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Charles Limb, MD, on the Science of Music, and the Music of Science

Scheck, Anne

doi: 10.1097/01.HJ.0000437997.17022.fe
Figure. C

Figure. C

There's a saxophone player from Johns Hopkins University who pops up periodically on Baltimore's jazz scene. Though he plays gigs with colleagues around Maryland and one of his earliest memories is tapping on piano keys at his boyhood home on Long Island, he insists he is not a professional.

“I've been obsessed with music from an early age,” said the musician, Charles Limb, MD, associate professor of otolaryngology–head and neck surgery at Johns Hopkins University, who is well-known for his work on how the brain creates and perceives music. “I don't ever remember a time when I didn't play.

“As I got older, around high school age, I realized that music was important to me in a way that I couldn't quite explain or understand. Sound just mattered to me in a way that was profound, and I felt personally that all of life could be encapsulated by a few moments of music.”

Today, the same could be said about his research.

By viewing functional magnetic resonance images of the brains of jazz musicians improvising at the keyboard, Dr. Limb has shown how different parts of the brain are activated depending on whether the music is played from memory or by improvisation.

In the latter scenario, regions that regulate inhibition shut down, allowing self-expression to take over with fewer constraints. These scans help explain how such musical creativity occurs; it appears to stem from an opportunity to use acquired musical knowledge in a way that frees it from the typical restrictions.

The idea that creativity is closely connected to intellect has become entrenched, but the drive for experimentation and exploration is likely different, and may be even more essential, Dr. Limb said.

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Not long after Dr. Limb graduated from medical school, he met the physician and surgeon who would become his mentor at Johns Hopkins, John Niparko, MD.

The very first meeting he had with this new resident revealed a keen scientific mind and a wry, self-deprecating sense of humor, Dr. Niparko said.

“It was just so obvious he was going to bring a unique perspective to the field,” Dr. Niparko said, noting that the way sound is experienced is much more complex than a top-down or bottom-up series of steps. Rather, it is a bidirectional cascade of events.

“This is a case where the whole becomes so much more than the sum of its parts,” said Dr. Niparko, who is now professor and chair of the Department of Otolaryngology–Head and Neck Surgery at the Keck School of Medicine of the University of Southern California (USC).

Dr. Limb not only understands the complex interplay of the structures and processes involved in hearing, but also appreciates how those signals “give rise to cognition, and then to emotion,” Dr. Niparko said.

And Dr. Limb has managed to hold onto that self-deprecating wit over the years.

“He has been in pretty competitive environments” yet always remains “understated,” Dr. Niparko noted.

Though the two now live and work on opposite coasts, Dr. Limb has a standing invitation to visit USC, Dr. Niparko said. “And I expect him to do so!”

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Dr. Limb's parents, both physicians, met in the United States after they arrived from Korea, choosing Port Washington, NY, as the place to raise a family.

As the youngest, Dr. Limb showed early promise at the piano and the science bench. He competed in the Westinghouse Science Talent Search (now the Intel Science Talent Search) and played a number of musical instruments in high school.

When it came time for higher education, he was torn. He had a passion for music, but, ultimately, he decided on medicine.

“Even though I loved it and felt talented, I never felt that I had enough conviction to be an artist, or had enough musical talent to contribute anything really meaningful to the musical world,” Dr. Limb said.

“I went into medicine for many of the reasons that I enjoyed music. They're both about life, and realized that I could study hearing in individuals.”

Otolaryngology was a natural fit, he explained, because music is the “pinnacle of hearing,” and the specialty allows him to study both.

“The more I learned about otology, the more I realized how far away I was from understanding music,” he said.

“The two were worlds apart, in a sense, despite being critically linked. This led me to study both music perception in hearing-impaired individuals and music cognition.”

And when it comes to teaching, he can be downright funky—as in Funkadelic, a favorite inspiration of Dr. Limb's when it comes to choosing music to play in the temporal bone surgery lab.

“He is a kind and patient teacher who cares very much about resident education,” said Bryan Ward, MD, a fifth-year resident in otolaryngology–head and neck surgery at Johns Hopkins.

The “great sense of humor” mentioned by Dr. Niparko about Dr. Limb “creates a fun, relaxed learning environment,” Dr. Ward said. And residents can count on an eclectic combination of music in the operating room, ranging from Korean pop to Bruno Mars, he added.

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“I probably get to make more of an impact in the music world by studying the neuroscience of music than I would have as a saxophonist,” Dr. Limb said. “For that, I'm truly grateful.

“I have been fortunate that I have found such support [at Johns Hopkins] because this is new, and they have been very accommodating. I'm grounded very fundamentally in surgery. Understanding how to help patients hear better is at the core of my work.”

It isn't enough for his patients to hear with a cochlear implant, he said. It is also important to him that they experience sound in a way that ignites inspiration. Cochlear implants capture speech, but tune and melody remain elusive, he added.

Technology that allows music to be perceived in the intended way would be a huge advance, Dr. Limb observed.

But restoration of hearing is profound no matter how it occurs, whether a patient is catching words, noises, or a few bars of music for the first time.

“It is all poignant,” Dr. Limb said. “It never ceases to be.”

Turn to page 4 to read Dr. Limb's Journal Club article about neural plasticity after cochlear implantation.

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