Emerging Use of Optical Coherence Tomography in Otolaryngology

OCT Applications in Otolaryngology

Our group at UC Irvine is leading the way in otolaryngological OCT research, as we have constructed different devices and used OCT on different patient populations, said Dr. Wong.

We see OCT as a hammer and we’re looking for nails, continued Dr. Wong. We are trying to determine the most important ENT problems that OCT can address and then match the technology to the application.

Other researchers, such as those working with Johannes F. De Boer, PhD, at Massachusetts General Hospital in Boston and those at the Nizhny Novgorod Medical Academy and the Institute of Applied Physics of the Russian Academy of Sciences, are also studying OCT, focusing primarily on imaging the larynx and radiation-related changes for head and neck cancer, respectively.

OCT has most commonly been used to image laryngeal tissue microstructure and determine minute changes in benign, premalignant, and malignant laryngeal pathologies of anesthetized adults who are undergoing surgical head and neck endoscopy in the OR. In most studies, images are acquired by inserting a fiberoptic OCT imaging probe through the laryngoscope, and then placing the tip near the region of interest.

We are looking to see if the basement membrane is intact, checking for scarring and determining the thickness of the epithelium, said Dr. Armstrong.

The Irvine group has also developed an office-based OCT sampling device that can be used in tandem with a conventional rigid laryngeal endoscope to image human vocal cords while the patient is awake.5 This technology provides otolaryngologists with information that can help them decide whether or not to pursue surgery, guide and direct biopsies, and potentially diagnose early laryngeal cancer.

Adam M. Klein, MD

One of the problems we deal with in cancer is sampling errors, said Dr. Armstrong. OCT has the potential to help you select your biopsy so that you get the best diagnostic yield.

Additionally, these researchers have used OCT to image the mucosa overlying structures in the nasal cavity to obtain information regarding normative in vivo tissue microstrucure. By inserting the scanning tip of the fiber-based handheld probe into the patient’s nasal cavity, either in the office or in the OR during surgical endoscopy, they are able to identify the distinct boundaries between the epithelium, lamina propria, and underlying bone/cartilaginous tissue.6

We are extremely excited about our most recent work in neonatal and pediatric patients, said Dr. Wong. In neonates, we are looking at factors and features that are related to extubation criteria-in particular, the evolution of subglottic stenosis due to prolonged mechanical ventilation.