7Graeme Clark & the Nucleus implant

FA surgeon with a personal mission

Graeme Clark, an Australian ear surgeon, began cochlear-implant research in earnest in the late 1960s. His motivation was personal as well as scientific: his father was deaf, and Clark had grown up watching the isolation that deafness imposed. Where House had built a simple single-channel device, Clark set out — against considerable scepticism — to build a multiple-channel implant that could give back speech.[2013]

CThe problems he had to solve

The multichannel ambition created hard engineering and surgical problems. An electrode array had to be flexible enough to follow the cochlea's tight spiral without tearing its delicate structures, yet carry many independent contacts. A famous anecdote has Clark working out the principle of graded flexibility by pushing blades of grass and seashells into a turban shell on a beach. The team developed a banded-electrode array and the techniques to insert it, alongside the receiver-stimulator electronics and the speech processor.

FTThe first patient, 1978

In 1978 Clark implanted his first patient, Rod Saunders, who had been deafened as an adult. When the device was activated and tuned, Saunders could use the multichannel information to help understand speech— the result the whole multichannel argument had predicted. Because he had been postlingually deafened, his intact language system could make sense of the new electrical input, foreshadowing a principle the atlas develops later: that outcome depends heavily on the brain's prior auditory experience (Chapter 3).[1979]

CFrom research to Cochlear Ltd

A laboratory success is not a treatment until it can be manufactured, regulated, and supported at scale. Around 1981 the Melbourne work entered an industry partnership that became Cochlear Ltd, and the device was productised as the Nucleus implant. The Nucleus 22 (twenty-two electrodes) underwent clinical trials and, in 1985, received US FDA approval for adults — the first multichannel cochlear implant cleared for market (Module 10).

FWhy Nucleus mattered

The Nucleus device did more than work; it set the template for what a cochlear implant is — a multichannel intracochlear array driven by a wearable processor, manufactured to a clinical standard and backed by a company that could support recipients for life. Multichannel implantation became the global standard largely on the strength of this program, and Cochlear remains one of the largest manufacturers in the world. But the device's early speech results, though real, were still modest — and the leap to today's performance came from elsewhere: not new hardware, but a new way of coding sound (Module 9).

First, though, the other half of the global picture — the European devices that grew up alongside Nucleus: Chouard and MED-EL (Module 8).