Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
Int J Pediatr Otorhinolaryngol. 2023 Feb;165:111430. doi: 10.1016/j.ijporl.2022.111430. Epub 2022 Dec 30.
Cochlear implantation (CI) in children with sensorineural hearing loss (SNHL) before 12 months of age (mo) improves language outcomes. MRI is important to assess CI candidacy. Anesthesia before 3 years old may increase risk of neurocognitive delay. Natural sleep MRI (NS-MRI) is an emerging technique to avoid anesthesia in infants, but relies on successful sleep for adequate imaging. Our multidisciplinary team hypothesized the following predictors of successful NS-MRI for CI evaluation: age, distance travelled, comorbidities, primary language, insurance type, HL characteristics, time and duration of MRI.
We performed retrospective review of children 0-12mo who attempted NS-MRI. The NS-MRI was successful if imaging was sufficient for definitive clinical management per the managing otolaryngologist.
Among 26 patients (29 scans), the median age was 3.2mo (range: 1.2-6.8mo), distance travelled was 16.3 miles (range: 0.9 to 365 miles), 12 (46%) children had medical comorbidities. 8 (31%) had public insurance. 10 (38%) had bilateral HL. 52% (15/29) of scans were successful. Patients with comorbidities had significantly lower odds of successful NS-MRI (OR 0.09; 95% CI 0.01-0.54). Success was not associated with age, distance travelled, insurance type, primary language, HL characteristics, time or duration of MRI on univariable analysis. All 11 children who failed NS-MRI underwent hearing-aid fitting and/or imaging with sedation and CI as clinically indicated before 12mo.
NS-MRI was successful in 52% of infants, regardless of age, demographics, HL or MRI characteristics. Unsuccessful NS-MRI did not result in delayed intervention. NS-MRI is an effective consideration for a broad range of infants with SNHL.
在 12 个月（mo）之前对患有感音神经性听力损失（SNHL）的儿童进行人工耳蜗植入（CI）可改善语言结果。MRI 对于评估 CI 候选者很重要。3 岁之前的麻醉可能会增加神经认知延迟的风险。自然睡眠 MRI（NS-MRI）是一种新兴技术，可避免婴儿麻醉，但需要成功睡眠才能进行充分成像。我们的多学科团队假设了以下成功进行 CI 评估的 NS-MRI 的预测因素：年龄、旅行距离、合并症、主要语言、保险类型、HL 特征、MRI 的时间和持续时间。
我们对尝试进行 NS-MRI 的 0-12mo 儿童进行了回顾性研究。如果管理耳鼻喉科医生认为成像足以进行明确的临床管理，则 NS-MRI 被认为是成功的。
在 26 名患者（29 次扫描）中，中位年龄为 3.2mo（范围：1.2-6.8mo），旅行距离为 16.3 英里（范围：0.9 至 365 英里），12 名（46%）儿童有合并症。有 8 名（31%）儿童有公共保险。10 名（38%）儿童有双侧 HL。29 次扫描中有 52%（15/29）成功。有合并症的患者 NS-MRI 成功的可能性明显较低（OR 0.09；95%CI 0.01-0.54）。在单变量分析中，年龄、旅行距离、保险类型、主要语言、HL 特征、MRI 的时间或持续时间与成功率均无关联。所有 11 名 NS-MRI 失败的儿童均在 12mo 之前根据临床需要进行了助听器适配和/或镇静下成像和 CI。
无论年龄、人口统计学、HL 或 MRI 特征如何，NS-MRI 在 52%的婴儿中均成功。NS-MRI 失败并未导致干预延迟。NS-MRI 是对广泛的 SNHL 婴儿进行的有效考虑。
