Diagnosis of tympanic effusions using hyperspectral imaging to prevent unnecessary paracentesis procedures

Otitis Media with Effusion (OME) is a prevalent childhood condition, affecting up to 90% of children with 10% progressing to a chronic state. It is commonly treated by tympanostomy tube placement. Diagnosis relies on clinical history, otoscopy, audiometry, and tympanometry, but these methods have a high false-positive rate of 15-28%. This highlights the need for an objective, reliable, and non-invasive diagnostic tool to reduce unnecessary surgeries.

To evaluate the rate of false-positive OME diagnoses in our tertiary hospital, a retrospective database analysis was conducted. To assess the feasibility of advanced imaging, experimental studies were performed ex vivo on human body donors. Sodium chloride solution was intratympanically injected under endoscopic guidance. Hyperspectral imaging (HSI) datasets were acquired using a customized endoscopic system to quantify tissue water content.

An analysis of hospital records identified a false positive rate of 29% (n = 4,564) for OME diagnosis, comparing the number of paracenteses to paracenteses plus tympanostomy tubes. In the ex vivo analysis of HSI, visual evaluation of the Tissue Water Index (TWI) demonstrated sensitivity, specificity, and accuracy of 89%, 78%, and 83%, respectively. The mean TWI of all evaluated tympanic membranes was 50.2 (± 7.1) before injection (control) and increased to 62.8 (± 14.8) after injection.

HSI presents a highly sensitive and user-friendly potential future diagnostic adjunct for diagnosing OME, which has shown its potential in an ex vivo approach. Now it needs in-vivo confirmation of the results as its implementation in clinical routine could contribute to avoiding unnecessary surgical interventions, minimizing patient burden and healthcare costs.