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S2 Intraoperative/objective measurements
Clinical application of postoperative stapedius reflex testing for the fitting of cochlear implants in
Stephan K. , Reider T. , Hahn E. , Koci V. , Weichbold V. , Seebacher J.
Innsbruck Medical University, Dept. Hearing, Speech & Voice Disorders, Innsbruck, Austria
Intro: Fitting of cochlear implants (CI) based on objective measures is important in children who cannot provide
sufficient feedback about loudness sensation when stimulated via cochlear implant. It has been demonstrated by
numerous authors that postoperative electrical stapedius reflex thresholds (ESRT) can serve as good estimators
for psychoacoustic comfort levels. However, the procedure of ESRT testing is not generally applied as there
exist some limitations for routine application in daily clinical practice. Aim of the study was to analyze the clinical
applicability of postoperative ESRT testing in an unselected clinical sample of children in whom fitting based on
objective criteria was needed.
Methods: In a retrospective evaluation, data from 70 unselected children supplied with MED-EL cochlear
implants were examined. It was analyzed, how often the ESRT testing procedure based on acoustic impedance
audiometry could be successfully applied and ESRT data could be used for CI fitting in children. Also, the
incidence of middle ear problems as possible limit of application was registered in the sample considered. In
addition the efficiency of a minimal intervention by an otolaryngologist (i.e. medication of nose drops, ventilation
of the Eustachian tube etc.) in case of minor middle ear problems was analyzed.
Results: ESRT testing could be applied successfully 2 months after implantation in 80-90% of patients. In 1020% of cases a minimal medical intervention was needed. In principal values for ESRT could be determined in
about 85% of cases.
Conclusion: The study demonstrated, that ESRT testing can be successfully applied postoperatively in a high
number of patients as long as the general requirements for stapedius reflex detection are met. ESRT testing can
serve as a useful objective tool for the CI fitting procedure in children when using appropriate instrumentation
and clinical infrastructure.