Introduction: When mapping cochlear implant (CI) patients with limited reporting abilities, the lowest electrical stimulus level that produces a stapedial reflex (i.e., the electrical stapedius reflex threshold [eSRT]) can be measured to estimate the upper bound of stimulation on individual or a subset of CI electrodes. However, eSRTs measured for individual electrodes or a subset of electrodes cannot be used to predict the global adjustment of electrical stimulation levels needed to achieve comfortable loudness sensations that can be readily used in a speech coding strategy. In the present study, eSRTs were measured for 1-, 4-, and 15-electrode stimulation to (1) determine changes in eSRT levels as a function of the electrode stimulation mode and (2) determine which stimulation mode eSRT levels best approximate comfortable loudness levels from patients’ clinical maps. Methods: eSRTs were measured with the 3 different electrical stimulation configurations in 9 CI patients and compared with behaviorally measured, comfortable loudness levels or M-levels from patients’ clinical maps. Results: A linear, mixed-effects, repeated-measures analysis revealed significant differences (p < 0.01) between eSRTs measured as a function of the stimulation mode. No significant differences (p = 0.059) were measured between 15-electrode eSRTs and M-levels from patients’ clinical maps. The eSRTs measured for 1- and 4-electrode stimulation differed significantly (p < 0.05) from the M-levels on the corresponding electrodes from the patients’ clinical map. Conclusion: eSRT profiles based on 1- or 4-electrode stimulation can be used to determine comfortable loudness level on either individual or a subset of electrodes, and 15-electrode eSRT profiles can be used to determine the upper bound of electrical stimulation that can be used in a speech coding strategy.

1.
Bates
D
,
Machler
M
,
Bolker
B
,
Walker
S
.
Fitting linear mixed-effects models using lme4
.
J Stat Softw
.
2015
;
67
(
1
):
1
48
.
2.
Brown
CJ
,
Hughes
ML
,
Luk
B
,
Abbas
PJ
,
Wolaver
A
,
Gervais
J
.
The relationship between EAP and EABR thresholds and levels used to program the nucleus 24 speech processor: data from adults
.
Ear Hear
.
2000
;
21
(
2
):
151
63
. .
3.
Buechner
A
,
Frohne-Buechner
C
,
Stoever
T
,
Gaertner
L
,
Battmer
RD
,
Lenarz
T
.
Comparison of a paired or sequential stimulation paradigm with advanced bionics’ high-resolution mode
.
Otol Neurotol
.
2005
;
26
(
5
):
941
7
. .
4.
Flottorp
G
,
Djupesland
G
,
Winther
F
.
The acoustic stapedius reflex in relation to critical bandwidth
.
J Acoust Soc Am
.
1971
;
49
(
2
):
Suppl-457
. .
5.
Gordon
KA
,
Papsin
BC
,
Harrison
RV
.
Toward a battery of behavioral and objective measures to achieve optimal cochlear implant stimulation levels in children
.
Ear Hear
.
2004
;
25
(
5
):
447
63
. .
6.
Han
DM
,
Chen
XQ
,
Zhao
XT
,
Kong
Y
,
Li
YX
,
Liu
S
, et al.
Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII bionic ear users with HiResolution sound processing strategies
.
Acta Otolaryngol
.
2005
;
125
(
7
):
732
5
. .
7.
Hernandez
LC
,
Sánchez
LC
,
Olivares
MC
,
Rodríguez
C
,
Finley
CC
,
Saoji
AA
.
Effect of probe-tone frequency on ipsilateral and contralateral electrical stapedius reflex measurement in children with cochlear implants
.
Ear Hear
.
2019
;
40
:
732
40
.
8.
Hodges
AV
,
Balkany
TJ
,
Ruth
RA
,
Lambert
PR
,
Dolan-Ash
S
,
Schloffman
JJ
.
Electrical middle ear muscle reflex: use in cochlear implant programming
.
Otolaryngol Head Neck Surg
.
1997
;
117
(
3 Pt 1
):
255
61
. .
9.
Jerger
J
,
Oliver
TA
,
Chmiel
RA
.
Prediction of dynamic range from stapedius reflex in cochlear implant patients
.
Ear Hear
.
1988
;
9
(
1
):
4
8
.
10.
Kuznetsova
A
,
Brockhoff
PB
,
Christensen
RHB
.
lmerTest package: tests in linear mixed effects models
.
J Stat Soft
.
2017
;
82
(
13
):
1
26
. .
11.
Margolis
RH
.
Detection of hearing impairment with the acoustic stapedius reflex
.
Ear Hear
.
1993
;
14
(
1
):
3
10
. .
12.
McDermott
HJ
,
McKay
CM
,
Richardson
LM
,
Henshall
KR
.
Application of loudness models to sound processing for cochlear implants
.
J Acoust Soc Am
.
2003
;
114
(
4 Pt 1
):
2190
7
. .
13.
McKay
CM
,
Remine
MD
,
McDermott
HJ
.
Loudness summation for pulsatile electrical stimulation of the cochlea: effects of rate, electrode separation, level and mode of stimulation
.
J Acoust Soc Am
.
2001
;
10
(
3 Pt 1
):
1514
24
.
14.
Meddis
R
.
Computational models of the auditory system
.
London, NY
:
Springer
;
2010
.
15.
Peterson
JL
,
Lidén
G
.
Some static characteristics of the stapedial muscle reflex
.
Audiology
.
1972
;
11
(
1
):
97
114
. .
16.
Polak
M
,
Hodges
A
,
Balkany
T
.
ECAP, ESR and subjective levels for two different nucleus 24 electrode arrays
.
Otol Neurotol
.
2005
;
26
(
4
):
639
45
. .
17.
Popelka
GR
,
Karlovich
RS
,
Wiley
TL
.
Letter: acoustic reflex and critical bandwidth
.
J Acoust Soc Am
.
1974
;
55
(
4
):
883
5
. .
18.
Scheperle
RA
,
Hajicek
JJ
.
Wideband acoustic immittance in cochlear implant recipients: reflectance and stapedial reflexes
.
Ear Hear
.
2020
;
41
(
4
):
883
95
.
19.
Shallop
JJ
,
Ash
KR
.
Relationships among comfort levels determined by cochlear implant patient’s self-programming, audiologist's programming, and electrical stapedius reflex thresholds
.
Ann Otol Rhinol Laryngol Suppl
.
1995
;
166
:
175
6
.
20.
Spivak
LG
,
Chute
PM
.
The relationship between electrical acoustic reflex thresholds and behavioral comfort levels in children and adult cochlear implant patients
.
Ear Hear
.
1994
;
15
(
2
):
184
92
. .
21.
Van Den Abbeele
T
,
Noël-Petroff
N
,
Akin
I
,
Caner
G
,
Olgun
L
,
Guiraud
J
, et al.
Multicentre investigation on electrically evoked compound action potential and stapedius reflex: how do these objective measures relate to implant programming parameters?
Cochlear Implants Int
.
2012 Feb
;
13
(
1
):
26
34
. .
22.
Wilson
RH
.
Factors influencing the acoustic-immittance characteristics of the acoustic reflex
.
J Speech Hear Res
.
1979
;
22
(
3
):
480
99
. .
23.
Walkowiak
A
,
Lorens
A
,
Polak
M
,
Kostek
B
,
Skarzynski
H
,
Szkielkowska
A
, et al.
Evoked stapedius reflex and compound action potential thresholds versus most comfortable loudness level: assessment of their relation for charge-based fitting strategies in implant users
.
ORL J Otorhinolaryngol Relat Spec
.
2011
;
73
(
4
):
189
95
. .
24.
Wolfe
J
,
Gilbert
M
,
Schafer
E
,
Litvak
LM
,
Spahr
AJ
,
Saoji
A
, et al.
Optimizations for the electrically-evoked stapedial reflex threshold measurement in cochlear implant recipients
.
Ear Hear
.
2017
;
38
(
2
):
255
61
. .
25.
Wolfe
J
,
Gifford
R
,
Schafer
E
.
Measurement of the electrically evoked stapedial reflex response with wideband acoustic reflectance measurement
.
J Am Acad Audiol
.
2018
;
29
(
4
):
337
47
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.