Optimizing Cochlear Implant Programming in Single-Sided Deafness and Asymmetric Hearing Loss: A Randomized Comparison of ESRT and Behavioral Methods
Related Experiment Video
Updated: Nov 6, 2026
Electrically Evoked Stapedius Reflex Measurements in Cochlear Implantation and Its Application in the Postoperative Fitting Process
Published on: June 21, 2024
Meredith A Holcomb1, Jennifer Coto1,2, Christina Sarangoulis1
1Department of Otolaryngology University of Miami Miami Florida USA.
Objectives:
To compare outcomes of electrically evoked stapedial reflex threshold (ESRT) and behavioral programming methods in cochlear implant (CI) recipients with single-sided deafness (SSD) and asymmetric hearing loss (AHL).
Methods:
Ten participants (mean age 43.9 years; 60% female; 60% non-Hispanic) with SSD (90%) or AHL (10%) were enrolled in a prospective randomized crossover study. Participants with SSD/AHL and at least 3 months of CI experience were programmed with ipsilateral ESRT (Ipsi ESRT), contralateral ESRT (Contra ESRT), and behavioral methods (Behav MCL) in randomized order. Outcome measures included speech perception (CNC words, BKB-SIN sentences), daily CI device use, and hearing-related CI quality of life (SSQ-12).
Results:
Contra ESRT programming yielded responses on 100% of active electrodes, compared to 70% for Ipsi ESRT. Most participants (80%) preferred ESRT-based programs, reporting better hearing and comfort compared to Behav MCL programming. Speech perception scores were similar across programming methods, but ESRT-based programs demonstrated more reliable upper stimulation levels and required fewer adjustments. Speech scores were similar across methods, and daily CI use averaged 6.5-8.5 h.
Conclusion:
Despite similar speech outcomes across methods, ESRT programming, specifically Contra ESRT, is recommended for SSD/AHL CI recipients to optimize patient preference and programming reliability.
Level Of Evidence:
2.
