CT, MRI Don't Change Therapy in Children With Hearing Loss

By Reuters Staff

April 10, 2019

NEW YORK (Reuters Health) - Imaging studies in children with unilateral sensorineural hearing loss (USNHL) generally don't yield clinically useful information, according to new findings.

"There is currently no convincing evidence supporting a strong recommendation for imaging in children who present with USNHL," Dr. Fabienne G. Ropers of Leiden University Medical Center in the Netherlands and colleagues write in JAMA Otolaryngology-Head and Neck Surgery, online April 4.

There's no evidence-based protocol for determining the cause of USNHL, the authors note. Patients are typically tested for congenital cytomegalovirus (CMV) infection, with temporal bone imaging with CT or MRI if CMV testing is negative.

To investigate the diagnostic yield of CT and MRI in USNHL, the authors reviewed 18 studies including 1,504 patients.

Pathophysiologically relevant findings were identified in 37% of cases with CT and 35% with MRI. Pooled frequency of cochleovestibular abnormalities was 19% for CT and 16% for MRI.

Cochlear nerve deficiency and associated cochlear aperture stenosis frequency was seen in 44% with CT and 16% with MRI. Pooled frequencies of enlarged ventricular aqueduct (EVA) were 7% with CT and 12% with MRI.

Risks of imaging include radiation exposure with CT and sedation with MRI, the authors note.

"Imaging provided insight into the cause of hearing loss in a pooled frequency of about 35% to 37% of children with isolated unexplained USNHL," they conclude. "However, none of these findings had therapeutic consequences, and imaging provided information on prognosis and hereditary factors only in a small proportion of children, namely those with EVA."

"Physicians may assume that parents and patients are reassured by knowing the exact anatomical cause of hearing loss, despite the fact that this information does not change the natural course of the condition," they add. "However, imaging with this sole purpose is a preference-sensitive decision."

"Therefore, we suggest a shared decision-making approach to help elucidate these preferences after providing the relevant information of advantages and disadvantages of imaging, as opposed to presenting imaging as a part of routine care in the diagnostic assessment of children with USNHL," Dr. Ropers and colleagues conclude.

In an editorial, Dr. Judith E. C. Lieu and Dr. Jay A. Gantz of Washington University in St. Louis School of Medicine, in Missouri, write that "by limiting 'benefit' only to information that has clinical implications for the patient, the authors essentially claim that there is little use in obtaining prognostic or diagnostic information that can help families understand why their child has hearing loss. The authors also ignore the possibility that future research into these abnormalities may improve the ability to derive a benefit that has clinical implications for the patient."

They add, "Findings on imaging, such as intracranial calcifications, white matter disease, or polymicrogyria, may suggest asymptomatic congenital CMV disease, and on rare occasions, neoplasms can be identified. Thus, the external generalizability of the authors' recommendation to forgo imaging is limited."

SOURCE: https://bit.ly/2WTg1tq and https://bit.ly/2Vyq9HQ

JAMA Otolaryngol Head Neck Surg 2019.