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Peer-reviewedCC BY-NC-ND 4.0Laryngoscope Investigative Otolaryngology

Optimizing Cochlear Implant Programming in Single‐Sided Deafness and Asymmetric Hearing Loss: A Randomized Comparison of ESRT and Behavioral Methods

  • Meredith A. Holcomb1
  • Jennifer Coto1,2
  • Christina Sarangoulis1
  • Tina Stern1
  • Sandra Prentiss1
  • E. Katelyn Glassman3
  • Molly R. Smeal4
4 affiliations
  1. 1Department of Otolaryngology University of Miami Miami Florida USA
  2. 2Department of Pediatrics University of Miami Miami Florida USA
  3. 3Med‐EL Corporation Durham North Carolina USA
  4. 4Hearts for Hearing Oklahoma Oklahoma USA
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Abstract

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

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Cite

BibTeXRIS
BibTeX
@article{holcomb2026optimizing,
  title = {{Optimizing Cochlear Implant Programming in Single‐Sided Deafness and Asymmetric Hearing Loss: A Randomized Comparison of ESRT and Behavioral Methods}},
  author = {Meredith A. Holcomb and Jennifer Coto and Christina Sarangoulis and Tina Stern and Sandra Prentiss and E. Katelyn Glassman and Molly R. Smeal},
  journal = {Laryngoscope Investigative Otolaryngology},
  year = {2026},
  month = nov,
  doi = {10.1002/lio2.70601},
  url = {https://doi.org/10.1002/lio2.70601},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Optimizing Cochlear Implant Programming in Single‐Sided Deafness and Asymmetric Hearing Loss: A Randomized Comparison of ESRT and Behavioral Methods
AU  - Meredith A. Holcomb
AU  - Jennifer Coto
AU  - Christina Sarangoulis
AU  - Tina Stern
AU  - Sandra Prentiss
AU  - E. Katelyn Glassman
AU  - Molly R. Smeal
PY  - 2026
DA  - 2026/11/04
JO  - Laryngoscope Investigative Otolaryngology
DO  - 10.1002/lio2.70601
UR  - https://doi.org/10.1002/lio2.70601
AB  - 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
SN  - 2378-8038
ER  -