- Published on Tuesday, 29 November 2016 15:37
40 years ago, Professor Claude-Henri Chouard performed the first cochlear implant. It was on September 22, 1976. A medical breakthrough that made history and that was possible only thanks to his boldness, perseverance, and talent. Professor Chouard and those who worked with him at that time, Patrick MacLeod, Claude Fugain and Bernard Meyer, tell us about this experience, drawing the portrait of this one-of-a-kind surgeon who is also a literary man, painter and music lover. A person with multiple facets.
September 22, 1976, Hôpital Saint-Antoine in Paris, France. For the first time, a patient with profound bilateral hearing loss will be able to go home with a cochlear implant making it possible for him to hear. Professor Claude-Henri Chouard and his team, made up of Patrick MacLeod (Study Director at the École Pratique des Hautes Études), Bernard Meyer (ENT specialist completing a thesis) and Claude Fugain (ENT physician and speech pathologist) enter medical history. This was 40 years ago now but for Prof. Chouard it was just a regular day, an operation like any other. “I don’t remember the patient that well, but this was a typical case of neonatal profound bilateral deafness. I can’t build an emotionally moving picture of that day. We didn’t feel any anxiety because we knew we were going to succeed.” “The only novelty was that we were going to provide the patient an implanted system,” says Bernard Meyer. “We didn’t realize we were making history. The medical feat had already been achived, when Patrick MacLeod invented the electronic system, and then during the clinical trials carried out in healthy volunteers with a petrous bone fracture causing complete deafness and facial paralysis on the same side, which needed to be operated in any case to free the nerve compressed by the fracture.”
Always with the patient’s consent: "I ensured every day that ethical aspects, which were not at that time protected by a committee, were strictly respected,” says Prof. Chouard, who has a long family history in surgery and who places great importance on these aspects. Prof. Chouard is modest about his success and refuses to take all the credit alone. “We benefitted from other people’s work. We arrived at the right time: most of the scientific community was ready, but no one dared use the electrophysiological knowledge of the time in humans”.
An exceptional surgeon
Like all scientific and medical breakthroughs, this first implant was performed by a pioneer. And that is precisely what Prof. Chouard is. "He was an excellent surgeon," says Prof. Patrick MacLeod, a visionary in electrophysiology, who was called on by Prof. Chouard a little earlier than 1973, and who developed the whole electronic part of the cochlear implant. “He did what he wanted with his hands, it was remarkable. He managed to perform acts in the cochlea, with or without a magnifier, that no one dared because it was so perilous.” But he is more than an excellent surgeon. "He’s a genius really," says Dr Claude Fugain, who took care of patient follow-up for Prof. Chouard. “He has one idea per second." A similar tribute from Bernard Meyer: “I learned from Claude-Henri Chouard what multidisciplinarity is: rather than staying closed off in one’s field, it’s having the curiosity to find out more about other sciences. He is so good at that." And Patrick MacLeod who adds, "He is one of those people who dares, but who dares intelligently.” And it was precisely this curiosity, the ability to get to the crux of the matter, and to truly challenge those around him that made it possible to bring together this resolutely multidisciplinary team – a novelty at the time – essential to imagine the cochlear implant. Claude-Henri Chouard had heard about the work done by André Djourno and Charles Eyriès on stimulation of the auditory nerve by electrodes. He in fact joined Eyriès’s team in 1960. He also found out about the studies carried out by the US researcher William House who invented the single-electrode cochlear implant.
In 1973, thinking that it was possible to go further, he decided to go to Venice, Italy and attend the 10th International ENT Congress. Patrick MacLeod who, during earlier discussions with Claude-Henri Chouard, had mentioned that it would be possible to rehabilitate hearing in people with profound deafness, was also heading to Venice. “I told him that if he was able to place a wire in the cochlea at a specific point, I was willing to help him to develop an electric stimulator to go with it. And, lone behold, he did it! Then we placed two wires, then four, then six, and each time he made a tiny additional hole [the electrode holder was only invented in the 1980s, editor’s note]. Making one hole was already difficult, but four!" It was during this congress in Italy around a table in a local café that the two scientists imagined what a cochlear implant could be. “The principles behind cochlear implants were laid down in a single afternoon,” says Bernard Meyer. “There were only three years between this meeting and the manufacture of the device in 1976. Enough time to test feasibility, to find a manufacturer, and get to work.”
Impatience serving success
We certainly could say that Prof. Chouard has an impatient side, and even a demanding one some say. “He got on my nerves until things were done,” says Patrick MacLeod. Claude Fugain confirms this lack of patience, which she considers a plus. “We were always going at full speed in the laboratory. He left us little time to show what we could do. But his demanding side challenged us," says Bernard Meyer. “It was the greatest pleasure of my life to assist him.” Thanks to this motivation, the project moved forward. “Each time he had an idea, or a decision needed to be made, he never said ‘we’ll have to do that’, he just did it immediately. This is a real lesson about how to approach things." Nothing went fast enough, and certainly not the company Bertin, which implemented the ideas of Professors MacLeod and Chouard, and thus made the first cochlear implant. In fact, the shareholders gradually withdrew from the project after the death of Jean Bertin in 1975 – to eventually abandon the project completely and sell the patents to MXM-Neurelec in 1988.
Stimulated from all sides
Claude-Henri Chouard had to get around other obstacles too, since his avant-garde ideas weren’t to everyone’s liking. At that time, some ENT specialists in France and some people in the deaf community were very strongly opposed to his ideas. “Those were difficult times,” he says. Part of this community was in fact opposed to cochlear implantation altogether. Prof. Chouard and his team were called “ethnic cleansers”, “Nazis”, who wanted to “eliminate the deaf-and-dumb race.” “Outwardly, he was indifferent," says Claude Fugain who was herself deeply affected by these insults. He was also stimulated by competition with other scientific teams from other countries who were working on the same subject.
In 1978, Graeme Clark, who created Cochlear Ltd, and Ingeborg Hochmair, co-founder of Med-El, attended a symposium organized by Prof. Chouard’s team in Paris. Because of the patent filed by the French team and the company Bertin in 1977, these groups were not able to use the same sound transmission technique. Graeme Clark did, however, find a very different solution thanks to which he was able to develop an external part that was much smaller than what Bertin created. “The Australian team had significant means thanks to support from their government,” which helped them gradually close the gap with the team in France.
And even though he isn’t someone who is looking for rewards, he wasn’t among the laureates for the Lasker award in 2013. Same thing for the Russ prize the next year. “Claude-Henri Chouard was always outside the industrial mold,” says Bernard Meyer. “He was a loner, a unique case. Where others tried to obtain big name research laboratories like the CNRS, Inserm, etc. to get funding, he had his small university hospital laboratory that he kept going thanks to a few personal partners. And this also gave him more freedom. He wasn’t looking for official glory, but scientific recognition." In 2015, however, during an international congress on pediatric cochlear implants, he received the University of Toulouse award alongside Ingeborg Hochmair and Graeme Clark. Even though some awards may have passed him by, there is no doubt that his work was fundamental. The proof is that the principles set down in just a few hours in a café in Venice in 1973 are today still used not only by all manufacturers of cochlear implants or brainstem implants, but also for multichannel electrostimulation implants. “He is unbeatable," says Patrick MacLeod. “Without him, the cochlear implant just wouldn’t exist, or it would be 50 years late.”