The cochlear implant (like its cousin, the auditory-brainstem implant) is the latest in a long line of devices intended to lessen or "correct" deafness.

The earliest assistive devices were probably cattle-horns, perhaps seashells. Persons who were deaf or hard-of-hearing discovered that these "natural devices," with a bit of adaptation (such as drilling), amplified sounds.

The seashell and cattle-horn evolved into the brass ear-trumpet. Unlike many other early devices, ear trumpets actually worked—to some extent, anyway. A variety of sizes and configurations were available, but the basic design remained the same—a curved, narrow funnel shaped rather like a horn.

The great English portraitist Sir Joshua Reynolds was quite hard-of-hearing, or moderately deaf, relied on an ear trumpet for social interactions, and even painted a self-portrait showing himself utilizing one. So closely has he become identified with this device that the ear trumpet became known as a "Reynolds trumpet" in England.

Visitors to the Beethoven-Haus in Bonn can see the array of ear trumpets that Beethoven used after he became severely deaf. Several were found in his possession after his death. Several were made to his specifications by J.N. Mälzel, (erroneously credited with having invented the metronome), and he switched from one to the other as his deafness grew more severe. One large one has a cuplike "sound-receiving" barrel. A much smaller one looks like a compact cornucopia. Both have curved earpieces to secure them behind the ears. Even though most of his ear-trumpets were no longer of any benefit to him, he retained them. He continued to use a small one to the end of his life, which suggests that it helped a little.

Ear trumpets continued to be used into the 20th century, until they were supplanted by battery-operated aids. The earliest models were bulky and cumbersome. Consuelo Vanderbilt, the American heiress whose mother forced her into an unhappy marriage with the Duke of Marlborough, had poor hearing in one ear and wore one of these early aids. She disguised it under her hair and a fashionably large, spreading hat, the kind loaded with ornamentation on top. (It was good camouflage.) Later she switched to the lighter, more streamlined models, as did others.

Children who attended schools and programs for the deaf during the 1950s and 1960s have vivid memories (and not necessarily fond ones) of having to wear bulk body-pack hearing aids. The electronic components of these aids were housed in a sturdy oblong plastic or Bakelite box secured in a white-fabric harness—a pouch for the plastic box and straps over the shoulders and around the body. The pouch hung squarely in front of the chest. Cords ran from the box to the wearer’s ears. Deaf kids who ventured out wearing these contraptions endured hazing from the hearing kids. As hearing-aid and microchip technology have evolved, of course, subsequent have become much less obtrusive.

The development of effective hearing aids parallels the evolution of medicine from quackery, folk remedies, and pseudo-science to the level of sophistication we now enjoy. Audiology and a scientific approach to medicine are fairly recent developments. Persons who lived in rural areas where there were few doctors and little in the way of treatment may have been luckier than those who lived in crowded, dirty cities. Different cultures and communities all had different approaches.

To cite one example: Jean-Marc Itard, the speech teacher and audiologist who is best known for his work with Victor, the "Wild Boy of Aveyron," was a faculty member of the Institution Nationale de Paris (The National Institute for the Deaf) after the French Revolution. Harlan Lane records that he experimented on the deaf students. Believing that chronic deafness might be caused by a buildup of fluid and improper drainage in the Eustachian tubes, he surgically installed metal shunts into several unlucky pupils. After two died from infections, Itard discontinued the "treatment." Itard’s approach was a bit radical, involving surgery, but no more or less absurd than the experiments carried out on deaf people by other doctors.

It should be remembered that Alexander Graham Bell invented the telephone while trying to perfect a hearing aid that would benefit his mother and wife, both of whom were deaf (and both of whom were in denial of being deaf). Ironically, the telephone ended up aggravating, not lessening, the communicative barriers between deaf and hearing people. Only when the team of Robert Weitbrecht, Andrew Saks, and James C Marsters developed the acoustic coupler, making telephone communication feasible for deaf people, did the barriers begin to come down. Even so, the Deaf community pushed long and hard to get more TTY access in public facilities, and better relay services.

During the 18th, 19th, and even into the 20th centuries, were all sorts of treatments, devices, potions, and poultices, all promising to cure or alleviate deafness, but very little progress until the invention of the battery-operated hearing aid, which mechanically amplified sound. These models became progressively more compact and lightweight, less obtrusive, until they reached the stage of development we’re familiar with—the behind-the-ear (BTE) or in-the-canal (ITC) models. Most BTEs are tiny battery-operated machines housed in flesh-colored plastic shells, with a flexible tube connected to the earmold, the customized part that goes into the ear canal. The batteries are about the size of a lentil. Although most BTE shells are flesh-colored, wearers now can choose brightly-colored shells if they like—including red or blue. ITC models are about the size of a garbanzo bean and even less visible than BTEs. Hearing aids are a familiar sight everywhere and an accepted part of Deaf culture.

The first cochlear implants were developed in the 1950s in Australia, and gradually refined. The familiar 22-channel model consists of the implanted magnetic disk and array of electrodes, a BTE-like unit and ring-shaped magnetic transmitter (the visible part that is attached to the scalp behind the ear), and a small speech-processor box (which can be tucked into a pocket), all connected by wires. The 24-channel model is less obtrusive, with fewer visible exterior components, and looks remarkably like a BTE.

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