Table 1.

Characteristics of the studies included in the integrative review.

	Author	Year/Country	Study type	Grade of recommendation/Level of scientific evidence	Objective	Sample	Age range in years	Mean age in years	Assessment	Results	Conclusion
1.	Stephan et al.18	1988/Austria	Case report	C/4	To develop a method that provides information on the dynamic area for electrical stimulation	12 users of CI	Not reported	Not reported	ESRT and C level	ESRT was observed, mostly above the dynamic range of electrical stimulation of the electrodes.	ESRT can provide appropriate assistance in adjusting the speech processor of the CI in inconsistent patients.
2.	Battmer et al.19	1990/Germany	Case report	C/4	To assess the use of ESRT for the definition of objective data in the speech processor	25 users of CI	19 to 68	42.8	ESRT	76% showed ESRT and a reflex amplitude saturation was observed in 56% of the sample.	ESRT can be used in the initial C level programming of the speech processor of CI.
3.	Stephan et al.20	1991/Austria	Case report	C/4	To analyze the usefulness and ESRT threshold values in the CI process	21 users of CI	Not reported	Not reported	ESRT, and C and T levels	ESRT was observed in 11 patients, and there was no correlation between the reflex threshold and the sensitivity threshold.	ESRT can estimate the upper limit of the dynamic range of the CI.
4.	Spivak et al.21	1994/USA	Case report	C/4	To assess the association between C levels and ESRT in adults and children using CI	35 users of CI	5 to 70	Not reported	ESRT and C level	ESRT differed from C levels in behavioral tests by an average of 19.4 units of stimulus level for adults and 9.6 units of stimulus level for children.	Data from the ESRT can be very useful in programming the CI of adults and children with inconsistent responses
5.	Van den Borne et al.22	1996/ the Netherlands	Case report	C/4	To compare the ESRT in the intraoperative and postoperative periods, as well as the C level	19 users of CI	Not reported	Not reported	ESRT and C level	The ESRTs in the intraoperative period were higher than those in the postoperative period and higher than C levels.	ESRT, especially for children with meningitis etiology, in the intraoperative period, is a poor predictor of C levels.
6.	Bresnihan et al.23	2001/Ireland	Case report	C/4	To assess the use of ESRT to measure C levels in children with CI and compare these results with behavioral methods	26 users of CI	2 to 9	4.9	ESRT, tympanometry, and behavioral measures	The C levels obtained from ESRT were considered lower than those btained with behavioral techniques.	The estimation of C level through ESRT is reliable and objective, and therefore a valuable programming tool in the pediatric population
7.	Gordon et al.24	2004/Canada	Case report	C/4	To report behavioral and electrophysiological responses in child candidates for CI	68 candidates for CI	0.7 to 17	4.6	ESRT, BAEP, ECAP, and C levels	BAEP and ECAP thresholds did not significantly change from the 1st to the 12th month of CI use, while ESRT and C levels increased	Nonbehavioral, intraor postoperative measures may assist in determining levels of stimulation in the CI, particularly in young children
8.	Mason25	2004/United Kingdom	Case report	C/4	To perform a retrospective study on the implementation of the electrophysiological and objective measures and their value when managing children with a CI	29 users of CI	Not reported	Not reported	BAEP, ECAP, and ESRT	ESRT was observed in 28 patients, BAEP in 27, and ECAP in 29.	Objective electrophysiological measures not only assist in the initial installation of the CI, but also provide valuable data for future device programming.
9	Caner et al.26	2007/Turkey	Case report	C/4	To investigate the association between NRT, ESRT, and behavioral outcomes	16 users of CI	Not reported	Not reported	ESRT, NRT, and behavioral measures	NRT was obtained in 91.7% of patients intraoperatively and 94.2% postoperatively. ESRT in 80% intraoperatively. ESRT levels were higher than NRT levels.	The two objective measures, together with the behavioral responses, should be included in the CI programming process to avoid setting C levels too high.
10.	Pau et al.27	2011/Germany	Case report	C/4	To compare the intraoperative and postoperative ESRT and tympanometry results	Six users of CI	Not reported	Not reported	Visual observation and tympanometry	There are no major differences between the two techniques used in the intraoperative period, but there are differences when comparing the intra- and postoperative periods.	ESRT valuesobtained intraoperatively are not suitable for exact definitions used for programming the speech processor of the CI.
11.	Cinar et al.17	2011/Turkey	Cohort	B/2B	To investigate the effectiveness of objective techniques in the programming of speech processors for cochlear implant users with cochlear malformations	35 users of CI	Not reported	Not reported	BAEP, ECAP, and ESRT	ECAP, BAEP, and ESRT thresholds differ from one another in both groups	BAEP is a more reliable measure than ECAP or ESRT
12.	Walkowiak et al.28	2011/Poland	Case report	C/4	To assess the viability of using ESRT and ECAP in the speech processor programming of a Medel CI	30 users of CI	18 to 66	45	ESRT, ECAP, and C level	In the adult population, the correlation between the ESRT and C level was better for apical, medial, and basal electrodes than between ECAP and C level. There was no significant difference in the mean values obtained for ECAP and ESRT in children and adults in any of the tested electrodes	Although ESRT has a better association with C levels, both ESRT and ECAP are useful in creating CI maps for children

ESRT, electrically evoked stapedius reflex threshold; ECAP, electrically evoked compound action potential of the auditory nerve; BAEP, brainstem auditory electrically evoked potential; NRT, neural response telemetry; CI, cochlear implant; C level, level of maximum sensation intensity that the patient will accept for electrical stimulation without discomfort; Τ level, threshold for electrical stimulation.