目的:耳蜗神经缺陷(CND)是单侧感音神经性耳聋(USNHL)患者常见的放射学表现。它通常通过磁共振成像(MRI)检测,这与更高的成本有关,可用性较低,可能需要镇静。因此,识别计算机断层扫描(CT)的发现,如耳蜗孔狭窄(CAS),能够可靠地预测CND是有价值的。我们的研究旨在确定CT诊断为CAS的儿科患者中CND的患病率。
方法:回顾性研究。
方法:三级护理中心。
方法:我们纳入了颞骨CT和颞骨MRI诊断为CAS的儿科患者。对于每个病人来说,耳鼻喉科医师和儿科神经放射科医师在CT上测量耳蜗孔径宽度以确认CAS(耳蜗孔径<1.4mm),并在MRI上评估耳蜗神经的状态.
结果:55名患者,代表65只耳朵,在CT测量上有CAS。CAS耳中的耳蜗孔径宽度为0.70mm(四分位数间距[IQR]:0.40-1.05mm),而非CAS耳中的耳蜗孔径宽度为2.00mm(IQR:1.80-2.30mm,P<.001)。在98.5%(n=64/65)的CAS耳朵中发现CND,而在1.5%(n=1/65)的CAS耳中发现了正常的耳蜗神经。
结论:CND在患有CAS的儿科患者中非常普遍。这表明,可能不需要MRI来评估USNHLCAS患者的CND,作为初始CT可以提供足够的信息来确定耳蜗植入候选。在确定是否在CAS诊断中进行MRI时,我们建议与USNHL患者的父母进行深思熟虑的共同决策。
OBJECTIVE: Cochlear nerve deficiency (CND) is a common radiologic finding among unilateral sensorineural hearing loss (USNHL) patients. It is generally detected with magnetic resonance imaging (MRI), which is associated with higher cost, less availability, and possible need for sedation. Therefore, identifying computed tomography (CT) findings, such as cochlear aperture stenosis (CAS), that can reliably predict CND is valuable. Our study aimed to determine the prevalence of CND in pediatric patients with CT-diagnosed CAS.
METHODS: Retrospective study.
METHODS: Tertiary care center.
METHODS: We included pediatric patients diagnosed with CAS on temporal bone CT and with available temporal bone MRI. For each patient, an otolaryngologist and a pediatric neuroradiologist measured the cochlear aperture width on CT to confirm CAS (cochlear aperture < 1.4 mm) and assessed the status of the cochlear nerve on MRI.
RESULTS: Fifty-five patients, representing 65 ears, had CAS on CT measurement. Median cochlear aperture width in CAS ears was 0.70 mm (interquartile range [IQR]: 0.40-1.05 mm) versus 2.00 mm in non-CAS ears (IQR: 1.80-2.30 mm, P < .001). CND was found in 98.5% (n = 64/65) of CAS ears, while a normal cochlear nerve was found in 1.5% (n = 1/65) of CAS ears.
CONCLUSIONS: CND is highly prevalent among pediatric patients with CAS. This suggests that MRI may not be needed to assess for CND in USNHL patients with CAS, as initial CT may provide sufficient information to determine cochlear implant candidacy. We recommend thoughtful shared decision-making with parents of USNHL patients when determining whether to pursue MRI in the setting of a CAS diagnosis.