Simulation of trans-nasal endoscopy of the middle ear for visualization of cholesteatoma

Cholesteatomas are benign lesions that form in the middle ear (ME). The standard of care is surgical removal. The traditional clinical approach for identifying cholesteatomas, visualization via a trans-aural approach, must be done in the operating room. This constraint complicates early diagnosis and treatment monitoring. Trans-nasal endoscopy of the ME may permit less invasive visualization as it could potentially be done in an outpatient setting. In this work, we propose a technique to quantitatively analyze the effectiveness of a trans-nasal endoscope for identifying cholesteatomas. Our approach is to quantify the surface area of MEs segmented in 6 CT volumes that is visible from a virtual endoscope inserted trans-nasally. Our preliminary results indicate that cholesteatomas located in certain sub-regions of the ME could indeed be well-visualized with a trans-nasal endoscope. Such an approach could have significant impact by facilitating earlier diagnosis and more frequent post-treatment monitoring of cholesteatomas.