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Role of modern imaging technology in the implementation of pediatric cochlear implants
B Silberman1, E N Garabedian, F Denoyelle
1Department of Pediatric Radiology, Trousseau Children's Hospital, Paris, France.
Insights
Computed tomography (CT) and magnetic resonance imaging (MRI) aid in cochlear implant decisions for children, especially those with meningitis history. Imaging helps select implants and confirm placement, guiding treatment for profound hearing loss.
Area of Science:
- Otorhinolaryngology
- Medical Imaging
- Pediatric Audiology
Background:
- Cochlear implantation is a treatment for profound hearing loss.
- Radiographic assessment is increasingly used to guide cochlear implant surgery.
- Multidisciplinary team assessment precedes imaging in cochlear implant candidates.
Purpose of the Study:
- To evaluate the role of combined CT and MRI in pediatric cochlear implant candidates.
- To determine how imaging influences implant selection and surgical planning.
- To assess the utility of imaging in detecting complications and confirming implant position.
Main Methods:
- Retrospective review of 17 pediatric patients undergoing cochlear implantation.
- High-resolution computed tomography (CT) as the initial imaging modality.
- Magnetic resonance imaging (MRI) combined with CT, particularly for patients with meningitis history.
Main Results:
- CT identifies congenital abnormalities and labyrinthine ossification, crucial for surgical planning.
- MRI evaluates the labyrinth's fluid status, especially valuable post-meningitis.
- Imaging findings impact implant choice, surgical side, and postoperative assessment.
Conclusions:
- Combined CT and MRI are valuable adjuncts in pediatric cochlear implantation decision-making.
- Imaging is particularly important for children with a history of bacterial meningitis.
- Modern imaging techniques enhance the precision and safety of cochlear implant surgery.
Abstract:
Since 1989, 40 patients have received cochlear implants in our institution. Over the past 2 years, 17 children among these patients have undergone radiographic assessment combining magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) scanning. Imaging is not essential, and is only used after assessment by a multidisciplinary team. However, the imaging results influence the choice of implant, and sometimes the side to be implanted. The first study is always CT, as it detects congenital abnormalities, and for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification that contraindicates or complicates cochlear implantation. These signs are not always visible with tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for postoperative confirmation of implant position in case of failure or complication. Over the past 3 years, MRI has been combined with tomodensitometry, especially with children having a history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A GE Signa 1.5-T unit was used by the authors, employing sequences of volumetric acquisition (steady state free precision with 1.5-mm image slices and an angle of 15 degrees to 35 degrees). Hence, modern imaging plays an important role when the decision to implant has already been made, particularly in the case of profoundly deaf children. We always use MRI in combination with a CT scanner in children with a history of meningitis.