First Use of Long‐Range Optical Coherence Tomography to Image Airway Structure in Awake Children

Abstract

Objectives: Identifying the appropriate operation(s) for children with sleep-disordered breathing (SDB) remains a challenge, and current imaging modalities have major shortcomings. We have pioneered the use of long-range optical coherence tomography (LR-OCT) to provide real-time images of the upper airway (UA) during sleep and wakefulness. Here we present our first use of LR-OCT to image the UA of awake children. (1) Understand how LR-OCT produces high-resolution structural images by acting as an optical range-finder. (2) Recognize how LR-OCT can identify strictures and real-time collapse of the airway. Methods: This study builds upon our experience using LR-OCT to image 58 children under sedation. Here 10 awake children (SDB, 4-15 years) underwent nasal endoscopy and LR-OCT. We designed a high-speed Fourier domain LR-OCT system. Imaging probe and fiberscope were transnasally inserted in tandem and axial images were rapidly acquired (spiral scan, 500-700 images, 30-40 seconds). 3D models of each airway were reconstructed. Results: Five airways yielded data suitable for 3D volumetric reconstruction, and identified the dominant site of airway obstruction as well as structure of the tonsils, adenoids, base of tongue, and epiglottis. Cross-sectional area of the axial airway level corresponding to these structures was calculated. Dynamic changes in 3D airway structure were visualized. Conclusions: The feasibility of LR-OCT to identify regions of stricture and collapse in children’s airways was established. Hence, patient-specific surgical treatments can be developed for children with SDB. The next step is to transition to imaging children during sleep, as we have in adults.