Sounds from a Gold Box

Even pieces of highly developed medical technology have stories behind them. The cochlear implant or ‘bionic ear’ was invented in Australia and has restored hearing to thousands of profoundly deaf patients. Its prototypes are now kept in collections, preserving the process of their development. [Scroll down past the interview if you’d like to read more on this history]

first commerical cochlear

It was an absolute pleasure to interview Professor Richard Dowell, the audiologist on the team that produced the first cochlear implant, about his memories of these prototypes. We sat down in his office at the School of Audiology, with trams juddering past.

Trunk: How did you get involved in working with the cochlear implant?

Professor Dowell: I had a science degree and didn’t know what I wanted to do with it. I was interested in hearing because I was a musician. My Mum had done voluntary work at the Eye and Ear Hospital, so she knew about Professor Clark. She said something like, “There’s this crazy guy who is trying to cure deafness”. Audiology was a pretty new thing at that time. I applied and got in.

I did enjoy audiology because it was about applying some of the science I had learnt. Then I got offered a job working with Professor Clark as a research assistant. There was just a small team, but I knew what they were doing. I wasn’t that keen on the other jobs in audiology. I thought they might end up being a bit boring, but this all sounded like science fiction – the cochlear implant business, the bionic ear. That seemed to be the exciting thing. 

T: Apart from seeing recipients having hearing restored, what has been the most rewarding thing about working on the early stages of developing the cochlear implant?

PD: Back at that time most people in the world and certainly in Australia, surgeons and audiologists, thought this was a lot of nonsense. You were fighting…trying to do something worthwhile, but really fighting against established views. Some thought that cutting someone’s head open and putting something in was a dangerous idea. They thought it would be impossible for such a device to give back any reasonable hearing.

Things changed once we started getting results. It was very rewarding from a clinical perspective, but also rewarding from the scientific point of view because there was all this negative talk around. People really thought it couldn’t be done. Once we got to a stage where it looked like it was going to happen, that was very rewarding. It took a while though. By around the end of the Eighties we knew it was going to be a big thing.

T: Do you think it is useful to keep old models and those early prototypes in historical collections?

PD: I actually want to set up a display in our building of old hearing aids and cochlear implant bits and pieces. It is interesting to get people to think about the history of how this came to be.

The cochlear implant has become a standard procedure. People don’t think about it as science fiction anymore. We have a habit of taking stuff for granted, human beings. I mean smart phones have only been around since about 2007, really. They transformed the world. You don’t think about how technology and other things in health have changed so dramatically. It’s good to look back at how some of these things happened.

In the case of the cochlear implant work in Melbourne, we had just a small group of relatively young people. I think one of the strengths of what went on then was that you did have people who were quite young, myself and others, who were not set in their ways. Those established views were coming down at us, but if you’re new to it you’re not so worried about saying, “Why don’t we try that? Maybe they’re wrong.” Looking back on how these things get started is of interest to understand what might be needed to challenge established ideas today.

 T: Has the technology led to developments or changes in areas you weren’t expecting?

PD: If we go back to those early days, even I didn’t expect that it would work but I was keen to give it the best possible try. However, we did get to a stage pretty quickly where we realised that this might do some actual good. The main thing for me that is beyond anything that we would have predicted is that now, because of the improvements in the cochlear technology, there’s just about half a million in the world with cochlear implants – that’s mind boggling to me. About half of those are getting a level of hearing that makes a life-changing difference to their communication. Some of them have better hearing than me! I’m getting old and losing some of my high frequency hearing. It’s just extraordinary. I couldn’t have believed that.

And has it spread out into other things? Well, the technology is being used for the current bionic eye work in Melbourne. That hasn’t come to fruition yet. It might still be a few decades away, but they use the same technology. The electronic stimulation technology is tried and true. You know it’s reliable. They know how to seal up the electronics, how to put them in the body and not let fluid in. I don’t know if anyone knows about that – there’s bionic eye work that’s being done right now, but the internal electronics are in fact those used in the cochlear implant.

T: I’m interested in the link between art, science and society. How do you think hearing connects these things?

PD: There are quite a few philosophical questions that come up with cochlear implants. You can ask if it is the right thing to do to put electronic devices that are interfacing directly with someone’s brain, because it’s the start of that connection people have to the world around them. People have talked about this in science fiction but it is now science fact.

Can we interface to the nervous system in better ways? There’s a lot of work going into that sort of thing (to interface closely with the brain so you just think something and it happens). Instead of your phone being able to remotely control everything in your house, you might be able to just think a command and your roller door goes up at home. Implanting things into people’s heads, however, is not a trivial thing to do. There many ethical and safety issues, but it opens up ideas of what might be possible. We have a successful neural prosthesis with the cochlear implant and, as technology gets smaller and more sophisticated, it does open up lots of questions for society to think about.

On the arts side? Well, for people who used to be musicians or who used to really enjoy music, getting back hearing of any type is fantastic from the point of view of enjoying that art again. This is quite a surprising thing to me. We used to try and simulate what music sounded like through the cochlear implant, and all our attempts came out sounding so awful that you couldn’t believe anyone would like to listen to music through it. The cochlear implant was originally designed specifically for coding speech. When people get a cochlear implant (and if they’ve previously had some hearing before their loss), they often say on day one that it sounds terrible. After three months, maybe even a year, their brain adjusts to this different input.

Many say they’re even happy using it for music. I think a lot of that relies on their memory of music because we know there are certain things that the cochlear implant cannot do. I’ve not tested some of these people, but there’s a musician in the United States who’s a keyboard player who uses cochlear implants. He said he had to work at getting his brain to learn the subtle things about how everything was sounding, but claims that it is just as good as before he lost his hearing. The brain is amazing.

Professor Dowell points to a bright pink and blue painting, spiralling round in patterns above his desk…

PD: I have a picture on my wall here. I bought it because this bit here looks exactly like the electrode array that goes into the inner ear in one of these cochlear devices. The artist had no idea of this, but there’s a bit of art that crossed over into the science of the cochlear implant – the world is a strange place.

Professor Dowell is the current Director of the Royal Victorian Eye and Ear Hospital Cochlear Implant Clinic and Chair in Audiology and Speech Science at the University of Melbourne.

 

The Gold Box

cochlear prototype

This original ‘gold box’ prototype cochlear implant was used in surgery on Rod Saunders in 1978. It is kept among 15 other prototype pieces as part of the Graeme Clark Collection at the National Museum of Australia. Professor Clark was appointed Founding Professor of the Department of Otolaryngology at the University of Melbourne in 1970. He led a team of engineers and audiologists in developing this device. What started off as a small but ambitious Australian invention went on to improve the quality of life of thousands worldwide. Today, almost half a million people of all ages hear using a cochlear implant.

The ‘golden box’ design had early success that provided the evidence used to justify clinical trials and eventually commercial production. On first testing whether the implant had worked, Rod Saunders jumped up and saluted to indicate that he could hear a recording of ‘God Save the Queen’ being played in the background. Another two key implant prototypes followed, with George Watson being the second recipient in 1981 and Graham Carrick receiving the first commercial ‘Nucleus’ cochlear implant in 1982. Nothing happened for fifteen anxious minutes after Carrick’s surgery. Then he heard the sound of a doorbell.

Professor Richard Dowell, the audiologist on Clark’s team, can be seen below testing the cochlear implant with Carrick.

1982 implant

While a hearing aid increases the volume of sound, a cochlear implant sends electrical impulses to the nerve endings in the inner ear across ‘channels’. The more channels, the better the sound. It might surprise you that the cochlear implant does not provide the ‘perfect’ hearing you are used to. However, it is worth remembering that there are variations in normal. The implant provides a greater range of hearing than most recipients can remember. Prototypes like those in the National Museum’s collection only had 8 channels whereas today’s have around 22. Early noises from the cochlear implant were often described as sounding like Mickey Mouse.

Here’s a simulation if you’re curious:

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