Frank Musiek, PhD
This year marks 50 years since the original article on the frequency or pitch pattern test was published in the Journal of the Acoustical Society of America (JASA). The authors of that article were Marilyn Pinheiro, a post doc student, and Paul Ptacek, a professor, both at Case Western Reserve University. The article was not clinically orientated but rather it focused on the perception of auditory patterns and the reversal of these patterns in normal hearing individuals. Later the concept of the frequency pattern perception was carried over to application in the clinical domain for which I had the wonderful opportunity to work with Marilyn.
In 2021 the frequency (pitch) pattern test is known by most audiologists. It is likely the most common temporal processing test used in CAPD with very good sensitivity and specificity for central auditory disorders. However, I would like to devote most of this article to some fond recollections I have of the late Marilyn Pinheiro. Despite her many important contributions to audiology and hearing science, Marilyn was not as well-known as some of her contemporaries in the field. This was likely related to a shortened career secondary to chronic health problems. Marilyn was legally blind until she was 30 years of age, hence she had a late start on her academic/research endeavors. Due to other health problems, she had to retire much earlier than she would have liked.
Marilyn was one of the brightest and innovative thinkers I have known. To provide some context as to Marilyn’s intellect she was a member of Mensa International, the oldest high I.Q. society in the world. A classic story about Marilyn when she was a student was told to me by one the Professors from the medical school who came into lecture the audiology students on brain anatomy. At the beginning of class, he asked the students “what do you know about the auditory cortex”? Marilyn raised her hand and went on to discuss in great detail, for the remaining 2 hours of the class on what she knew about auditory cortex ! –The professor was so enthralled he did not interrupt her. In addition to her doctoral training in Audiology she spent 3 years working with Dr. Foley a neurologist at the medical school where she studied neuroanatomy and neurological disorders. She also was a key player in the inner ear lab at Case Western Reserve directed by Dr. Val Jordan. They published extensive articles on the histology of cochlear damage from high intensity impulse noise on primates.
Marilyn’s Ph.D. dissertation was completed with Henry Tobin and focused on intracranial lateralization as a function of intensity difference of acoustic stimuli at each ear. Marilyn followed up on her dissertation doing an intriguing study on individuals with neurological disorders. This study showed that individuals with neuro-auditory problems had difficulty making judgements of intensity difference between ears with the dysfunction manifesting in the ear contralateral to the lesioned auditory cortex. It was soon after this study that Marilyn starting working with Dr. Paul Ptacek on auditory pattern perception. This lead to publications in the early 1970s on frequency pattern perception in normal hearing individuals. Several years later Marilyn completed a study using early editions of the frequency pattern test on individuals with cortical lesions. Her rational was based on previous, classic animal studies by Drs. Neff, Butler and Diamond showing pattern perception was compromised after auditory cortex ablation. Unfortunately, Marilyn’s wonderful study, in my opinion, was wasted on publication in a journal that was of little consequence and therefore did not receive the scientific and clinical merit it should have…In the early 1970s Marilyn took a position at the Ohio College of Medicine as professor of neuroscience. There she helped teach neuroanatomy and continued her auditory research in both basic and clinical science domains.
What many people did not realize was that Marilyn was an excellent and enthusiastic clinician. She was perhaps the best diagnostician I knew. Her background in neurology served her well in helping patients with auditory problems related to neurological disorders. She was one of the first to develop and employ a central auditory test battery for patients she saw in the clinic. Marilyn was fascinated how individuals with major involvement of the auditory cortex or brainstem could reveal normal audiograms. This was the major impetus for her to create tests of higher auditory function in order to better serve patients with central auditory disorders.
In the late 1970’s Marilyn consulted and helped direct me in my research on split brain patients when I first started at Dartmouth. This lead to our article in 1980 on pattern perception in split brain patients. Over the next decade or so, I was fortunate to work on several research projects and two books with Marilyn. Even though Marilyn was retired due to medical problems, we addressed validity of the frequency pattern test, enhanced the test battery for central auditory disorders and drew correlations of clinical findings to auditory neuroanatomy. Interestingly, in the 1970s, Marilyn showed a relationship between deficits in central auditory processing deficits and dyslexia. This was well before many later studies demonstrated this relationship.
Along with her expertise in audiology Marilyn was an elite neuroanatomist. Her teaching, regardless of the course always had a heavy dose of neuroanatomy and physiology. She was insistent on her students learning the basics of human neuroanatomy. Marilyn was exposed to a unique perspective of neuroanatomy from the then world famous David Bassett. This experience helped her cleverly mix structure and function of the auditory system with audiology and passed this hybrid information on to her students. Marilyn taught medical students, residents and audiology students which allowed her to present a multidisciplinary approach to hearing to whomever were in her classes.
Dr. Marilyn Pinheiro was an elite scientist, clinician and teacher who graced our field of audiology with outstanding contributions to our understanding of the ear, the brain and hearing.
References and Readings
Jordan, V., Pinheiro, M., Chiba, H. et al. (1973) Cochlear pathology in monkeys exposed to impulse noise, Acta Otolaryngologica, 76, suppl. 312,pp. 16-30
Musiek, F.E. & Pinheiro, M.L. (1987). Frequency Patterns in Cochlear, Brainstem, and Cerebral Lesions. Audiology, 26, 79-88.
Musiek, F.E., Baran, J. & Pinheiro, M. (1994). Neuroaudiology: Case Studies. San Diego, CA: Singular Publishing Group.
Pinheiro, M., Jordan, V., & Luz, G. A. (1973). The relationship between permanent threshold shift and the loss of hair cells in monkeys exposed to impulse noise. Acta Oto-Laryngologica, Suppl 312, 31–40
Pinheiro, M.L. & Musiek, F.E. (1985). Assessment of Central Auditory Dysfunction: Foundations and Clinical Correlates. Baltimore, MD: Williams and Wilkins.
Pinheiro, M., Ptacek, P. Reversals in the Perception of Noise and Tone Patterns The Journal of the Acoustical Society of America 49, 1778 (1971)
Pinheiro, M., Tobin, H. Interaural Intensity Difference for Intracranial Lateralization (1969) The Journal of the Acoustical Society of America 46, 1482
Ptacek, P., Pinheiro, M., Pattern Reversal in Auditory Perception, (1971) The Journal of the Acoustical Society of America 49, 493 (1971)