BrazJOtorhinolaryngol.2015;81(2):124---125
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
History
of
cochlear
implants
夽
História
dos
implantes
cocleares
After finishing my internship at Washington University in SaintLouis,Ihavebeen severaltimesin LosAngeles with the House Group. It was there where I learned to oper-ateacousticnervetumorsandperformendolymphaticsac surgery. But, interestingly, I first heard about cochlear implants during an Auditory Canal Transtemporal Micro-surgeryInternationalCoursecoordinatedbyProf.UgoFisch, in1972.Afterthismeeting, someparticipantstraveled to thepicturesquevillageofBurgenstockfor apost-congress tour.
One morning, Ugo took us to a small room in which Dr.William Houseshowedusafilmabout themakingofa cochlearimplantandafewstepsofthepatient’s rehabili-tation(Iexhibitedthismovieatthesymposiumweheldin November2007 tocelebrate 30 yearsof the firstimplant performed in Brazil; the odd thingis that Bill House had forgottentheexistenceofthisfilm...).
Iwasfascinatedwiththispresentation.Duringmythree yearsin Saint Louis,Ihave been always nearthe Central InstitutefortheDeafandhadcontactnotonlywith audi-ologists andneurophysiologists, but withdeaf children as well.Perhapsthiswasthereasonformyimmediateinterest inimplants.Iwassurethattheseexperimentsrepresented the starting point to a new era of Otology. Afterwards, I wasgiventheopportunity towatch some surgeriesin Los Angeles.
InMay1976,BillcametoBrazilfortheFirstSymposium ofNeuro-Sensory DeafnessandCochlear Implants,held at theAlbert Einstein Hospital. At that timehe hadalready performed 15 implants and told us about creating other cochlear implant centers in the United States and other countries.
In February 1977, the 1st International Conference on CochlearImplantswasheldinLosAngeles.Otologists inter-ested in performing implants were invited to attend this meeting;butinaccordancewithUSlaw,theotologistshould
夽
Pleasecitethisarticleas:MangabeiraAlbernazPL.Historyof cochlearimplants.BrazJOtorhinolaryngol.2015;81:124---5.
beaccompaniedbyafullteamofcollaborators;otherwise he/shewouldbeconsideredonlyasanobserver.Therewere about20otologists,butonlysixteams.MyteamincludedDr. ChihChaoChun(ElectronicEngineer),MarleneMangabeira Albernaz(Audiologist)andEvaOcougne(Psychologist).The presence of anengineer was critical,becausethe adjust-ments were made with an oscilloscope, considering that therewasnocomputerinterfaceatthattime.Inaddition, we had thedevice circuit, andDr.Chao triedto buildan externalunithereinSãoPaulo,butthecomponentsthathe couldgetatthattimeweretoolarge.
WebroughtbackthefirstSigmasystemimplantableunit, which had been used to operate our first four patients. Afterwards,thissystemwasreplacedby3M/Housesystem. Andthen,cametheNucleus,MedEl,AdvancedBionics, All-Hear,Neurelec...OurfirstpatientwasoperatedinOctober
1977 at Hospital Israelita Albert Einstein. It wasthe sec-ond implantto beperformed outsidethe United States.I mustmentiontheparticipationofYotakaFukudainallmy implants,untilanaggressivediseaseandhisuntimelydeath preventedhimfrombeingatmyside.
In1981,Ipublished,alongwithYotakaFukuda,Mauricio Gananc¸a,MarleneMangabeiraAlbernaz,SoniaChiarella,Eva Ocougne,LeniBalabanSassonandChihChunChao,a mono-graphdescribinghowcochlearimplantsweremadeatthat time, and addressing our first two patients. Pedro Bloch, a veryspecial friend, wasthrilled withthe implants,and graciously wroteabeautifulpreface forus.Otology hasa historyofoppositiontoprogression.Thefenestration oper-ationwasviolentlycondemned bymany, includinghere in Brazil.Thesamehappenedwithstapedectomy andtumors oftheacousticnerve.
The opposition to implants was particularly strong. Accustomedtoaudiologicalresultsoftympanoplastiesand stapedectomies,ourotologistsbelievedthatthedegreeof discrimination achievedwiththe implant did not warrant thissurgery.Itturnsoutthat,atthattime,mostotologists hadverylittlecontactwithprofounddeafness. Bill House received numerous requests from doctors and companies toabandonhisprojectofimplantuse,somethingthathad
http://dx.doi.org/10.1016/j.bjorl.2014.12.006
EDITORIAL 125
alreadyhappenedwhenhebegantooperateacousticnerve tumors.
IalsosufferedagreatdealofoppositionhereinBrazil, whenIstartedtheimplants’programatEscolaPaulistade Medicina, evenfromphysicians whoarecurrently leading groupsinimplantsurgery.
It is clear that cochlear implants have been continu-allyimproved, buteventhefirstimplantsweusedgreatly improvedthequalityoflife ofitsusers.The Universityof Iowaconducteda surveyonthequalityof lifeofpatients implantedwiththeearlyimplantsandconcludedthatthese patients achieved real benefits from their use. Profound deafnessisthemostdisablingofhumandiseases;thus, any-thingwecandotorelieveitwouldrepresentagreathelp. Thatiswhyoftentimespatientswhoachieverelativelypoor resultswiththeimplantmayfeelmuchbenefited.
Theuseofimplantsinchildrenisparticularlyimportant, because these devices reduce the hardships in language acquisition.
These proceduresare important,so thatdeaf children havetheopportunitytostudyinregularschools,integrating themintothecommunityoflisteners.
Today,implantsareanintegralpartofOtology.Our coun-tryhasalreadymany centers,withdedicateddoctorsand audiologists.Certainly,theiruserepresentsanextraordinary progress.Buteach breakthrough advanceneeds astarting point,andBillHousewasthemanwhohadthecourageto makethisthinghappen.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
PedroLuizMangabeiraAlbernaza,b
aEscolaPaulistadeMedicina,UniversidadeFederal
Paulista(EPM-UNIFESP),SãoPaulo,SP,Brazil
bHospitalIsraelitaAlbertEinstein,SãoPaulo,SP,Brazil
