Anatomy-Based Fitting for Cochlear Implants: Evaluation of Hearing Performance in Newly Implanted Cochlear Implant Users – A Randomized Clinical Trial

Antoine De Deurwaerdère, Thomas Gimenez, Vincent Péan, Pierre Valognes, Damien Bonnard
Clinical and Experimental Otorhinolaryngology. 2026-03-31; :
DOI: 10.21053/ceo.2025-00251

1. Clin Exp Otorhinolaryngol. 2026 Mar 31. doi: 10.21053/ceo.2025-00251. Online
ahead of print.

Anatomy-Based Fitting for Cochlear Implants: Evaluation of Hearing Performance
in Newly Implanted Cochlear Implant Users – A Randomized Clinical Trial.

Deurwaerdère A(1)(2), Gimenez T(1), Péan V(3), Valognes P(1), Bonnard D(1)(2).

Author information:
(1)Bordeaux University Hospital, Department of Otolaryngology-Head and Neck
Surgery, Bordeaux, France.
(2)University of Bordeaux, Bordeaux, France.
(3)Research department, MED-EL, Paris, France.

OBJECTIVES. The current settings of cochlear implants (CIs) do not respect
specific cochlear tonotopy, resulting in tonotopic mismatch and potentially
decreased auditory performance. The development of new implant settings adapted
to individual tonotopy, called anatomybased fitting (ABF), could improve the
auditory information coding, particularly by making surrounding sounds more
recognizable. This study aimed to evaluate whether ABF allows better
environmental sound recognition in new CI users compared to the conventional
setting (CS); and to investigate the effect of ABF on speech recognition in
quiet and noise.
METHODS. A prospective, randomized, double-blind, two-period cross-over study in
17 new CI users was performed between March 2022 and August 2024. Adult subjects
were recruited from candidates selected for cochlear implantation within a
single French university hospital. Newly implanted adult recipients of a MED-EL
cochlear implant with an electrode array insertion angle greater than 540° were
eligible. Subjects were randomized to receive either ABF or CS for 6 weeks, then
switched to the other setting for the same duration. Audiometric testing,
including Environmental Sound Identification Test (Test d’Identification des
Sons de l’Environnement, TISE), speech audiometry in quiet using Fournier lists,
and speech audiometry in noise (Vocale Rapide dans le Bruit, VRB) was performed
at 6 and 12 weeks.
RESULTS. Sixteen subjects (mean age 60 years [SD=15.1]) were analyzed. ABF
showed a significant improvement in the TISE score (mean effect (ME)=1.2, 95%
confidence interval (CI95%)=[0.3;2.0], standardized effect size (SES)=0.97,
p=0.016). Speech recognition in quiet was statistically better with CS (ME=3.6,
CI95%=[1.8;5.3], SES=1.4, p=0.001) while no statistically significant difference
was found for speech recognition in noise (CI95%=[- 2.8;0.1], p=0.08).
CONCLUSION. In newly implanted cochlear implant users, ABF improved
environmental sound recognition, suggesting improved perceived sound naturalness
in the first weeks after implantation. This benefit did not extend to speech
recognition in quiet and remains inconclusive in noise due to floor effect.