Evaluation of the ‘Fitting to Outcomes eXpert’ (FOX^®) with established cochlear implant users

Objectives: 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. Methods: Ten adult post-lingually deafened and unilateral long-term users of the Advanced Bionics CI system (Clarion CII or HiRes 90K) 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. Results: 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. Conclusion: 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.