TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.
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August 2017Background
Computed tomographies (CTs) and magnetic resonance imagings (MRIs) have been traditionally used to evaluate cochlear implant (CI) candidates. The utility of preoperative imaging in pediatric CI candidates is well documented because anatomic abnormalities can alter surgical planning in up to 20% of cases. However, the utility of preoperative imaging is yet to be determined in adult CI candidates with postlingual deafness. Today, institutional protocols and surgeon preference determine the preoperative radiographic evaluation. But there is no consensus on when and which imaging modality should be employed to assess adult CI candidates with postlingual deafness.
Best Practice
The otologic history, exam, and audiologic evaluation can guide the need for preoperative imaging in CI candidates but is not predictive in identifying significant lesions. Computed tomography should be considered in patients with middle ear disease. Preoperative MRIs should be considered when there is history significant for temporal bone fracture, meningitis, or asymmetric hearing loss. It can also be performed to rule out incidental intracranial lesions, because even MRI-compatible CI can cause significant image artifacts, precluding adequate imaging of the brain after implantation. Despite the fact that studies demonstrate that preoperative image findings may facilitate surgical planning, there are no statistically significant associations between eventful surgeries and significant image findings. Although postlingually deaf adults with an unremarkable history and exam may not require preoperative imaging, additional studies of higher quality—including cost analysis studies—are required to substantiate these recommendations (Laryngoscope. 2017;127:287–288).