Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation

Abstract

Objectives/Hypothesis: There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual-imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI-predominant with selective HRCT imaging protocol.Study Design: Retrospective review. Methods: The protocol was implemented over a 4-year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained.Results: Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced.Conclusions: MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI.

Outcomes of Cochlear Implantation in Prelingual Hearing Impaired Children With Abnormal Preimplantation Imaging Findings

“…In this study, 30% of children with prelingual hearing impairment who underwent unilateral CI had abnormal imaging findings. This finding was slightly higher than reported in the previous literature which ranges from 15 to 20% [9,10]. This could be because of the small sample size.…”

“…MRI offers additional information on cochleovestibular bundles and central nervous system pathology [11]. Siu et al recommend that MRI alone is sufficient as radiological evaluation prior to CI, and HRCT should only be done if MRI reveals significant abnormality [10]. In contrast, several studies propose that both HRCT of the temporal bone and MRI of the IAC and brain should be routinely implemented prior to CI [12][13][14].…”

Cochlear Implantation in Infants: Why and How

“…The details of preoperative imaging protocol are typically surgeon- and institution-dependent. One approach suggested in the literature is to perform magnetic resonance imaging (MRI) for all children undergoing assessment for cochlear implant candidacy and add computed tomography of temporal bone for patients considered at risk of having more surgically challenging anatomy, such as children with craniofacial anomalies ( Chin et al.,2020 ; Siu et al., 2019 ; Trimble et al., 2007 ). However, some institutions prefer to recommend computed tomography for almost all children with congenital deafness who are potential CI candidates ( Sepahdari et al., 2014 ; Yigit et al., 2019 ).…”

Welche Qualität macht den Unterschied in der Cochlea-Implantat-Versorgung?

“…Currently, the regular application of hrCT in the preoperative diagnostics of children is controversially discussed because of the radiation exposure [63]. However, in the recent past, work groups (Siu et al) could present algorithms that should reduce the frequency of hrCT in children without causing disadvantages regarding the surgical safety by ignoring anomalies [64]. Every patient first undergoes MRI.…”