Switching On Hearing

Harold

It’s an iconic and powerful photo.

The face of a young child, born deaf, hearing sounds for the first time. Jack Bradley, photojournalist from the Peoria Journal Star, captured the exact moment a doctor fitted five year old Harold Whittles with an earpiece and turned on the hearing aid. First printed in the February 1974 issue of ReadersDigest, the photo has propped up in numerous “best-of” lists on the Internet. It is “shocking,” “miraculous,” “unbelievable,” “influential,” “heartbreaking,” “heart-warming,” “amazing,” and “evocative.” It has been circulated thousands of times on Facebook, where commentators have expressed their thoughts: the photo brings tears, it serves as a reminder of our humanity, it tells people to “count their blessings,” it resonates to personal experiences with deafness and hearing, and it triggers debates about language, culture, and technological achievements. For many individuals, the photo immortalizes more than Harold’s astonishment. It serves as a testament of the wonders of medicine and science, the abundance of hope, and provides us with a glimpse into the future.

Bradley’s photo is only one in a long list of sensationalized stories on deaf people hearing sounds. A search through YouTube lists about 72,800 results for videos on “hearing sound for the first time.” At least once a month, someone sends me a link to a new video, or to a post discussing the novelty of sharing stories like this.

I may not remember exactly what it was like when I first heard sounds again after losing my hearing, but I have a problem with the way these videos are promoted: they sensationalized the notion that hearing could be “switched on.” This is a misleading claim. Implants, whether they are cochlear, auditory, or the newer brainstem versions do not restore “normal” hearing but makes it easier for deaf individuals to distinguish sounds. It’s not like wearing these technologies miraculously provide the wearer an understanding of all the sounds in the world. I’ve had friends who’ve been fitted with cochlear implants describe how overwhelming the sound were, and how certain everyday noises, like wind hitting the trees or leaky faucets, created so much confusion.* Cochlear implants in particular, create a representation of sounds that serves to assist in understanding speech; because of this, speech can sound robotic, or filtered as if everyone was speaking underwater. I wear digital hearing aids and even I have trouble distinguishing certain noises or even pinpointing the source of sounds.

Once, while out dining with friends, I watched a restaurant worker remove the external part of her cochlear implant nearly every time she went behind the counter. But when she went towards the dining room to seat customers or bus tables, she had the device on. I imagine the cacophonic atmosphere of the dining room might have overwhelmed her–I know for me, it was so loud I ended up leaving the restaurant with a throbbing headache (I’m very sensitive to loud sounds, which often trigger migraines).

But for me, the larger problem with these videos is that they depict deafness as a defect, a problem that must be corrected, medically, surgically, technologically, and even culturally. This is a perspective that has long been criticized  by members of the Deaf community, who argue these devices are another instance of the historical oppression of Deaf culture and a tremendous threat against sign-language. I’m not going to go too much into this. There’s plenty of literature on the subject. I don’t identify myself as a member of the Deaf community and I do write about the medicalization of deafness, but I try to be sensitive to balancing the perspectives of both hearing and Deaf culture–even if at times, it’s so challenging to do so.

*This point reminds me of one of my favourite philosophical thought experiments: If Mary was born and raised in a black-and-white room and never seen color, but one day, is allowed to go outside, does Mary understand, or have any concept of, the color red?

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Dancing

A while back me and some of my girlfriends went dancing. At the club, we encountered a group of some of my deaf friends, some who were profoundly deaf and could not hear or speak–but communicated via sign language. All of us went off to the dance floor.

The music was, indeed, VERY loud. I’m always amazed and intrigued about how people process sound (or noise); I couldn’t actually hear the music, but rather, my experience of music was just blurred words and sounds all jumbled together into some weird notion of “beats.” Strangely enough, when I’m hearing a song on my iPod, I can hear the words and recognize the singer. I can’t do that over speakers or over a radio–unless someone actually tells me what the song/singer/band is.

Anyways, one of my friends was watching my deaf friends dance. Curiously, she asked me how could they “hear” the music, let alone seem to dance perfectly in tune with the beats. Were they imitating other partygoers around them, or were they actually hearing the music–and if so, how? I asked her if she’s ever leaned against the wall or placed her own hand on her chest when loud music is playing–and we all placed our hands to our chest–and if she could “hear” the oscillations waving through her bones. My goodness–the looks on my girlfriends’ faces! Priceless!

I do hear loud music that way sometimes. I place my hand to my chest to make out what I cannot “hear” through my hearing aids. It was always an intuitive thing and I never thought about the science behind the acoustics or of oscillation…but I was amazed when I saw this piece, over from Modern Mechanix, which is possibly one of my new favorite blogs:

Modern Mechanix, July 1935
Modern Mechanix, July 1935

 

What do you think? Have you ever experienced such a sensation?

A Bead and a Thwack

Surgeon John Abernethy (1764-1831), in his Lectures on Operative Surgery (reprinted in The Lancet vol.8 (1827), 449):

Now I remember, not a very great many years ago, that there were paragraphs put into the newspapers, about a child having got something into its ear, which could not be got out. The poor child was in great agony, and it was said that this foreign body produced irritation in the child’s brain, and I don’t know what all. As the British public are very much alive to humanity, there were, morning after morning, in the papers, paragraphs exhorting the friends of this family not to be afraid, for the body would come out. To these paragraphs, I confess to you, I added one myself, and it was the following effect:–A child got a bead from its mother’s necklace; it was a large bead, and in playing with it, it put into its ear. In trying to get it out, she only poked it further down. In others attempting the same thing, they only made bad worse in the same manner. A surgeon was sent for, but this large bead had got so far down into the tube of the ear, that the surgeon said at first he did not believe it was there; being assured that it was, he put down a probe, and felt that there was something in it. The child was a good-natured child, and the surgeon said to it, Now I wish you would just lie down upon that ear; put your head upon this cushion, it’s a large soft cushion belonging to a fashionable sofa. The child did so. He took up another cushion, and put it upon the opposite ear. Now, said he, I will strike the opposite one, and tell me if it hurts you. The child said, No, it does not hurt me at all. He therefore kept thumping the cushion that was laying on the child’s head for eight or ten times, and then he said, Now let me look at your ear. He looked at it, and then said, Now I see it plainly enough. On repeating the operation, the bead came out. And now I really believe that that’s the best way of getting those things out.

 

A Brief History of the Eustachian Tube

The Eustachian tube is a passageway that lies between the middle ear and the pharynx, the upper part of the mouth located just below the top of the nose. One of the primary functions of the tube is to equalize ear pressure between the middle ear and the atmosphere; most of the time the tube is closed, but it can open to let in a small amount of air to prevent damage to the ear. Early mentions of the tube dates back to Alcmaeon of Sparta around 500B.C., who constructed a basis for understanding medicine via dissection, and thought the tube enabled goats to breathe through their ears as well as noses.[1] Other Greek philosophers, including Aristotle and Celsus, also vaguely referred to the tube’s existence, but did not elaborate on its function or purpose.

The Eustachian Tube
(from University of Maryland Medical Center)

The surge of Italian anatomists during the Renaissance period and their emphasis on dissection brought forth new understandings of the body and its parts. Andreas Vesalius (1514-1564), Professor of Anatomy of Padua, provided detailed descriptions of two of the tiny bones in the middle ear (the malleus and incus), but although he was aware of the existence of the Eustachian tube, he does not comment on its role in hearing. His contemporary, Bartholomeus Eustachius (1510-1574) who held the Chair of Anatomy at Rome, published the first detailed anatomical description of the tube in his 1562 Epistola de auditus organis (Examination of the Organ of Hearing), possibly the first treatise on the ear:

It originates at the anterior course of the base of the skull, and takes an anterior course toward the pterygoid process of the sphenoid bone. It consists of two parts: the first solidly connected with the temporal bone, close to the tympanic cavity; the second soft, partly ligamentous, partly cartilaginous, directed towards the nasopharyx. Cross sections of the tube are not perfectly round and the inner part is twice as wide as the outer.[2]

Bartholomeus Eustachius

Comparing the tube to a quill pen, Eustachius provided precise descriptions of its structure and position in the face, but he made no mention of its function:

Comparing to a Quill pen
(Wellcome Library Images)

Nor did he publish an engraving of the tube as part of the external auditory system in his 1651 Tabuli Anatomiceu, which also contained detailed figures of the ear ossicles and the tympanum membrane in man and dog.[3] It is likely that Eustachius held the long-standing belief that the Eustachian tube functioned as (another) avenue for breathing, since he postulated that other parts of the ear, especially the ossicles and tympanum, were involved in the mechanism of sound transduction. Not until 1683, with the work of French anatomist Guichard Joseph DuVerney (1648-1730) was this belief corrected. In Traité de l’organe de l’ouie, DuVerney described the Eustachian tube as a means for renewing air within the tympanum and for equalizing air pressure, believing that the tube was always open and it was the eardrum that maintained the flow of air.

Anatomy of the Human ear (1686); Steven Blankaart & Guichard Joseph Duverney
(Wellcome Library Images)

Descriptions of the Eustachian tube contained more than just anatomy: they highlighted the physiological and therapeutic importance of diagnosing and treating ear diseases confined to the Eustachian tube or tympanum. Antoine Maria Valsalva (1666-1732) is historically credited for giving the tube its eponymous name in honor of Eustachius, whose work set the foundation for understanding the anatomy and physiology of the ear. Valsalva, a pupil of the famed physician Marcello Malpighi (1628-1694), was appointed Professor of Anatomy at the University of Bologna in 1705, where his main interests were on anatomy and the function of the middle and internal ear.

Antonio Maria Valsalva. Line engraving by R. Ceracchi.
(Wellcome Library Images)

In 1705, Valsalva published De aure humana tractatus, which followed years of intense observations, animal experiments, and numerous dissections; the treatise included enhanced descriptions of the physiology and pathology of the ear, even demonstrating communication between the mastoid cells and the tympanic cavity. Valsalva also outlined the function of the Eustachian tube and its diagnostic use; the tube, he claimed, worked alongside the pharyngeal muscles of the ear. Believing that Eustachian tube blockages were among the main causes of deafness, in De aure, Valsalva also outlined his “Valsalvian maneuver,” a method consisting of the forced expiration of air through the Eustachian tube with the mouth and nostrils closed, thus resulting in increased pressure to the tympanic membrane. The procedure dates back to Arab physicians in the 11th century and was used as a remedy for cleansing the middle ear from pus, and hence, unblocking the ear and restoring hearing.[4]


NOTES

[1] Charles D. Bluestone, Eustachian Tube: Structure, Function, and Role in Otitis Media, Vol.2 (PMPH-USA, 2005), 4.

[2] Translated & quoted in Bluestone, Eustachian Tube, 5.

[3] Most of Eustachius’ works were not published during his lifetime or simply lost. His copper plates of anatomical engravings were discovered early in the eighteenth century and presented by Pope Clement XI to his physician Lanncisi (1655-1720), who then published the plates in 1712. Unlike Vesalius, Eustachius’ plates represented dead, not living anatomy.

[4] Steven H. Yale, “Antonio Maria Valsalva (1666-1723), Clinical Medical & Research 3: 35-38. The Valsalva maneuver remains a staple in modern medicine, having been adapted as a diagnostic procedure in modern cardiology for assessing heart murmurs and heart failure.