Download What can surgeon do for deafness?

“What can surgeons do for deafness?” – Lecture given at the
official launch of the Friends of the NDA , 3 November 2011
Tony Innes welcomed everyone to the meeting and then handed over
to Frank Eliel, the Chairman of the Friends Committee. Frank explained the
aims and objectives of the Friends and then welcomed the inaugural speaker,
Mr Peter Prinsley, FRCS, who works as a Consultant Ear, Nose and Throat
Surgeon at the Norfolk and Norwich and James Paget University Hospitals,
and is also an Honorary Senior Lecturer at the UEA.
What follows is a transcript of Mr Prinsley’s excellent presentation entitled
“What can Surgeons do for Deafness?”
“Thank you very much for asking me to come and talk this evening. I'm
going to try and say a little bit about what surgeons can do for deafness.
I asked Tony how long he wanted me to talk for and I said that the
battery on the laptop lasts for five hours {laughter}. So we'll be out of here...
well, we'll be out of here in not too long, if that's all right.
As you know the N&N is an excellent hospital and the James Paget
University Hospital, in the news this week, is also an excellent hospital
{cheers from some members of audience}
So the story of what surgeons can do for deafness is a very long one.
It starts in medieval times, with this man, Bartolomeo Eustachi (picture on
screen). This is the man who gave his name to the tube, the little tube, that
runs from the back of your nose into your ear. If you didn't know that you had
got one of these tubes, what you could is, you could just hold the end of your
nose now and swallow. What do you notice? Notice that if you weren't deaf
before…. {laughter}.
_____________________________________________________________________
[1/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
So, he was a contemporary of a man called Andreas Vesalius, and he
identified first the cochlea and then the little muscles inside the ear.
This is his book (picture on screen), a book of anatomical engravings,
which beautifully demonstrate the anatomy of the ear, which he wrote about
500 years ago.
Here is something of the anatomy of the ear. On the bottom right
(picture on screen), I hope you can see, a picture of the eardrum. You can
see a little white line running up to about 2 o'clock which represents the main
bone within the eardrum, the hammer or malleus bone. Shining downward
and forwards is a little triangle of light, that's what we see in a healthy
eardrum. That's a right eardrum but I could turn the slide round and it would
be a left eardrum {laughter}.
Here is a drawing (picture on screen) taken from the book of the
anatomy of the inside of the ear. You can see the drum, and you can see,
beyond the drum, a chain of little bones, known as the hammer, the anvil and
the stirrup bone that carries the sound from the drum across to the inner ear.
That works as a little amplifier. The eardrum collects the sound, the sound
from the forest floor of the rustling snake, so the drum points slightly
downwards and forwards and amplifies it by a mechanical process, so the
little stirrup bone moves in and out causing vibrations in the delicate fluid of
the inner ear, which turns mechanical energy of fluid vibration into electrical
energy which passes along the nerves to the brain where sound is
interpreted. Okay?
So that's enough about the anatomy and physiology of the ear. Got it?
{Laughter} .
So, of course, the story of what surgeons can do for hearing starts with
what surgeons could do for the ear. Now, the first English ENT surgeon was
_____________________________________________________________________
[2/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
this man, Joseph Toynbee (picture on screen), the first man to have beds at
St Mary's in London for treating patients with diseases of the ear.
What some of you just did about five minutes go was Toynbee's test,
you felt the eardrum move in and out. If your Eustachian tube is working
properly then that's what you will feel and somebody looking with an
instrument in to your ear would see your eardrum move in and out Toynbee's test. He had a famous son, and a lot is known about his son as
well. There is a lovely story about him. He was described by William Wilde a
famous Irish ear, nose and throat surgeon, the father of Oscar Wilde, and he
writes, "The labours of Mr Toynbee, have effected more for aural pathology,
than those of all his predecessors, either in England or on the continent."
Now the story of Oscar Wilde we'll tell in a minute.
Now, unfortunately, Joseph, who had dissected more than 2,000
temporal bones to demonstrate the anatomy of the ear, died when he inhaled
a mixture of chloroform and prussic acid. He was experimenting to find a cure
for tinnitus. That's the sad tale of Joseph.
The early ear surgeons, they weren't too concerned with treating
hearing loss. In fact, they didn't think that they could do that. What they were
concerned with was saving lives.
Ear infection, suppuration within the ear, killed people in large numbers
in previous generations. The early ear surgeons were involved in draining
pus, pus out of the mastoid to stop people dying. Here is a small child
(picture on screen) treated fairly recently in our hospital, who came with acute
mastoiditis, infection of the mastoid bone behind the ear, with the ear pushed
downwards and forwards. And there is the operation to drain the pus out of
her ear (picture on screen)
_____________________________________________________________________
[3/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
Here is another patient (picture on screen) admitted about three or
four months ago to the excellent James Paget University Hospital, with a fit.
What you can see is the patient has an abscess in the brain. Even I can see
that. A large circular area, abscess in the brain - not Oscar Wilde who,
incidentally is someone my Registrar had never heard of {laughter} - the son
of William Wilde the famous Irish ear surgeon, he died of suppuration of the
ear which was neglected whilst in Reading Jail. The story is he died of
Syphilis, but he died probably of mastoid infection in, I think, 1901.
Okay. So let's just talk about some of the more contemporary patients.
Would anybody like to say where this man (picture on screen) is from?
From the floor: Sweden
From the floor: Australia.
Mr Prinsley: That's true, he's from Australia, doesn't he look Australian?
{laughter}.
What do you think he does? He's a surfer isn't he? He's an Australian
surfer. The picture on the left (on screen) shows his ear canal. Now, I showed
you a picture of the eardrum before, do you remember? The shiny thing with
the triangle of light. You can't see that in here, he's developed bony swellings
in his ear canal, caused by repeated immersion in water. So these are the
Australian ear disease, so the Australian ear surgeons, especially the ones up
the coast of Queensland are excellent at treating this condition {laughter}.
Although this particular patient, this Australian, is a builder from
Beccles. {laughter}.
Now, probably the commonest thing that we see causing hearing loss
that we do something about, is this condition of glue ear. Glue ear. Glue ear
is caused by a problem with the tube described by Bartolomeo Eustachi. We
_____________________________________________________________________
[4/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
usually see it in children who have big adenoids at the back of their nose
blocking it up. The child will come with poor language development, unable to
hear. The parents will say they have learned to turn the volume up on the
remote. The picture on the bottom left (picture on screen) is a normal
eardrum, the picture in the middle shows that sort of treacle appearance of
sticky glue behind the drum, and the picture on the bottom right shows the
treatment for this, which is a little plastic drainage tube put into the drum to let
air in and out of the ear, the artificial Eustachian tube , or the grommet.
Here's a sort of hearing loss that ear surgeons treat. This is the sort of
thing that we do all the time at the Norfolk and Norwich and James Paget.
This patient (picture on screen) has a perforation of the eardrum, and it's
possible to see some of those little bones the hammer, anvil and the stirrup.
What you might notice is that the anvil bone isn't quite touching the stirrup
bone. Can you see that? You can see a big hole in the drum, instead of the
end of the anvil bone sitting on the stirrup it's not quite connected, so the
patient has hearing loss.
Now this is quite high-risk. What I was hoping to be able to do was to
show this, this should play, maybe it won't. That's the trouble with these sort
of presentations. I will show, at the end, a little video of the sort of procedure
that can be done to correct this. The basic problem is that there is no mouse
appearing on this screen, which I really don't understand.
From the floor: It's on the big screen.
From the floor: If you keep moving it to the left, perhaps it will move across
to where you are {laughter}.
Mr Prinsley: You know that might have been quite an intelligent suggestion,
from my former senior colleague.
_____________________________________________________________________
[5/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
Mr Prinsley : Right, okay. You can see (Video) an operation being done and
a little prosthesis is being put into the ear to join the anvil bone to the stirrup
bone can you see that, made of ceramic. It just sits in between the end of the
anvil bone which is a bit short and the stirrup bone, correcting the blocked
conducting mechanism in the ear. Of course it's a little bit of a fiddle, but in a
minute you will see it sit in place, I think. Okay, can you see that? Happy with
that? Right. So now let's go, let's go to that slide and... slide show. Right.
Now I want to talk to you about another condition now, this is a
condition also of blocked hearing conducting hearing loss, the condition is
otosclerosis. You can see (picture on screen) around the foot plate of the
stirrup bone, it's as if someone tipped cement on to the stirrup foot plate and it
doesn't move properly, This causes progressive hearing loss in middle life,
slightly more common in women than men, slightly worse during pregnancy,
starts in one ear but often involves the other ear.
On the right (picture on screen) is the typical sort of hearing test of a patient
with this condition. I mean, perhaps some of you are slightly familiar with
hearing tests, but on the vertical axis is the hearing level in decibels and on
the horizontal axis is the frequency. That patient has a hearing level round
about 70 decibels, that means in order to hear a conversation the person
talking to them would have to almost shout. The little line of boxes and
triangles across the top represents the hearing if the hearing testing is put on
to the bone behind the ear, this what's called a 'Conducting hearing loss', if we
see a patient with a conducting hearing loss with a normal eardrum, what the
ENT surgeon says is this is otosclerosis. Okay?
So this is Julius Lempert (picture on screen) . What I need to get to
is... hang on a minute… I'm trying to get my notes up on here which should
have been printed. The basic problem here is that I'm a technical failure, but I
can do ear surgery. {laughter}.
_____________________________________________________________________
[6/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
Yeah. That's him, (picture on screen) Julius, he was born Lublin, 1821,
and went to the Long Island Medical School in 1913. That was a third class
medical school in those days, so he was unable to get any sort of residency.
What that meant was that he couldn't get any post-graduate training in
America at that time. So he spent his time going around visiting ENT
surgeons all over New York and learning what he could. Then he set up a
practice and he had a unique trick which was what he would say to the
referring doctors, was that if you sent him a patient he would send the
referring doctor half of the fee. {laughter}. So before long he had the largest
practice {laughter} for ENT in the whole of America. He became immensely
wealthy.
What he did was he was one of the first ENT surgeons to be able to do
anything about this condition that we talked about, of otosclerosis.
He described this operation, this operation is called the fenestration
operation. Actually this operation was done in Norwich, it was done in
Norwich in quite large numbers. I came across only about a week ago a letter
in a patient's notes from 1956, when one of my predecessors’ predecessors’
predecessors had operated on this condition, a mastoidectomy, so that the
sound would pass straight into the semi-circular canal from the outside, this
so-called fenestration operation. For some patients that turned out to be a
helpful thing, this was the first successful surgery for this condition of
otosclerosis.
Now, this is John Romm (picture on screen) this is Marian's (Mrs
Prinsley’s) grandfather, who travelled back to Russia, so the story goes, from
South Africa where he had gone to live in about 1900. He had otosclerosis
and he went back to Russia to be operated from where he had come, I think
he must have had the fenestration operation, but the problem is they operated
on the wrong ear! So when he came back to South Africa he was completely
deaf in both ears.
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[7/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
From the floor: Oh dear.
Mr Prinsley: But he lived to a great old age. He had a horse and cart.
Eventually he died in a horse and cart accident, because the train which was
coming along frightened the horse and he didn't hear the train coming and he
was killed when he was thrown from the horse and cart, so that's the story of
the fenestration operation being done on the wrong ear all those years ago.
This photograph is in our house.
This is quite difficult to read (picture on screen), but this is a report of
Samuel Rosen, who devised another operation for treating this condition. He
operated on the stapes bone itself. He was able to give that stuck stirrup bone
a little shake to try and crack it and get it moving. This is the report of Samuel
Rosen, the first case of hearing improvement following mobilisation of a fixed
foot plate, occurred in 1952 by Rosen, and since then many patient with
otosclerosis have been operated on by this indirect method. That's the report,
the first page of the original article describing those operations more than fifty
years ago, so they restored hearing in patients with otosclerosis.
Of course the story of surgery for hearing loss is the surgery of things
that are very small. So the whole thing depends on Karl Zeiss, the first man
to commercially produce microscopes that could be used to operate. Now, of
course, all over the world surgery is done with microscopes. When this
started it was considered to be a fantastic thing. Even in my experience I've
seen how people have been unable to be believe what they can see down an
operating microscope. Sometimes I go to do surgical camps in other parts of
the world and one of the places I go is to Bangladesh, I can remember quite
clearly only about ten years ago trying to show somebody what to do down an
operating microscope. He sat there for ages, looking down the operating
microscope at the ear and I said, now what you need to do is make the
incision, so what he did was he went... (Mr Prinsley moved his head to one
side) {laughter}.
_____________________________________________________________________
[8/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
He had completely failed to believe that what he was looking at was
what he could see.
So we mustn't think that any of this has happened without all the major
technical advances, particularly of microscopes, which has happened over the
last few decades.
Now this is Dr John Shea (picture on screen), who I think is still alive,
born in 1924 in Tennessee, He must be very old. In 1956 he did the world's
first stapedectomy, on a woman who was 54 years old. He repaired
perforations of the eardrum, and was one of the founders of modern ear
surgery. He also became immensely rich and immensely successful. One of
the things he did was get married to Miss America in 1960.
Now what I'm going to do next is I'm going to, I'm going to try and
show you a short video of what this operation is. This is the operation to bypass the stuck stirrup with a little prosthesis. If you like, an ear by-pass
operation, but we have to go to this pantomime of getting it working again.
So here is a view (video) looking into the ear. The eardrum has been
lifted up and we are looking at the anvil bone on the top of the stirrup. What
you will see in a minute is a little green light firing-a laser. Can you see that?
The laser is being used to cut away the bones inside the ear. This is a little
titanium prosthesis that will be used to put between the stuck stirrup foot plate
and the anvil bone. Here is a little hole being cut in the foot plate with a laser
and there is a drill being used, it's amazingly quick to do it by video. There is a
little drill and now you can see a small hole through the foot plate in to the
inner ear. Now, that's that little metal hook, which is put into the ear and
clipped on to the anvil bone, there it is. Okay, that's it, that's the operation of
a stapedectomy, the way we do it today. He didn't have such good
microscopes, he didn't have a laser and I don't think the little drills he had
_____________________________________________________________________
[9/19] This is a draft transcript prepared by Norma White for Speech-to-Text purposes
only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
were anything like as good as the drills we have now so it’s remarkable that
the results were as good.
One of the things that ear surgeons have done more recently, they
have had to think very carefully about what the results of the operations that
they do actually are. Not just the results for an individual, but the results for
populations. This sort of chart (picture on screen) allows us to do that, to
some extent.
What ear surgeons do now, to see whether the operations they do help
hearing, is that they make comparisons around the world. So, most ear
surgeons now enter the results of their operations on an international audit,
which takes results from hospitals all over the world and compares them.
This is done in real time so that the cases are entered on to the database at
the time of the operation and then when the patients are seen in the clinics we
can follow them up and see how we do, compared to centres around the
world.
Just by way of example, this is a slightly complicated chart (on screen)
which shows the comparative data for stapes operations done in Norwich,
with those compared around the world.
So what that audit allows us to do is to be able to say that the
operations that we do actually work. They work about as well as could be
expected, because they compare, almost exactly, with the results of 3,500
operations done around the world.
So that's what is meant by 'Clinical audit'. All of the surgeons in all the
specialities now are obliged to do this sort of work and keep careful records of
what happens.
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[10/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
For instance, we could work out, using this sort of data, what would be
the best sort of piston to use for the operation. We have done cases with
Teflon pistons and titanium pistons and we can see the results.
Now we need to move on to other things that surgeons can do for
deafness. This is Branemark (picture on screen), a genius, a dentist who
invented a way of implanting metal into bone so that it would stay there
without getting infected, so-called osseo-integration, something metal into a
tooth socket. Anyone here got a dental implant? it was invented by this man,
he invented the way of fixing a titanium screw into the skull, which allows a
dentist to fix a screw, reliably into the mouth. We can do the same with a
hearing-aid.
For many years now, we have been implanting little titanium screws
into people's heads and clipping hearing-aids on, so-called bone-anchored
hearing aids, or BAHA. This is a sort of hearing aid that works really well for
patients with a conducting problem. In other words the cochlea works well but
the sound simply can't get to it, perhaps because of otosclerosis or mastoid
disease or some other reason that the patient can't hear.
Why do you think this patient (picture on screen) can't hear? Boxing?
No not boxing, not rugby. Not trauma. Genetic, yes, what do you think
happened? Well, the patient was born with no ear, the patient has no ear, this
is a so-called microtia, absence of the ear. This patient has had an ear made
by an exceptional plastic surgeon in London, I think that's a pretty good ear,
rib cartilage and bits of skin graft, done over a series of operations. Of course
what the plastic surgeon couldn't do is restore the hearing, because the ear
canal is completely closed so the bone anchored hearing-aid, colour matched
to the patient's air, works perfectly in this situation. This operation was done
some years ago, but funnily enough, when visiting another patient on a ward
last week, this lady came over and gave me a kiss. She came over and said
“Mr Prinsley, I want to tell you how fantastic this hearing-aid was.” I didn't
_____________________________________________________________________
[11/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
realise who she was! This is a magical operation, offered in Norwich for ten or
twelve years, and we have done hundreds of these.
He is a somewhat notorious patient of mine (picture on screen),
‘though no longer. At the time he was a jumbo jet pilot for British Airways. He
has poor hearing caused by mastoid disease. He's had operations for, it and
was unable to wear a conventional hearing aid. If he put one in his ears would
discharge and whistle and block. He had a bone-anchored hearing-aid, he
was able to connect the console of the jumbo jet directly to the hearing-aid
and didn't have to wear headphones, truly a bionic pilot.
Now we must move on. George Bekesy, one of the few people in
the ENT world to win a Nobel prize (picture on screen). It was for working out
how the cochlea worked. He discovered that inside the cochlea, that snailshaped thing described originally by Eustachi, is a long vibrating membrane.
The way it was done was by putting little flakes of silver on to the cochlea and
taking time-lapse photography and blasting the models of the cochlea with
different frequencies and he could see the little flakes of silver moving up and
down at different frequencies. He was the person that worked out there was
sort of tonaltopic reflection of sound along the cochlea. Of course it's that
work that led to the development of the cochlear implant.
Now this is Graham Clark (picture on screen) a professor of ENT
surgery in Melbourne in Australia, who I have met several times. My father is
also a professor of medicine in Melbourne Australia and a friend of his.
Graham Clark has done most in the world to develop the magic
cochlear implant. There are now thousands of patients around the world who
have this gadget that turns speech through clever processing into a electrical
signal which can be interpreted, amazingly, by the fibres of the auditory nerve
and carried to the brain. In fact there is a cochlear implant wearer in this room,
with whom I have an absolutely perfectly clear conversation when I came in
_____________________________________________________________________
[12/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
the room, which would not be possible without the cochlear implant. This is
the miracle of modern otology, the invention of this device.
Now, what I would really like to do... yeah, so this (picture on screen) is
a schematic representation of a cochlear implant. What you can see is that
there is a gadget hooked on to the back of the patient's ear which picks up
sound in the same way as a conventional hearing-aid. It's connected via a
magnet to a thing which is placed underneath the skin. That gadget
processes the sound information, turns it into electrical signals, passes it
along a wire and into the cochlea, you can see a little coil passing in to the
cochlea with usually 22 electrodes, each picking up a different pitch and
presenting it to a different point along the cochlea. Nowadays children who
are found to be profoundly deaf, and of course we have a vast industry of
people trying to identify children who are born profoundly deaf, will be offered
bilateral cochlea implants in the first few years of life. With luck, if it works
and it usually does, they will be able to grow up as speaking individuals with
good hearing, educated in ordinary schools.
Of course I know that, in itself, has a whole lot of other issues attached
to it to do, also with what's called deaf culture and whether this, in some way,
has a problem for those that have a deaf culture.
Here is a child (picture on screen) wearing a cochlear implant. Now I,
as I said, get involved in surgical camps in foreign countries. One of the
things I was lucky enough to be able to do was to be involved in this operation
which was the first cochlear implant ever done in Bangladesh, done in 2005
by John Osborne, a friend of mine and an ENT surgeon in North Wales.
Now, it may not be that the cochlear implant is such a good answer in
the third world. It's thought that in India there are one million profoundly deaf
children. Now, we can't do one million cochlear implants, we will never be
able to do that. So sometimes we will have to come up with some other way
_____________________________________________________________________
[13/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
of preventing this problem, but just at the moment if you are a child born in
Norwich with profound hearing loss, the chances are you will be offered a
cochlear implant and you will do very well.
This is the queue for out-patients (picture on screen) and it's very
orderly as you can see. Orderly because there is a man with a Lee Enfield
rifle standing at the entrance to the clinic, I wonder whether such an
arrangement might be suitable in Norwich... any way, there we are {laughter}.
Now, what about the future? Here's a new sort of implanted hearing-aid
(picture on screen) This is a hearing-aid which is connected to the hearing
bones, to the ossicles. You can see on the drawing a little piece of gold, it's
not just gold really, it's a rather clever piece of gold which is fixed to the incus,
and to a fine cable. It's held on the outside rather like a cochlear implant, but
this is a middle ear implant and this would be for a patient who didn't have
profound deafness, but a patient who couldn't wear, for one reason or
another, a conventional hearing-aid. Of course there are lots of people who
have great difficulties with conventional hearing-aids because of feedback,
because of the occlusion effect, or their ear canals won't tolerate the hearingaid. I don't need to tell the Norfolk Deaf Association the problems people have
with conventional hearing-aids. This might be the solution for some people,
the idea that a hearing-aid could be implanted into the ear, the so-called
'Sound Bridge'.
This is another drawing (picture on screen) that shows the difference
between a conventional hearing-aid and the sound bridge. On the left we can
see a small, discreet conventional hearing-aid fitted into the ear canal. Of
course the patients think that nobody can see an in the ear hearing-aid, but
anybody looking at the side of your head can see it immediately.
_____________________________________________________________________
[14/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
The hearing-aid on the other side has nothing in the ear canal at all,
the coil is fitted directly to the Incus and the sound is picked up behind the
ear.
Of course the dream of the otologist might be something like this
(picture on screen) . I must read you this, hang on:"The Babel Fish … is small, yellow and leech-like, and probably the oddest
thing in the Universe. It feeds on brainwave energy received, not from its
own carrier but from those around it. It absorbs all unconscious mental
frequencies from this brainwave energy to nourish itself with. It then excretes
into the mind of its carrier a telepathic matrix formed by combining the
conscious thought frequencies with nerve signals picked up form the speech
centres of the brain which has supplied them. The practical upshot of all this
is if you stick a Babel fish in your ear you can instantly understand anything
said to you in any form of language. The speech patterns you actually hear
decode the brainwave matrix which has been fed into your mind by the Babel
fish."
The Babel fFsh of Douglas Adams and The Hitch Hiker’s Guide to the
Galaxy.
Probably, the future of doctors’ input into hearing loss is this. The idea
is that genetic doctors will be able to do something to modify the biology of the
cochlea. Most patient who lose hearing, lose hearing because of the delicate
hair cells in the cochlea giving up the ghost, you can see (picture on screen)
the little hair cells curl up and die.
What people are working on are ways of regenerating the cells of the
cochlea. Here is a piece from the BBC , "Gene therapy has the potential to
restore hearing in mice, offering hope for humans too. The team discovered
gene transfer produced functioning hair cells for the inner ear to interpret
sound” Nature reports, 2008.
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[15/19] This is a draft transcript prepared by Norma White for Speech-to-Text
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So I think this is quite optimistic. I think one day, maybe one day soon,
surgeons will be able to do something about this. They will be able to correct
the actual biological defect that caused the problem in the first place.
This is a picture (on screen) taken from the paper, the gene, the atonal
gene, it shows the gene being picked up in the cells of the cochlea, you can
see the way the green dots light up and that's the gene being implanted into
the cochlea from this group in Oregon. I don't think that's happening any time
in Norwich soon, but maybe one day.
So what we have done, we have seen how surgeons started with an
understanding of anatomy, they set about stopping people dying of ear
disease by draining pus from their ear. Microscopes came along that allowed
surgeons to see what was wrong inside the ear. A series of clever surgeons,
over the period of perhaps the last 70 or 80 years have invented a whole lot of
operations to treat hearing loss. We have Lempert, Rosen and Shea, we
have the pioneers of the cochlear implants, the first person to try and
electrically stimulate the cochlea was Volta, who put metal rods in his ear,
connected them to a battery and felt a kind of sizzling noise!
The thousands of patients around the world who have had implants
and had the miracle of being stone deaf, being turned into being able to talk
on the a telephone. Now we have the spin-offs of that, the other implanted
hearing-aids and finally the future which is really the genetic biology of what
goes wrong with the ear.
That is my little whiz through what surgeons might be able to do for
hearing loss. {applause}.
Frank Eliel: Okay, Peter is very happy to take some questions if you have
got any, if anyone feels brave enough to ask him something and be dazzled
some more.
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[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
From the floor: I have to ask, why did you go into ENT and not heart
surgery, or oncology or something else?
Mr Prinsley: That's a good question, I suppose serendipity. In my first
hospital job, I was a graduate at Sheffield I turned up on the first day and they
said “What is your name?”, I said “Prinsley”, they said “Right, you are doing
three months of vascular surgery with him and three months of ENT with her.”
I didn't know I would do it for my first job, but I really liked the ENT surgeons in
Sheffield and I was just attracted by the people I met, I think.
Q: Thank you very much for a fantastic presentation, I really enjoyed that.
With all the cuts they are talking about, how is the future going to be with the
NHS going to presumably going to come under pressure, things like the
sound bridge, will it develop?
A: This is a question of how the NHS will pay for technological leaps in
science, providing better care for patients? It doesn't just apply to hearing
problems, it's all manner of developments, in particular to the developments
with drugs. The most expensive thing that the NHS pays for are drugs,
cancer drugs for instance are much more expensive than operations. I
suppose what will happen, the cases will be done in small numbers, by way of
trials and if the results show a benefit then there will be public pressure for
money to be spent on this service. I mean that's what happened with
cochlear implantation. When it started it was regarded as a rather
experimental thing. Probably wasn't going to work. What we would do? We
would set up a small number of centres and we would try it. The story is that
it's been a huge success. I don't know whether implanted hearing-aids will be
the same success as cochlear implants, but there are certainly many, many
more people who might potentially benefit from it.
Q: What progress is being made on reducing tinnitus, if any?
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[email protected]
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Tel/SMS: 07967 362501
A: Well, I don't know that there is any progress in reducing tinnitus.
Q: Or healing it?
A: The question is, what treatment strategies are available for patients with
tinnitus?
Well, the first thing to say is the idea that nothing can be done about
tinnitus is completely wrong. Of course that is what a lot of doctors will tell
their patients, they will say, "No, there is nothing can be done about that, you
will have to put up with it." We, in our department, have all manner of
hearing-aid and hearing professionals able to help with tinnitus. Essentially
there are two strategies, the strategy of masking by putting noise into the ear
to mask out the sound of the tinnitus and the patient becomes habituated - it
would work in here actually, if you can hear it, you can hear rather noisy air
conditioning buzzing away, but you didn't notice it until I told you to listen to it.
If I gave you a masking device that made a noise like that, that would mask
the tinnitus. Then there are strategies which I call mental tricks, they are to do
with distracting people from the noise that their ear is making. Some people
call it cognitive behaviour therapy, but mental tricks is what it is really, I think.
Q: Can you give us an idea of what happens with Menieres disease and what
can be done about it?
A: {laughter} How long have you got? Menieres disease, I'm very interested
in it. The answer to the question is that a lot can be done for it. Menieres
disease, as you may know, is a condition that relapses and remits, people will
have periods where they are in trouble with their Menieres disease and then
with luck they well run into a period where it's not much trouble. In essence
it's matching the treatment to the symptoms. We have all manner of
treatments for Menieres disease: medical treatments, we have various
gadgets that we can use, pressure machines. We have treatment that we can
_____________________________________________________________________
[18/19] This is a draft transcript prepared by Norma White for Speech-to-Text
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[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501
do locally to the ear with, at the moment using antibiotics to turn the balance
systems off, various operations can be done inside the ear. What many
patients need I think is support and encouragement, they need their hearing
help, but it's rather like tinnitus, it's not true that nothing can be done for
Menieres disease, we have many effective treatments for the symptoms of
Menieres disease, although we can't make it go away, at least not in Norwich.
{laughter}.
Frank Eliel: Okay. Well I think if that's the end of the questions, it's just
really my job to thank Peter one more time and perhaps ask you to show your
appreciation in the normal way one more time. {applause}
It's my pleasant task to asked Aliona to give to Peter a gift in recognition of
him giving up an evening to entertain us.
Mr Prinsley: That's very kind, thank you very much, it's been a pleasure to
come.
_____________________________________________________________________
[19/19] This is a draft transcript prepared by Norma White for Speech-to-Text
purposes only. It is not for further circulation in any form and has no legal standing.
[email protected]
www.normawhite.co.uk
Tel/SMS: 07967 362501