Page 55 - Spring 2019
P. 55

The Remarkable Cochlear
Implant: and Possibilities for
the Next: Large Step Forward
Blake 5. Wilson The modern cochlear implant is an astonishing success; however,
Addrm: room remains for improvement and greater access to this already-marvelous
2410 Wrightwood Avenue ’"""°1°g)’-
Durham. North Carolina 27705 In can"
USA The modem cochlear implant (Cl) is a surprising achievement. Many experts in
A15” “[5 otology and auditory science stated categorically that pervasive and highly syn-
D“k9 Unl"“5l‘Y chronous activation of neurons in the auditory nerve with electrical stimuli could
cheslflfield Building not possibly restore useful hearing for deaf or nearly deaf persons. Their argument
701 W55‘ Main 5”?“ in essence was “how can one have the hubris to think that the exquisite machin-
R°°m 4122- 5“i‘‘'- 410 ery of the inner ear can be replaced or mimicked with such stimuli?” They had a
Durham. North Carolina 27701 Po-mg
USA
However, the piece that everyone, or at least most everyone, missed at the begin-
E"““l‘ ning and for many years thereafter was the power of the brain to make sense of a
bk-k‘-“’“5°“@d“k“-Ed“ sparse and otherwise unnatural input and to make progressively better sense of it
over time. In retrospect, the job of designers of CIS was to present just enough in-
formation in a clear format at the periphery such that the brain could “take over"
and do the rest of the job in perceiving speech and other sounds with adequate ac-
curacy and fidelity. Now we know that the brain is an important part of the pros-
thesis system, but no one to my knowledge knew that in the early days. The brain
“saved us” in producing the wonderful outcomes provided by the present-day Cls.
And indeed, most recipients of those present devices use the telephone routinely,
even for conversations with initially unfamiliar persons at the other end and even
with unpredictable and changing topics. That is a long trip from total or nearly
total deafness!
Now, the Cl is widely regarded as one of the great adwnces in medicine and in en-
gineering. Recently, for example, the development of the modern CI has been rec-
ognized by major international awards such as the 2013 Lasker~DeBakey Clinical
Medical Research Award and the 2015 Fritz I. and Dolores H. Russ Prize, just to
name two among many more.
As of early 2015, more than half a million persons had received a CI on one side
or two Cls, with one for each side. That number of recipients exceeds by orders of
magnitude the number for any other neural prosthesis (e.g., retinal or vestibular
prostheses). Furthermore, the restoration of function with a Cl far exceeds the
restoration provided by any other neu.ral prosthesis to date.
01' course, the CI is not the first reported substantial restoration of a human sense.
The first report, if I am not mistaken, is in the Gospel of Markin the New Testa-
ment (Mark 7:31-37), which describes the restoration of hearing for a deaf man by
Iesus. The CI is the first restoration using technology and a medical intervention
and is similarly surprising and remarkable.
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