The Long-Term Stability of the Electrical Stapedial Reflex ... · A group of us were interested in...
Transcript of The Long-Term Stability of the Electrical Stapedial Reflex ... · A group of us were interested in...
The Long-Term Stability of the Electrical Stapedial Reflex
Threshold; A Retrospective Chart Review
Cache Pitt, AuD, CCC-AKaren Munoz, EdD, CCC-AMcKay Kunz, AuD, CCC-A
Disclosure
Employed at Utah State University
Audiology Advisory Board Member, MedEl
Introduction
The electrical stapedial reflex threshold (eSRT) is a valid and reliable tool for establishing upper limits of loudness Hodges, et al 1997
Brickley, et al 2005
Walkowiak et al 2010
Introduction
Purpose of the study – 2 questions 1. Investigate the stability of eSRT over time…How much does eSRT change
over time?
2. What is the relationship between eSRT and the upper limit of loudness…Where do I put the upper limit of loudness (C, M, MCL) based on eSRT
Methods
Study design (Utah State University IRB Approved)
206 clinic files were reviewed between January 2013 and December 2015
% (n) M (SD)Subject Demographics
Male 55% (113)Female 45% (93)Age at implantation (in months) 15 (24)Age at hearing loss onset (in months) 5 (14)Bilateral implants 61% (125)Unilateral right implant 22% (46)Unilateral left implant 17% (35)
Methods
Study design (Utah State University IRB Approved)
206 clinic files were reviewed between January 2013 and December 2015
% (n) M (SD)Subject Demographics
Male 55% (113)Female 45% (93)Age at implantation (in months) 15 (24)Age at hearing loss onset (in months) 5 (14)Bilateral implants 61% (125)Unilateral right implant 22% (46)Unilateral left implant 17% (35)
Methods
Study design (Utah State University IRB Approved)
206 clinic files were reviewed between January 2013 and December 2015
% (n) M (SD)Subject Demographics
Male 55% (113)Female 45% (93)Age at implantation (in months) 15 (24)Age at hearing loss onset (in months) 5 (14)Bilateral implants 61% (125)Unilateral right implant 22% (46)Unilateral left implant 17% (35)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Other subject demographics% (n) M (SD)
Individual Participants with eSRT 77% (159)eSRT obtained ipsilaterally 64% (102)eSRT obtained ipsilaterally & contralaterally 26% (42)eSRT obtained contralaterally 10% (15)
Individual Participants without eSRT 23% (47)Total Appointments (n=903)
eSRT obtained 59% (537)No reflex present 21% (189)eSRT not tested 20% (181)
Reason eSRT not tested Patient behavior (e.g., cooperation) 35% (64)Other (e.g., hookup appointment) 35% (63)Middle ear (e.g., present tubes, fluid) 20% (36)History that patient could not tolerate loudness 6% (10)Equipment problem 4% (8)
Results
Relationship between eSRT and upper limits of loudness Established by globally decreased M, C, MCL until patient reported overall
loudness comfort.
Advanced Bionics Cochlear MedEl
10% 3%19 units
Results
Long-term stability of eSRT
Established by comparing eSRT values for at least 3 different points in time within the same individual (linear regression line) 43% of the patients met this criteria
Time Span of 3 appointments
Mean 20.7 Months
Median 23 Months
Range 4-34 Months
Results
Rate of change in eSRT per year
Advanced Bionics 3 clinical units
Cochlear -1.4 clinical units
MedEl 0.4 clinical units
Conclusions
Sample is very large
eSRT is stable over time for at least a period of 20 months
The relationship between eSRT and upper limit of loudness was established
Other interesting conclusions include eSRT is present in most cases (77%) and
eSRT is recorded in the ipsilateral condition the majority of the time (64%)
Contact