Video

CellScope Technology Used for Entertainment

We are proud to share the “Dot” film, the world’s smallest stop-motion animation character shot on a Nokia N8, which used an earlier version of our very own CellScope technology from 2010.

[youtube.com/watch?v=CD7eagLl5c4&w=640&h=385]

CellScope Oto’s predecessor, a Nokia device with a microscope attachment invented in the lab of UC Berkeley Professor Daniel Fletcher, was the inspiration for a teeny-tiny film created by Sumo Science at Aardman Animations. It stars a 9mm girl named Dot as she struggles through a microscopic world. All the minuscule detail was shot using CellScope technology and a Nokia N8, with its 12 megapixel camera and Carl Zeiss optics.

Pretty amazing!

Ear Pic of the Week – TM Perforation Post Infection

Dr. Kenneth Deem, a Tacoma, Washington based ENT, is a first time contributor to the Tympanic Times.

Image of left ear drum with a persistent tympanic membrane perforation and infection. Taken by Dr. Kenneth Deem with the CellScope Oto

Image captured with CellScope Oto showing right ear drum with a persistent tympanic membrane perforation (indicated by arrow). Image was acquired after drainage and infection improved.

This Ear Pic of the Week shows a longstanding perforation in a 49 year old woman with recent right ear drainage. The drainage and infection improved after she used Ofloxacin antibiotic ear drops.

According to Dr. Deem, the infection was likely caused by water going through the ear canal, through the perforation and into the middle ear. The principal cause of tympanic membrane perforation is infection. Traumatic perforations occur from blows to the ear, severe atmospheric overpressure, exposure to excessive water pressure (e.g., in scuba divers), and improper attempts at wax removal or ear cleaning. Perforation with infection typically results in copious purulent drainage, as was reported by Deem’s patient, which may contain blood in both acute and chronic perforation.

In this case, the doctor notes that the perforation was likely caused long ago from a prior ear infection and difficulty with Eustachian tube function. Dr. Deem suggested the patient undergo a hearing test prior to considering repair of the TM with tympanoplasty, the suggested surgical treatment for tympanic membrane perforations. The left ear (not shown) displayed myringosclerosis and evidence of TM retraction related to a history of ear infections and Eustachian tube dysfunction.

Everything in Moderation, Even Ear Wax!

Dr. Jonathan Kahn, Associate Chief Head and Neck Surgery and Medical Director of the Kaiser Hearing Aid Center in the Diablo Service Area at Kaiser Walnut Creek, is a first-time contributor to the Tympanic Times.

We’ve asked Dr. Kahn to give his two cents on wax! Ear wax is an evolutionary design to catch insects and keep them out of the middle and inner ear. Dr. Kahn elaborates on the subject for this week’s Ear Pic of the Week.

Image taken by Dr. Jonathan Kahn is described below!

Image taken by Dr. Jonathan Kahn with the CellScope Oto of an ear with cerumen impaction.

This is a photo of a 70 year old man with cerumen (ear-wax) impaction. Impacted ear wax can cause a type of decreased hearing that is called conductive hearing loss. This hearing loss will go away when the wax is removed. I usually remove ear wax under direct vision using a binocular ear microscope. I will use instruments such as small curettes (they look like tiny spoons), and small suctions. Most of the time, excess ear wax can be removed at home by the use of over the counter ear wax removal drops for several days and then gentle irrigation with warm water using a bulb type syringe. Kits containing the drops and syringe are available at all pharmacies. You should see a physician if hearing loss persists after using the drops, or if there is ear pain or drainage. Q-tips are actually a bad idea for cleaning the ears because the Q-tip will push most of the wax farther down the ear canal where it can get stuck. Please don’t use ear candles. Tests have shown that they don’t help and they can actually cause burns to the ear canal and ear drum. The brown residue left over from the candles is not ear wax, but instead is residue left over from the burning candle.

Most people’s ears are self cleaning. The action of chewing, combined with the migration of skin in the ear canal, pushes out excess wax that can then be easily removed from the ear opening by using a moist cloth.

In conclusion, ear wax is actually a good thing. It has antibiotic, anti-fungal and water repellant properties. People who clean their ears too frequently have very dry itchy ears and are more prone to having outer ear infections. Sometimes you can have too much of a good thing and have excess wax, but most of the time your ears will take care of themselves and don’t need any special care.

Aside

Anatomy of a Tympanic Membrane

At the request of one of the CellScope team members, we have found a great sketch of the structures the right tympanic membrane. By understanding the anatomy of the ear drum, we hope to better understand the images taken with the CellScope Oto.

The pars flaccida of tympanic membrane or Shrapnell’s membrane is the small, triangular, flaccid portion of the tympanic membrane.

The umbo is the most depressed part of the tympanic membrane.

The malleus is the small, hammer-shaped bone which connects with the incus and is attached to the inner surface of the eardrum. In the sketch we see both the head and the handle of the “hammer”, whereas in the image taken with the CellScope Oto, we only see the handle.

The incus is the small, anvil-shaped bone in the middle ear. The incus transmits sound vibrations from the malleus to the stapes.

The cone of light is in the 5 o’clock position when viewing a normal right ear drum and in the 7 o’clock position for a normal left ear drum. The absence or bent nature of a cone of light can indicate infection.

Ear Pic of the Week – Attic Retraction

This week’s Ear Pic of the Week was taken by Dr. Villasuso of the Cleveland Clinic.

Image taken with the CellScope Oto by Dr. Eloy Villasuso

Image taken with the CellScope Oto by Dr. Eloy Villasuso

Tympanic membrane retraction describes a condition in which a part of the ear drum lies deeper within the ear than its normal position. In this image, Dr. Villasuso points out the retraction of the left tympanic membrane as well as the partially retracted pars tensa has partially eroded part of the incus.

The ear drum comprises two parts, the pars tensa, which is the main part of the ear drum, and the pars flaccida, which is a smaller part of the ear drum located above the pars tensa. Either or both of these parts may become retracted. The retracted segment of ear drum is often known as a retraction pocket. The terms “atelectasis” or sometimes “adhesive otitis media” can be used to describe retraction of a large area of the pars tensa.

Dr. Villasuso marked the attic retraction pocket in this image. For those of us non-clinicians, the attic retraction pocket where the tympanic membrane is adhesed to the superior part of the malleus (at 10 o’clock) and the anterior malleolar ligament (12 o’clock), malleus at 3 o’clock. If that doesn’t help clear up any confusion, we’ll refer you Ear Drum Anatomy.

The Brief History of the Otoscope

Though the word may seem unfamiliar to some, but an otoscope device has been used nearly every day somewhere in the world for the last 650 years! An otoscope facilitates examination of the ear canal and tympanic membrane. From the color, shape and general appearance, a doctor can assess abnormalities by peeking through a viewing window.

otoscope-historic

The device was first described and illustrated in France in 1363 by Guy de Chauliac. Its primary use included the examination of aural and nasal passages. Because of the similar problems posed by inspecting conical cavities, early otoscopy and rhinoscopy instruments were similar in design.

In Italy in 1838, Ignaz Gruber invented the first funnel-shapped speculum, although he didn’t publish his findings. In Germany in 1864, E. Siegle invented a pneumatic otoscope, a model that allows the user to administer air pressure.

Pneumatic Otoscope illustration

Many otoscopes used in doctors offices today are wall-mounted, attached by a flexible power cord to a base, which serves to hold the otoscope when it’s not in use and also serves as a source of electric power, being plugged into an electric outlet. Portable models are powered by batteries in the handle; these batteries are usually rechargeable and can be recharged from a base unit.

Smartphone-enabled otoscopes are the newest advance in otoscopy.
CellScope Oto
The CellScope Oto harnesses the light of the iPhone camera to enable assessment of the outer and middle ear. An app allows users to visualize, record, store and compare images and videos of the ear canal and tympanic membrane.

Ear Pic of the Week: A Well Visit AOM

Dr. Jessica Kaplan, a favorite San Francisco pediatrician in Noe Valley who has been known to say that ‘the CellScope Oto’ has replaced her traditional otoscope’ shared her AOM Case file with us this week.

Image captured by Dr. Jessica Kaplan of the left ear of an 18 month old with Acute Otitis Media

Image captured by Dr. Jessica Kaplan of the left ear of an 18 month old with Acute Otitis Media

This tympanic membrane pic of an 18 month old in group care who had been well for many months, although had an infant history of several episodes of bronchiolitis and wheezing, presented on well child exam with no complaints. The child had been mildly congested and upon inspection of the ear canal, Dr. Kaplan found this ear ailment. She first instructed the family to give the child oral antihistamines but the ear findings persisted. The child was ultimately treated with antibiotics and the acute Otitis Media was resolved.

Thank you, Dr. Kaplan for snapping a pic with your CellScope Oto and sharing information about the case.