Intraoperative electrically evoked stapedial reflex thresholds (eSRT) for cochlear implant programming: a postoperative validation study

Objective To determine if intraoperative electrically evoked stapedial reflex thresholds (eSRT) correlate with postoperative eSRT and can predict programming levels in cochlear implant patients.Design Prospective cohort study conducted at a tertiary hospital. Seventy-seven patients who underwent cochlear implant surgery were included. Intraoperative and postoperative eSRT testing was performed at electrodes E1, E6, E12, E17, and E22, with postoperative testing conducted at a median of 4 weeks.Results Eighty-four cochlear implants in 77 patients met inclusion criteria, with intraoperative eSRT attempted in 72 ears and postoperative testing in 50. Intraoperative response rates were significantly higher than postoperative rates overall (83.1% vs. 70.9%, p = 0.0005), with the highest rates at middle and apical electrodes. Median intraoperative thresholds were significantly higher than postoperative thresholds (21.2 vs. 15.6, p < 0.0001), but no significant correlations were observed between the two time points.Conclusion Intraoperative eSRT was feasible and yielded high response rates, particularly at apical and middle electrodes. However, intraoperative thresholds did not correlate with early postoperative values and cannot currently predict early postoperative eSRTs. These findings support the utility of intraoperative eSRT as a qualitative intraoperative tool, but further refinement is needed to improve its predictive value for postoperative cochlear implant programming.