Clinical translation of optical coherence tomography for the diagnosis of otitis media: validation and tracking of biofilms on the tympanic membrane and development of a novel automated classification and diagnostic platform

Otitis media (OM), an infection of the middle ear, is one of the most common reasons for children to seek medical care and receive antibiotics. While typically identified and diagnosed through the visual examination of the ear with an otoscope, this method provides limited quantitative information and relies on the skill level of the observer. Previous investigation of pediatric subjects using optical coherence tomography (OCT), a noninvasive cross-sectional imaging modality that uses low-power near-infrared light to provide depth-resolved structural images of tissue, characterized and established normative bounds for in vivo acute and chronic OM infection states. While it is known that biofilms are present on the middle ear mucosa during chronic OM, similar microbial-related structures were observed to be affixed on the internal mucosal surface of the tympanic membrane (TM) using OCT. These structures have not been identified or analyzed by any characterization technique, or observed for the response to standard of care treatment of OM. Furthermore, OCT experts have been primarily responsible for the assessment of OCT images of OM, with little translation of this technique outside of well-controlled academic-led studies. This dissertation establishes (1) the presence and characterization of biofilms adhered to the TM through direct observation, sampling, and analysis, (2) tympanostomy tube surgery as an effective therapeutic treatment to clear biofilms on the TM, and finally demonstrates (3) automated classification methods to identify features of OM infection in OCT data. Collectively, these results provide new insight into the pathogenesis and treatment of OM and demonstrate new quantitative tools that are crucial to further disseminate OCT imaging as a diagnostic tool for OM.U of I OnlyAuthor requested U of Illinois access only (OA after 2yrs) in Vireo ETD syste