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Preoperative radiologic evaluation in cochlear implantation
T P Nikolopoulos1, G M O'Donoghue, K L Robinson
1ENT & Audiology Directorate, Nottingham University Hospital, United Kingdom.
Insights
Computed tomography (CT) effectively identifies cochlear obliteration in children, especially after meningitis. However, CT has limitations in detecting minor cochlear changes and imaging auditory pathways for cochlear implantation.
Area of Science:
- Radiology
- Otolaryngology
- Pediatric Imaging
Background:
- Cochlear implantation requires detailed imaging of the cochlea and auditory pathways.
- Computed tomography (CT) is a common imaging modality used in pre-surgical evaluation.
- Assessing the accuracy of CT in identifying cochlear abnormalities is crucial for surgical planning.
Purpose of the Study:
- To evaluate the diagnostic value of computed tomography (CT) in assessing cochlear and auditory pathway abnormalities.
- To determine the effectiveness of CT in identifying cochlear obliteration, particularly in post-meningitic children.
Main Methods:
- CT scans were performed on 108 children prior to cochlear implantation.
- Patient data included age at implantation and etiology of deafness (meningitis, congenital, other).
- Diagnostic performance metrics (accuracy, sensitivity, specificity) were calculated for CT in detecting cochlear obliteration.
Main Results:
- CT identified partial cochlear obliteration in 16.6% of all children and 34% of post-meningitic children.
- Congenital cochlear malformations were found in 2% of children, and brain abnormalities in 11.1%.
- For post-meningitic children, CT showed 75% accuracy, 62% sensitivity, and 82% specificity for cochlear obliteration.
Conclusions:
- CT is valuable for detecting significant cochlear obliteration, especially in post-meningitic cases.
- CT is limited in predicting minor cochlear obliteration with certainty.
- CT cannot reliably image the auditory nerve or its central connections.
Aim Of Study:
Assess the value of computed tomography (CT) in the evaluation of abnormalities in the cochlea and auditory pathways.
Material And Methods:
We used CT to evaluate 108 children before cochlear implantation surgery. Children's ages at implantation ranged from 21 months to 16 years (mean age, 5.4 years). The etiology of deafness was meningitis in 44 children (40.8%), congenital in 51 (47.2%), and other in 13 children (12%).
Results:
Eighteen of the 108 (16.6%) children and 34% of the postmeningitic children were found to have at least partial obliteration of the cochlea. Two (2%) children had congenital malformations of the cochlea and 12 children (11.1%) had abnormalities in the brain CT-scan. CT diagnostic values in postmeningitic children regarding cochlear obliteration were accuracy, 75%; sensitivity, 62%; specificity, 82%; positive predictive value, 66.6%; and negative predictive value, 79.3%. In six (20.6%) of postmeningitic children with normal CT-scans, some scala tympani drillout was required.
Conclusion:
CT-scan is capable neither of predicting with certainty the presence of minor degrees of cochlear obliteration nor of specifically imaging either the auditory nerve or its central connections.