March 7, 2008
Science of hearing loss moving near speed of sound
The music coming from Bob Dylan and his band at the indoor concert is awesome, but what I can hear of his vocals suggests that people backstage are strangling frogs and stepping on ducks.
Sure, Dylan's voice is throaty and growly, but he can articulate his songs as well as anyone. I know it from his CDs. At a distance of more than 50 yards from the stage, however, the form of his words, especially the higher frequencies of his consonants, are lost in the hurricane of sound from the mighty speakers and the reverberations of the theater's vast interior.
If I were a hearing-impaired person, I might switch my hearing aid to the "T" setting and get the best of Bob with sound of near-studio CD quality, while the hearing-normal folks around me were still worrying about those frogs and ducks.
At least I could do that if the concert were taking place at the DeVos Performance Hall in Grand Rapids, Mich., or the Rialto Cinemas Lakeside in Santa Rosa. These are among the growing number of facilities equipped with induction loop systems that broadcast directly from the output of instruments and microphones to hearing aids equipped to receive them.
Science is ringing in a new era in the world of the hearing-impaired, and the technologies to accommodate, treat and prevent hearing loss -- and even cure it -- are advancing at almost sonic speed. And that's welcome news, considering how doctors are wringing their hands over study after study predicting hearing loss for a generation that seems constantly connected, almost from birth, to MP3 players.
Age is the major cause of hearing loss, and your level of predisposition to it is genetic. If your parents lost hearing with age, it's likely you will, too. Age-related hearing loss is found in about one-third of people older than 60 and half of people older than 80.
The hearing loss comes from breakdown of the "hair cells" in the cochlea (the spiral-shaped part of the inner ear containing the auditory nerve endings). There are some 16,000 to 20,000 of them in each ear, and each hair cell is believed to have about 100 tiny hairs known as stereocilia. Sound causes pressure variations in the cochlea, which makes the stereocilia vibrate and send impulses to the brain.
First lost with a combination of age and excessive sound -- like loud music from your iPod -- are the hair cells that resonate to higher frequencies, which is why speech becomes harder to understand as the ability to hear the higher frequencies of consonants disintegrates. But that could change, thanks to research at the House Ear Institute in Los Angeles.
"We're developing totally implantable hearing aids, so we may some day implant a device allowing a person to hear without having an [external] aid," said John House, the institute's president.
Within five years, such hearing aids should be sufficiently developed that the institute will be implanting them in children on a regular basis, House said
Among other projects at the House Ear Institute are hearing aids that completely bypass the ear and wire sound directly into the brain.
"Many years ago, we developed a process of implanting electrodes directly applied to the surface of the brain in the area of what's called the cochlear nucleus, where the nerve attaches to the brain," House said. "Now we're working on penetrating electrodes, not only to go on the surface but to penetrate the surface of the brain. That's called a penetrating auditory brainstem implant. We've implanted eight or 10 now."
Founded in 1946 by House's father, Dr. Howard P. House, to advance hearing science and improve the quality of life, the institute is among the world's leading centers of hearing-related research and education. The connection of hearing to cognitive function is taken seriously.
"We're now screening newborns for hearing loss, something that was developed at the House Ear Institute," House said, "identifying them at birth, rather than waiting until parents notice they're not responding at the age of 1, or 2 or 3 years old."
Besides surgical and other medical interventions, the institute also does research and development on hearing technologies, such as signal processing algorithms applicable in hearing aids. Hybrid electrical-mechanical hearing aids are another example: The cochlea is implanted with an electrode for high frequencies associated with subtle voice recognition, while standard hearing aids provide the lower frequencies.
"We've been working on that for the past five years, and it's still investigational," House said. "Maybe within five years, we'll be able to implant hybrid [hearing aids] in people who have residual hearing but not enough to understand speech."
The hearing aids of today are digital, with increasingly powerful microchips and software that can customize to the individual's frequency spectrum of hearing loss and can adjust to the conditions of a noisy gymnasium or a quiet garden. Hearing aids are moving toward unprecedented abilities to convey subtleties like footsteps in another room, the sound of the wind, the nuances in music or the voices of loved ones.
"Analog tends to amplify everything, whereas with digital we can actually tune it to respond only to whatever frequencies are needed, and we can insert different programs so the hearing aid can respond to different sounds," House said. "There have been tremendous advances in hearing aids in the last five years."
One example, House said, is that of multiple-microphone hearing aids available just in the last two or three years, which help filter out background noise and tune in on close-up speech. The newest, he said, available in just the two or three years, is the "open-fit" hearing aid. It uses a narrow and inconspicuous tube to carry amplified higher frequencies into the ear, leaving the ear largely open to a natural inflow of the lower frequencies without completely plugging the ear like the traditional ear mold.
"In the past, hearing aids couldn't do that because they couldn't eliminate the squeal, the feedback problem," House said. Tiny computers, capable of screening out noise and amplifying pertinent sounds, prevent those problems.
"I get very excited about it, because it fills a niche that's been very difficult to fill," House said. "People don't like the ear to be completely plugged up. They like to hear their own voice."
Despite the resounding success of all these technologies and techniques, however, many of them may, in decades to come, become as irrelevant as VHS tape.
"We won't have a need for some of these technologies, because we'll be able to regenerate the cochlear hair cells that allow us to hear," House said. "One of the major projects here is related to finding the genes responsible for age-related hearing loss. As we identify those genes, we hope some day we will be able to manipulate those genes and do gene therapy, and not only treat hearing loss but prevent it.
"Some animals -- chickens and fish and frogs -- can regenerate their hair cells," House said. "Destroy the hair cells in a baby chick, and within two weeks they grow back. In humans, or any mammal, they don't grow back. Now we have been somewhat successful in regrowing hair cells in rats. That's a long way from humans, but we're beginning to find out what the key is to turn it back on again."
Small wonder that House is able to envision reducing the one-third of people who develop significant hearing loss by age 60 to 10 percent -- or even 5 percent -- within the next 20 years. And beyond that time, House foresees the problems of hearing loss receding still further with advances in areas including hearing-aid technology, surgical reconstruction and prostheses. Once scientists begin to understand how we hear on molecular and cellular levels, hearing loss may become an unheard-of anachronism.
"Today. we can replace ear drums [and] ear bones, and that's something we do on a daily basis," House said. "By 50 years in the future, hearing loss will be mostly preventable or curable."
Robert Ebisch has written for USA Today, Science News, the Washington Post, Consumers Digest and Wireless Review.
The Future of Hearing
"We will hopefully see hearing aids that have better distinction of hearing and noise, and better appreciation of music," said John House, president of the House Ear Institute in Los Angeles. "We may see fully implantable hearing aids, so we don't have to wear the external hearing aid, and we should be able to identify a large number of the genes responsible for hearing loss."
Scientists will begin to be able to alter genes to prevent certain types of hearing loss. Penetrating auditory brainstem implants, which wire sound directly to the brain, will become more common. Cochlear implants will also become more common for people with mild hearing loss. Patients can expect surgical approaches that will be simpler and can be done by a wider variety of surgeons.
Stimulating hair cells so they'll regenerate will be on the horizon, as well as restoring hearing to those who have lost their hearing to age, loud noise and certain diseases. These and other techniques and devices could reduce age-related hearing loss from one-third of the population older than 60 to 10 percent or even 5 percent.
Hearing loss will be mostly preventable or curable, and it may even be possible, prior to conception of their children, to alter the genes of parents so they don't pass on their predisposition to age-related hearing loss.