Cochlear implant candidates: assessment with CT and MR imaging

Eighty-seven patients with severe to profound hearing loss were evaluated for possible placement of a multichannel cochlear implant hearing device. After initial clinical screening, 42 patients underwent computed tomographic (CT) examination. Five of these patients were also examined with magnetic resonance (MR) imaging. Twenty-two patients received implants. CT of the middle and inner ear was normal in 24 patients (57.1%) and showed labyrinthine ossification in 12 (28.6%), cochlear or fenestral otosclerosis (or both) in four (9.5%), and congenital cochlear malformation in two (4.8%). The information provided by CT was used to (a) exclude patients in whom multichannel cochlear implantation would most likely be unsuccessful (owing to obliterative labyrinthine ossification, or congenital cochlear malformation, severe cochlear, or fenestral otosclerosis), (b) help select the best ear for implantation, and (c) provide a preoperative picture of normal variants and avoidable surgical pitfalls. MR experience is limited but assessment of the size of the cochlear nerve and the membranous labyrinth is possible with this modality and may provide additional information in the evaluation of these patients.