The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.

To evaluate the long-term effect of intracochlear steroid deposition on electrode impedance in patients with cochlear implants. A retrospective study was carried out comparing the impedances of cochlear implant electrodes with and without a single application of steroids in the cochlea. Ninety two implanted children with an average age of 5 years (range, 0.7 to 16 years) were divided in four groups according to the type of electrode and the use of steroids or not. In addition, the impedances of five children who required a reimplantation are reported. The impedances of Nucleus electrodes, either straight or Contour, were measured at regular intervals up to 12 months after surgery. Two months after surgery, the impedances in the steroid groups were significantly lower than in the nonsteroid groups (straight electrodes, 3.9 versus 4.7 kOhm, respectively; Contour electrodes, 5.4 versus 6.5 kOhm, respectively). This reduction remained stable over time for the straight electrodes, but for the Contour electrodes, it seemed to disappear after 6 months. The impedances after a second implantation were significantly higher than after a first implantation (median value, 8.8 kOhm after 2 months). The application of a single dose of a steroid solution reduces the electrode impedances significantly, and, for the straight electrodes, this effect seems to last. It seems justified to reimplant with caution, because this seems to increase the impedances substantially.

Objective: The software application FOX (‘Fitting to Outcome eXpert’) is an intelligent agent to assist in the programing of cochlear implant (CI) processors. The current version utilizes a mixture of deterministic and probabilistic logic which is able to improve over time through a learning effect. This study aimed at assessing whether this learning capacity yields measurable improvements in speech understanding. Methods: A retrospective study was performed on 25 consecutive CI recipients with a median CI use experience of 10 years who came for their annual CI follow-up fitting session. All subjects were assessed by means of speech audiometry with open set monosyllables at 40, 55, 70, and 85 dB SPL in quiet with their home MAP. Other psychoacoustic tests were executed depending on the audiologist's clinical judgment. The home MAP and the corresponding test results were entered into FOX. If FOX suggested to make MAP changes, they were implemented and another speech audiometry was performed with the new MAP. Results: FOX suggested MAP changes in 21 subjects (84%). The within-subject comparison showed a significant median improvement of 10, 3, 1, and 7% at 40, 55, 70, and 85 dB SPL, respectively. All but two subjects showed an instantaneous improvement in their mean speech audiometric score. Discussion: Persons with long-term CI use, who received a FOX-assisted CI fitting at least 6 months ago, display improved speech understanding after MAP modifications, as recommended by the current version of FOX. This can be explained only by intrinsic improvements in FOX's algorithms, as they have resulted from learning. This learning is an inherent feature of artificial intelligence and it may yield measurable benefit in speech understanding even in long-term CI recipients.

Objective: This study aims to assess the feasibility of autonomous cochlear implant (CI) fitting by adult CI recipients based on psychoacoustic self-testing and artificial intelligence (AI). Design: A feasibility study was performed on six adult CI recipients implanted with a Nucleus device. Two weeks after processor activation in the clinic, a ‘self-fitting’ session was organized in a supervised simulated home environment. The CI recipient performed pure tone audiometry and spectral discrimination tests as self-tests. The AI application FOX analysed the results and recommended a new map. The participants filled out a questionnaire and were tested again after 2 months of take-home experience. Results: Four out of six patients performed the self-tests without any help from the audiologist and four were fitted by FOX without any manual intervention. All patients were comfortable with the concept of self-testing and automated fitting. Patients acknowledged that at this stage the remote supervision of an audiologist remains essential. Conclusions: The study showed that audiological self-assessment and remote CI fitting with AI under the supervision of an audiologist is feasible, at least in a number of CI recipients. Currently, there are still some technical and regulatory challenges to be addressed before this can become routine practice.

Cochlear's new sound processor system (Nucleus(®) 6) features a new noise reduction algorithm called SNR-NR (signal-to-noise ratio), and an environmental classifier called SCAN, which activates the appropriate sound coding algorithms for a given listening environment. In addition, the sound processors (CP910 and CP920) have a data logging feature with data visually summarized using clinical programing software and come with two remote controls, CR210 and CR230. The objective of this clinical study was to conduct a field acceptance study comparing the user experience with the Nucleus(®) 6 to the Nucleus(®) 5 system and to evaluate the benefits of Nucleus(®) 6 in an adult population currently equipped with the previous generation Nucleus(®) 5 sound processor. Our primary objective was to compare speech recognition in speech-weighted noise using Nucleus(®) 6 with SCAN (activating SNR-NR) with the default Nucleus(®) 5 'Noise' Program. Secondary objectives included comparisons of speech recognition in quiet, subjective performance feedback via questionnaires and diaries, and recipient preference for device and program type. A prospective controlled trial was conducted with 30 adult Nucleus CI recipients using the Nucleus(®) 5 sound processor (condition A). The Nucleus(®) 6 sound processor (condition B) was evaluated in a within-subject ABBA design, with repeated speech in noise (S0N0, LIST sentence test), and speech in quiet testing (S0, NVA words). The remote controls were randomly given during the two B intervals. In addition, recipients had to complete questionnaires and diaries on the use of their current as well as new sound processors and remotes. The group mean speech reception threshold in noise (SRT50) with Nucleus(®) 6 SCAN was significantly better (1.2 dB SNR) than with the Nucleus(®) 5 'Noise' Program. Mean speech recognition scores in quiet were not significantly different between the processors. Subjective performance feedback (APHAB) did not show a significant difference between Nucleus(®) 6 and Nucleus(®) 5 with high satisfaction scores being reported for both sound processors. Recipients preferred the SCAN program in noise and reported a clear overall preference for the Nucleus(®) 6 system. Clinicians were satisfied with the conversion process from Nucleus(®) 5 to Nucleus(®) 6. SNR-NR provides a significant benefit in noise. Recipients were easily converted from Nucleus(®) 5 to Nucleus(®) 6 requiring little or no sound quality adjustment period. The Nucleus(®) 6 SCAN program was well accepted by the majority of recipients for use during their daily life.

To evaluate the possible impact of 'Fitting to Outcomes eXpert (FOX(®))' on cochlear implant (CI) fitting in a clinic with extensive experience of fitting a range of CI systems, as a way to assess whether a software tool such as FOX is able to complement standard clinical procedures. Ten adult post-lingually deafened and unilateral long-term users of the Advanced Bionics(TM) CI system (Clarion CII or HiRes 90K(TM)) underwent speech perception assessment with their current clinical program. One cycle 'iteration' of FOX optimization was performed and the program adjusted accordingly. After a month of using both clinical and FOX programs, a second iteration of FOX optimization was performed. Following this, the assessments were repeated without further acclimatization. FOX prescribed programming modifications in all subjects. Soundfield-aided thresholds were significantly lower for FOX than the clinical program. Group speech scores in noise were not significantly different between the two programs but three individual subjects had improved speech scores with the FOX MAP, two had worse speech scores, and five were the same. FOX provided a standardized approach to fitting based on outcome measures rather than comfort alone. The results indicated that for this group of well-fitted patients, FOX improved outcomes in some individuals. There were significant changes, both better and worse, in individual speech perception scores but median scores remained unchanged. Soundfield-aided thresholds were significantly improved for the FOX group.