Measurement of comfort levels by means of electrical stapedial reflex in children

Background: Patient success and satisfaction with a cochlear implant largely depend on the adequacy of the speech-processing program. The program is generated by means of behaviorally determined threshold and comfort levels for each electrode. As the minimum age for implantation continues to decrease, behavioral methods of measuring comfort levels have become more problematic, and so the need for objective ways to program speech processors has become more important. Objectives: To evaluate the use of electrically evoked stapedial reflexes (ESRs) to measure comfort levels for children and compare these results with behavioral measurements, and to report the results of a questionnaire assessing the acceptability and general performance of program before and after adjustment of comfort levels measured with ESRs. Design and Setting: Before-after trial in the cochlear implant unit of a tertiary hospital. Patients and Methods: Programming with the ESR technique was successfully completed in 20 of a consecutive sample of 26 children undergoing programming of their cochlear implants. Outcome Measures: Programming units as measured by the 2 programming techniques and numerical score of questionnaire. Results: Comfort levels with the ESR method were found to be consistently lower than those obtained with behavioral techniques. Children using programs set with ESRs wore their implants longer and had fewer episodes of discomfort to environmental sounds. Conclusion: Comfort level estimation by means of ESRs is reliable and objective and hence a valuable programming tool in the pediatric population.