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.
現在當我們想到知覺時 我們通常並不會特別去想 從生物演化的觀點,他們是怎麼發展而成的 我們並不會特別去想在演化上有什麼需要 讓我們被這些知覺保護著 但這大概正是這些知覺得以演化的真正原因-- 保護我們安全,讓我們繼續存活 當我們真的開始思考我們的知覺 或是思考失去某些知覺的可能時 我們其實是這樣子思考的: 可以去觸摸些高級用品,去品嘗些美食的能力 聞到香氣 或看見美麗事物的能力 這是我們希望知覺可以帶給我們的 我們想要美好的事物;而不單只是物理功能而已 所以當我們講到知覺重建的時候 其實我們離可以提供美好的感受這階段還很遠 而這就是我今天想要談論的內容
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.
好比說聽力 當你想到為什麼我們要聽 我們並不會想到是聽到警報的能力 雖然那當然是一件很重要的事 我們真正想要聽到的是音樂
(Music)
(音樂)
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?
很多人都知道那是貝多芬的第七交響曲 也很多人知道在他寫這曲子的時候 他耳聾了,或接近全聾 現在我想要強調的是 我們可以聽見音樂是一件多麼不尋常的事 音樂只是眾多奇怪事情的其中之一 那是空氣中的聲波震動 微小的能量波動,搔動著我們的耳膜 基於某些原因,當耳膜被搔動的時候 這些能量就會傳到我們的聽小骨 接著轉換成耳蝸內的流態神經衝動 接著便在我們的聽覺神經轉換成電子訊號 然後神奇的抵達我們的大腦 接收成一首歌或是一段美好的音樂 這個過程是完全抽象,和非常、非常不尋常的 單就這個主題我們就可以討論好幾天 去真的了解,當它們的起源都不過是空氣中的震動時 我們到底是怎麼去聽見這些充滿情緒的聲響的呢?
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.
結果發現當我們失去聽覺時 許多失去聽覺的人 都是失去所謂的耳蝸,內耳。 失去的是毛細胞的部分 現在如果讓你挑個知覺失去 我會非常誠實的跟你說 相較於其他知覺 我們比較擅長重建聽力 事實上,沒有任何其他知覺的重建 和重建聽力的能力有得比 身為一個物理學家和外科醫師,我可以自信地告訴我的病人 如果你非得挑個知覺失去 聽覺重建是醫學上和手術上發展最進步的 而身為一個音樂家,我可以告訴你 如果我做了人工內蝸移植術 我將會心碎,徹底的心碎 因為我知道音樂聽起來再也不會像從前一樣了
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.
現在我要播放一段影片給你們看 一個出生就失去聽覺的女孩 有個非常支持她的環境 她的母親竭盡所能照顧她 好,請撥放影片
(Video) Mother: That's an owl. Owl, yeah. Owl. Owl. Yeah. Baby. Baby. You want it? (Kiss)
(影片) 母親: 那是一隻貓頭鷹 貓頭鷹,對 貓頭鷹。貓頭鷹。 對 寶貝。寶貝。 你要這個嗎? (親吻)
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:除了這些 家庭給這孩子的支持 和簡單的灌輸學習 對這些聽障的孩子,或出生就失去聽覺的嬰兒來說 在這世界上,總是有些限制 不論是社會、教育、就業的機會 我不是指他們無法擁有美好的生命 我是說他們將會面對諸多阻礙 是聽力正常的人所不需要面對的
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.
到目前為止,聽力損失和治療聽障的技術 已經發展了將近200年 我說真的 人們曾經試過將耳朵形狀的物體貼到耳朵上 插根漏斗進去 那曾經是治療聽障的唯一可做的 當時我們甚至還沒辦法看到耳膜 所以當時無法就聽障提供良好的治療 其實並不讓人驚訝
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.
而今天我們有現代的多頻道內蝸植入手術 這是一個門診手術 要將這人工耳蝸手術放至在內耳 依據醫院的不同,手術約需一個半小時到兩個小時 手術需要全身麻醉 末了,你會得到類似這樣的結果 一個電極陣列會插入你的耳蝸 事實上,相較於正常的內耳 這有點粗
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.
而這是和稍早影片中的同一個女孩,她現在做了植入手術 這是十年之後的她 而這個影片是由 我的手術導師John Niparko醫師主刀、錄製的 麻煩播放這個影片
(Video) John Niparko: So you've written two books?
(影片) John Niparko: 所以妳寫了兩本書?
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: 我寫了兩本書 (母親:另外一本是書還是日記?) 女孩:不是,另一本也是書 (母親:喔,好)
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:這本書有七個章節 而最後一個章節 標題是「耳聾的好處」 你還記得你寫過這個章節嗎?
Girl: Yes I do. I remember writing every chapter.
女孩: 我記得。我記得寫了每一個章節。
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:有時候我妹妹會有點煩人 所以耳聾還滿方便的,讓我不要被她煩
JN: I see. And who is that?
JN: 我了解。那這是誰?
Girl: Holly. (JN: Okay.)
女孩: Holly。 (JN:好。)
Mother: Her sister. (JN: Her sister.) Girl: My sister.
母親: 這是她妹妹。(JN:她妹妹。) 女孩: 我的妹妹。
JN: And how can you avoid being annoyed by her?
JN: 那你是怎麼避免被她煩的呢?
Girl: I just take off my CI, and I don't hear anything. (Laughter) It comes in handy.
女孩: 我就把我的植入拿下來,然後我就什麼都聽不到了 (笑聲) 很方便的
JN: So you don't want to hear everything that's out there?
JN:所以妳不想要什麼聲響都聽得到嗎?
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: 她非常厲害 這絕對會被視為非常成功的案例 這正是。在現代醫學的角度說,這的確是個成功的故事 但是,除了這些非常好的輔助設備 讓一些耳蝸植入者可以用語言表達之外 當你把收音機打開,他們突然就都聽不到音樂了 事實上,幾乎所有的植入者都非常掙扎 而且不喜歡音樂,因為聽起來很糟 因此,當我們談到 "重建美麗到這些人的生命裡"這點子時 關於聽覺,我們還有好長一段路要走
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.
這有很多原因 我稍早提到 音樂和語言不同,因為那很抽象 語言是非常精準的 事實上,我們使用它的原因 就是因為語言是有語意特異性 當你說一個字 你在意的是這個字有沒有被正確的解讀 當它被念出來的時候 你並不在意這個字好不好聽
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.
而音樂是截然不同的 當你聽到音樂,如果它不好聽,那又何必聽呢? 如果音樂對你來說不好聽的話 聽音樂就沒有什麼意義 音樂聲學比語言更難 就像你從這個圖表可以看到的 頻率的幅度、 分貝範圍、音樂的動態範圍 差異度都遠高於語言 所以當我們要設計一個完美的耳蝸植入器時 我們會嘗試的目標 是能夠傳輸音樂 因為我始終認為,音樂是聽覺的頂峰 如果你可以聽得到音樂 那你應該什麼都可以聽得到
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.
現在問題從音準開始 我的意思是,我們大部分人都知道,音準是建立音樂的基礎 若沒有辨識音準的能力 音樂和旋律都是非常困難的 更別提和諧度或是其他類似的事情 現在這是 拉赫曼尼諾夫 的<前奏曲>MIDI版本 現在我們播放這個
(Music)
(音樂)
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,現在我們考慮 對耳蝸植入患者 音準的感知可以大到兩個八度 那我們來看看會發生什麼事 我們將這些隨機變換在半音的幅度裡 如果能在患者身上發現對一個半音音準的辨識能力的話,我們會很高興 好,開始播放
(Music)
(音樂)
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.
我播放這個的目的 是想要讓你知道音樂不能這樣隨意的更換 你換了一點點,尤其是音準,整個曲子就不一樣了 當然你可能有點喜歡新的版本 有點催眠的功效 但那很顯然不是音樂本來想要表現的 而且你現在並不是在聽 那個多數聽力正常的人可以聽到的版本
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.
另外一個隨之而來的問題是 不單只是分辨音準的能力 還有分辨各種聲音的能力 多數耳蝸植入手術的患者無法分辨不同的樂器 如果我們連續撥放這兩段聲音 (小喇叭) 那是小喇叭 接著第二個 (小提琴) 那是小提琴 它們有類似的聲波,但是截然不同的樂器 耳蝸植入的患者無法分辨 這兩個樂器之間的差異 聲音的品質,或是聲音的聲音 是我用來形容音色,色調 但他們怎麼都無法分辨這些的不同 這些植入並無法傳遞 這些音質,好比溫暖的音色
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.
現在如果你看這些植入手術患者的腦部 然後讓他們聽一段演講 讓他們聽一段節奏,聽一段旋律 你會發現,聽覺皮層 在聽演講的時候最為活躍 你會以為這些植入對於演說有加分的效果、 本來就是設計來聽話的 然而,事實上你如果看看旋律 你會發現,相較於正常聽力者 在植入患者身上,皮質活動非常少 不論原因為何 當在接收旋律的時候 這些植入無法成功刺激聽覺皮層
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.
所以下一個問題是 那旋律到底聽起來像什麼? 現在我們做了一些研究 去了解這些音質對植入患者來說,到底像什麼 我要撥放兩段亞瑟小子(Usher)的影片 一段是正常的 一段幾乎沒有高頻和低頻 也幾乎沒有中頻 現在我們播放
(Music)
(音樂)
(Limited Frequency Music)
(音頻限制的音樂)
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.
我有患者告訴我這兩段聽起來一樣 在這兩段不同的音樂片段中 他們沒有辦法分辨音質的差異 再強調一次,我們離想要達成的目標還非常非常遠
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.
所以現在的問題是,有希望嗎? 有的,是有希望的 我不知道有沒有任何人知道這是誰 這是....有人知道嗎? 這是貝多芬 我們怎麼知道貝多芬的頭骨長這樣? 因為他的墳墓被挖掘出來 結果發現他死的時候,顳骨被取走(顳骨位於顱骨兩側,又稱為內耳門的開口) 想辨別他失去聽覺的原因 這就是為什麼上面有一些模型用的陶土 然後他的頭骨側面有些鼓鼓的 但是貝多芬即使在失去聽覺很久之後 他依舊作曲 這顯示即使失去聽覺 音樂的能力還是保存下來 大腦還是可以接受音樂
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.
我非常幸運的可以和David Ryugo醫生一起工作 我們研究一些失聰的白貓 試著給它們做人工耳蝸植入 這是一隻被訓練會對小喇叭反應以換取食物的貓
(Music)
(音樂)
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:貝多芬並不讓她興奮 (音樂) 柴可夫斯基的1812序曲也不值得她起床 (小喇叭) 但她聽到這個訊號立刻採取行動! (小喇叭)
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:我現在不是說 貓聽到這個小喇叭的聲音和我們聽到的是一樣的 我是想說經過訓練 你可以灌輸音樂聲的意義 即使對象是一隻貓 如果我們現在把這些努力 用來訓練耳蝸植入者聽音樂-- 因為現在基本上是完全沒有、 沒有任何康復的策略 很少真正使用先進技術提高音樂品質的努力-- 我們有很長的路要走
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.
我現在要播放最後一段影片 這是我的一個學生叫作約瑟 我有幸和他在我的實驗室裡共事三年 他是聽障,在他接受人工耳蝸植入後 他學會彈鋼琴 這是一段約瑟的影片
(Music)
(音樂)
(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.
(影片) 約瑟: 我出生於1986年 大概四個月大的時候 我被診斷有嚴重的聽覺障礙 在那不久之後 我就裝了聽力輔助器 但即使是當時市場上 最好的輔助器 也都不太有用 基於這個原因,我得學習讀唇語 我也其實聽不太到別人在說什麼 而當我十二歲的時候 我是新加坡頭少數幾個 接受人工耳蝸植入手術的病人 接受手術之後不久 我就開始學琴 而那真是太美好了 自從那之後,我再也不回頭看
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:約瑟非常驚人,他太棒了 他現在是耶魯大學醫學系的學生 他目標成為外科手術醫生 是少數聽障者得以考慮擁有這樣的職業 這世界上幾乎沒有聽障的醫生 這基本上是前所未聞的,都拜科技所賜 而他可以彈琴這個事實 就是他大腦的最好證明 事實上,就算沒有植入你也可以學會彈琴 因為你只需要在適當的時機按下正確的按鍵 你其實不真的需要聽到聲音 我知道他聽得不好,因為我聽他唱過歌 (笑聲) 而那是世界上最糟糕的事情之一 非常溫暖人心,但是非常糟糕 (笑聲) 所以這世界的確有希望 但我們還有很多需要做的
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.
所以我想要用下面這段話做為今天的結論 關於聽覺重建 我們確實已經走了一段很長的路 然而關於重建完美聽力的想法 我們還有一段更長的路要走 現在,讓我告訴你 我們當然可以對聽得到說話感到滿意 但是我告訴你,如果我們失去聽力 如果現在這裡任何一個人突然失去聽力 你會想要重拾完美的聽覺 你不會想要一個"還可以"的聽覺,你會想要完美的聽覺 重建這個基礎感知是非常重要的 我並不想低估 重建基礎功能的重要性 但是重建對於美的感知 是我們可以得到啟發的關鍵 而我想我們不應該放棄美好的事物
And I want to thank you for your time.
謝謝各位的時間
(Applause)
(鼓掌)