OBJECTIVE: To evaluate the relationship between open-field stapedius reflex thresholds (oSRT) and word recognition scores (WRS) in cochlear implant (CI) users and to assess the effectiveness of electrically evoked stapedius reflex threshold (eSRT)-based CI fitting compared with conventional subjective fitting.

DESIGN: In this prospective study, oSRTs and WRS were measured in 39 experienced MED-EL CI users (44 ears) fitted by subjective methods. The CI users were classified into three groups according to whether their oSRTs were above, within or below a reference range derived from normal-hearing listeners. A subset of 15 CI users also underwent an alternative fitting procedure based on eSRT, and WRS were re-evaluated.

RESULTS: Subjects with oSRTs within the reference range showed significantly better WRS (mean 53%) compared with those who had oSRTs above or below the range (mean 30%). eSRT-based fitting improved mean WRS in both groups.

CONCLUSIONS: oSRTs outside the 'normal' range are associated with poorer speech perception, supporting their use as an objective marker for under- or overstimulation. Furthermore, eSRT-based fitting improves speech outcomes and may optimise stimulation even in seemingly well-fitted users. These findings emphasise the potential value of incorporating objective measures such as oSRT and eSRT into routine fitting procedures.