Optical Coherence Tomography (OCT) has shown its detection and diagnostic capabilities for otitis media (OM), enabling visualization through scattering tissues including the tympanic membrane and biofilms, and into the middle ear cavity. Preliminary results from an ongoing five-year 235-subject study at Children’s Wisconsin, Medical College of Wisconsin, are presented. A vision-language machine learning model was trained on OCT image features and clinical metadata to differentiate OM disease states and predict required interventions. This study demonstrates the prognostic value of OCT in assessing OM and offers the potential for improving the management of patients with OM.

Biofilms are persistent microbial communities that play a significant role in middle ear pathologies. Spectral domain (SD)-OCT has been used to detect biofilms in the middle ear during otitis media. However, it cannot measure birefringence or probe deeper regions of the middle ear cavity. A polarization-sensitive swept-source OCT system has been developed to image in vitro biofilms and cholesteatoma to enhance identification and classification of these pathologies. Biofilms were grown on tympanic membranes and ossicles to assess for changes in birefringence. A handheld probe is being developed to compare against a library of in vivo SD-OCT images.

Despite the large population that suffers from inner ear diseases, there is a limited understanding and capacity to diagnose the cellular origins of inner ear diseases. One major obstacle is difficulty accessing and observing the inner ear in living patients. We developed an ultra-flexible miniature micro-OCT endoscope that can be inserted into the scala tympani through the round window over more than 20 mm and take cellular resolution OCT images. It has the potential to provide physicians with a new diagnostic approach for tailoring next-generation cochlear implants and administering personalized pharmacologic treatments for a wide variety of inner ear diseases.

Proper ciliary dynamics is vital for effective mucociliary transport, the primary defense mechanism for the upper respiratory tract. Abnormal cilia behavior could lead to chronic respiratory disease, making it essential to conduct more detailed studies. In this study we present a multimodality system, specifically using optical coherence tomography (OCT) and phase-resolved spectrally encoded interferometric microscopy (PR-SEIM). We have already shown that PR-SEIM is capable of measuring cilia beat frequency ex vivo. Although we were able to visually identify the ciliary motion in the nasal cavity of rabbits in vivo, due to its sensitivity to motion artifacts, it has been difficult to quantitatively analyze ciliary dynamics. To overcome this obstacle, we incorporated OCT along with a high-speed laser source to compensate for bulk motion. Ultimately, this system will provide a way to study ciliary dynamics in its natural environment, thus allowing more in-depth understanding of ciliary functions.

Anatomical optical coherence tomography (aOCT) is a real-time imaging technique with micron-scale resolution. This study presents the challenges and outcomes of the first several children subjects imaging in the otolaryngology operating room (OR). Utilizing a custom aOCT system, we performed aOCT within a bronchoscope-guided setup. Challenges encountered in the OR included maintaining aseptic conditions during catheter insertion and addressing aliasing artifacts caused by the larger tracheal size. To mitigate artifacts, a correction method was proposed and implemented, along with the use of machined tubes for image recalibration. This study demonstrates the successful application of aOCT in the OR for human imaging, highlighting its potential in otolaryngology.

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition in critically ill patients, characterized by severe acute hypoxemia and lung injuries. The complexity of ARDS and its high mortality rates warrant innovative approaches for accurate assessment and early intervention. In this scientific study, we present an advanced methodology to evaluate proximal airway volume (PAV) in a porcine model using optical coherence tomography (OCT) and deep learning techniques. We developed an OCT system capable of capturing changes in mucosa thickness (MT) and proximal airway volume in response to smoke inhalation injury in the porcine model. OCT images were acquired at various time points, including baseline, post-injury, and 24, 48, and 72 hours after injury. A comprehensive dataset was compiled for training and validating the deep learning models. The deep learning approach, employing U-Net, DeepLabv3, and SegNet architectures, demonstrated remarkable efficiency in automated PAV calculation when compared to manual segmentation. The Intersection over Union and Dice similarity coefficient metrics validated the accuracy of the models in delineating proximal airway structures.

We present an early release of our study utilizing a fiber-based Optical Coherence Tomography (OCT) probe to acquire 3D images of the airway in sleep apnea patients. The probe, with a 1.3mm diameter, navigates from the nasal cavity to the vocal cords while rotating within a transparent protective sheath. Long-range OCT imaging (2-30mm) enables comprehensive airway visualization. Our approach facilitates airflow dynamic analysis, aiding in the identification of critical regions prone to collapse during sleep. This non-invasive technique promises to revolutionize sleep apnea diagnostics and personalized treatment planning, offering substantial benefits to patient care.

The intraoperative assessment of tumor margins of head and neck cancer is crucial for complete tumor resection and patient outcome. The current standard is to take intraoperatively tumor biopsies for frozen section analysis or to wait for the postoperative final histopathology report. The intraoperative evaluation is time-consuming, subjective, and methodologically limited. Optical methods like hyperspectral imaging (HSI) are of high interest to overcome these limitations. We present a framework to connect in-vivo HSI measurements to ex-vivo histopathological assessments with results as first steps towards the use of HSI as a tool for in-vivo tumor evaluation during head and neck surgery.

Hyperspectral imaging (HSI) is a new emerging modality for noncontact assessement of tissue perfusion parameters. This study includes investigations on monitoring perfusion changes of the hand during a modified Allen test and cuff occlusion test, on the influence of the skin tones during HSI-measurements and the feasibility of HSI monitoring of intraoral free flaps

Head and neck cancers are the 16th most prevalent globally, and survival relies on early detection. Widefield autofluorescence (WFAF) shows potential for identifying neoplastic sites but lacks specificity. We investigate multispectral WFAF imaging to identify spectral features from endogenous biomarkers in native and neoplastic oral mucosa, using a DMBA-treated hamster buccal pouch model, with the aim to increase specificity. Spatially resolved spectra revealed variations between nonneoplastic and neoplastic areas. Analyses will compare spectral features in benign, dysplastic, and carcinoma sites from preclinical animal model and human tissues. Refinements in the red/green WFAF approach, by analyzing spectral features, are considered.

We present a study investigating fluorescence lifetime signatures of normal tissues adjacent to tumors (NATs) in head and neck squamous cell carcinoma (HNSCC) using fluorescence lifetime imaging (FLIm). Label-free FLIm offers insight into the metabolic activity and extracellular matrix composition. Understanding the metabolic activity, tissue heterogeneity and tumor-associated alterations in these transition areas can enhance the accuracy of margin delineation. Initial results show that the fluorescence lifetime is gradually increasing from shorter to longer lifetimes with increasing distance from the cancer and with varying magnitudes of change being observed in the individual emission bands.

In this study, we study the influence of dye to antibody ratio on the imaging and therapeutic performance of an EGFR-targeted dual function conjugate. We further demonstrate the efficacy of the conjugate in identifying tumor depth to guide surgical resections and the ability to eliminate residual microscopic disease through photoimmunotherapy, in a single intra-operative setting.

Master-slave “robotic” systems have been implemented in various surgical fields, although very few are able to perform microsurgical tasks, and, if so, only for very specialized purposes. From February 2023 we have performed microvascular anastomosis for vascularized free tissue transfer in n=9 patients with extensive (>T2) malignancies in the oral cavity and the oropharynx and hypopharynx. The Symani Surgical master-slave robotic system (MMI Inc., Pisa, Italy) consists of a set of two disposable microsurgical manipulators that are attached to the arms of the motorized “slave” unit. Radial forearm flaps were used in all cases for reconstruction of the tumor defect. Arterial micro anastomosis was performed successfully in all cases end-to-end with either the facial or superior thyroid artery as donor vessel. 2 cases required revision of arterial anastomosis due to early failure of blood flow. Duration of ischemia for the radial forearm flap was kept under 2 hours in all but one case, before arterial perfusion was re-established. The microsurgical master-slave system was successfully used to perform micro vascular surgery unde specific conditions of mucosa defect reconstruction.

This study introduces mesoscopic FLIm as a potential solution to address the challenge of residual cancer in Transoral Robotic Surgery. Current methods rely on intraoperative frozen sections analysis (IFSA), which can yield false negatives. FLIm utilizes tissue fluorophores to delineate head and neck cancer in the surgical cavity accurately. A FLIm-based semi-supervised classification model was developed using data from 22 patients, achieving a sensitivity of 0.75 for residual tumors and an overall tissue specificity of 0.78. The proposed approach also outperformed IFSA in detecting positive surgical margins. FLIm shows promise in guiding TORS and improving surgical outcomes.

Laser speckle contrast imaging (LSCI) is a contrast-free optical method offering quantitative assessment of superficial blood vessel vascularity. Its clinical significance is evident in intraoperative scenarios, particularly for assessing parathyroid gland viability in thyroid surgery. Despite notable sensitivity and specificity, conventional overhead LSCI methods, characterized by bulky designs, present integration challenges in surgical procedures. To address these limitations, we developed a miniaturized handheld LSCI probe, enhancing portability and maneuverability. A validation assessment compared the handheld system with an overhead LSCI setup for detecting vascularity in parathyroid glands in parathyroidectomy surgeries. Results from comparisons with the established overhead LSCI system, combined with evaluations by an experienced surgeon, underscore the handheld LSCI system's effectiveness in human parathyroid gland vascularity classification. This study's findings offer valuable insights into the performance and clinical utility of the newly developed miniaturized handheld LSCI system.