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ObjectivesTo present our experience using the first commercially available optical coherence tomography (OCT) device for use in the head, neck, and upper aerodigestive tract and to determine the feasibility and efficacy of this system in comparison with our previous experience using other research OCT systems.MethodsUsing the Niris OCT imaging system (Imalux, Cleveland, OH), we obtained OCT images of benign and premalignant laryngeal disease in 33 patients undergoing surgical head and neck endoscopy. This imaging system has a spatial depth resolution of 10 to 20 mum and a depth scanning range of 2.2 mm, obtaining images of 200 x 200 pixels at a maximum frame rate of 0.7 Hz. The scanning mechanism of the device is located at the distal end of a flexible probe that is placed in contact or near-contact with the area of interest. The tip of the probe was inserted through a rigid laryngoscope, and still images were obtained.ResultsOCT images of arytenoids, aryepiglottic folds, piriform sinus, epiglottis, and true and false vocal cords were obtained. In patients whose OCT images were taken from normal tissue, the normal microstructures were clearly identified, as well as disruption of the latter in malignant pathologies.ConclusionsThe device can easily be incorporated into the operating room and requires minimal set-up and staff to operate. OCT imaging with this device potentially offers an efficient, quick, and reliable imaging modality in guiding surgical biopsies, intraoperative decision making, and therapeutic options of various laryngeal pathologies and premalignant disease.

Optical coherence tomography (OCT) is an evolving noninvasive imaging modality that has been used to image the human larynx during surgical endoscopy. The design of a long gradient-index lens-based probe capable of capturing images of the human larynx by use of spectral domain OCT during a typical office-based laryngoscopy examination is presented. An optical-ballast-based 4f optical relay system is proposed to realize variable working distance with a constant optical delay. In-vivo OCT imaging of the human larynx is demonstrated. Office-based OCT is a promising imaging modality for early laryngeal cancer diagnosis.

ObjectiveOptical coherence tomography (OCT) is a diagnostic imaging modality that combines low coherence light with interferometry to produce high-resolution cross-sectional images of living tissues. Using this technology, we have imaged in vivo the human tympanic membrane (TM) in the office clinic setting and characterized TM microstructure in normal and pathologic conditions.Study designProspective clinical trial.Materials and methodsThe normal and diseased TMs in 10 adult subjects were examined. Each subject underwent direct microscopic examination before OCT imaging to provide visual coregistration of associated subsites including the anulus fibrosus, pars tensa, pars flaccida, and umbo. The probe from the imaging system (1,310-nm central wavelength, 15-microm coherence length, Niris; Imalux, Cleveland, OH, USA) was introduced into the ear canal to obtain lateral cross-sectional images.ResultsSystematic imaging of the TM was performed with characterization of the epithelial and collagenous layers. The overall TM thickness was clearly demonstrated and quantified.ConclusionThe ability to noninvasively study middle ear microstructures in vivo is essential in the treatment of diseases of the ear. OCT may provide the otologist/neurotologist with the ability to 1) image pathology such as cholesteatoma, dimeric TMs, and chronic otitis media; 2) gauge the response to pharmacological therapy; and 3) monitor postsurgical changes after tympanoplasty and other procedures. OCT may provide a means to optimize the diagnosis and management of patients with middle ear disease.

ObjectivesAcquired subglottic stenosis in a newborn is often associated with prolonged endotracheal intubation. This condition is generally diagnosed during operative endoscopy after airway injury has occurred. Unfortunately, endoscopy is unable to characterize the submucosal changes observed in such airway injuries. Other modalities, such as magnetic resonance imaging, computed tomography, and ultrasound, do not possess the necessary level of resolution to differentiate scar, neocartilage, and edema. Optical coherence tomography (OCT) is an imaging modality that produces high-resolution, cross-sectional images of living tissue (8 to 20 microm). We examined the ability of this noninvasive technique to characterize the newborn airway in a prospective clinical trial.MethodsTwelve newborn patients who required ventilatory support underwent OCT airway imaging. Comparative analysis of intubated and non-intubated states was performed.ResultsImaging of the supraglottis, glottis, subglottis, and trachea was performed in 12 patients, revealing unique tissue characteristics as related to turbidity, signal backscattering, and architecture. Multiple structures were identified, including the vocal folds, cricoid cartilage, tracheal rings, ducts, glands, and vessels.ConclusionsOptical coherence tomography clearly identifies in vivo tissue layers and regional architecture while offering detailed information concerning tissue microstructures. The diagnostic potential of this technology makes OCT a promising modality in the study and surveillance of the neonatal airway.

ObjectiveTo demonstrate the feasibility of performing optical coherence tomography of the human larynx on the awake patient with a novel flexible fiberoptic delivery system.Study designProspective clinical trial.Subjects and methodsImaging was performed in 17 awake patients. A flexible optical coherence tomography probe was inserted through the nose and placed in near or gentle contact with laryngeal tissues under direct endoscopic visualization.ResultsImages were successfully obtained from all laryngeal subsites and clearly identified laryngeal mucosal microanatomy. Several critical probe design modifications improved rotational and angular control of the distal tip while allowing linear translation of the probe and allowing more accurate apposition of the probe onto target tissues, which is critical for transnasal laryngeal imaging.ConclusionThis study demonstrates the feasibility of awake transnasal laryngeal optical coherence tomography and identifies key instrumentation needed to obtain useful images.

A biopsy is a well-known medical test used to evaluate tissue abnormality. Biopsy specimens are invasively taken from part of a lesion and visualized by microscope after chemical treatment. However, diagnosis by means of biopsy is not only variable due to depth and location of specimen but may also damage the specimen. In addition, only a limited number of specimens can be obtained, thus, the entire tissue morphology cannot be observed. We introduce a three-dimensional (3-D) endoscopic optical biopsy via optical coherence tomography employing a dual-axis microelectromechanical system scanning mirror. Since this technique provides high-resolution, noninvasive, direct, and multiple visualization of tissue, it could function as a clinical biopsy with advanced performance. The device was integrated with a conventional endoscope and utilized to generate in vivo 3-D clinical images in humans and animals.