I Can Hear You Whisper (11 page)

Bill House told me he had been a mediocre student. Later in life, he realized he probably had dyslexia; writing and reading were always a challenge. But he excelled at working with his hands—a skill his dental training helped hone—and became a top-notch surgeon. He was also driven to solve problems. He spent hours in the morgue, practicing surgical techniques and new approaches on unclaimed bodies. His wife, June, was a registered nurse. If she could get a babysitter, she joined him in the morgue to hand over his instruments.

One of House's first innovations was to introduce and improve upon the use of a surgical microscope for ear surgery. He developed new surgical techniques for acoustic neuromas that he says helped reduce mortality
from 40 percent to less than 1 percent and preserved the facial nerve. For patients with Ménière's disease, a disease of the inner ear whose symptoms include vertigo, vomiting, tinnitus, and hearing loss, he created a small device, a shunt, to correct the condition. His most famous patient was astronaut
Alan Shepard, who developed Ménière's after his first space flight. With one of House's shunts in place, Shepard went back into space as commander on Apollo 14. A grateful Shepard invited House and his wife to Cape Canaveral for the liftoff.

When House got interested in cochlear implants, he enlisted the help of electrical engineer
Jim Doyle. As a first step, Doyle built a battery-operated amplifier and electrode that could be applied to the round window, the membrane that leads to the inner ear. House tried it out during middle ear surgery with three volunteer patients who had lost their hearing after developing speech. Under local anesthesia, he lifted the eardrum and delivered small alternating currents to the round window. All of the patients heard sounds; furthermore, the sounds seemed related to the frequency and intensity of the electrical stimulus. Excited, House had Doyle set to work creating an implantable version. The new device had a silicone-covered coil to generate current, amplifiers, and an electrode, but nothing as fancy as a speech processing program. The coil would be placed in the mastoid bone and the electrode in the cochlea. Wires running from the coil ended in a plug in the skin behind the ear. In the lab, patients would be connected—plugged in—to an electronic stimulator that could send signals through the system to the auditory nerve. When not in use, the plug behind the ear would be covered with a bandage.

Two adult patients volunteered, and they were implanted early in 1961. For two weeks, they underwent testing with a variety of sounds. “They could hear the sounds, and it was obvious that even though the sounds were not clear, the devices would be of great help for environmental warning sounds and lipreading,” says House. Soon, however, redness and swelling appeared around the external wires. “I got kind of scared at that, and I had to take it out,” says House. “They were disappointed and so was I.” He had run up against the problem of biocompatibility.

Even in the 1960s, when research protocols did not preclude putting an untested device straight into human subjects, many researchers considered House's approach at best unscientific and at worst dangerous. Certainly, it was emblematic of the strengths and weaknesses of House's hands-on style. “He started building things and putting them in patients,” says Eisen. “He got his information from talking to people, not reading books. You'd get in big trouble if you did what he did today, but . . . if he'd read more books, he might have believed all the people who told him it couldn't be done.”

Biocompatibility was not the only problem. Doyle, the engineer, had made grand claims of eliminating deafness, which caught the imagination of technology buffs and science-fiction fans: “
Electronic Firm Restores Hearing with Transistorized System in Ear,” read a typical headline in
Space Age News
. Doyle also saw commercial potential and set about creating a company around the device, a move that was at odds with House's more altruistic vision. The ensuing publicity was too much too soon. It offended other doctors and scientists and led to a deluge of calls from people seeking help whom House had to send away. According to House, he told Jim Doyle he was going to put the project on hold until they had biocompatible materials and asked for a full report on the materials and electronics. Doyle refused. “He said I was a damn fool, and he was going to get a Nobel Prize,” House says, still visibly upset by it fifty years later. “It was my first disappointment of many that followed.”

 • • • 

News of what House had done reached an auditory researcher named
Blair Simmons, who was a new assistant professor of otolaryngology at Stanford University School of Medicine. Simmons was interested in the physiology of sound reception. His studies of the auditory systems of cats had been published in the prestigious journal
Science
. A scientist's scientist, Simmons was angry at what he regarded as “
irresponsible claims” emanating from Los Angeles, but he was captivated by what he considered a true research problem.

A year later, in 1962, Simmons saw an opportunity.
An eighteen-year-old cancer patient with increasing hearing loss was going to have exploratory brain surgery under local anesthesia. As with House's patients, the young man's inner ear would be exposed during the operation. In his work with cats, Simmons had successfully implanted electrodes into the inner ear without destroying the auditory nerve. Now he wanted to try his technique in a human subject who would be able to describe what he heard. “We were amazingly lucky on our first try,” Simmons later wrote. With an electrode stimulating his auditory nerve, the teenager heard a wide variety of sounds. Most surprising was the boy's ability to hear sounds at either end of the spectrum beyond the range required for speech.

Two years later, Simmons went a little further. Sixty-year-old
Anthony Vierra of San Jose suffered from retinitis pigmentosa, a condition that causes an increasing loss of peripheral vision. Eventually, the tunnel vision narrows completely and the patient is left blind. By the time he met Simmons, Vierra was also profoundly deaf in his right ear and was losing what hearing remained in his left. He gamely agreed to be permanently implanted with a six-electrode cochlear implant that Simmons had devised. Like the House implant, this one had wires threading through the skull, just behind the ear, that had to be connected to a computer or electronic stimulator in the laboratory for Vierra to hear anything. The surgery was performed at Stanford, but even a respected researcher like Simmons had trouble finding basic-science colleagues willing to work with him on testing such a controversial project. So he turned to one of the few places in the country with an established interest in the alchemy of electricity and human speech: Four scientists at Bell Labs, which had moved from Manhattan to New Jersey, agreed to perform the audiological testing of Vierra. “They were outsiders,” Simmons commented later. “I don't think they'd read the publicity.” Vierra had never been on a plane before, and since he was nearly blind, Simmons and his wife escorted him across the country.

The combination of Vierra's poor vision and hearing meant the researchers had to communicate with big block-letter signs saying things like:
TELL US WHEN YOU THINK YOU HEAR SOMETHING. Vierra needed some lessons in how to accurately describe and compare the sounds he was hearing, but he ultimately was able to identify them in terms anyone could understand. At a slow rate of one pulse per second, he heard a ping or a ding. Three to four pulses per second resulted in clicks. As the rate increased, he heard a buzz, then a sound like a telephone ringing, and finally a car horn above thirty pulses per second. Vierra was able to recognize familiar tunes like “Jingle Bells” and “Mary Had a Little Lamb.” In the eighteen months he wore the device, however, he never could understand speech. In a
Science
article on the work coauthored by Simmons, his Stanford colleague John Epley (who collaborated on the surgery), and the Bell Labs researchers, the conclusions were cautious. They had succeeded in expanding technical knowledge about pitch perception, although in a qualified way. As to the larger goal, they wrote: “Much remains uncertain. . . . It is unlikely that stimulation with any speech-derived signal would permit this subject to discriminate an appreciable number of words, unless considerable learning were possible.”

Early in 1967, Simmons presented everything that was known about cochlear implants at a Chicago conference on microsurgery of the ear. “
I am glad this meeting is a workshop,” he began, “because most of what I have to suggest means exactly that: work.” The auditory stimulation done to that point had been crude, said Simmons. “We must be able to produce an orderly and predictable array of pitches, loudnesses, rhythms, etc. These must be close enough to normal neural patterns so that a deaf person's task in learning will be no more difficult than learning a foreign language.” Should they ever succeed, Simmons guessed it would take new users at least as long to acclimate as it takes babies to decipher the auditory world around them: a year, give or take a few months.

Success would require a cooperative effort, Simmons said. Part of the problem was just how little was known about how the brain understood pitch. Frequency information was transmitted in two ways: via the rhythm of the sound, technically the repetition rate of the stimulus; and via the place on the basilar membrane that is tuned to respond best to a particular frequency. Like real estate investors, scientists were essentially asking which mattered more: timing or location. Simmons was blunt about their ignorance. When he displayed Mr. Vierra's responses to variations in the rate of the pulse, the lines of the graph lay on top of a photograph of a crater of the moon. “The exact information we have about the major portion of the conventional speech frequencies (500–2,000 Hz) is best represented by the rather large hole I have placed in the background,” he said. The question of pitch needed an answer because it would guide the placement of electrodes and decisions about what information to send over them. Even if no one ever succeeded in building a workable artificial ear, Simmons concluded, the knowledge they would gain about how the ear and the brain process sound would be valuable and important. Besides, he finished a little impishly, a cochlear implant “just
might
be possible.”

Bill House had “
unabashed admiration” for Simmons. It encouraged him that someone of the Stanford researcher's stature was tackling cochlear implants. “You have no idea how many people have told me that this problem is completely unsolvable,” House told Simmons that day in Chicago. But he disagreed about the need for animal studies and working out answers in the laboratory—standard operating procedure for most research scientists. “We must be willing to take some risks in applying what we have already found out,” said House. He insisted there was benefit to patients even “if they can only hear sounds such as footsteps and auto horns.”

 • • • 

Anything House could offer appealed to
Charles “Chuck” Graser. The California man had been
writing to House every six months since news of the 1961 surgeries broke. A high school teacher, Graser drove a tanker truck in the summers to make extra money and had been badly burned in a truck fire. Doctors had given him streptomycin to fight infection, and it had caused him to lose his hearing. In the ten years that he was deaf before getting an implant, Graser depended completely on lipreading and he experienced “strictly silence.” He had begun to think, he joked, that in order to communicate he would have to carry around a pair of scissors to cut off all the newly fashionable mustaches. After the accident, he had to give up his teaching job and was only able to take on part-time work as a school librarian. Like many people who had lost their hearing as adults, Graser experienced deafness purely as a loss of the life he had once had.

Nearly ten years after they began corresponding, Bill House finally told Chuck Graser he was ready to try again. Biocompatible silicone had been developed by the inventors of the pacemaker, and in aerospace engineer Jack Urban he had found a collaborator who was more of a soul mate than Jim Doyle had ever been. Most of Urban's other work was defense-related, and he told House he was “no longer anxious to help blow people up” and wanted to do some good. That suited House, who never applied for a patent for his implant because “I felt it would restrict others who might want to pursue this promising lead.” Since both men had day jobs, they hammered out ideas over dinner in their regular booth at a favorite Italian restaurant.

Like the earlier prototype, the prosthesis that House and Urban built for Graser and two others could only be used in the laboratory. An early computer served as both microphone and sound processor and sent its instructions along wires that connected to the implanted electrodes via the metal plug behind the patients' ears. Of the volunteers, Graser proved to be the most determined and interested. He came to Urban's laboratory several days a week and kept extensive field notes of his own. “We knew exactly what electricity was going into the head because he was hardwired,” says House. “It allowed us to try all different kinds of electrical stimuli. Then we'd think of something else. Everything we built was battery-operated. We weren't going to hook him up to the wall circuit because we didn't know what was going to happen.” As an additional precaution against the delivery of too great a shock, they had Graser sit on a wooden chair placed on a rubber mat. Two years into the work, in 1972, Urban miniaturized the electronics and packaged them in a gunmetal-gray box the size of two stacked decks of cards, which Graser could wear on his belt or in a pocket. House worried about the untested effects of constant stimulation of the nerve, but they were all excited by the prospect of allowing Graser to hear at home.

Suddenly, Graser could hear a dog bark and was able to recognize the squawk of blue jays from time to time. He wrote of his experience: “
You would probably describe my current progress as changing from profoundly deaf to just hard of hearing, but difficulty hearing and comprehending is in a completely different league from silence. For instance, tonight I can finally hear the bell that indicates that I am at the right hand margin, as I type this letter. . . . I used to be a [ham] radio operator, and sometimes I would get a distant signal that I couldn't really hear. It sounded dim and garbled. That's the way this sounds. It's definitely an electronic sound.”