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    Optical Imaging With a High-Resolution Microendoscope to Identify Cholesteatoma of the Middle Ear

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    Author
    Levy, Lauren L.; Jiang, Nancy; Smouha, Eric; Richards-Kortum, Rebecca; Sikora, Andrew G.
    Date
    2013
    Abstract
    Objectives/Hypothesis: High-resolution optical imaging is an imaging modality that allows visualization of structural changes in epithelial tissue in real time. Our prior studies using contrast-enhanced microendoscopy to image squamous cell carcinoma in the head and neck demonstrated that the contrast agent, proflavine, has high affinity for keratinized tissue. Thus, high-resolution microendoscopy with proflavine provides a potential mechanism to identify ectopic keratin production, such as that associated with cholesteatoma formation, and distinguish between uninvolved mucosa and residual keratin at the time of surgery. Study Design: Ex vivo imaging of histopathologically confirmed samples of cholesteatoma and uninvolved middle ear epithelium. Methods: Seven separate specimens collected from patients who underwent surgical treatment for cholesteatoma were imaged ex vivo with the fiberoptic endoscope after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. Results: Cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Keratin-bearing areas of cholesteatoma lack nuclei and appear as confluent hyperfluorescence, whereas nuclei are easily visualized in specimens containing normal middle ear epithelium. Hyperfluorescence and loss of cellular detail is the imaging hallmark of keratin, allowing for discrimination of cholesteatoma from normal middle ear epithelium. Conclusions: This study demonstrates the feasibility of high-resolution optical imaging to discriminate cholesteatoma from uninvolved middle ear mucosa based on the unique staining properties of keratin. Use of real-time imaging may facilitate more complete extirpation of cholesteatoma by identifying areas of residual disease.
    Citation
    Levy, Lauren L., Jiang, Nancy, Smouha, Eric, et al.. "Optical Imaging With a High-Resolution Microendoscope to Identify Cholesteatoma of the Middle Ear." The Laryngoscope, 123, no. 4 (2013) Wiley: 1016-1020. http://dx.doi.org/10.1002/lary.23710.
    Published Version
    http://dx.doi.org/10.1002/lary.23710
    Keyword
    Cholesteatoma; keratin; optical imaging; otology; high-resolution microendoscopy
    Type
    Journal article
    Publisher
    Wiley
    Citable link to this page
    https://hdl.handle.net/1911/70706
    Rights
    Article is made available in accordance with the publisher's policy and may be subject to US copyright law. Please refer to the publisher's site for terms of use.
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    • Bioengineering Publications [684]
    • Faculty Publications [5504]

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    Managed by the Digital Scholarship Services at Fondren Library, Rice University
    Physical Address: 6100 Main Street, Houston, Texas 77005
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    Site Map