arXiv:2610.41054v1 Announce Type: new Abstract: Purpose: Patient-specific electro-anatomical models (EAMs) of the implanted cochlea are crucial for auditory nerve fiber simulation in cochlear implant (CI) programming and neural health estimation. Fitting an EAM to the stimulation current induced non-stimulating electrode voltage (SCINSEV) currently requires manual expert adjustment or exhaustive search over precomputed forward solutions, neither of which scales to routine clinical use. We present an automated optimization pipeline that fits patient specific EAMs in minutes. Methods: Four compartment tissue label maps (perilymph, soft tissue, modiolus, and bone) derived from postoperative CT were used to construct a finite difference forward model, fitted to the measured SCINSEV by Gaussian process Bayesian optimization. Three reductions cut fitting cost: a coarsened grid with trilinear injection and readout at sub-voxel contact positions; solving half the stimulating contacts and completing three quarters of the matrix by reciprocity; and a Jacobian-based identifiability analysis reducing four resistivities to two. Each reduction was validated separately against the measurement's reciprocity residual and the reproducibility of the fit. Results: Across 43 implanted ears, fitting took a median of 2.6 minutes per ear. Median SCINSEV RMSE on the reduced-resolution objective was 0.069 mV, against 0.084 mV for grid search at a matched evaluation budget. Against an exhaustive full-resolution grid search requiring a median of 9.1 hours per ear, the pipeline reached statistically indistinguishable fitting error roughly 210x faster. Conclusion: Patient-specific cochlear EAM fitting can be performed at clinically practical timescales without expert supervision, removing a major computational barrier to patient-specific cochlear implant programming and cochlear simulation.