As a child in Jacksonville, Fla., Alex Chern built string instruments out of office supplies and tuned them, stretching rubber bands taut to change their pitch. Starting at age 7, he took violin lessons and continued playing all the way through college at Yale University. He loved playing Beethoven, expressive pieces written in F major like “Romance No. 2” or the “Spring Sonata,” and technically challenging pieces like Bach’s “Sonatas and Partitas,” where chords left a violinist no room for error.
In medical school at Vanderbilt University, however, Chern was so busy that his violin sat untouched in his closet until one afternoon in his third year. On a lunch break during one of his clinical rotations, he was sitting in the cafeteria reading the school’s newsletter when he stopped, struck by an article on the first page. Reyna Gordon, a young neuroscientist who’d also received a degree in vocal arts, was starting a music cognition lab.
“I thought it was the coolest thing ever,” said Chern. He decided to take a research year before his last year of medical school and, that July, joined Gordon’s lab.
Today, Chern is a researcher and fellow in otology-neurotology, a subspecialty of ear, nose, and throat doctor focused on surgery of the ear and lateral skull base. Chern, who was recently named a STAT Wunderkind, has spent years studying hearing loss: its links with cognitive decline in older adults, and how hearing aids affect how people enjoy music. Now at Johns Hopkins University, he hopes to improve the experience of listening to music for people with hearing loss.
“My dream would be not just to restore functional hearing … My dream would really be to help restore the ability to experience all the richness and the beauty of the sound of music,” he said. “That’s a higher bar than restoring the ability to perceive speech.”
It is a focus that is personal for Chern, who first took up violin after he was diagnosed with hearing loss himself because his mother thought the instrument might help him hear high-pitched sounds. Though he no longer plays in an ensemble, Chen’s violin case stays open, within reach from his desk. Now, he looks back on that day in the cafeteria as the start of the year everything came together — the year he found the research he loved and the specialty to which he’d dedicate his career; the year he started playing music again; the year he started seeing music through a scientist’s eyes. But the path to those realizations was far from straightforward.
Carving out space for music in the wake of a car accident
One evening in April 2016, three months before he joined Gordon’s lab, Chern was walking home from the gym when he was hit by a car going 40-50 mph. He woke up from a coma in the hospital 10 days later with a tracheostomy tube and a knee brace. Though he doesn’t remember much from that time, Chern knows he asked his mother for his laptop and, on YouTube, searched for Beethoven’s Pastoral Symphony: a calming five-movement piece that evokes a walk through the country, raindrops and thunder, and the tranquility after a storm.
As he recovered, Chern found himself revisiting other music he’d played during childhood and, as soon as he was discharged from the hospital, picked up his violin again. When he returned to school, he made time to play in a chamber music group. Later, with Gordon, he began studying the shared neural processes between music and language in children. Music, it seemed, was again part of his every day, and this time no longer confined to just his personal life.
In 2018, Chern moved to New York for a residency at the NewYork-Presbyterian Hospital in otolaryngology — head and neck surgery, a speciality he’d chosen in part for the dexterity demanded by its surgeries and in part for the role hearing had played in his own life as both a musician and a person with hearing loss, who’d worn hearing aids on and off since childhood.
Within a few months, he reached out to Justin Golub, an otologist-neurotologist studying how age-related hearing loss affects the brain at Columbia University. With Golub’s guidance, Chern spent the next four and a half years studying the connections between hearing loss and cognitive decline.
Though causality is a tricky thing to prove — scientists can’t give people hearing loss and study their cognitive symptoms — several studies have provided strong evidence that hearing loss is linked to cognitive decline. Chern, Golub, and their co-workers found that this relationship extended even to the early stages of hearing loss, in the range of normal hearing. The discovery suggested a broader definition of hearing loss could be useful and highlighted the importance of improving the acoustic environment for everyone, not just people with a diagnosis.
Chern also continued his music research in the lab of Anil Lalwani, an otolaryngologist-head and neck surgeon at Columbia. Though many researchers had studied how people with cochlear implants experienced music, comparatively few had done the same for those with hearing aids, which are more common. Again and again, Lalwani’s patients had come to him concerned that with hearing aids, music would sound different.
“In New York, where I practice, there are plenty of people that come in worried that they don’t want to get hearing aids because they’re musicians, or they really like music, and they don’t want music to change for them,” Lalwani said.
But it wasn’t a concern to which clinicians had ready answers. Hearing aids are designed to help users detect speech, rather than music. Where speech is generally confined to a specific range in loudness and pitch, music gets louder and softer, higher and lower in pitch, and can vary when produced by different instruments or in different sections in a single song. Hearing aids, which work by amplifying sound waves, are programmed with a compression algorithm that makes soft sounds louder and loud ones quieter.
To get a clearer understanding of how people with hearing aids were experiencing music, Chern and Lalwani conducted a survey of about 100 hearing aid users who also completed an active listening task. Without hearing aids, people with more severe hearing loss reported enjoying music less in their everyday lives. Wearing a hearing aid helped users with moderate to moderately severe hearing loss enjoy music more, but did not make a significant difference to people with mild hearing loss.
Chern hopes that their findings can help shift attention to designing hearing aids and cochlear implants with music in mind.
The ties between music, hearing loss, and cognitive decline
After years of studying how hearing loss affects cognition and how people enjoy music, Chern is now drawing on all of those experiences as a fellow at Hopkins. Together with Gordon, he is the recipient of a grant, funded by the Reneé Fleming Foundation and the NeuroArts Blueprint initiative, that seeks to understand how hearing loss and engaging with music influence cognitive decline.
Chern and Gordon will also compare cognition and hearing loss in musicians and non-musicians, which could help them disentangle whether engaging with music can improve cognition or aspects of hearing such as the ability to distinguish speech in a crowded room.
As a step toward improving music listening for people with hearing loss, Chern wants to create a better measure for that experience, which can be hard to quantify. How much a person enjoys music depends not only on their ability to discern pitch, timing, and timbre, but also on other factors such as the social environment in which they experience the music and their own personal associations with it.
“Music really encompasses a lot of what makes us human,” Chern said. He hopes that a well-defined measure of music enjoyment can help researchers improve it in a more focused way.
Once, at a conference, he heard keynote speaker Charles Limb — an otolaryngologist and jazz saxophonist — call music the “pinnacle of hearing.” Chern scribbled it down because, though he was then new to music as a researcher, it felt true.
As a musician, and as someone who has hearing loss himself, it just made sense. In medicine, a person’s hearing is often measured by their ability to simply hear a sound or recognize speech, he says.
“But I think music is a lot more than that.”