The order, ingenuity, and simultaneous complexity and simplicity of the human organs are simply marvelous. The wonder one feels only increases when the organ for hearing, the ear, is examined. Not only are the organ structures and operation principles amazing, but the atomic level of sensitivity to sound waves is incredible. In this paper we will venture not only into the operation of the human ear and hearing but will also examine today’s technological advancements to replace or fix the parts of the ear through Cochlear Implant (CI) systems which provide sound sensation to people with profound hearing impairments, as well as examining the issues that surround these systems.
The human ear and hearing
The human ear can be divided into several functional sections: the outer ear, the middle ear, the inner ear, and the auditory nerve. Sound goes through a series of changes as it travels through these sections until reaching the brain. The outer ear picks up sound pressure waves, amplifies them and then converts them into mechanical vibrations on the ear drum, which is connected to a series of small bones in the middle ear. These small bones further amplify or diminish the mechanical vibrations in the ear drum and transfer them to the cochlea, a snail-shaped cavity filled with fluid which is located in the inner ear. Change in fluid pressure caused by vibrations within the cochlea lead to changes in the flexible membrane, called the basilar membrane. These changes contain information about the frequency and strength of the sound that has entered the ear. Attached to the basilar membrane are mechanical receptor cells, called hair cells, which are bent according to the deflections of the basilar membrane.The hair cells have hair-like structures. The bending of these hairs assists the release of an electrochemical substance that causes neurons to send electrical signals to the brainstem through the auditory nerve. These signals are in the form of a message (or a code) that the brain understands.
Cochlear Implant (CI) devices
If there is a broken link in any part of the auditory pathway, the brain does not receive any coded signals, and hearing impairment occurs. If a large number of hair cells or auditory neurons in the cochlea have been damaged, then the person is diagnosed as profoundly deaf. The hair cells can be damaged by certain diseases (e.g., meningitis, Meniere’s disease), by congenital disorders, by certain drug treatments, or by other causes. One negative outcome of damaged hair cells is that they can subsequently lead to the degeneration of adjacent auditory neurons. Research has indicated that the most common cause of deafness is the loss of hair cells (>95%) rather than the loss of auditory neurons. This has encouraged scientists to try implanting a device inside the iner ear or cochlea, bypassing the normal hearing mechanism of the ear, to stimulate the remaining auditory neurons directly through electrical signals. These are called Cochlear Implant (CI) devices, which can restore partial hearing in profoundly deaf people . A standard CI system, shown in Figure 1, composes of and performs the following functions: a microphone picks up sound pressure waves and converts these into electrical signals. The signals are sent to the speech processor that is worn by the patient. The speech processor analyzes and encodes these sound signals, sending them back to the external pick-up coil . After passing through a wireless radio link that lies between the external and implanted coils and an implanted electronic devise, coded signals are sent to the implanted array of electrodes in the cochlea to electrically stimulate the remaining auditory neurons , and the brain receives what it interprets to be sound.
Electrical stimulation of the ear, or CI research, can be traced back to the 1800s. The Italian scientist Alessandro Volta used a battery as a research instrument to demonstrate that electric stimulation could result in a number of human sensations . After connecting a 50- volt battery to his ears, he noted that “...at the moment when the circuit was completed, I received a shock in the head, and some moments after I began to hear a sound, or rather noise in the ears, which I cannot well define: it was a kind of crackling with shocks, as if some paste or tenacious matter had been boiling...”. That electric stimulation of the auditory nerve provides hearing sensation in deaf people was reported more than 100 years after Volta . Electric stimulation in two deaf patients resulting in hearing was reported in 1957. These successes resulted in intensive research into helping deaf people hear in the 1960s and 1970s. One of the early successful single-channel CI devices was developed in the early 1970’s (3MCorp/House) and became the first commercially available CI device approved in the United States in 1984. The University of Utah developed a six electrode implant called the Ineraid or the Symbion device in the early 1990s. It was followed by other devices in Europe, the United States, and Australia.
The present status of Cochlear Implants
Today, around 10% of the population in developed countries suffers from hearing impairment. At present, the number of CI users has reached more than 100,000 worldwide, and is still growing rapidly. Functionally, CI has evolved from the single-electrode device that was used as an aid for lip-reading and
sound awareness to a modern, multielectrode device that can allow an average user to talk on the telephone. Even though significant technological progress has been achieved in the last 50 years, there are still many mysteries about the human hearing process and the parts of the ear. Here, we will compare some aspects of the healthy human ear and CI devices, looking to the future. The human ear operates over a range of sound pressures (its dynamic range) which is greater than one million to one (120dB), with as many as 200 discrete steps in the range. In contrast, today’s CI devices typically provide a dynamic range of three to one (10dB) to ten to one (20dB) with 20 discrete steps. This major difference is mainly due to the fact that the human ear is very adaptive in noisy environments, and is able to suppress noisy background, while picking up and processing appropriate sound signals for better perception. CIs do not differentiate between sounds, but amplify all sounds, which results in poor sound perception. Today, a typical multi-channel CI system uses 16 to 24 electrodes implanted in the cochlea with 8 to 22 signal processing channels. A potential shortcoming of having so many electrodes and channels in current CI technology is the electrical interference of electrodes during simultaneous electrode stimulation. These electrical interactions can disrupt the stimulus waveform prior to neural activity and degrade sound perception. The normal ear contains roughly 3,500 inner hair cells in the cochlea that are tuned to different frequencies from 20 to 20,000 Hz. They are connected to about 35,000 auditory nerves. Hair cells work as signal processing channels, yet each of the inner hair cells has also been wired in a sophisticated and little-understood fashion to 10-20 auditory nerve fibers that carry information to the central nervous system. Since they work in the chemical domain, they do not have the gross interference issues of CI electrodes. While good speech understanding has been achieved by users of modern multi-electrode CIs operating in quiet environments with 70–80% sentence recognition, allowing users to talk on the telephone, the CI devices do not discriminate between noise and the meaningful signals, only achieving speech understanding at between 70% and 80%, which falls to 10% or lower in noisy environments. It is a great challenge for CI users to appreciate music. Some CI listeners reported that they can enjoy music and are able to recognize melodies, but most described musicas sounding unpleasant and noisy, and performance could not be increased with current CI technology. CI users have difficulty in identifying differences in frequencies. Typically, they cannot discriminate any frequency difference for frequencies higher than 500 Hz, while the normal ear can hear up to 20,000 Hz with frequency discrimination between 2 to 3Hz at best. This gross difference is related to the issues surrounding signal processing strategies and electrodes of current CI systems. Predicting post-surgical performance based on presurgical conditions and tests of a CI candidate is still a problem for the physician. The cost of surgery is still high; in the United States, for example, a typical cost is between $40,000 and $75,000. Beyond these issues, the moral, cultural and ethical issues related to CIs are very complex. They are still debated, and are an important part of CI development in the world today. The hair cells in the human ear naturally deteriorate and die as we grow older. This process is typically sped up with exposure to loud noise. In common with all mammals, new hair cell generation in human ears stops right after the birth. However, in fish and amphibians, very similar cells are present and reproduce throughout life. Recently, it was found that hair cells of birds are repaired after being damaged by exposure to noise or ototoxic agents. It was also discovered that hair cells in the mammalian vestibular (balance) organ, very similar to those in the hearing system, can regenerate. These findings, along with other advancements in medical fields, lead to long-term research into different aids for hearing- impaired people. Despite the fact that hearing loss is usually permanent, scientists are optimistic that it may eventually be possible to reverse the damage in the ear by repairing or regenerating the sensory hair cells through gene therapy, stem cell transplantation, or ultimately by replacing the human cochlea with an artificial one. Today, Auditory Brainstem Implants are also being tried on humans for direct brainstem stimulation, bypassing the ears and the auditory nerves. Human beings and most animals on earth are born and equipped with a pair of ears for a good reason: having two ears enhances hearing and sound localization. Scientists are examining whether this is also true for deaf children who receive not one, but two CIs.
The sense of hearing is a gift for human beings which they hold dear and are grateful for, as much as for any of the other senses with which they have been equipped. It is important to strive to find cures for all kind of diseases, yet, more important than the cure is prevention of harm to our body and its amazing senses. Here, we have tried to open a small window onto human hearing, to examine how related impairments are being dealt with through cochlear implant (CI) devices, as well as looking at the issues related to these devices and the future directions of research for restoring hearing to deaf people. It is obvious that we have learned much about human hearing and ear in the past century; yet, this may well be just the tip of the iceberg.
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