Stereo microscope based OCT system capable of subnanometer vibrometry in the middle ear

A principal tool for the visual inspection of the middle ear in the hearing clinic is the surgical stereo-microscope. We have developed a compact accessory for the surgical microscope that enables volumetric optical coherence tomography (OCT) imaging of the middle ear as well as functional vibratory imaging with subnanometer sensitivity. The sensitivity to vibration is achieved by careful engineering of the microscope attachment and frequency-domain processing. The microscope attachment integrates the entire OCT interferometer onto a custom aluminum base that mounts directly to the accessory area at the foot of most surgical microscopes. This approach is effective at removing high-frequency phase-noise, thus enabling near shot-noise limited sensitivity above ~2 kHz even though the OCT system is suspended above the patient by a boom arm. We analyze the vibratory response in the frequency domain, hence our ability to measure vibrations in the tympanic membrane and ossicles is near the shot-noise limit. As a demonstration of this system we have recorded in vivo volumetric images of a healthy human patient as well as the vibratory response at the tympanic membrane down to the hearing threshold. We also show that it is possible to use time averaging to drive the noise floor down below 2 pm which allowed us to make the first measure of distortion product otoacoustic emissions (DPOAE) using OCT. Finally, the system can easily be taken on and off of the surgical microscope and when in use does not impinge on the normal view through the surgical microscope.