Interview with William F. House M.D., Physician, Dentist, Father of Neurotology
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To read PART ONE of this Interview with Dr. House, CLICK HERE.
AO/Beck: Dr. House, you have an incredible spirit, and your ability to stay focused and persevere is outstanding. All right, so what happened after that?
House: I decided that we could actually go from the middle fossa, because I knew how to follow the facial nerve in and take the tumors out. We began a using pantopaque with our x-rays and we could see the tumors a lot earlier. They were using air studies before that, and that didn't tell you very much.
AO/Beck: Pantopaque is actually a dye isn't it?
House: Yea, it's a dye. They still use it to look at back problems where you have protrusion of stuff from between the vertebra. Jack Urban developed a chair for me, and the same design is used now in surgery all over the world with armrests on it.
AO/Beck: So you could hold the instruments without tiring your arms too much?
House: Yes, and I remember as a joke he put a little push button on it, Ejection Button.
AO/Beck: So your first acoustics were through the middle fossa approach?
House: That's right. I would go ahead and take out the labyrinth and sometimes part of the cochlea too because you could see all the structures and we could see the tumor and where the facial was, and then strip out the tumor. We did about ten cases.
AO/Beck: So was that in the pre-Hitzelberger era?
House: Yea. I had a neurosurgeon that was working with me, and he was difficult to work with, very difficult. He described otologists as ear scratchers. He didn't think that we should have anything to do with anything that crossed the dura. Then I worked with another neurosurgeon, and that didn't work out real well either.
AO/Beck: Just to clarify, the first ten or so were approached via the middle fossa approach, and were they sitting up or supine?
House: They were sitting up. One day it occurred to me -- My God, this whole thing of sitting patients up is so dangerous because there was a significant potential of air embolism. Because when sitting up, the venous pressure in your head is lower than atmospheric pressure. So I said, why don't we just lay them down and then I can remove the labyrinth and everything from the translabyrinthine approach, and that's when that was developed. I went out and did a lot of dissections on cadavers, worked out the techniques of locating the facial nerve and I began teaching that. We could locate the facial just exactly where it was. So then we started doing that and after we had done a few cases we set up the first class with seven or eight surgeons watching it and we had the old black and white televisions at that time. That was the first time anybody had ever televised anything through the microscope.
AO/Beck: That's incredible. What year was that Dr. House?
House: Oh that would have been about 1970 or 1971.
AO/Beck: So it was televised live into a teaching arena and you were operating and narrating at the same time?
House: Yes. The second neurosurgeon I mentioned a moment ago was in the audience. He was always assigned to me and we worked on these patients together. I would do most of the approach through the labyrinth and then we would both work on the tumor. I would show him how to see exactly where the facial was and so on. But he felt that was a very dangerous approach. I don't know why. I think it was because he felt that I was getting completely away from the neurosurgical approach. He was sitting in the audience saying, If this patient dies from this procedure I won't sign a death certificate. He said that to the audience while I was up there operating.
AO/Beck: That's incredible. Did you know that he was saying that?
House: It was two-way communication, so yes; I heard it as he said it. I was going to go ahead and do my surgery. It was a foolish thing for him to say, and so finally Dr. Sooy, the head of the department at UC San Francisco was in the audience, and he said to the neurosurgeon Let's just shut up and let him do the operation, and then he kind of quieted down. Of course the patient did very well. We saved the facial and the patient. That's when I had to start looking for somebody else to work with. That's about the time Hitzelberger came along. He just finished his residency at the Mayo Clinic in neurosurgery. I felt that if I got in any trouble and I didn't have a neurosurgeon to back me up that they would probably throw me out of medicine or something. But Bill Hitzelberger and I didn't have any trouble. Bill got interested and he was the only neurosurgeon I had worked with, up to that time, that was willing to learn how to do temporal bone work and understand the whole thing. So it worked out very well.
AO/Beck: And Dr. Hitzelberger sort of took up residence with your practice?
House: Yes. He joined our practice briefly and then went off and had his own practice, which we all agreed was probably a better deal.
AO/Beck: How many patients would you say you operated on for acoustic neuromas across your career?
House: I don't know exactly, but I think at least a thousand.
AO/Beck: What year was your first translabyrinthine craniotomy?
House: That would have been probably 1971 or so.
AO/Beck: If you were to speak to a patient with an acoustic neuroma today, and you were talking about the benefits of the translab versus suboccipital versus middle fossa approach, it seems to me the translab approach has stood the test of time and it's still the preferred surgical route. Is that correct, and is that what you would recommend?
House: That's correct. There are a number of advantages to the translab approach. If you go through the suboccipital approach with the patient sitting up, there's a greater risk of air embolism. Without getting too graphic, when they place the patients in position for suboccipital procedures, and I know you've seen many of these Doug, the head is in a head-holder to keep it from moving, and of course to keep it in position. So the patient is essentially hanging by their head and they are asleep. As you can imagine, there have been some kinks of the cervical spinal cord and quadriplegics too. That was a very serious problem. Bill Hitzelberger and I reported that, and of course, the neurosurgeons were up in arms but they couldn't say anything because obviously the patients were injured. The other disadvantage was that with the suboccipital approach you had to take off the outer third of the cerebellum, and if you get a little too deep into what's called a dentate nucleus in the cerebellum, then the patient would have a permanent cerebellar ataxia. With the translab approach, we don't have to take out any cerebellum. The suboccipital approach can also cause very severe and prolonged headaches.
AO/Beck: Please tell me the advantages of the middle fossa approach?
House: The reason for using the middle fossa approach is if the tumor is quite small, we can sometimes get it out through the middle fossa approach, and save the facial nerve and the hearing too. I think they're using it a lot more now because we can detect tumors while they are still quite small. But middle fossa surgery was so difficult, or thought to be so difficult, that it wasn't very popular. Very few people wanted to do it. It was more popular in Europe for a long time before it kind of came back to the USA.
AO/Beck: And translab obviously has the best exposure out of all of them so you can actually take out 7-8 cms tumors is that right?
House: That's right yes. And you can usually take those very large tumors out without doing damage to the cerebellum. The advantages of the translabyrinthine approach are numerous, and as you said earlier, it has stood the test of time.
AO/Beck: And so I guess you were getting bored, didn't have enough challenges in your life, and one day you decided to create cochlear implants?
House: Well, no! What got me thinking about cochlear implants was Eddie Johnson, remember him?
AO/Beck: Absolutely. He was the Chief of Audiology at the Otologic Medical Group when I started at the House Ear Institute, in the 1980s.
House: Yes, that's right. Eddie had a daughter who was congenitally deaf. They went to the John Tracy Clinic, and he got me very interested in deafness in children. When parents would bring deaf children in, Eddie would confirm the hearing loss and then I'd say Yes, they're very deaf.
I found it very difficult to tell the parents There's not much we can do. Why don't you get some hearing aids and we'll refer you down to the John Tracy Clinic. Many of the patients ultimately ended up with manual communication, sign language. So that was, one about the time this patient brought me a little clipping about two gentlemen, Dijourno and Eyries, one of them was a physiologist and the other an otologist, both in Paris. I think both of them are gone now. They reported two cases, they never did anymore. They reported on two patients that had labyrinths destroyed by cholesteatoma so they were totally deaf. So they just saw a nerve ending there and put some wires into them.
AO/Beck: That's amazing. And that was what year would you guess?
House: That was 1958.
AO/Beck: So in 1958 they just used copper wires that had been autoclaved I would guess? And they pretty much just started sending current through the wires?
House: Yes, I think so. They would transmit current into the wires, and the patients could hear some tones.
AO/Beck: And obviously you thought about that, and what did you think?
House: Well I thought it was a tremendous idea. Why can't we learn to do it? I had already developed the facial recess approach, and I knew we could go that way and get to the round window. So I began working first with an engineer named Doyle, and he worked out some devices for me.
I began to gather some information when I was doing stapes surgery under local. I would put an electrode in the round window and then put tiny electric currents through the wires and ask the patient what they heard. So I began to get some idea about the amount of electrical current, what they could hear, and things like that with normal bone conduction cases. The engineer worked with me for a while. We did a couple of cases, and then we got a grant of $10,000 from George Ectles in Utah. He was quite a financier and he was one of the people that helped set up the foundation. So he gave us a $10,000 grant at the request of Howard to work on this problem. So I began working on dissections, introducing electrodes into the cochlea, and things like that.
AO/Beck: Did you have concerns like IRB issues or FDA approval or any such thing?
House: The FDA did not control anything in the way of medical devices at that time. Must've been about 1957 or 1958.
AO/Beck: So as a surgeon and a physician you could just think these things through and just go for it.
House: That's it.
AO/Beck: I love it. I think I was born a few decades too late!
House: I do honestly feel that in today's environment I couldn't have done these things. I don't think we would have gotten by the IRB and stuff, and the FDA would have said this is crazy.
AO/Beck: So did you implant a few people with Mr. Doyle's designs?
House: Yes. The two or three cases that I did with Doyle were OK for a starting point, not amazing, but very useful. We didn't have good compatible insulating material and silicon rubber was not well cured. The wires were encased in insulation material that was very bad. We got some swelling around them so I had to take those out even though we got some responses right off the bat from the first two or three patients. They were totally deaf patients, and they did hear with the first design. We just backed off because we didn't have good compatible insulation materials. But with all the work that was going on with animal work and developing drains for ventricles for hydrocephalus, things like that, they began to develop good stuff. Doyle and I parted ways because the $10,000 ran out and I said We'll have to stop this project. The story got even more interesting because he was apparently advertising that this was a big breakthrough and if you were to invest in his company you would end up on easy street. I thought that was all wrong. It was like the Wright brothers advertising to charter a plane across the country. It was ridiculous what he was doing. Howard and I didn't like that because he came out with some newspaper articles and stuff. So anyhow we parted ways and then a few years later, in the early '60's, Jack Urban and I started working together on the whole problem. Jack developed some plugs, instruments and tools and protocols. We put the electrode in and then we'd take the patient to Jack's office and try different currents and things, that took us about two years. We tried all kinds of different things. He developed circuits and tried dozens and dozens of options. Jack would sometimes take a month or so to build up a device and then we would try it on our patients.
AO/Beck: Do you remember the early lessons that you learned?
House: Well we developed a lot of different things. It was pretty obvious that he was hearing well with some of the electronic gear, and other things didn't work very well at all. So Jack and I would usually go out to dinner afterwards and we would sit and talk about it for a while. And we would work out what our next step was. This went on for two years and finally we came to the idea of an amplitude-modulated signal. And we found out things like, well very early we found out that if you use the ground outside the cochlea it took less current than if we put it in the cochlea. And of course they've now come around to that, as you know. I think all of the FDA approved devices on the market today are using monopolar stimulation, which we did very early. So anyhow it came out that our patient said the one sound he liked best was amplitude modulating the electric analog of sound onto a 16 kHz carrier wave. We tried different carriers of different frequencies and 16 seemed to be the one he liked pretty well. Our next problem was that we had never tried long-term stimulation. We'd only stimulated him maybe half an hour or 45 minutes at a time to see what he heard and then we'd unplug him and he'd go home. So we finally decided all right let's give him a wearable device. His wife Barbara was wonderful, she was his interpreter and she helped us out a lot. She came with him all the time. My main concern was that I'd been told by people that should have known that if you put electric current in the ear, it's going to destroy whatever you're stimulating. So we needed to get him to use it for a longer time to see if it was going to poop out or not. We eventually sent him home with a device and let him try it for a longer duration. We had a device that they could plug in and we taught Barbara how to manage it and be very careful with it. So they took it home and the next day I called them and she said it was still working. So I called her every day for a while and she'd say, Yes it's working fine. And it kept on working. So as each day went by we were very encouraged that maybe we had something here and it wasn't going to poop out. He wore this hardwire device for a month or two and then I decided to do more patients.
AO/Beck: What year was that?
House: That would have been about 1969. I did recruit some more patients again telling them that I didn't know if this was going to be permanent but it looked like it was a good possibility. These were all totally deaf people and none of them turned me down. Jack and I published some work on it and then stuff started to hit the fan about that time.
AO/Beck: Dr House, I am very appreciative of your time. You have been very generous and patient! Maybe the best thing to do here is to place an excerpt from your website www.allhear.com into this interview, and then I'll recommend that the readers review your website to learn more about the history, controversies, and your reflections on cochlear implants and related issues?
House: That's a great idea Doug. Please go ahead.
AO/Beck: For readers who would enjoy a more detailed history, and more of the thoughts and opinions of Dr. William F. House, I encourage you to review the website www.allhear.com.
Additionally, I'd like to encourage readers to visit www.h4c.org, which is the Hearing for Children Society website. They're a non-profit organization that promotes the AllHear device and the website offers very interesting perspectives and analysis on many issues relating to cochlear implants and related matters.
The following pages are from www.allhear.com and they are reprinted here with permission.
I remember ... Requesting to present the very preliminary anecdotal findings on our implant patient at a national meeting. I was turned down on the basis that reporters would be at the meeting and their reports of the implant would cause otologists to have to contend with a flood of patients with unrealistic expectations.
Finally, however, in 1973, The American Otological Society Saint Louis meeting held a session on cochlear implants.
Dr. Nelson Kiang, a very prominent neurophysiologist for Harvard, expressed the belief that a single-electrode device, such as all of our patients were then using, would only produce a kind of buzzing, Morse code-like sounds, and from a theoretical standpoint, this was a very reasonable position.
Dr. Kiang felt strongly that, if an electric field was generated around the neural tissue in the inner ear, the nerve fibers would all fire, go into a refractory state, and then fire again, repeatedly, for as long as the stimulation lasted. This would result in a buzz sound that turned on and off as the current was turned on and off.
For those who had not actually seen any implant patients, this belief regarding the limitations of cochlear implants was widespread.
The Journal which resulted from the meeting printed Dr. Kiang's thoughts, as well as contrasting comments by noted researchers such as Dr. Merzenich of San Francisco. Dr. Merzenich had seen some of our patients and had begun work with Michelson. He said:
Dr. Kiang's remarks suggest little or no discriminative hearing can be generated from a single-electrode pair. However, it should be pointed out that these subjects do have some discriminative hearing in the sense that small differences in stimulus frequency can be detected. And subjects describe sounds which they hear as 'tones'. This must be faced up to and explained. These and other qualitative observations on hearing in these subjects have also been made by Dr. Simmons and others. They are bonafide, as you will appreciate the first time that you see a patient. They simply must be explained in terms of neural mechanisms.
I remember hearing once that, according to standard aerodynamic theory, a bumblebee cannot fly. Apparently no one has successfully convinced the bumblebee of this, however, and these sound theoretical arguments regarding the response of the neural system likewise seemed not to be able to convince our patients that they were not hearing something useful.
As the saying goes, there are none so blind as those who will not see. Despite repeated requests to observe the patients as Dr. Merzenich had done, there were those whose minds were made up and they continued to insist that no benefit was possible with a cochlear implant.
I remember one remark by a scientist at the 1973 meeting who said: If I tell you that a lead balloon will not fly, and you go out and build a lead balloon and it does not fly, what have you learned? I could not help but remark that I had flown to St. Louis in a lead balloon. (Two Wrights had not been proven wrong.)
Editor's Note: I am proud to have known Dr. Bill House for the last 20 years. He has been a personal friend, a colleague, and in many respects - one of my professional mentors. I want to take this time to thank him for his amazing curiosity, fortitude, integrity, and most importantly, his unselfish and compassionate quest, So all may hear. Thanks Dr. Bill! ---Douglas L. Beck, Editor-In-Chief, February, 2004.
AO/Beck: Dr. House, you have an incredible spirit, and your ability to stay focused and persevere is outstanding. All right, so what happened after that?
House: I decided that we could actually go from the middle fossa, because I knew how to follow the facial nerve in and take the tumors out. We began a using pantopaque with our x-rays and we could see the tumors a lot earlier. They were using air studies before that, and that didn't tell you very much.
AO/Beck: Pantopaque is actually a dye isn't it?
House: Yea, it's a dye. They still use it to look at back problems where you have protrusion of stuff from between the vertebra. Jack Urban developed a chair for me, and the same design is used now in surgery all over the world with armrests on it.
AO/Beck: So you could hold the instruments without tiring your arms too much?
House: Yes, and I remember as a joke he put a little push button on it, Ejection Button.
AO/Beck: So your first acoustics were through the middle fossa approach?
House: That's right. I would go ahead and take out the labyrinth and sometimes part of the cochlea too because you could see all the structures and we could see the tumor and where the facial was, and then strip out the tumor. We did about ten cases.
AO/Beck: So was that in the pre-Hitzelberger era?
House: Yea. I had a neurosurgeon that was working with me, and he was difficult to work with, very difficult. He described otologists as ear scratchers. He didn't think that we should have anything to do with anything that crossed the dura. Then I worked with another neurosurgeon, and that didn't work out real well either.
AO/Beck: Just to clarify, the first ten or so were approached via the middle fossa approach, and were they sitting up or supine?
House: They were sitting up. One day it occurred to me -- My God, this whole thing of sitting patients up is so dangerous because there was a significant potential of air embolism. Because when sitting up, the venous pressure in your head is lower than atmospheric pressure. So I said, why don't we just lay them down and then I can remove the labyrinth and everything from the translabyrinthine approach, and that's when that was developed. I went out and did a lot of dissections on cadavers, worked out the techniques of locating the facial nerve and I began teaching that. We could locate the facial just exactly where it was. So then we started doing that and after we had done a few cases we set up the first class with seven or eight surgeons watching it and we had the old black and white televisions at that time. That was the first time anybody had ever televised anything through the microscope.
AO/Beck: That's incredible. What year was that Dr. House?
House: Oh that would have been about 1970 or 1971.
AO/Beck: So it was televised live into a teaching arena and you were operating and narrating at the same time?
House: Yes. The second neurosurgeon I mentioned a moment ago was in the audience. He was always assigned to me and we worked on these patients together. I would do most of the approach through the labyrinth and then we would both work on the tumor. I would show him how to see exactly where the facial was and so on. But he felt that was a very dangerous approach. I don't know why. I think it was because he felt that I was getting completely away from the neurosurgical approach. He was sitting in the audience saying, If this patient dies from this procedure I won't sign a death certificate. He said that to the audience while I was up there operating.
AO/Beck: That's incredible. Did you know that he was saying that?
House: It was two-way communication, so yes; I heard it as he said it. I was going to go ahead and do my surgery. It was a foolish thing for him to say, and so finally Dr. Sooy, the head of the department at UC San Francisco was in the audience, and he said to the neurosurgeon Let's just shut up and let him do the operation, and then he kind of quieted down. Of course the patient did very well. We saved the facial and the patient. That's when I had to start looking for somebody else to work with. That's about the time Hitzelberger came along. He just finished his residency at the Mayo Clinic in neurosurgery. I felt that if I got in any trouble and I didn't have a neurosurgeon to back me up that they would probably throw me out of medicine or something. But Bill Hitzelberger and I didn't have any trouble. Bill got interested and he was the only neurosurgeon I had worked with, up to that time, that was willing to learn how to do temporal bone work and understand the whole thing. So it worked out very well.
AO/Beck: And Dr. Hitzelberger sort of took up residence with your practice?
House: Yes. He joined our practice briefly and then went off and had his own practice, which we all agreed was probably a better deal.
AO/Beck: How many patients would you say you operated on for acoustic neuromas across your career?
House: I don't know exactly, but I think at least a thousand.
AO/Beck: What year was your first translabyrinthine craniotomy?
House: That would have been probably 1971 or so.
AO/Beck: If you were to speak to a patient with an acoustic neuroma today, and you were talking about the benefits of the translab versus suboccipital versus middle fossa approach, it seems to me the translab approach has stood the test of time and it's still the preferred surgical route. Is that correct, and is that what you would recommend?
House: That's correct. There are a number of advantages to the translab approach. If you go through the suboccipital approach with the patient sitting up, there's a greater risk of air embolism. Without getting too graphic, when they place the patients in position for suboccipital procedures, and I know you've seen many of these Doug, the head is in a head-holder to keep it from moving, and of course to keep it in position. So the patient is essentially hanging by their head and they are asleep. As you can imagine, there have been some kinks of the cervical spinal cord and quadriplegics too. That was a very serious problem. Bill Hitzelberger and I reported that, and of course, the neurosurgeons were up in arms but they couldn't say anything because obviously the patients were injured. The other disadvantage was that with the suboccipital approach you had to take off the outer third of the cerebellum, and if you get a little too deep into what's called a dentate nucleus in the cerebellum, then the patient would have a permanent cerebellar ataxia. With the translab approach, we don't have to take out any cerebellum. The suboccipital approach can also cause very severe and prolonged headaches.
AO/Beck: Please tell me the advantages of the middle fossa approach?
House: The reason for using the middle fossa approach is if the tumor is quite small, we can sometimes get it out through the middle fossa approach, and save the facial nerve and the hearing too. I think they're using it a lot more now because we can detect tumors while they are still quite small. But middle fossa surgery was so difficult, or thought to be so difficult, that it wasn't very popular. Very few people wanted to do it. It was more popular in Europe for a long time before it kind of came back to the USA.
AO/Beck: And translab obviously has the best exposure out of all of them so you can actually take out 7-8 cms tumors is that right?
House: That's right yes. And you can usually take those very large tumors out without doing damage to the cerebellum. The advantages of the translabyrinthine approach are numerous, and as you said earlier, it has stood the test of time.
AO/Beck: And so I guess you were getting bored, didn't have enough challenges in your life, and one day you decided to create cochlear implants?
House: Well, no! What got me thinking about cochlear implants was Eddie Johnson, remember him?
AO/Beck: Absolutely. He was the Chief of Audiology at the Otologic Medical Group when I started at the House Ear Institute, in the 1980s.
House: Yes, that's right. Eddie had a daughter who was congenitally deaf. They went to the John Tracy Clinic, and he got me very interested in deafness in children. When parents would bring deaf children in, Eddie would confirm the hearing loss and then I'd say Yes, they're very deaf.
I found it very difficult to tell the parents There's not much we can do. Why don't you get some hearing aids and we'll refer you down to the John Tracy Clinic. Many of the patients ultimately ended up with manual communication, sign language. So that was, one about the time this patient brought me a little clipping about two gentlemen, Dijourno and Eyries, one of them was a physiologist and the other an otologist, both in Paris. I think both of them are gone now. They reported two cases, they never did anymore. They reported on two patients that had labyrinths destroyed by cholesteatoma so they were totally deaf. So they just saw a nerve ending there and put some wires into them.
AO/Beck: That's amazing. And that was what year would you guess?
House: That was 1958.
AO/Beck: So in 1958 they just used copper wires that had been autoclaved I would guess? And they pretty much just started sending current through the wires?
House: Yes, I think so. They would transmit current into the wires, and the patients could hear some tones.
AO/Beck: And obviously you thought about that, and what did you think?
House: Well I thought it was a tremendous idea. Why can't we learn to do it? I had already developed the facial recess approach, and I knew we could go that way and get to the round window. So I began working first with an engineer named Doyle, and he worked out some devices for me.
I began to gather some information when I was doing stapes surgery under local. I would put an electrode in the round window and then put tiny electric currents through the wires and ask the patient what they heard. So I began to get some idea about the amount of electrical current, what they could hear, and things like that with normal bone conduction cases. The engineer worked with me for a while. We did a couple of cases, and then we got a grant of $10,000 from George Ectles in Utah. He was quite a financier and he was one of the people that helped set up the foundation. So he gave us a $10,000 grant at the request of Howard to work on this problem. So I began working on dissections, introducing electrodes into the cochlea, and things like that.
AO/Beck: Did you have concerns like IRB issues or FDA approval or any such thing?
House: The FDA did not control anything in the way of medical devices at that time. Must've been about 1957 or 1958.
AO/Beck: So as a surgeon and a physician you could just think these things through and just go for it.
House: That's it.
AO/Beck: I love it. I think I was born a few decades too late!
House: I do honestly feel that in today's environment I couldn't have done these things. I don't think we would have gotten by the IRB and stuff, and the FDA would have said this is crazy.
AO/Beck: So did you implant a few people with Mr. Doyle's designs?
House: Yes. The two or three cases that I did with Doyle were OK for a starting point, not amazing, but very useful. We didn't have good compatible insulating material and silicon rubber was not well cured. The wires were encased in insulation material that was very bad. We got some swelling around them so I had to take those out even though we got some responses right off the bat from the first two or three patients. They were totally deaf patients, and they did hear with the first design. We just backed off because we didn't have good compatible insulation materials. But with all the work that was going on with animal work and developing drains for ventricles for hydrocephalus, things like that, they began to develop good stuff. Doyle and I parted ways because the $10,000 ran out and I said We'll have to stop this project. The story got even more interesting because he was apparently advertising that this was a big breakthrough and if you were to invest in his company you would end up on easy street. I thought that was all wrong. It was like the Wright brothers advertising to charter a plane across the country. It was ridiculous what he was doing. Howard and I didn't like that because he came out with some newspaper articles and stuff. So anyhow we parted ways and then a few years later, in the early '60's, Jack Urban and I started working together on the whole problem. Jack developed some plugs, instruments and tools and protocols. We put the electrode in and then we'd take the patient to Jack's office and try different currents and things, that took us about two years. We tried all kinds of different things. He developed circuits and tried dozens and dozens of options. Jack would sometimes take a month or so to build up a device and then we would try it on our patients.
AO/Beck: Do you remember the early lessons that you learned?
House: Well we developed a lot of different things. It was pretty obvious that he was hearing well with some of the electronic gear, and other things didn't work very well at all. So Jack and I would usually go out to dinner afterwards and we would sit and talk about it for a while. And we would work out what our next step was. This went on for two years and finally we came to the idea of an amplitude-modulated signal. And we found out things like, well very early we found out that if you use the ground outside the cochlea it took less current than if we put it in the cochlea. And of course they've now come around to that, as you know. I think all of the FDA approved devices on the market today are using monopolar stimulation, which we did very early. So anyhow it came out that our patient said the one sound he liked best was amplitude modulating the electric analog of sound onto a 16 kHz carrier wave. We tried different carriers of different frequencies and 16 seemed to be the one he liked pretty well. Our next problem was that we had never tried long-term stimulation. We'd only stimulated him maybe half an hour or 45 minutes at a time to see what he heard and then we'd unplug him and he'd go home. So we finally decided all right let's give him a wearable device. His wife Barbara was wonderful, she was his interpreter and she helped us out a lot. She came with him all the time. My main concern was that I'd been told by people that should have known that if you put electric current in the ear, it's going to destroy whatever you're stimulating. So we needed to get him to use it for a longer time to see if it was going to poop out or not. We eventually sent him home with a device and let him try it for a longer duration. We had a device that they could plug in and we taught Barbara how to manage it and be very careful with it. So they took it home and the next day I called them and she said it was still working. So I called her every day for a while and she'd say, Yes it's working fine. And it kept on working. So as each day went by we were very encouraged that maybe we had something here and it wasn't going to poop out. He wore this hardwire device for a month or two and then I decided to do more patients.
AO/Beck: What year was that?
House: That would have been about 1969. I did recruit some more patients again telling them that I didn't know if this was going to be permanent but it looked like it was a good possibility. These were all totally deaf people and none of them turned me down. Jack and I published some work on it and then stuff started to hit the fan about that time.
AO/Beck: Dr House, I am very appreciative of your time. You have been very generous and patient! Maybe the best thing to do here is to place an excerpt from your website www.allhear.com into this interview, and then I'll recommend that the readers review your website to learn more about the history, controversies, and your reflections on cochlear implants and related issues?
House: That's a great idea Doug. Please go ahead.
AO/Beck: For readers who would enjoy a more detailed history, and more of the thoughts and opinions of Dr. William F. House, I encourage you to review the website www.allhear.com.
Additionally, I'd like to encourage readers to visit www.h4c.org, which is the Hearing for Children Society website. They're a non-profit organization that promotes the AllHear device and the website offers very interesting perspectives and analysis on many issues relating to cochlear implants and related matters.
The following pages are from www.allhear.com and they are reprinted here with permission.
I remember ... Requesting to present the very preliminary anecdotal findings on our implant patient at a national meeting. I was turned down on the basis that reporters would be at the meeting and their reports of the implant would cause otologists to have to contend with a flood of patients with unrealistic expectations.
Finally, however, in 1973, The American Otological Society Saint Louis meeting held a session on cochlear implants.
Dr. Nelson Kiang, a very prominent neurophysiologist for Harvard, expressed the belief that a single-electrode device, such as all of our patients were then using, would only produce a kind of buzzing, Morse code-like sounds, and from a theoretical standpoint, this was a very reasonable position.
Dr. Kiang felt strongly that, if an electric field was generated around the neural tissue in the inner ear, the nerve fibers would all fire, go into a refractory state, and then fire again, repeatedly, for as long as the stimulation lasted. This would result in a buzz sound that turned on and off as the current was turned on and off.
For those who had not actually seen any implant patients, this belief regarding the limitations of cochlear implants was widespread.
The Journal which resulted from the meeting printed Dr. Kiang's thoughts, as well as contrasting comments by noted researchers such as Dr. Merzenich of San Francisco. Dr. Merzenich had seen some of our patients and had begun work with Michelson. He said:
Dr. Kiang's remarks suggest little or no discriminative hearing can be generated from a single-electrode pair. However, it should be pointed out that these subjects do have some discriminative hearing in the sense that small differences in stimulus frequency can be detected. And subjects describe sounds which they hear as 'tones'. This must be faced up to and explained. These and other qualitative observations on hearing in these subjects have also been made by Dr. Simmons and others. They are bonafide, as you will appreciate the first time that you see a patient. They simply must be explained in terms of neural mechanisms.
I remember hearing once that, according to standard aerodynamic theory, a bumblebee cannot fly. Apparently no one has successfully convinced the bumblebee of this, however, and these sound theoretical arguments regarding the response of the neural system likewise seemed not to be able to convince our patients that they were not hearing something useful.
As the saying goes, there are none so blind as those who will not see. Despite repeated requests to observe the patients as Dr. Merzenich had done, there were those whose minds were made up and they continued to insist that no benefit was possible with a cochlear implant.
I remember one remark by a scientist at the 1973 meeting who said: If I tell you that a lead balloon will not fly, and you go out and build a lead balloon and it does not fly, what have you learned? I could not help but remark that I had flown to St. Louis in a lead balloon. (Two Wrights had not been proven wrong.)
Editor's Note: I am proud to have known Dr. Bill House for the last 20 years. He has been a personal friend, a colleague, and in many respects - one of my professional mentors. I want to take this time to thank him for his amazing curiosity, fortitude, integrity, and most importantly, his unselfish and compassionate quest, So all may hear. Thanks Dr. Bill! ---Douglas L. Beck, Editor-In-Chief, February, 2004.
