Fluorescence Spectroscopy for Real-Time Intraoperative Detection of Middle-Ear Cholesteatoma.

OBJECTIVE: To evaluate whether autofluorescence spectroscopy (AFS) can reliably distinguish cholesteatoma from surrounding middle-ear tissues, and to develop a real-time intraoperative diagnostic tool. STUDY DESIGN: Prospective ex vivo study. SETTING: Besançon University Hospital, France (tertiary care center). METHODS: In this prospective ex vivo study, middle-ear tissue biopsies were collected during cholesteatoma surgeries and analyzed using autofluorescence following 405-nm laser excitation. Each sample was classified based on its spectral signature and confirmed by histopathology. A computer-assisted model was applied to differentiate cholesteatoma from noncholesteatoma tissues, and its performance was assessed using standard cross-validation. RESULTS: Thirty-six tissue samples from 23 patients were analyzed, generating nearly 3800 fluorescence spectra. The model correctly classified all samples, achieving 94.5% accuracy, 94.7% sensitivity, and 94.2% specificity. The system provided consistent performance across tissue types and returned results in real time, with a response time of 0.1 seconds per sample. Each output included a probability score indicating the likelihood of cholesteatoma presence. CONCLUSION: AFS demonstrated high accuracy in distinguishing cholesteatoma from other middle-ear tissues. Its speed, simplicity, and probabilistic feedback suggest strong potential for real-time intraoperative use. Once validated in vivo, this technology could assist surgeons by improving tissue discrimination and potentially reducing recurrence rates.