Now when we think of our senses, we don't usually think of the reasons why they probably evolved, from a biological perspective. We don't really think of the evolutionary need to be protected by our senses, but that's probably why our senses really evolved -- to keep us safe, to allow us to live. Really when we think of our senses, or when we think of the loss of the sense, we really think about something more like this: the ability to touch something luxurious, to taste something delicious, to smell something fragrant, to see something beautiful. This is what we want out of our senses. We want beauty; we don't just want function. And when it comes to sensory restoration, we're still very far away from being able to provide beauty. And that's what I'd like to talk to you a little bit about today.
当我们想到我们的感官时, 我们一般不会从生物学的角度来考虑 为什么我们会进化出感官。 我们并不会想到,因为进化需求, 我们需要得到感官的保护。 但那也许才是我们的感官进化的真正原因—— 保护我们的安全,让我们得以存活。 当我们想到我们的感官时, 或想到失去感官时, 我们更多想到的是: 触摸奢华物品的能力,品尝美味食物的能力, 嗅到芬芳气息的能力, 看见美丽事物的能力。 这些正是我们希望通过感官得到的东西。 我们追求美;我们不只是追求实用。 当我们帮患者恢复感官时, 我们离帮助他们恢复赏美能力还差得远。 这就是我今天想要和大家讲的。
Likewise for hearing. When we think about why we hear, we don't often think about the ability to hear an alarm or a siren, although clearly that's an important thing. Really what we want to hear is music.
听力亦如此。 当我们想到我们为什么要听时, 我们一般不会想到能听见警报或者警笛, 虽然毫无疑问这也是很重要的。 但我们真正想要听的是音乐。
(Music)
(音乐)
So many of you know that that's Beethoven's Seventh Symphony. Many of you know that he was deaf, or near profoundly deaf, when he wrote that. Now I'd like to impress upon you how unusual it is that we can hear music. Music is just one of the strangest things that there is. It's acoustic vibrations in the air, little waves of energy in the air that tickle our eardrum. Somehow in tickling our eardrum that transmits energy down our hearing bones, which get converted to a fluid impulse inside the cochlea and then somehow converted into an electrical signal in our auditory nerves that somehow wind up in our brains as a perception of a song or a beautiful piece of music. That process is entirely abstract and very, very unusual. And we could discuss that topic alone for days to really try to figure out, how is it that we hear something that's emotional from something that starts out as a vibration in the air?
在座的许多都知道这是贝多芬的第七交响曲。 在座的许多都知道当他谱写这首曲子时, 他已失聪,或近乎完全失聪。 我想向诸位强调, 我们能够听到音乐, 是多么的不寻常。 音乐真是所有事物中最奇特的事物之一。 它是空气中的声波震动, 空气中的微小的能量波敲击我们的耳膜。 在声波敲击我们的耳膜时, 能量被传送入我们的听骨, 在耳蜗里被转化为流体性冲力, 然后在我们的听觉神经中被转变成电信号, 最后传入我们的脑中, 被大脑接收为一首歌或者一首美丽的乐曲。 这个过程是完全抽象的,而且非常、非常得不寻常。 我们光讨论这个话题就可以讨论上好多天, 来试着弄清楚,我们从最开始的空气中的震动, 到最后听到充满感情的音乐,到底是怎么一回事。
Turns out that if you have hearing loss, most people that lose their hearing lose it at what's called the cochlea, the inner ear. And it's at the hair cell level that they do this. Now if you had to pick a sense to lose, I have to be very honest with you and say, we're better at restoring hearing than we are at restoring any sense that there is. In fact, nothing even actually comes close to our ability to restore hearing. And as a physician and a surgeon, I can confidently tell my patients that if you had to pick a sense to lose, we are the furthest along medically and surgically with hearing. As a musician, I can tell you that if I had to have a cochlear implant, I'd be heartbroken. I'd just be plainly heartbroken, because I know that music would never sound the same to me.
事实上如果你失去了听力, 大多数人失去听力是 因为失去了耳蜗,就是内耳。 这种失聪发生在毛细胞水平。 如果你不得不失去一项感官的话, 我必须实话告诉你, 我们恢复听力的能力 比我们恢复其他感官的能力都要好。 事实上,我们恢复其他感官的能力 跟我们恢复听力的能力根本没法比。 作为一位内外科医生,我可以很自信地告诉我的病人, 如果你不得不失去一项感官的话, 从医学和手术角度上讲,我们更容易帮助你恢复听力。 作为一个音乐家,我可以告诉你, 如果我不得不做耳蜗植入的话, 我会伤心欲绝的。我真的会伤心欲绝, 因为我知道音乐听起来决不会和以前一样了。
Now this is a video that I'm going to show you of a girl who's born deaf. She's in a very supportive environment. Her mother's doing everything she can. Okay, play that video please.
现在我想展示一段录像。 这段录像是关于一个失聪的女孩的。 她周围的环境给予了她很大的支持。 她的妈妈做了一切她能做的事来支持她。 好,请播放这段录像。
(Video) Mother: That's an owl. Owl, yeah. Owl. Owl. Yeah. Baby. Baby. You want it? (Kiss)
(录像)母亲:这是个猫头鹰。 猫头鹰,对! 猫头鹰。猫头鹰。 对! 宝宝。宝宝。 你想要宝宝么? (亲吻)
Charles Limb: Now despite everything going for this child in terms of family support and simple infused learning, there is a limitation to what a child who's deaf, an infant who was born deaf, has in this world in terms of social, educational, vocational opportunities. I'm not saying that they can't live a beautiful, wonderful life. I'm saying that they're going to face obstacles that most people who have normal hearing will not have to face.
Charles Limb: 尽管这个孩子得到了许多帮助, 有家庭支持, 和简单的灌输式学习, 但一个失聪的孩子,一个生来就失聪的孩子, 在这个世界上能得到的东西还是有限的, 不管是社交方面、教育方面,还是职业方面。 我并不是说他们就不会有幸福美好的生活, 我只是说,他们要面对许多大多数听力正常的人 不会遇到的困难。
Now hearing loss and the treatment for hearing loss has really evolved in the past 200 years. I mean literally, they used to do things like stick ear-shaped objects onto your ears and stick funnels in. And that was the best you could do for hearing loss. Back then you couldn't even look at the eardrum. So it's not too surprising that there were no good treatments for hearing loss.
失聪和治疗失聪 在过去的200年有了很大的发展。 过去人们会把耳朵形的东西插进你的耳朵里, 把漏斗插进你的耳朵里, 是真的把这些东西插进耳朵里。 那就是当时我们能做的最好的失聪治疗了。 那时我们甚至不会看耳鼓。 因此当时没有好的失聪治疗, 这一点也不吃惊。
And now today we have the modern multi-channel cochlear implant, which is an outpatient procedure. It's surgically placed inside the inner ear. It takes about an hour and a half to two hours, depending on where it's done, under general anesthesia. And in the end, you achieve something like this where an electrode array is inserted inside the cochlea. Now actually, this is quite crude in comparison to our regular inner ear.
现在我们有现代的多通道人工耳蜗植入, 这是个门诊治疗。 人工耳蜗通过手术,被放置入内耳。 在全身麻醉下,根据手术地点, 整个手术需要一个半到两个小时。 手术最后就是这个效果, 一个电极阵列被放入在耳蜗内部。 事实上,这个和我们正常的内耳比, 太粗糙了。
But here is that same girl who is implanted now. This is her 10 years later. And this is a video that was taken by my surgical mentor, Dr. John Niparko, who implanted her. If we could play this video please.
但是这是刚才同一个女孩,她植入了人工耳蜗。 这是她10年后的录像。 这段录像是我的手术导师,John Niparko医生,拍摄的。 他为她做了人工耳蜗植入手术。 请播放这段录像。
(Video) John Niparko: So you've written two books?
(录像)John Niparko:你写了两本书?
Girl: I have written two books. (Mother: Was the other one a book or a journal entry?) Girl: No, the other one was a book. (Mother: Oh, okay.)
女孩:我写了两本书。(母亲:另一本是书还是日记?) 女孩:不,另一本是本书。(母亲:好吧。)
JN: Well this book has seven chapters, and the last chapter is entitled "The Good Things About Being Deaf." Do you remember writing that chapter?
JN:这本书有7个章节, 最后一章 叫做“失聪的美妙”。 你还记得你写了这个章节么?
Girl: Yes I do. I remember writing every chapter.
女孩:记得。我记得我写过的每个章节。
JN: Yeah. Girl: Well sometimes my sister can be kind of annoying. So it comes in handy to not be annoyed by her.
JN:好。 女孩:有时候我妹妹很烦人。 失聪就不会被她烦到了。
JN: I see. And who is that?
JN:明白了。她是谁?
Girl: Holly. (JN: Okay.)
女孩:Holly。(JN:好吧。)
Mother: Her sister. (JN: Her sister.) Girl: My sister.
母亲:她的妹妹。(JN:她的妹妹。)女孩:我妹妹。
JN: And how can you avoid being annoyed by her?
JN:你怎么避免被她烦到?
Girl: I just take off my CI, and I don't hear anything. (Laughter) It comes in handy.
女孩:我把我的人工耳蜗取下来,我就什么都听不到了。 (笑声) 很方便的。
JN: So you don't want to hear everything that's out there?
JN:你不想听到所有的声音?
Girl: No.
女孩:不想。
CL: And so she's phenomenal. And there's no way that you can't look at that as an overwhelming success. It is. It's a huge success story in modern medicine. However, despite this incredible facility that some cochlear implant users display with language, you turn on the radio and all of a sudden they can't hear music almost at all. In fact, most implant users really struggle and dislike music because it sounds so bad. And so when it comes to this idea of restoring beauty to somebody's life, we have a long way to go when it comes to audition.
CL:她的例子令人惊叹。 我们不能不承认人工耳蜗是个巨大的成功。 它是的。它是现代医学的巨大成功。 然而,尽管这个设备如此奇特, 一些人工耳蜗的使用者甚至都写了书, 你打开收音机,他们却几乎完全听不到音乐。 事实上,大部分人工耳蜗使用者听到音乐时一点也不喜欢, 感到痛苦极了,因为音乐听起来太糟糕了。 我们距离 帮助病人恢复审美能力 还差的远得很。
Now there are a lot of reasons for that. I mentioned earlier the fact that music is a different capacity because it's abstract. Language is very different. Language is very precise. In fact, the whole reason we use it is because it has semantic-specificity. When you say a word, what you care is that word was perceived correctly. You don't care that the word sounded pretty when it was spoken.
导致这个的原因有许多。 之前我提到过 音乐是不一样的,因为它是抽象的。 语言就不同了。语言非常的具体。 事实上,我们使用语言, 就是因为它具有特定的语义。 当我们说到一个词时, 我们在乎的是这个词是否被准确得理解了。 我们不在乎这个词说起来 好不好听。
Music is entirely different. When you hear music, if it doesn't sound good, what's the point? There's really very little point in listening to music when it doesn't sound good to you. The acoustics of music are much harder than those of language. And you can see on this figure, that the frequency range and the decibel range, the dynamic range of music is far more heterogeneous. So if we had to design a perfect cochlear implant, what we would try to do is target it to be able to allow music transmission. Because I always view music as the pinnacle of hearing. If you can hear music, you should be able to hear anything.
音乐完全不一样。 当我们听到音乐时,如果它不好听,我们还听什么? 如果音乐听起来不好听, 我们就不会再听下去了。 音乐的音质比语言的音质要高多了。 从这幅图中我们可以看到, 音乐的频率范围, 分贝范围,和能动范围 比起语言要复杂多了。 因此如果我们必须要设计出一个完美的人工耳蜗的话, 我们必须要让它能够 传输音乐。 我一直把音乐视为听力的巅峰。 如果你能听见音乐, 你就应该可以听见任何东西。
Now the problems begin first with pitch perception. I mean, most of us know that pitch is a fundamental building block of music. And without the ability to perceive pitch well, music and melody is a very difficult thing to do -- forget about a harmony and things like that. Now this is a MIDI arrangement of Rachmaninoff's Prelude. Now if we could just play this.
问题首先起于音高接收。 我们大部分人都知道音高是音乐的一个基本组成部分。 如果不能很好地接收音高, 音乐和旋律听起来就会非常困难。 更别说和弦之类的了。 这是拉赫玛尼诺夫的序曲的MIDI版本。 我们来播放一下。
(Music)
(音乐)
Okay, now if we consider that in a cochlear implant patient pitch perception could be off as much as two octaves, let's see what happens here when we randomize this to within one semitone. We would be thrilled if we had one semitone pitch perception in cochlear implant users. Go ahead and play this one.
好的,现在我们假设 有一个植入了人工耳蜗的病人, 他的音高接收也许能差上两个八度, 我们来看看当我们随机地把这些音符升高或降低半个音调时 会发生什么。 如果人工耳蜗的使用者能接收到半个音调的不同,那会好极了。 播放一下这段音乐。
(Music)
(音乐)
Now my goal in showing you that is to show you that music is not robust to degradation. You distort it a little bit, especially in terms of pitch, and you've changed it. And it might be that you kind of like that. That's kind of hypnotic. But it certainly wasn't the way the music was intended. And you're not hearing the same thing that most people who have normal hearing are hearing.
我向各位展示这段音乐的目的 是想展示音乐经不起损伤。 你只是篡改了一点点,特别是从音高角度来讲,但你已经改变整个音乐。 也许你有点喜欢这么做。 这有点儿像催眠。 但毫无疑问,音乐听起来不应该是这样的。 你听到的和大多数听力正常的人听到的 是不一样的。
Now the other issue comes with, not just the ability to tell pitches apart, but the ability to tell sounds apart. Most cochlear implant users cannot tell the difference between an instrument. If we could play these two sound clips in succession. (Trumpet) The trumpet. And the second one. (Violin) That's a violin. These have similar wave forms. They're both sustained instruments. Cochlear implant users cannot tell the difference between these instruments. The sound quality, or the sound of the sound is how I like to describe timbre, tone color -- they cannot tell these things whatsoever. This implant is not transmitting the quality of music that usually provides things like warmth.
另一个问题不仅是因为病人 缺乏区分音高的能力, 还因为他们无法区分声音。 大多数人工耳蜗使用者不能区分不同的乐器。 我们来连续播放一下这两段音频。 (喇叭) 喇叭。 第二段。 (小提琴) 是小提琴。 这两段音频的声波波形很相似。它们都来自持续演奏的乐器。 人工耳蜗使用者无法辨别 乐器间的差异。 我喜欢用音质,或是说声音的声音 来描述音色,音调—— 但人工耳蜗使用者无法辨别这些区别。 人工耳蜗没法传递 音乐的质感,这种质感带给我们,比如说,温暖的感觉。
Now if you look at the brain of an individual who has a cochlear implant and you have them listen to speech, have them listen to rhythm and have them listen to melody, what you find is that the auditory cortex is the most active during speech. You would think that because these implants are optimized for speech, they were designed for speech. But actually if you look at melody, what you find is that there's very little cortical activity in implant users compared with normal hearing controls. So for whatever reason, this implant is not successfully stimulating auditory cortices during melody perception.
我们来观察一下一位人工耳蜗使用者的大脑, 让他听人讲话, 或者听节奏,听旋律, 我们会发现他的听觉皮层 在他听别人讲话时最活跃。 你也许会认为这是因为这些人工耳蜗是专为听讲话设计, 会优化话语。 但事实上我们来看一下人工耳蜗使用者听旋律时的反应, 我们会发现,和听力正常的人比起来, 他们的皮质活动非常少。 不管是基于什么原因, 耳蜗的植入没能在病人听旋律时 成功地刺激他的听觉皮层。
Now the next question is, well how does it really sound? Now we've been doing some studies to really get a sense of what sound quality is like for these implant users. I'm going to play you two clips of Usher, one which is normal and one which has almost no high frequencies, almost no low frequencies and not even that many mid frequencies. Go ahead and play that.
下一个问题就是, 对于耳蜗植入者来说,音乐听起来到底是什么样的? 我们一直在研究, 对于这些人工耳蜗使用者,音质到底是什么样的。 我会给大家播放两段Usher的音乐, 一段是正常的, 另一断几乎没有高频音,没有低频音, 甚至中频率音也没有多少。 来播放一下。
(Music)
(音乐)
(Limited Frequency Music)
(限频音乐)
I had patients tell me that those sound the same. They cannot differentiate sound quality differences between those two clips. Again, we are very, very far away in just getting to where we want to get to.
病人告诉我,这两段音乐听起来是一样的。 他们不能区分 这两段音频的音质。 再一次强调,我们距离我们的目标还差得非常、非常远。
Now the question comes to mind: Is there any hope? And yes, there is hope. Now I don't know if anybody knows who this is. This is ... does somebody know? This is Beethoven. Now why would we know what Beethoven's skull looks like? Because his grave was exhumed. And it turns out that his temporal bones were harvested when he died to try to look at the cause of his deafness, which is why he has molding clay and his skull is bulging out on the side there. But Beethoven composed music long after he lost his hearing. What that suggests is that, even in the case of hearing loss, the capacity for music remains. The brains remain hardwired for music.
现在问题变成了:有希望么? 有的,希望是有的。 我不知道有没有人知道这是谁。 有人知道么? 这是贝多芬。 我们为什么会知道贝多芬的头骨是什么样的? 因为他的坟墓被挖掘了。 事实上在他辞世时,他的颞骨被取走 以研究他失聪的原因, 这就是为什么在他的头骨里有黏土, 头骨的侧面是鼓出来的。 但是贝多芬在他失聪后很长时间 还在作曲。 这意味着,即使在失去听力的情况下, 欣赏音乐的能力还是能保留下来。 大脑还对音乐有感觉。
I've been very lucky to work with Dr. David Ryugo where I've been working on deaf cats that are white and trying to figure out what happens when we give them cochlear implants. This is a cat that's been trained to respond to a trumpet for food.
我曾有幸和David Ryugo医生一同工作。 在他那儿我研究,如果我们给失聪的白猫 植入人工耳蜗,会发生什么。 这只猫受训后,知道喇叭声就是发食物的信号。
(Music)
(音乐)
Text: Beethoven doesn't excite her. (Music) The "1812 Overture" isn't worth waking for. (Trumpet) But she jumps to action when called to duty! (Trumpet)
文字:她对贝多芬不感冒。 (音乐) “1812序曲”也不管用。 (喇叭) 但是一听到喇叭,她就跳了起来! (喇叭)
CL: Now I'm not suggesting that the cat is hearing that trumpet the way we're hearing it. I'm suggesting that with training you can imbue a musical sound with significance, even in a cat. If we were to direct efforts towards training cochlear implant users to hear music -- because right now there's virtually no effort put towards that, no rehabilitative strategies, very little in the way of technological advances to actually improve music -- we would come a long way.
CL:我不是说 这只猫听喇叭就跟我们听到喇叭一样。 我是说,通过训练, 你甚至可以给一只猫灌输 一种特别的音乐。 如果我们花些功夫, 来训练人工耳蜗植入者听音乐—— 目前我们还从来没有在这方面上下过功夫, 我们没有什么康复策略, 我们也没什么能改进音乐的技术上的进步—— 我们将取得很大的成就。
Now I want to show you one last video. And this is of a student of mine named Joseph who I had the good fortune to work with for three years in my lab. He's deaf, and he learned to play the piano after he received the cochlear implant. And here's a video of Joseph.
现在我想给大家播放最后一段录像。 这是关于我的一个学生,他叫Joseph, 三年前我有幸和他在我的实验室里一同工作。 他失聪了,在他植入人工耳蜗后, 他学会了弹钢琴。 这是Joseph的录像。
(Music)
(音乐)
(Video) Joseph: I was born in 1986. And at about four months old, I was diagnosed with profoundly severe hearing loss. Not long after, I was fitted with hearing aids. But although these hearing aids were the most powerful hearing aids on the market at the time, they weren't very helpful. So as a result, I had to rely on lip reading a lot, and I couldn't really hear what people were saying. When I was 12 years old, I was one of the first few people in Singapore who underwent cochlear implantation. And not long after I got my cochlear implant, I started learning how to play piano. And it was absolutely wonderful. Since then, I've never looked back.
(录像)Joseph:我出生于1986年。 大概在我4个月大的时候, 我被诊断患有严重的失聪。 之后没过多久, 我开始使用助听器。 尽管那些助听器 是当时市场上最好的助听器, 它们没怎么帮到我。 因此,我不得不经常依靠唇读。 我没法真的听见人们在说什么。 在我12岁时, 我成了新加坡为数不多的、 接受人工耳蜗植入的人。 之后不久, 我开始学习演奏钢琴。 钢琴真是太美妙了。 从此之后,我一直在演奏。
CL: Joseph is phenomenal. He's brilliant. He is now a medical student at Yale University, and he's contemplating a surgical career -- one of the first deaf individuals to consider a career in surgery. There are almost no deaf surgeons anywhere. And this is really unheard of stuff, and this is all because of this technology. And the fact that he can play the piano like that is a testament to his brain. Truth of the matter is you can play the piano without a cochlear implant, because all you have to do is press the keys at the right time. You don't actually have to hear it. I know he doesn't hear well, because I've heard him do Karaoke. (Laughter) And it's one of the most awful things -- heartwarming, but awful. (Laughter) And so there is certainly a lot of hope, but there's a lot more that needs to be done.
CL: Joseph真是令人赞叹。他卓越杰出。 他现在是耶鲁大学的医学院学生, 他想作一位外科医生—— 他是最早考虑作外科医生的失聪患者之一。 失聪的外科医生几乎哪儿也没有。 这前所未闻,这是人工耳蜗技术的功劳。 他能够那样演奏钢琴 是对他大脑的证明。 事实是,你没有人工耳蜗也可以弹钢琴, 因为你只需要在适当的时间按琴键就是了。 你不需要真的能听见。 我知道Joseph的听力不是很好,因为我听过他唱卡拉OK。 (笑声) 那真是最糟糕的事情之一—— 他的心意我领了,但是还是很糟糕。 (笑声) 因此毫无疑问我们有希望帮患者恢复审美, 但我们需要做的还有很多。
So I just want to conclude with the following words. When it comes to restoration of hearing, we have certainly come a long way, a remarkably long way. And we have a much longer way to go when it comes to the idea of restoring perfect hearing. And let me tell you right now, it's fine that we would all be very happy with speech. But I tell you, if we lost our hearing, if anyone here suddenly lost your hearing, you would want perfect hearing back. You wouldn't want decent hearing, you would want perfect hearing. Restoration of basic sensory function is critical. And I don't mean to understate how important it is to restore basic function. But it's really restoration of the ability to perceive beauty where we can get inspiring. And I don't think that we should give up on beauty.
我想用以下的话来结束我的演讲。 说到帮患者恢复听力, 我们毫无疑问已经走了一段很长、非常长的路。 我们前方的路会更长, 如果我们想帮助患者恢复完美的听力。 我现在就告诉大家, 我们为能听见别人讲话而满意,这没什么不好。 但我想告诉大家,如果我们失去了听力, 如果在座的某位突然失去了听力, 我们会想要恢复完美的听力的。 我们不会想要不错的听力,我们想要完美的听力。 恢复基本的感官功能是极其重要的。 我不是在低估, 恢复基本功能的重要性。 但我们真正会从中得到启发的, 是恢复欣赏美的能力。 我想我们不会放弃美的。
And I want to thank you for your time.
谢谢大家。
(Applause)
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