Department of Otolaryngology, McLaren Oakland Health System, Michigan State University, Pontiac, MI, United States of America.
Division of Scholarly Inquiry, McLaren Health System, Michigan State University, Pontiac, MI, United States of America.
Am J Otolaryngol. 2021 May-Jun;42(3):102853. doi: 10.1016/j.amjoto.2020.102853. Epub 2021 Jan 4.
To determine the utility and value of pre-operative imaging among the elderly population ≥70 y.o. with bilateral progressive sensorineural hearing loss undergoing cochlear implantation.
A retrospective, cross-sectional review was performed at a tertiary referral center between 2010 and 2018 including patients ≥70 y.o. with bilateral presbycusis who underwent preoperative imaging and cochlear implantation. Primary outcome was whether pre-operative imaging changed the surgeon's surgical plan such as side of implant or abort procedure entirely. Patient characteristics including age, sex, side of implant, imaging modality, whether imaging changed surgical plan, and surgical complications were reviewed. One-way analysis of variance with post-hoc tests using the Bonferroni and Fisher's exact test were used to examine differences between groups. Secondary outcome was cost of preoperative imaging.
One hundred thirty-three patients (mean age 79.38 [5.51 SD]) who underwent a total of 142 surgical cases and 147 total scans. There were 92, 27, and 14 patients who underwent CT, MRI, or both, respectfully (n=133). Of the 142 implants that were placed, preoperative imaging did not reveal a contraindication to placing implant on one side over another. Total cost of imaging was $29,694. Estimated cost if 20% of cochlear implant eligible patients ≥70 y.o. underwent imaging is $7,763,490.
Decreasing unnecessary preoperative imaging can potentially decrease cost in cochlear implantation. In this sample, preoperative imaging did not affect the surgeon's choice of which side to operate on. However, imaging may provide an anatomic roadmap and contribute to either surgical confidence or caution. With the increasing amount of cochlear implant eligible elderly adults, preoperative imaging needs to be more clearly defined in this unique population.
确定在接受人工耳蜗植入术的≥70 岁双侧进行性感音神经性听力损失的老年人群中，术前影像学检查的实用性和价值。
本研究为回顾性、横断面研究，在 2010 年至 2018 年期间在一家三级转诊中心进行，研究对象为≥70 岁的双侧 presbycusis 患者，这些患者接受了术前影像学检查和人工耳蜗植入术。主要结局是术前影像学检查是否改变了外科医生的手术计划，例如植入物的侧别或完全终止手术。研究人员还回顾了患者的特征，包括年龄、性别、植入物侧别、影像学方式、影像学是否改变手术计划以及手术并发症。采用单因素方差分析和事后检验（Bonferroni 和 Fisher 精确检验），比较组间差异。
共纳入 133 例患者（平均年龄 79.38±5.51 岁），共进行了 142 例手术和 147 例影像学检查。92、27 和 14 例患者分别接受了 CT、MRI 或两者联合检查（n=133）。在植入的 142 个人工耳蜗中，术前影像学检查未发现植入物一侧相对于另一侧的禁忌证。影像学检查的总费用为 29694 美元。如果将 20%的≥70 岁符合人工耳蜗植入条件的患者进行影像学检查，预计费用为 7763490 美元。
减少不必要的术前影像学检查可能会降低人工耳蜗植入术的成本。在本研究中，术前影像学检查并没有影响外科医生选择手术侧别。然而，影像学检查可能提供解剖学路线图，并有助于增加手术的信心或谨慎性。随着越来越多的符合人工耳蜗植入条件的老年患者，术前影像学检查在这一特殊人群中需要更明确的界定。
