Electrical Cochlear Response as an Objective Measure of Hearing Threshold and Hearing Performance Evaluation in Pediatric Cochlear Implant Users

  • Agar Karina Quintana López Universidad Autonoma Metropolitana
  • Nohra Elsy Beltran Vargas Universidad Autonoma Metropolitana
  • Maria del Pilar Granados Trejo Universidad Autónoma Metropolitana
  • Juan Manuel Cornejo-Cruz Universidad Autónoma Metropolitana
Keywords: Electro-acoustic test, Frequency specificity, Intensity calibrated sounds, Hearing performance


The difficulties of applying the audiometry in pediatric populations and its methodological limitations in implanted patients have spurred the development of new alternative auditory evaluation methods. This study aimed to show an objective method to estimate hearing thresholds in pediatric cochlear implanted patients through Electrical Cochlear Response (ECR) and to quantify the hearing performance by using an Auditory Skills Questionnaire (ASQ) and a Calibrated Sounds Test (CST) designed on purpose. Eighteen implanted patients, 1-6 years old underwent standard audiometry, ECR, and ASQ in two evaluation sessions T1 and T2. At T2, in addition, patients underwent CST. For patients ≤3 years old (G1), Pure Tone Averages PTA and PTAECR showed a statistically significant difference between them at T1 and T2. At T2 improvements in audiometric and ECR thresholds were observed (p<0.05), regarding T1. Patients older than 3 years (G2) had significantly better ASQ and CST scores. CST detection scores at 40 dBHL for groups G1 and G2, 36% and 70% respectively, showed a better relationship to ECR thresholds. The relationship observed between ECR thresholds and CST detection scores seems to confirm that ECR brings the feasibility of objective hearing threshold estimation and provides a better frequency resolution than audiometry.


Download data is not yet available.


Flores-Beltran L. The Auditory-Verbal Therapy: a Trainning Program for Professionals in the Field of Hearing Disorders [Ph.D.'s thesis]. [Honolulu]: Atlantic International University, 2007. 251p.

Manrique Rodríguez M, Huarte Irujo A. Organisation of a Cochlear Implant Programme. Acta Otorrinolaringol [Internet]. 2013;64(1):55-67. Available from: https://doi.org/10.1016/j.otoeng.2013.02.006

Mitchell RM, Christianson E, Ramirez R, Onchiri FM, Horn DL, Pontis L, et al. Auditory comprehension outcomes in children who receive a cochlear implant before 12 months of age. Laryngoscope [Internet]. 2020;130(3):776-81. Available from: https://doi.org/10.1002/lary.28061

Baudhuin J, Cadieux J, Firszt JB, Reeder RM, Maxson JL. Optimization of Programming Parameters in Children with the Advanced Bionics Cochlear Implant. J Am Acad Audiol [Internet]. 2012;23(5):302-12. Available from: https://doi.org/10.3766/jaaa.23.5.2

Eisenberg LS. Clinical Management of Children With Cochlear Implants. 2nd ed. San Diego: Plural Publishing Inc; 2009. 890p.

Guenser G, Laudanski J, Phillipon B, Backus BC, Bordure P, Romanet P, et al. The relationship between electrical auditory brainstem responses and perceptual thresholds in Digisonic® SP cochlear implant users. Cochlear Implants Int [Internet]. 2015;16(1):32-8. Available from: https://doi.org/10.1179/1754762814Y.0000000082

Lira De Andrade KC, De Caevalho Leal M, Ferreira Muniz L, De Lemos Menezes P, Gomes De Albuquerque KM, Tenório A. The importance of electrically evoked stapedial reflex in cochlear implant. Braz J Otorhinolaryngol [Internet]. 2014;80(1):68-77. Available from: https://doi.org/10.5935/1808-8694.20140014

Gattaz G, Battmer RD, Lehnhardt E, Gnadeberg D. [Correlation between electrically-induced stapedius reflex and discomfort threshold in cochlear implant patients]. HNO [Internet]. 1992;40(12):480-3. German. Available from: https://pubmed.ncbi.nlm.nih.gov/1493968/

Van Den Abbeele T, Noël-Petroff N, Akin I, Caner G, Olgun L, Guiraud J, et al. Multicentre investigation on electrically evoked compound action potential and stapedius reflex: how do these objective measures relate to implant programming parameters? Cochlear Implants Int [Internet]. 2012;13(1):26-34. Available from: https://doi.org/10.1179/1754762810Y.0000000001

Walkowiak A, Lorens A, Polak M, Kostek B, Skarzynski H, Szkielkowska A, et al. Evoked Stapedius Reflex and Compound Action Potential Thresholds versus Most Comfortable Loudness Level: Assessment of Their Relation for Charge-Based Fitting Strategies in Implant Users. ORL [Internet]. 2011;73(4):189-95. Available from: https://doi.org/10.1159/000326892

Marsella P, Scorpecci A, Pacifico C, Resca A, Vallarino MV, Ingrosso A, et al. Safety and Functional Results of Early Cochlear Implant Switch-On in Children. Otol Neurotol [Internet]. 2014;35(2):277-82. Available from: https://doi.org/10.1097/mao.0000000000000259

Botros A, Banna R, Maruthurkkara S. The next generation of Nucleus® fitting: a multiplatform approach towards universal cochlear implant management. Int J Audiol [Internet]. 2013;52(7):485-94. Available from: https://doi.org/10.3109/14992027.2013.781277

American Speech-Language-Hearing Association. Guidelines for Methods for Manual Pure-Tone Threshold Audiometry [Internet]. New York: Acoustical Society of America; 2004. Available from: https://www.asha.org/policy/gl2005-00014/

Caner G, Olgun L, Gültekin G, Balaban M. Optimizing Fitting in Children Using Objective Measures Such as Neural Response Imaging and Electrically Evoked Stapedius Reflex Threshold. Otol Neurotol [Internet]. 2007;28(5):637-40. Available from: https://doi.org/10.1097/mao.0b013e3180577919

Katz J. Hand book of clinical audiology. 7th ed. Philadelphia: Wolters Kluwer; 2009. 927p.

Cosetti M, Shapiro W, Green J, Roman B, Lalwani A, Gunn S, et al. Intraoperative Neural Response Telemetry as a Predictor of Performance. Otol Neurotol [Internet]. 2010;31(7):1095-9. Available from: https://doi.org/10.1097/mao.0b013e3181ec1b8c

Gifford RH. Cochlear Implant Patient Assessment: Evaluation of Candidacy, Performance, and Outcomes. 2nd ed. San Diego: Plural Publishing Inc; 2020. 189p.

Cornejo Cruz JM, Granados Trejo MP, inventors; Systems and methods for detecting and using an electrical cochlear response (“ECR”) in analyzing operation of a cochlear stimulation system. WO2010041920A1. 2010. Spanish.

Quintana A, Beltran N, Granados PM, Chamlati E, Mena M, Cornejo JM. Objective Approach to Audiometry in the Pediatric Implanted Patient. In: Braidot A, Hadad A. (eds.). VI Latin American Congress on Biomedical Engineering CLAIB 2014 [Internet]. Paraná, Argentina: IFMBE Proceedings, Springer Cham. 2014;49:707-10. Available from: https://doi.org/10.1007/978-3-319-13117-7_180

Cavicchiolo S, Mozzanica F, Guerzoni L, Murri A, Dall’Ora I, Ambrogi F, et al. Early prelingual auditory development in Italian infants and toddlers analysed through the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS). Eur Arch Otorhinolaryngol [Internet]. 2018;275(2):615-22. Available from: https://doi.org/10.1007/s00405-017-4847-6

Dos Santos Pedrett M, Pedrett Costa MB. Application of RDLS scale to characterize oral language profiles in children using cochlear implant. CoDAS [Internet]. 2019; 31(5):1-7. Portuguese. Available from: https://doi.org/10.1590/2317-1782/20192018158.

Klem GH, Lüders HO, Jasper HH, Elger C. The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl. 1999;52:3-6.

Fu Y, Chen Y, Xi X, Hong M, Chen A, Wang Q, Wong L. [Development of early auditory and speech perception skills within one year after cochlear implantion in prelingual deaf children]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;50(4):274-80. Chinese.

Ling D. Speech and the hearing-impaired child Theory and Practice. Washington: The Alexander Graham Bell Association’for the Deaf. Inc; 1976. 402p.

Archbold S. Organisation of the Nottingham Paediatric Cochlear Implant Programme. Central East Eur J. 1996;1(1):20-7.

NCSS Software. NCSS 9 Statistical Software. Kaysville, Utah, USA. 2013.

El Shennawy AM, Mashaly MM, Shabana MI, Sheta SM. Telemetry changes over time in cochlear implant patients. Hear Balance Commun [Internet]. 2016;13(1):24-31. Available from: https://doi.org/10.3109/21695717.2014.999427

Moura ACG, Goffi-Gomez MVS, Couto MIV, Brito R, Tsuji RK, Befi-Lopes DM, et al. Longitudinal Analysis of the Absence of Intraoperative Neural Response Telemetry in Children using Cochlear Implants. Int Arch Otorhinolaryngol [Internet]. 2014;18(4):362-8. Available from: https://doi.org/10.1055/s-0034-1372510

How to Cite
Quintana López, A. K., Beltran Vargas, N. E., Granados Trejo, M. del P., & Cornejo-Cruz, J. M. (2020). Electrical Cochlear Response as an Objective Measure of Hearing Threshold and Hearing Performance Evaluation in Pediatric Cochlear Implant Users. Mexican Journal of Biomedical Engineering, 41(3), 72-86. Retrieved from https://rmib.com.mx/index.php/rmib/article/view/1111
Research Articles