Optical Imaging With a High-Resolution Microendoscope to Identify Cholesteatoma of the Middle Ear
Author
Levy, Lauren L.; Jiang, Nancy; Smouha, Eric; Richards-Kortum, Rebecca; Sikora, Andrew G.
Date
2013Abstract
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
Published Version
Keyword
Cholesteatoma; keratin; optical imaging; otology; high-resolution microendoscopy
Type
Journal article
Publisher
Citable link to this page
https://hdl.handle.net/1911/70706Rights
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.Metadata
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