Histotripsy for the Treatment of Cauliflower Ear: A Feasibility Study in Porcine Ears
Evaluating Noninvasive Focused Ultrasound Ablation of Simulated Chronic Auricular Hematomas
DOI:
https://doi.org/10.58445/rars.3879Keywords:
Histotripsy, Focused Ultrasound, Therapeutic Ultrasound, Cauliflower Ear, Auricular Hematoma, Ultrasound Ablation, Biomedical Engineering, Cavitation, Porcine Model, Noninvasive Therapy, Sports Medicine, Image-Guided Therapy, Tissue Ablation, Regenerative Medicine, OtolaryngologyAbstract
Chronic auricular hematoma (cauliflower ear) is a common deformity among contact-sport athletes that results from ear trauma and can lead to hearing impairment, recurrent infections, and cosmetic disfigurement. Current treatments for established cases typically require invasive surgical reconstruction and may yield suboptimal outcomes. This study evaluates histotripsy—a noninvasive, non-ionizing, and non-thermal focused ultrasound ablation technique—as a potential alternative treatment for chronic cauliflower ear. An ex vivo porcine auricular model with gelatin-based simulated hematomas was developed to determine whether cavitation generated by histotripsy could liquefy clot-like material to enable minimally invasive removal. Targeted single-cycle pulses were delivered under real-time ultrasound guidance using a high-frequency transducer. In pilot testing (n = 20), measurable mass reduction occurred only in fully embedded, clot-injected models, with a mean mass decrease of 0.03 ± 0.03 g. In the structured experimental phase (n = 8), the greatest and most interpretable ablation occurred in 15% gelatin models with intact skin covering, which demonstrated mass decreases (0.01–0.02 g). Even though no-skin models showed confounding water absorption, ablation was clearly seen. A two-way analysis of variance demonstrated a significant overall difference in mass change among experimental conditions (F(2,5) = 180.97, p < .0001), supporting the structural dependence of histotripsy efficacy. These findings provide preliminary evidence that histotripsy can noninvasively ablate cauliflower ear–like tissue while preserving overall auricular structure. This proof-of-concept supports further optimization and in vivo investigation to determine whether image-guided histotripsy could serve as a minimally invasive alternative to surgical reconstruction for chronic cauliflower ear.
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