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

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