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Interview with William House, M.D.

William F. House, MD

August 29, 2011
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Topic: New Memoir - The Struggles of a Medical Innovator. Cochlear Implants and Other Ear Surgeries
CAROLYN SMAKA: This is Carolyn Smaka, and today I am talking to one of the great otology pioneers, William House. Dr. House, it's an honor to speak with you about your new memoir, The Struggles of a Medical Innovator.

WILLIAM HOUSE: Glad to be here.

SMAKA: On the cover of the book is a photo of you sitting in front of some sort of microscope. Does that photo have particular significance?

HOUSE: Yes it does. In the early years of my practice with my half-brother, Howard House, we had a lot of patients with a variety of ear conditions, but treatment back then was limited, and we wanted to see how we could improve that.

Howard went to Germany and saw this microscope that was being used in ear surgery at that time. It was a very good microscope for any kind of surgical procedure, although it was originally designed as a colposcope for use in gynecology. That microscope has revolutionized otology because it has strong light, and it's bifocal. When I first saw the ear through that microscope, I knew that it would give me the means to change otology by approaching problems of the inner ear. I guess I'm usually credited with being the first to use a microscope for removal of an acoustic tumor. Also, you might notice in the picture that I'm holding a small round black object. That was an early cochlear implant coil. And the picture also shows the House-Urban observer tube and a TV camera for filming through the scope. These were all innovations that I worked on with Jack Urban, a wonderful engineer.

SMAKA: I was reading that your practice with Howard was the first otology practice in the United States. There were otolaryngology practices, but none specializing in just otology. Is that correct?

HOUSE: That's correct. I had originally gone to dental school and became a dental officer in the Navy. I thought I'd be interested in maxillofacial surgery, and as a resident I did a lot of that. Then I decided I would work with Howard on the weekends because he was 15 years older and had a practice that was primarily otology. It gave me a chance to decide that I wanted to go into otology because the patients were so appreciative, unlike what I saw in the county hospital. You know, so many drunks would come in with their jaws broken from sitting at the bar and taking a punch, that kind of thing. I just didn't care for that group of patients. But the ones that wanted their hearing back and got it back were just eternally grateful, and so it was a wonderful way to practice. When I joined Howard's practice, he was doing 90% otology. But he also did sub- mucous turbinate surgery for nasal allergy. I was the first to open a practice just doing otology.

SMAKA: One of your crowning achievements was the development of the cochlear implant. How did you go about developing that?

HOUSE: Well, I was very impressed early on in my practice when two parents brought me their child who was maybe three years old, and who was profoundly deaf. There was not much question about that. I had an audiologist with me at the time who was also a father of a deaf child, so he was very interested in evaluating these children. I felt very inadequate with the children because there wasn't much I could do. I would say, "Maybe you can go and get a hearing aid," but they were body-worn, vacuum-tube type aids, and I just felt that the child would never be like the parents and never learn their language. I felt it was a tragedy.

Fortunately a patient brought me a clipping from a French newspaper that said two doctors, Djourno and Eyries, had put an electrode into the ear of a patient who was totally deaf because of the destruction of the inner ear by a cholesteatoma. We knew that electrical current would cause a sensation of sound in people with normal hearing, but this was the first time I had heard of anybody implanting someone who had destruction of the inner ear, and yet they still had the hearing nerve there. So electrical currents would stimulate the hearing nerve and then propagate a sound to the brain. That was the beginning of it, but we didn't get around to doing children for some time.

I worked with Jack Urban, the engineer. He was a really good engineer involved with a lot of aerospace work. He wanted to get out of that and do something that would make a difference in people's lives. I had taken the microscope to him because at the time we didn't have any way of teaching students how to operate through the microscope by having them watch simultaneously while the procedure was taking place. The field through the observer tube that was available at that time was upside-down and backwards, so Jack Urban said, "Well, I can fix that," and so he did. That's all in the book if you want to read up on the details of it. Then we were able to train doctors through the microscope which revolutionized otology.

It was just Jack and me for a long time, so we took the attitude that we would try all kinds of different things to get the cochlear implant right. We didn't know what kind of electric current was needed to give the patient some meaning from the sound, so we just had to experiment. Jack would build up these circuits and then we'd try them on a volunteer patient, Charles Graser. He was a high school teacher who had been burned on a summer job from a fire in a gasoline truck. He was completely deafened by the use of streptomycin. Before World War II, we used to perform radical mastoidectomies, which follow the old principle of incision and draining, in the cases of severe infections. Then, around the time I got into practice, penicillin became widely available. So the feeling at that time was that otolaryngology was a field that had been eliminated because penicillin was going to cure all the infections in the mastoid and the sinuses, but it was actually just the opposite. The ability to prevent infection let us do more and safer operations on the ear. But, unfortunately, these stronger antibiotics were ototoxic and could actually cause hearing losses, like in Charles Graser. In working with him we found out a lot about what electric currents could do in terms of sound. In 1972, this patient was the first ever to walk out of the testing laboratory with a wearable cochlear implant. I discuss in the book how nervous I was!

SMAKA: And your memoir also includes your work with the short electrode implant?

HOUSE: Yes. I feel it continues to be misunderstood, and I'm trying to get information out that shows my theory as to how cochlear implants work, and that is part of the book.

SMAKA: Dr. House, what are some of the other highlights that you include in the new book?

HOUSE: Well, I also studied Meniere's disease, and I had a very famous patient by the name of Alan Shepard. He was an astronaut. Do you remember him?

SMAKA: Sure do.

HOUSE: He was one of the early astronauts, and he had what they kept calling "the right stuff." He was willing to take any risk, and he had a lot of guts. At that time Meniere's disease was considered by many doctors to be a psychosomatic disease which was terrible because the patients, often women, were afraid to go out to the grocery store for fear of knocking over a display, or they were afraid to pick up the baby because they might drop it if they had a sudden attack. They didn't like to drive on the freeway or do other daily tasks, so it was easy to say, "Well, these people sure are invalids." It absolutely wasn't true, because here was a guy who had spent so much time becoming certified as an astronaut, and he could take it. It wasn't that he could avoid these attacks, but he could deal very well with them. So it sort of hit the psychosomatic thing right in the head. So there's one chapter on Meniere's disease that features Alan Shepard. I performed one of my early shunt operations on him and he was able to return to active duty and go to the moon.

There's another chapter on chronic ear disease where we talk about the surgical approaches to treating chronic ear disease. There were some revolutionary techniques and breakthroughs discovered over my lifetime, like penicillin, again. I was able to contribute to these by introducing the use of irrigation/suction and dental drill with a diamond bur and also the intact canal wall surgical procedure.

SMAKA: How did founding the House Ear Institute come about?

HOUSE: About 10 years before I joined his practice, Howard had operated on a young woman and restored her hearing. Her father was very grateful and gave Howard a donation to start some research. This was the beginning of the Los Angeles Foundation of Otology which later became Ear Research Institute, then House Ear Institute, and now House Research Institute.

Howard, being much older, had a large practice when I joined him. He was doing fenestration surgeries at the time. That was where they put a window over the horizontal semicircular canal, which resulted in a lot of problems because of the dizziness it created. Then Samuel Rosen came along with the stapes mobilization surgery, and then finally John Shea, Jr. performed the original stapedectomy as we know it.

These advancements and practices opened up a lot of surgical doors. You operate on one patient and they send you two more. So in my early days of practice, I had all the surgery that I could manage. I was in surgery several days a week just because we had so many patients. And this large otology practice of Howard and me and others who joined the practice enabled the Institute to do an unprecedented amount of clinical research. Also, the development of the observer tube for the microscope and the camera for filming surgical procedures allowed us to start giving ear surgery training courses as part of the Institute's educational programs.

SMAKA: It's amazing how things have changed over the years. Do you think we'll ever get to the point where we'll have hair cell regeneration that actually can help eliminate some hearing loss?

HOUSE: Well, never say never. They have tried and tried and tried, and it apparently worked well in birds, but so far they've not been able to get it to work in any kind of mammal. So maybe it'll come along some day. I hope so, but so far it seems like there are certain cells that just don't replace themselves.

SMAKA: Your book includes information about how you revolutionized acoustic neuroma surgery.

HOUSE: Yes. Initially, surgeons didn't like to operate on small acoustic neuromas because the surgery compromised the facial nerve. But with the microscope, I worked out a method of identifying the facial nerve and then opening the internal auditory canal. I was able to then separate the facial nerve away from the tumor. So it made it possible to save the facial nerve, and that has revolutionized acoustic neuroma surgery.

SMAKA: You mentioned Alan Shepard and Charles Graser - are there any other patients you saw during your career that stand out?

HOUSE: At one point, a group of my early implant patients threw me a party and had patients from all over the country write me letters about what the implant meant to them. Their comments are included in the book. Many described moving from feeling like they were living behind a glass shield to being a part of the hearing world after they received their implant. That stands out to me.

SMAKA: To think about how many people in the world today have been helped through cochlear implants and the procedures you describe - the number is too big to conceptualize.

HOUSE: I think the estimates are probably 3 million people in the world who would benefit from cochlear implants, but it is maybe 200,000 who have them. I don't know the exact number. It's not a lot compared to the need for it, and I'm hoping that with a simpler device, a single, short electrode implant, the cost may be reduced.

SMAKA: I really enjoyed the book. I think audiologists, or anyone interested in the history of otology and neurotology will find your stories about the development of the cochlear implant and other surgical techniques fascinating.

Can I ask you about another book - "The Complete Idiot's Guide to Hearing Loss"?

HOUSE: Sure. House Clinic was invited by the publisher to do a book on hearing loss. The authors include House Clinic, William Luxford, M.D., Jennifer Derebery, M.D., and Karen Berliner, Ph.D. The only other really 'medical' books in the Idiot's series were on arthritis and diabetes. As with all of the Idiot's Guide books, there is humor and interesting tidbits ("sidebars") in the book. But it's really a great book for patients with hearing loss and for their friends and family to understand how hearing loss affects someone and what can be done to help improve communication. Your readers might want to consider recommending it to their patients. It's available on Amazon.com.


SMAKA: I should mention that the new memoir is available through the publisher at CreateSpace (www.createspace.com/3588234). Dr. House, it's been my pleasure speaking with you today. Thank you so much for your time and contributions.

HOUSE: Thank you, Carolyn.
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William F. House, MD

Physician, Dentist, Father of Neurotology