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Updated: Aug 20, 2025
Electrically Evoked Stapedius Reflex Measurements in Cochlear Implantation and Its Application in the Postoperative Fitting Process
Published on: June 21, 2024
Evaluation of the Electrically-Evoked Stapedial Reflex Threshold in Pediatric Cochlear Implant Users with
Saravanan Palani1, Arun Alexander1, Anuprasad Sreenivasan1
1Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Insights
Higher probe tones improve electrically-evoked stapedial reflex threshold (ESRT) measurements in pediatric cochlear implant (PCI) users. This method increases measurement success and correlates with comfort levels, offering a valuable alternative when standard methods fail.
Area of Science:
- Audiology
- Cochlear Implants
- Pediatric Hearing
Background:
- Electrically-evoked stapedial reflex threshold (ESRT) is crucial for setting comfort levels in pediatric cochlear implant (PCI) users.
- Current limitations exist as ESRT is not consistently obtained in all PCI users, impacting clinical utility.
- The standard 226 Hz probe tone may not be optimal for all individuals.
Purpose of the Study:
- To investigate the impact of probe-tone frequency on ESRT measurements in PCI users.
- To determine the relationship between ESRT measured with different probe tones and behavioral comfort levels.
- To enhance the success rate of ESRT measurements in pediatric populations.
Main Methods:
- ESRT was measured in 14 pediatric cochlear implant users (ages 5-8) using 678 Hz, 1000 Hz, and the standard 226 Hz probe tones.
- Measurements were conducted using single-electrode stimulation at basal (E01), middle (E11), and apical (E22) electrode locations.
- ESRT levels were compared across probe-tone frequencies and correlated with established behavioral comfort levels.
Main Results:
- While mean ESRT levels were lower with higher frequencies (1000 Hz, 678 Hz) compared to 226 Hz, no significant main effect of probe-tone frequency was found (p > 0.05).
- A significantly higher incidence of successful ESRT measurements was observed using higher-frequency probe tones (p < 0.039).
- ESRT measurements obtained with higher probe tones demonstrated a significant positive correlation with behavioral comfort levels.
Conclusions:
- Utilizing higher-frequency probe tones for ESRT measurements in PCI users improves the success rate of obtaining objective data.
- ESRT measured with higher probe tones correlates well with behavioral comfort levels, providing a reliable indicator.
- Higher-frequency probe tones (678 Hz, 1000 Hz) serve as a valuable alternative when the standard 226 Hz probe tone yields no measurable ESRT.
Abstract:
Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users. Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users. Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels. Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency ( p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone ( p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels. Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.
