What is the utility of MRI imaging, compared with CT, in the evaluation of pediatric sensorineural hearing loss?
Background: In the evaluation of pediatric patients with sensorineural hearing loss, imaging of the temporal bone and inner ear may lead to diagnoses pertinent to the etiology of the hearing loss or to findings affecting medical decisions for that child. Questions arise as to the relative utility of MRI or CT imaging in this scenario.
Study design: Retrospective systematic review.
Synopsis: A systematic review of MEDLINE from 1996 through December 2013 was performed. Inclusion and exclusion criteria narrowed the results, yielding 29 studies (n=2,434 patients with MRI and n=1,451 patients with CT). The pooled data diagnostic yield for MRI was 26% for all imaging findings, combining otologic and brain findings.
The risks and benefits of the two modalities were compared. For the specific finding of enlarged vestibular aqueduct, CT had a higher yield than MRI. The risks associated with CT radiation have to be compared to MRI-associated risks of gadolinium administration, if used. In addition, MRI in the pediatric age group often requires sedation, with the attendant anesthesia risks.
Bottom line: MRI or CT imaging in the setting of pediatric sensorineural hearing loss can yield beneficial information. If there is a high suspicion of enlarged vestibular aqueduct, then CT appears to have a higher diagnostic yield. The choice between MRI and CT will have to be determined by individual clinicians, based on their assessments of relative risks and benefits.
Citation: Kachniarz B, Chen JX, Gilani S, Shin JJ. Diagnostic yield of MRI for pediatric hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2015;152:5-22.