AO Technologies, founded by USC researchers John Oghalai and Brian Applegate, has secured an ARPA-H small business award to develop a cochleoscope for clinical imaging of the inner ear.

USC researchers John Oghalai, MD and Brian Applegate, PhD’s startup AO Technologies was recently awarded an up to $3.7 million small business award from the Advanced Research Projects Agency for Health (ARPA-H) to refine the cochleoscope for clinical imaging of the inner ear. The cochleoscope will aid otolaryngologists in diagnosing inner ear conditions that can be treated with medications, improving outcomes and quality of life for patients.

“Our goal is to have something that we can put into the ear that can image the tissues of the cochlea, which, in humans, is encased in the densest bone in the body,” said Oghalai, chair of the USC Caruso Department of Otolaryngology – Head and Neck Surgery, and professor of otolaryngology – head and neck surgery, neurological surgery and biomedical engineering at the Keck School of Medicine of USC and USC Viterbi School of Engineering.

Oghalai and Applegate began collaborating with one another almost 20 years ago when Oghalai was at Baylor College of Medicine and Applegate was at Texas A&M University. They continued working together while Oghalai served on the faculty at Stanford University. Their research, which started with using optical coherence tomography (OCT) to look at the tissues of the inner ear of mice and other animals, would eventually lead to the creation of the cochleoscope.

Oghalai became part of the faculty at USC in 2017. Applegate followed in 2019, joining the faculty at USC as a professor of otolaryngology – head and neck surgery, biomedical engineering, and electrical and computer engineering. This allowed Oghalai and Applegate to accelerate the progress of their collaborative research, more effectively iterating to solve complex problems related to imaging the inner ear.

Though current OCT imaging is capable of seeing through the dense bone that surrounds the cochlea, it cannot yet produce images that are clear and detailed enough to be valuable in a clinical setting. Oghalai and Applegate hope to be able to use a combination of hardware and algorithms so that the cochleoscope will be able to deliver higher-quality images of the inner ear. They feel optimistic given the significant advances in lasers and optical tools in the last decade.

“Our first set-up was as big or bigger than a Toyota Corolla and weighed about as much,” Oghalai said. “Now the equipment fits on a medical cart in a clinical setting.”

The power of partnership

The ARPA-H funding underscores the value not only of collaboration between researchers, but also of partnerships between academic labs, startups and the government.

After over 20 years of National Institutes of Health funding for their animal studies, Oghalai and Applegate began to submit patents for the new technologies they were developing to USC’s licensing office. USC encouraged them to form a startup, and the USC Stevens Center for Innovation offered an initial grant to collect seed data.

In 2023, they were also awarded the Nemirovsky Engineering and Medical Opportunity (NEMO), which supports early-stage research at the intersection of health sciences and engineering.

“The NEMO Prize enabled us to try some experiments that would have been considered very risky by a traditional funding agency,” Applegate explained.

The goal of the startup is to pursue projects, like the cochleoscope, that can one day be used to help patients in a clinical setting. Unlike many other startups, AO Technologies does not have to rely on venture capital (VC) investments, instead using money received through grants from the federal government.

“The startup very much spun out from the university, and they have been helping us along the way to make sure we’re successful,” Applegate said. “Venture capital wants you to make a profit tomorrow, but we have the ability to boot-strap our company without those external pressures.”

In partnering with an academic institution like USC, startups like AO Technologies can subcontract some of the work that needs to be done to research labs at the university as well.

“Of course, we have to manage conflicts of interest according to USC policy,” said Oghalai, “but the labs at the university that are set up for this research are the best way we know to iteratively improve the device and test new technology.”

Another benefit of AO Technologies’ partnership with the university is that Keck Medicine of USC has many clinics throughout the LA area, giving Oghalai and Applegate the opportunity to get their devices into clinics so that they can be tested with patients in a real-world setting.

Over the next four years, Oghalai and Applegate will work with ARPA-H on the cochleoscope with the goal of imaging patients and refining the device so that the images from the cochleoscope can provide useful information to patients and doctors alike.

“One of USC’s greatest strengths is that it is a collaborative institution,” Oghalai said. “The leadership facilitates that, and this is a great example.”