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Intraoperative Label-free Detection of Cholesteatoma Using Autofluorescence: A Feasibility Study.

Intraoperative Label-free Detection of Cholesteatoma Using Autofluorescence: A Feasibility Study. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Park, R. K., Penaranda, D., Nyaeme, M. S., Chang, K. W., Blevins, N. H., Ahmad, I., Valdez, T. A. 2026; 47 (2): e467-e472

Abstract

To evaluate the ability to distinguish cholesteatoma from surrounding tissues using autofluorescence intraoperatively.Prospective cohort study.Tertiary referral center.Patients with cholesteatoma undergoing middle ear surgery.Autofluorescence imaging with 470 nm excitation light.Compare cholesteatoma autofluorescence with surrounding mucosa, bone, and granulation tissue.A total of 6 patients undergoing cholesteatoma surgery were prospectively enrolled in the study for imaging. A custom-designed endoscopic and macroscopic imaging set-up utilizing 470 nm excitation was used to image the surgical field in real-time. Intraoperatively, autofluorescence imaging allowed delineation of cholesteatoma from surrounding bone, granulation tissue, and mucosa, even when cholesteatoma identification was difficult with white light alone. The 470 nm excitation was able to target endogenous fluorophores, specifically flavin adenine dinucleotide (FAD) and keratin, which are present within cholesteatoma, but not present in mucosa and granulation tissue.This study demonstrates the feasibility of autofluorescence-guided identification of cholesteatoma intraoperatively. The results support its potential as an adjunctive tool to surgeons for cholesteatoma identification.

View details for DOI 10.1097/MAO.0000000000004733

View details for PubMedID 41508359