Towards an optical diagnostic system for otitis media using a combination of otoscopy and spectroscopy

Numerical investigation of the influence of the source and detector position for optical measurement of lung volume and oxygen content in preterm infants

There is an urgent need for improved respiratory surveillance of preterm infants. Gas in scattering media absorption spectroscopy (GASMAS) is emerging as a potential clinical cutaneous monitoring tool of lung functions in neonates. A challenge in the clinical translation of GASMAS is to obtain sufficiently high signal-to-noise ratios in the measurements, since the light attenuation is high in human tissue. Previous GASMAS studies on piglets have shown higher signal quality with an internal source, as more light propagates through the lung and the loss due to scattering and absorption is less. In this article we simulated light propagation with an intratracheal and a dermal source, and investigated the signal quality and lung volume probed. The results suggest that GASMAS has the potential to measure respiratory volumes; and the sensitivity is higher for an intratracheal source which also enables to probe most of the lung.

Intelligent smartphone-based multimode imaging otoscope for the mobile diagnosis of otitis media

Otitis media (OM) is one of the most common ear diseases in children and a common reason for outpatient visits to medical doctors in primary care practices. Adhesive OM (AdOM) is recognized as a sequela of OM with effusion (OME) and often requires surgical intervention. OME and AdOM exhibit similar symptoms, and it is difficult to distinguish between them using a conventional otoscope in a primary care unit. The accuracy of the diagnosis is highly dependent on the experience of the examiner. The development of an advanced otoscope with less variation in diagnostic accuracy by the examiner is crucial for a more accurate diagnosis. Thus, we developed an intelligent smartphone-based multimode imaging otoscope for better diagnosis of OM, even in mobile environments. The system offers spectral and autofluorescence imaging of the tympanic membrane using a smartphone attached to the developed multimode imaging module. Moreover, it is capable of intelligent analysis for distinguishing between normal, OME, and AdOM ears using a machine learning algorithm. Using the developed system, we examined the ears of 69 patients to assess their performance for distinguishing between normal, OME, and AdOM ears. In the classification of ear diseases, the multimode system based on machine learning analysis performed better in terms of accuracy and F1 scores than single RGB image analysis, RGB/fluorescence image analysis, and the analysis of spectral image cubes only, respectively. These results demonstrate that the intelligent multimode diagnostic capability of an otoscope would be beneficial for better diagnosis and management of OM.

Lung tissue phantom mimicking pulmonary optical properties, relative humidity, and temperature: a tool to analyze the changes in oxygen gas absorption for different inflated volumes

SIGNIFICANCE

Gas in scattering media absorption spectroscopy (GASMAS) enables noninvasive gas sensing in the body. It is developing as a tool for diagnosis and monitoring of respiratory conditions in neonates. Phantom models with relevant features to the clinical translation of GASMAS technology are necessary to understand technical challenges and potential applications of this technique. State-of-the-art phantoms designed for this purpose have focused on the optical properties and anthropomorphic geometry of the thorax, contributing to the source-detector placement, design, and optimization. Lung phantom mimicking the alveolar anatomy has not been included in the existent models due to the inherent complexity of the tissue. We present a simplified model that recreates inflated alveoli embedded in lung phantom.

AIM

The goal of this study was to build a lung model with air-filled structures mimicking inflated alveoli surrounded by optical phantom with accurate optical properties (μa  =  0.50  cm  -  1 and μs'=5.4  cm-1) and physiological parameters [37°C and 100% relative humidity (RH)], and to control the air volume within the phantom to demonstrate the feasibility of GASMAS in sensing changes in pulmonary air volume.

APPROACH

The lung model was built using a capillary structure with analogous size to alveolar units. Part of the capillaries were filled with liquid lung optical phantom to recreate scattering and absorption, whereas empty capillaries mimicked air filled alveoli. The capillary array was placed inside a custom-made chamber that maintained pulmonary temperature and RH. The geometry of the chamber permitted the placement of the laser head and detector of a GASMAS bench top system (MicroLab Dual O2  /  H2O), to test the changes in volume of the lung model in transmittance geometry.

RESULTS

The lung tissue model with air volume range from 6.89  ×  10  -  7  m3 to 1.80  ×  10  -  3  m3 was built. Two measurement sets, with 10 different capillary configurations each, were arranged to increase or decrease progressively (in steps of 3.93  ×  10  -  8  m3) the air volume in the lung model. The respective GASMAS data acquisition was performed for both data sets. The maximum absorption signal was obtained for configurations with the highest number of air-filled capillaries and decreased progressively when the air spaces were replaced by capillaries filled with liquid optical phantom. Further studies are necessary to define the minimum and maximum volume of air that can be measured with GASMAS-based devices for different source-detector geometries.

CONCLUSIONS

The optical properties and the structure of tissue from the respiratory zone have been modeled using a simplified capillary array immersed in a controlled environment chamber at pulmonary temperature and RH. The feasibility of measuring volume changes with GASMAS technique has been proven, stating a new possible application of GASMAS technology in respiratory treatment and diagnostics.

Optical Identification of Middle Ear Infection

Ear infection is one of the most commonly occurring inflammation diseases in the world, especially for children. Almost every child encounters at least one episode of ear infection before he/she reaches the age of seven. The typical treatment currently followed by physicians is visual inspection and antibiotic prescription. In most cases, a lack of improper treatment results in severe bacterial infection. Therefore, it is necessary to design and explore advanced practices for effective diagnosis. In this review paper, we present the various types of ear infection and the related pathogens responsible for middle ear infection. We outline the conventional techniques along with clinical trials using those techniques to detect ear infections. Further, we highlight the need for emerging techniques to reduce ear infection complications. Finally, we emphasize the utility of Raman spectroscopy as a prospective non-invasive technique for the identification of middle ear infection.

Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries

OBJECTIVE:

Summarise the published evidence on otitis media and associated hearing loss in low to middle-income countries (LMIC) and disadvantaged populations.

DATA SOURCES:

PubMed and other databases.

REVIEW METHODS:

Firstly, sensitive search strategy using ‘otitis media’, combined with specific key words for each topic of the review, from January 2015 to June 2019. Then, restriction to LMIC and disadvantaged populations. Topics covered included prevention, epidemiology, risk factors, microbiology, prognosis, diagnosis, and treatment.

CONCLUSIONS:

There was a high degree of methodological heterogeneity and high risk of bias. The majority of studies were school-based. In Africa, Asia and Oceania (e.g., Australian Aboriginal populations) the prevalence of OM was respectively 8% (range 3–16%), 14% (range 7–22%) and 50% (4–95%). Prevalence of any hearing loss in these regions was 12% (range 8–17%), 12% (range 3–24%), and 26% (range 25–28%) respectively. Risk factors in LMIC and disadvantaged populations included age, gender, exposure to smoke and pollution. Microbiology was reported for otitis media with effusion at time of surgery or ear discharge (acute otitis media with perforation or chronic suppurative otitis media). Specimen handling and processing in hospital laboratories was associated with low detection of S. pneumoniae and H. influenzae. Case series described complicated cases of OM due to M. tuberculosis, multidrug resistance and HIV. QOL studies identified discrimination of persons with OM and hearing loss. Diagnostic methods varied greatly, from naked eye to tympanometry. Treatment interventions were reported from four RCTs. Non-RCTs included evaluations of guidelines, surgery outcomes, access to ENTs.

IMPLICATIONS FOR CLINICAL PRACTICE:

Chronic suppurative otitis media, otitis media with effusion and conductive hearing loss are common in LMIC and disadvantaged populations. Paucity of research, poor regional representation, non-standardised methods and low-quality reporting preclude accurate assessment of disease burden in LMIC and disadvantaged populations. Awareness and adherence to reporting Guidelines should be promoted.

Laser-based gas absorption spectroscopy in decaying hip bone: water vapor as a predictor of osteonecrosis

Affluent blood flow through a complicated net of vessels supplies skeletal bone tissue with oxygen and nutrients. Due to accidental events or physiological processes, the blood supply might be deficient or even disrupted, and the healthy bone decays in a process that, for the hip location, is denoted as osteonecrosis of the femoral head (ONFH) or avascular femoral head necrosis. Early diagnosis is important for the prognosis. X-ray-based imaging, such as CT or MRI, is not of much value for the early detection. As the decay theoretically is associated with the development of gas-filled pores, gas analysis should have diagnostic value. We have introduced gas in scattering media absorption spectroscopy, as a complementary modality. Eighteen extracted femoral joint heads, diseased as well as normal, were investigated. Diseased samples are associated with clear signals due to water vapor, whereas the normal ones largely lack such features. The results suggest that free water vapor could serve as an early indicator of pore development and thus as a promising predictor of ONFH pathological changes, once the technique has been fully refined.