinois College of Medicine, University of Illinois Urbana-Champaign, 807 South Wright Street, Champaign, IL 61820, USA
- Department of Pediatrics, Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801, USA
| | - Michael A. Novak
- Carle-Illinois College of Medicine, University of Illinois Urbana-Champaign, 807 South Wright Street, Champaign, IL 61820, USA
- Department of Otolaryngology, Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801, USA
| | - Ryan G. Porter
- Carle-Illinois College of Medicine, University of Illinois Urbana-Champaign, 807 South Wright Street, Champaign, IL 61820, USA
- Department of Otolaryngology, Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801, USA
| | - Eric Chaney
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Ronit Barkalifa
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
| | - Stephen A. Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1304 W. Springfield Avenue, Urbana, IL 61801, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA
- Carle-Illinois College of Medicine, University of Illinois Urbana-Champaign, 807 South Wright Street, Champaign, IL 61820, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, 306 N Wright Street, Urbana, IL 61801, USA
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12
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Monroy GL, Pande P, Nolan RM, Shelton RL, Porter RG, Novak MA, Spillman DR, Chaney EJ, McCormick DT, Boppart SA. Noninvasive in vivo optical coherence tomography tracking of chronic otitis media in pediatric subjects after surgical intervention. J Biomed Opt 2017; 22:1-11. [PMID: 29275547 PMCID: PMC5745859 DOI: 10.1117/1.jbo.22.12.121614] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/15/2017] [Indexed: 05/12/2023]
Abstract
In an institutional review board-approved study, 25 pediatric subjects diagnosed with chronic or recurrent otitis media were observed over a period of six months with optical coherence tomography (OCT). Subjects were followed throughout their treatment at the initial patient evaluation and preoperative consultation, surgery (intraoperative imaging), and postoperative follow-up, followed by an additional six months of records-based observation. At each time point, the tympanic membrane (at the light reflex region) and directly adjacent middle-ear cavity were observed in vivo with a handheld OCT probe and portable system. Imaging results were compared with clinical outcomes to correlate the clearance of symptoms in relation to changes in the image-based features of infection. OCT images of most all participants showed the presence of additional infection-related biofilm structures during their initial consultation visit and similarly for subjects imaged intraoperatively before myringotomy. Subjects with successful treatment (no recurrence of infectious symptoms) had no additional structures visible in OCT images during the postoperative visit. OCT image findings suggest surgical intervention consisting of myringotomy and tympanostomy tube placement provides a means to clear the middle ear of infection-related components, including middle-ear fluid and biofilms. Furthermore, OCT was demonstrated as a rapid diagnostic tool to prospectively monitor patients in both outpatient and surgical settings.
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Affiliation(s)
- Guillermo L. Monroy
- University of Illinois at Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, United States
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Paritosh Pande
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Ryan M. Nolan
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Ryan L. Shelton
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
| | - Ryan G. Porter
- Carle Foundation Hospital, Department of Otolaryngology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
| | - Michael A. Novak
- Carle Foundation Hospital, Department of Otolaryngology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Eric J. Chaney
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | | | - Stephen A. Boppart
- University of Illinois at Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, United States
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
- Address all correspondence to: Stephen A. Boppart, E-mail:
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13
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Shelton RL, Nolan RM, Monroy GL, Pande P, Novak MA, Porter RG, Boppart SA. Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique. J Assoc Res Otolaryngol 2017; 18:555-568. [PMID: 28653118 DOI: 10.1007/s10162-017-0629-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Ryan L Shelton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Ryan M Nolan
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Paritosh Pande
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Michael A Novak
- Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, IL, USA
- Department of Surgery, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ryan G Porter
- Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, IL, USA
- Department of Surgery, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA.
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Internal Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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14
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Monroy GL, Pande P, Shelton RL, Nolan RM, Spillman D, Porter RG, Novak MA, Boppart SA. Non-invasive optical assessment of viscosity of middle ear effusions in otitis media. J Biophotonics 2017; 10:394-403. [PMID: 27009636 PMCID: PMC5094900 DOI: 10.1002/jbio.201500313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 05/03/2023]
Abstract
Eustachian tube dysfunction can cause fluid to collect within the middle ear cavity and form a middle ear effusion (MEE). MEEs can persist for weeks or months and cause hearing loss as well as speech and learning delays in young children. The ability of a physician to accurately identify and characterize the middle ear for signs of fluid and/or infection is crucial to provide the most appropriate treatment for the patient. Currently, middle ear infections are assessed with otoscopy, which provides limited and only qualitative diagnostic information. In this study, we propose a method utilizing cross-sectional depth-resolved optical coherence tomography to noninvasively measure the diffusion coefficient and viscosity of colloid suspensions, such as a MEE. Experimental validation of the proposed technique on simulated MEE phantoms with varying viscosity and particulate characteristics is presented, along with some preliminary results from in vivo and ex vivo samples of human MEEs. In vivo Optical Coherence Tomography (OCT) image of a human tympanic membrane and Middle Ear Effusion (MEE) (top), with a CCD image of the tympanic membrane surface (inset). Below is the corresponding time-lapse M-mode OCT data acquired along the white dotted line over time, which can be analyzed to determine the Stokes-Einstein diffusion coefficient of the effusion.
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Affiliation(s)
- Guillermo L. Monroy
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1270 Digital Computer Laboratory, MC-278, Urbana, IL 61801, USA
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
| | - Paritosh Pande
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
| | - Ryan L. Shelton
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, 306 N. Wright St., Urbana, IL 61801
| | - Ryan M. Nolan
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
| | - Darold Spillman
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
| | - Ryan G. Porter
- Carle Foundation Hospital, Otolaryngology, 611 W. Park Street, Urbana, IL 61801
- College of Medicine, University of Illinois at Urbana-Champaign, 506 South Mathews Ave, Urbana, IL 61801
| | - Michael A. Novak
- Carle Foundation Hospital, Otolaryngology, 611 W. Park Street, Urbana, IL 61801
- College of Medicine, University of Illinois at Urbana-Champaign, 506 South Mathews Ave, Urbana, IL 61801
| | - Stephen A. Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1270 Digital Computer Laboratory, MC-278, Urbana, IL 61801, USA
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL 61801, USA
- College of Medicine, University of Illinois at Urbana-Champaign, 506 South Mathews Ave, Urbana, IL 61801
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, 306 N. Wright St., Urbana, IL 61801
- Corresponding Author:
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15
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Jaber JJ, Kircher ML, Thorpe E, Porter RG, Leonetti JP, Marzo SJ. Recurrent Post-Tympanostomy Tube Otorrhea Secondary to Aerobic Endospore-Forming Bacilli: A Case Report and Brief Literature Review. Ear Nose Throat J 2013. [DOI: 10.1177/014556131309200209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.
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Affiliation(s)
- James J. Jaber
- From Ear, Nose, and Throat Services, University of Pittsburgh Medical Center
| | | | - Eric Thorpe
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Ill
| | | | - John P. Leonetti
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Ill
| | - Sam J. Marzo
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Ill
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16
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Jaber JJ, Kircher ML, Thorpe E, Porter RG, Leonetti JP, Marzo SJ. Recurrent post-tympanostomy tube otorrhea secondary to aerobic endospore-forming bacilli: a case report and brief literature review. Ear Nose Throat J 2013; 92:66-72. [PMID: 23460214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.
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Affiliation(s)
- James J Jaber
- Ear, Nose, and Throat Services, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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17
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Porter RG, Chan D, Ravindra VM. Lower Cranial Nerve Function Following Jugular Foramen Tumor Resection. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Describe the presentation, tumor characteristics, and postoperative lower cranial nerve function following surgery for jugular foramen tumors. Method: Thirty jugular foramen tumor resections performed between 1989 and 2009 were reviewed. The mean age was 48.2 years (range, 18.6-77.7 years) at time of presentation. Surgical approaches included infratemporal fossa (70%), retrosigmoid (23%), transtemporal (20%), transcondylar (17%), and transcervical (17%). The mean follow-up was 4.6 years. Results: Combined surgical approaches were used in over 50% of the cases, and 60% underwent preoperative tumor embolization. Tinnitus was the most common presenting symptom, and middle ear or neck mass was the most common presenting sign. The most common diagnosis was paraganglioma. Six patients required tracheotomy, and 8 had feeding tubes at discharge. Fifty-seven percent of patients underwent speech or swallow therapy, 43% were treated with vocal cord injections, and 17% underwent medialization thyroplasty. Cerebrospinal fluid leak was uncommon (13%), and meningitis occurred in 1 patient. Normal or near-normal facial nerve function was maintained in 89% of patients. Conclusion: Resection of jugular foramen tumors carries a significant risk of lower cranial nerve dysfunction; however, long-term speech, airway, and swallowing morbidity can be minimized with contemporary ancillary surgical procedures.
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18
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Leonetti JP, Marzo SJ, Zender CA, Porter RG, Melian E. Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol 2010; 31:656-659. [PMID: 20964249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the incidence of osteoradionecrosis (ORN) of the temporal bone after surgery with radiotherapy for malignant parotid tumors. SETTING A tertiary care, academic medical center. PATIENTS All patients who underwent surgical resection with postoperative radiotherapy (RT) for a malignant parotid tumor between July 1988 and July 2007. INTERVENTIONS A retrospective chart analysis to determine the extent of surgery, the RT parameters, and the incidence of ORN of the temporal bone. MAIN OUTCOME MEASURES The incidence of ORN in 3 subgroups of patients. RESULTS The 221 patients with malignant parotid tumors who underwent surgical resection with postoperative RT were divided into groups 1, parotidectomy only; 2, parotidectomy with mastoidectomy; and 3, parotidectomy with subtotal petrosectomy. The overall incidence of temporal bone ORN in group 1 was 2 (2%) of 106; in group 2, 8 (13%) of 64; and in group 3, 0 (0%) of 51. CONCLUSION The incidence of temporal bone ORN is higher after mastoidectomy for facial nerve identification or resection in patients undergoing parotidectomy with postoperative radiotherapy. Oversew of the ear canal with mastoid obliteration should be considered in this subgroup of patients to avoid this long-term complication of radiotherapy used in the treatment of malignant parotid tumors.
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Affiliation(s)
- John P Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A.
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19
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Sharma N, Coughlin L, Porter RG, Tanzer L, Wurster RD, Marzo SJ, Jones KJ, Foecking EM. Effects of electrical stimulation and gonadal steroids on rat facial nerve regenerative properties. Restor Neurol Neurosci 2010; 27:633-44. [PMID: 20042787 DOI: 10.3233/rnn-2009-0489] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The neurotherapeutic effects of nerve electrical stimulation and gonadal steroids have independently been demonstrated. The purpose of this study was to investigate the therapeutic potential of a combinatorial treatment strategy of electrical stimulation and gonadal steroids on peripheral nerve regeneration. METHODS Following a facial nerve crush axotomy in gonadectomized adult male rats, testosterone propionate (TP), dihydrotestosterone (DHT), or estradiol (E(2)) was systemically administered with/without daily electrical stimulation of the proximal nerve stump. Facial nerve outgrowth was assessed at 4 and 7 days post-axotomy using radioactive labeling. RESULTS Administration of electrical stimulation alone reduced the estimated delay in sprout formation but failed to accelerate the overall regeneration rate. Conversely, TP treatment alone accelerated the regeneration rate by approximately 10% but had no effect on the sprouting delay. Combining TP with electrical stimulation, however, maintained the enhanced rate and reduced the sprouting delay. DHT treatment alone failed to alter the regeneration rate but combining it with electrical stimulation increased the rate by 10%. E(2) treatment alone increased the regeneration rate by approximately 5% but with electrical stimulation, there was no additional effect. CONCLUSIONS Electrical stimulation and gonadal steroids differentially enhanced regenerative properties. TP, an aromatizable androgen, augmented regeneration most, suggesting a synergism between androgenic and estrogenic effects. Therapeutically, combining electrical stimulation with gonadal steroids may boost regenerative properties more than the use of either treatment alone.
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Sharma N, Cunningham K, Porter RG, Marzo SJ, Jones KJ, Foecking EM. Comparison of extratemporal and intratemporal facial nerve injury models. Laryngoscope 2009; 119:2324-30. [DOI: 10.1002/lary.20627] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Porter RG, Leonetti JP, Marzo SJ, Sharma N, Jones K, Foecking E. SP331 – A rat model for intratemporal facial nerve crush injuries. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Porter RG, Leonetti JP, Marzo SJ, Hacein-Bey L. P094: Ruptured Carotid Artery Pseudoaneurysm in the Middle Ear. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Porter RG. The essence of Catholic health care. A collection of stories that capture the "core commitments" of Catholic identity. Health Prog 2000; 81:14-20. [PMID: 11143213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- R G Porter
- SSM Health Care, DePaul Health Center, St. Louis, USA
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Abstract
BACKGROUND Condensation occurs rapidly on intraocular lenses (IOLs), particularly silicone IOLs, after vitrectomy and fluid-air exchange in the presence of a posterior capsulotomy and severely limits the surgeon's view of the retina. This study investigated the value of heating contact lens irrigation fluid to prevent condensation on IOLs. DESIGN An experimental in vitro study and a noncomparative interventional case series. PARTICIPANTS Five control eyes had temperature measurements during fluid-air exchanges. Two patients with silicone IOLs and posterior capsulotomies underwent a vitrectomy involving a fluid-air exchange with heated contact lens fluid. METHODS An in vitro model allowed monitoring of temperature and humidity changes during condensation formation on four different IOL materials. Adjusting variables to promote evaporation rather than condensation was achieved in vitro. In vivo, intraocular temperatures were measured at various stages of five vitrectomies involving a fluid-air exchange. Finally, in two in vivo cases a blood warmer was used to heat the accessory contact lens irrigation fluid during the vitrectomy and fluid-air exchange. MAIN OUTCOME MEASURES Successful prevention of condensation on the silicone IOL during the fluid-air exchange. RESULTS Anterior segment temperature influences the IOL temperature, such that when it is higher than the posterior segment temperature, condensation does not form and evaporation is promoted. In vivo the temperatures in the eye are hypothermic throughout the vitrectomy. At fluid-air exchange the posterior segment heats rapidly as irrigation ceases and low specific heat gas enters. Finally, in two in vivo cases with silicone IOLs, condensation was predicted then prevented by our intervention for the duration of the fluid-air exchange. CONCLUSIONS Heating the anterior segment by conduction from warmed irrigation fluid flowing through the irrigating contact lens represents a cheap, noninvasive, and safe means to prevent condensation on IOL materials.
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Affiliation(s)
- R G Porter
- The Royal Brisbane Hospital, Ophthalmology Department, Herston, Australia
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