The Giants of Audiology: Interview with James W. Hall III, Ph.D.

Bob Traynor 0:14
Welcome to This Week in Hearing – our series we call The Giants of Audiology. I’m Bob Traynor, your host for this episode, coming to you live from the Tinnitus Enhancer Bar in Fort Collins, Colorado. Today, my guest is Dr. Jay Hall an internationally known audiologist whose topic for this episode is titled, Golden OAEs and Jewett Bumps in the Road. Thanks for being with us today, Jay. And we’re really excited to have you here with us to talk about things and and I understand that you’re quite a beer guy. And you brought some things with you some actual beers from your area with you that you love. And, and I have some with me. And so if you show me yours, I’ll show you mine.

James Hall 1:14
That’s a deal, Bob, more than happy to. Yeah, I do have you know, one of the thing about Maine I’m on the coast of Maine is we have a lot of micro breweries throughout the state. Actually, you might be interested in knowing this. But there are more micro breweries in Maine, per capita than any other state except Colorado. So we have that in common. So this is a an organic, not that I always seek it out organic session. Beer. It’s a summer session, which means it’s it’s derived from the British policies or a tradition of the professor taking some of the students from the college to the pub to continue the expression to continue the class. And so they continue their session at the pub and he had to have low alcohol beer to do that, obviously, to make it work. This is another great brewery, Baxter. It’s about an hour away, and they make they brew their own seltzer as well as beer. My wife loves seltzer now, so we go up there and buy two or three cases and have it. And then one last prop here. And I don’t know if you can top this one in terms of size. But this is, of course, a growler. And this is one of our favorite little micro breweries. It’s way out in the woods got to go on a dirt road for about five miles to get to it, walk through the cow poop. But the beer is great. They’ve got a Scottish ale. That’s excellent.

Bob Traynor 2:35
Well, and, and of course, you’ve shown me yours -now it’s my turn, you know, now no Coloradoan would would be would be worth their salt without a Coors in their hand. Of course, I remember the day as an assistant at University of Arkansas medical sciences where I bought it brought a whole truckload of this back at Christmas time, just to serve to my friends. Here’s one of our local ones. That’s a that is a great German Pilsner. And the German Pilsner this was like a little brewery out of Loveland, Colorado called Prost. And, but it’s a super little Pilsner. But you know, it’s early here in Colorado, so I have to I won’t be able to imbibe too much without having it be cut just a little bit. And so the sole people make a Chelada, which is tomato juice and beer. We’ve had those over the years as well. I’m not sure that that this is Sol means anything on the outside of the can, but here we go. So my understanding is that that is not really easy for for a new speech pathologist to come from Northwestern University, to go to Baylor University and study audiology under the prelim- the preeminent. Dr. James Jerger. So I understand we were going to talk just a little bit about some of those first experiences with well, the Jewett bumps in the road?

James Hall 4:17
Absolutely. By Well, you know, I was at Northwestern University as a speech pathologist, but I was a closet audiologist at the time of course, that term wasn’t commonly used, because I really wanted to be an audiologist have after taking in my first semester of the Master’s course, a wonderful intro to audiology course by Earl Harford, who, as you know, is one of Jim Jerger’s colleagues slightly younger and also a Raymond Carhartt student by the way, Raymond Carhartt was right there at the time, and he would come into the intro class or also a special topics and audiology had a few electives. And I took that course and he would come in Tom Tillman. Doug Offsinger I mean, if you if you didn’t want to be an audiologist after listening to these guys talk, you know that just wasn’t going to be your profession. So I knew I wanted to be an audiologist when I got my master’s degree in speech pathology. And and I talked to Deborah Hayes, who was a master’s degree student and audiology, that same time that I was there. She said, Well, I’m gonna go to Baylor College of Medicine and study with Jim Jerger. And I started, of course, I knew who he was. And I just said, I think I’ll do that too. So I went down as a speech pathologist, and as luck would have it, shortly thereafter, about six months after I got there, Craig Dunkel, a lot of people know Craig, he quit the staff there to go into one of the very first private practices in Texas, it was in Dallas, so he moved up to Dallas. And that open that was created an opening and audiology and Jim Jerger came over to me. He knew already I was wanting to be an audiologist, he said, How do you like to work in the audiology clinic in the morning, because the speech pathology clinic wasn’t all that busy. And I jumped at the opportunity and never looked back.

Bob Traynor 5:58
Cool. Well, and and of course, now, we all know you as a guy who’s had 200 peer review publications, invited articles, book chapters, and even 11 books. And I would say that in any audiologist that has not read one of your books from cover to cover now, which and they are kind of thick, if I remember, right, but if they haven’t read that cover, and there it is,

James Hall 6:25
you mean 871 pages.

Bob Traynor 6:28
And, of course, we’ve all read that from cover to cover Jay. Audiologists worth their salt have all read your your stuff. And and you know, we also know that that in addition to our relationship at the University of Florida, where we worked together for 20 years or so, you have now you now hold part time audiology positions at Salus University and the University of Hawaii. And then I hear you always have to tell your wife, every once in a while that you hold a position that’s titled, extra ordinary professor at the University of Pretoria in South Africa.

James Hall 7:10
I’ll tell you, Bob, whenever people introduce me, they always kind of somehow emphasize that extra ordinary, you know, word in that title. And my wife has been in the audience with those introductions and I look at her and she rolls her eyes today. He’s as ordinary as can be. But the term it’s a wonderful term. It’s, of course, in South Africa, there’s a British influence, but also a Dutch influence. And so the term actually is a nice way of saying you’re not getting paid. It’s an adjunct position, but an unpaid adjunct. So that’s extraordinary, because most of the people there actually get paid. They’re the ordinary ones.

Bob Traynor 7:46
Yeah, the the idea is all of us that have taught courses at one time or another, all felt thought that we were extraordinary professors anyway.

James Hall 7:56
In our own mind, we were legends, in our own

Bob Traynor 7:59
mind. That’s right. Well, you know, what kind of equipment where are you even could tell me what kind of equipment was around in 1973 when you began looking at these Jewett bumps in the road?

James Hall 8:12
Well, you know, Jim Jerger, known for many things, obviously, diagnostic audiology and, and the crosscheck principle, but many people don’t realize it back in the 60s. Now, this is before the discovery of ABR back in the 60s- 60s Jim Jerger had this rack of equipment in the clinic not in a lab in the clinic with you know, switches and filters and Sound producer sound generators. And and a little Nikolay oscilloscope, which was used for averaging cortical evoked responses. That’s what he was doing. He stayed away from ECOG entirely because one of the faculty members in otolaryngology Al Coates, who did a lot of work with ECog and ENG was the Ecog King, their guru. So Jim had this rack of equipment. So as the 1960s ended, he was Jim was good friends with Robert Lambos. So I mean, he knew Jim knew the ABR was coming along before anybody else probably except maybe a few other of Lambo’s colleagues. So he modified this rack of equipment to do a br It was quite easy to do, you just change a few parameters. So by the time I got there 1973 Two years before there was big studies and in right around the time a year or so after the Jordan Wilston paper and 70 and 71. We were doing ABRs. I say we I was still in a speech pathologist trying to get my ccc’s in audiology, so I was kind of low on the totem pole, but I was well aware that this new electrophysiologic technique, the art wasn’t called ABR it was called brainstem evoked potential or brainstem evoked response, but I knew that that would be the next wave of of diagnostics. testing at least in children.

Bob Traynor 10:01
Now my understanding is you had kind of a unique assignment as as kind of the lowest guy on the pole there to, to conduct these ba e ours as well.

James Hall 10:16
Absolutely. That is true. You know, I was again I was spending actually the afternoons in speech pathology my mornings in audiology and then I finally I had enough coursework in audiology and I got my ccc’s and I was a full time audiologist. But still I was low on the totem pole, Deborah Hayes was well on our way to being an expert in audiology, there were others and of course, Dr. Jerger was there. So I was basically functioning as an assistant, which was fine with me, because I could learn learn the technique. So what we do Bob is we would, we would see older children for ABRs right in the clinic. But even then this is 1974-75 kids would come in, I mean, the word got out, they were coming from all around the world, really for ABRs, and some of them needed to be sedated. So we would roll this rack of equipment that was one of my jobs, roll the rack of equipment to an elevator go up two floors and the neurosensory center there, Houston, and we go to the ambulatory pediatric ambulatory surgery area, and some nurse prior to us getting there would sedate our patient. So we get up there in the morning, usually eight or nine, it was very exciting. We all had well starched stiff, you know, lab coats, we we strode into that image and with masks on like, we own the place. And of course, nobody knew what the hell we’re doing there to be honest with you. And so I would do the assistant, I scrub the baby and, of course, roll the equipment up and I’d handle any problems that might arise. If you want me to get into the nitty gritty, let me just tell you that some of these kids would wake up soon after they were supposed to be asleep and and where you’re testing them. And the conclusion, we draw the conclusion that maybe this sedation was not having an effect. Now back then Bob, the sedation was not oral syrup is where you’d squirt it in the mouth. In the little babies, it was a suppository, and it basically looked like a little pill, it was blue, we call them blue bullets, oh, the little blue pills, the little blue pills would be pushed up where the sun don’t shine, so to speak. And the baby, if they had a bowel movement would eject this little blue pill. And that’s when Larry Malden and Deborah Hayes and the rest of the crew would go for coffee and say, Jay, can you see get that sedation back where it belongs? So I started at the bottom, so to speak, and I work my way up?

Bob Traynor 12:45
Well, the obviously the bottom is a great place to start because you learn to so many extra kinds of things that you wouldn’t necessarily know if you started in the middle or somewhere. But my understanding is you were one of the early investigators and developers of some of the newborn hearing screening specific procedures. And I know you’ve worked with Marion downs. If life our colleagues don’t remember Marion, that’s a void in your in your historical background of Audiology. So go to hearing and children and find out. But I know you worked with Marion and the development of the newborn hearing screening programs. That’s the standard almost all over the world now.

James Hall 13:35
Absolutely. You know, in my career, I’ve been around at the right time, the right place to be involved some exciting endeavors, and one of the most exciting really was in the early 1980s. Now, at the time, it seemed like I’d gotten my PhD ages ago, but that was in 1979. I got my PhD by 1980 and 81. I was performing ABR is on infants at University of Pennsylvania were my first real job after my PhD. And newborn hearing screening was already being discussed galabmos had had shown it could be done. And then I took a position as director of audiology at the University of Texas Medical School in Houston. And the hospital there had a big Hermann Hospital had a big nursery intensive care nursery had three helicopters would bring kids in. And I approached neonatology and I said, you know people around the country at a teaching hospitals where their children are now screening the hearing of babies who are at risk, and I told told them about Marion downs about the Joint Committee on Infant Hearing what she basically started at back then there were seven risk factors. And by 1982, the same year I got there, we had started a newborn screening program. That was an at risk program using the big Nikolay ca 1000. Now interestingly, when I talked to my colleagues, Roger Ruth and Paul Kalani, and many others around the country they were all doing the same thing. Everybody was independently getting into this area. And that that that experience starting that program, and I did it again at Vanderbilt started a newborn hearing screening first for the at risk. And later for the well, babies that got me to know Marian downs really well, and Christy Yoshinaga Itano, and others. And before you know it, Marion had arranged for all of us go to Capitol Hill in Washington to meet with senators and congressmen to talk to them about the importance of early identification of hearing loss and early intervention. And, and then as time went on, against all odds, thanks to Mary and downs as our leader, we then had universal hearings, new, new universal newborn hearing screening, and of course, it was a an NIH connect consensus conference in 93, that spurred that along. So it all started with my interest in ABR. And I think for any young people listening, that the message here is when when somebody knocks on the door, grab the door and open it up, and just rush in and and and even if you don’t know everything you need to know, you can always wing it at the beginning. But what audiologists are capable of getting involved in all kinds of interesting endeavors if they just give it a try.

Bob Traynor 16:08
Yeah, the Mary was one of my professors, I was just fortunate to be at the University of Colorado as an intern when she was when she was active. And, and we learned how to go about doing pediatric hearing assessment from the masterless of the of pediatric hearing assessment. And, and when the ABR procedures came about, those of us that had gone through all of the hour and a half, two hour sessions with kids now realized we could do it in a much shorter period of time, thanks to colleagues who have done some of the research and development of that area. Well, what now in the newborn hearing screening, hearing, what kind of equipment was was used back in the in the early days?

James Hall 16:58
Yeah. And I would just want to point out, they were early days, but boy, I’ll tell you, things were happening fast. And here’s the ABR being introduced as a tool for newborn screening by Robert Kalambo. In 1975, published a series of articles and within five or six years, a lot of us almost every major teaching hospital in the country was using ABR in the in the intensive care nursery for at risk kids. And we, Deborah Hayes, Jerry Northern few others, Jack Roush began to to point out that of all the children who say enter school with hearing loss, only about half of them are at risk for hearing loss at birth, the rest of them are healthy babies. So that’s what a lot of people thinking, if we’re if we think newborn hearing screening is so important, we should be doing it in all babies, not just the at risk. But to do that, we need to have some equipment that’s not going to be used by an audiologist that’s automated, that could be used by a nurse or a technician. And so a quick story here. At this point, I was at the University of Texas. And I got a call from Aaron Thornton, who was a bright bright guy, Iowa grad at Mass Eye and Ear, and I am from Connecticut. And I’ve been visited, I visited his clinic once on a trip back to Connecticut. He was in Boston, when I was going to see my family and he showed me this phenomenal template that he developed. It started with just transparencies, which he laid over ABR hours of infants. And he began to show that if he traced the ABR of every infant onto a single transparency, and then he put all these transparencies up on an x ray viewing box. There was a template you could see you all the ABRs kind of fit in the same pattern. And so he developed a very rudimentary computer program to detect ABRs Well, a company out in Palo Alto picked up on that idea. Somehow the the rights were sold one. And the next thing you know, I’m winging my way to San Francisco, where I’m meeting again, Paul Cleany, Roger Ruth Aaron Thorne, a bunch of big names Mike Gorga. And, and we were showed that we were shown this prototype, automated, totally automated ABR system called the Algo One. And then they said we need someone to collect it to conduct the clinical trials to collect some clinical data. And I volunteered so did Paul Cleany. He was at Michigan, Roger Ruth was at University of Virginia, I’m I’m in Texas, and we were selected as the three sites. And so this was the first automated ABR system in the world. And the later generations of that equipment are still being used today. And we conducted data only in the at risk. We showed that this automated device did just as good a job as an expert in ABR in terms of identifying an ABR when it was there, and most importantly, not seeing an ABR when it shouldn’t have been there. So the false negatives and false positives were sufficiently low to justify its use as a clinical device. I mean, I’ll tell you about that was so exciting. As that was the lynchpin for universal newborn hearing screening, and and all the Early Hearing Detection and Intervention programs that have developed since then.

Bob Traynor 20:10
And of course, now all the millions of children that have had around the world around the world, it’s it that was a one of the main contributions to the profession from a group of very innovative colleagues, including yourself. Now, it with with, with ABR, where do you see the use of things like 40 hertz and middle latencies and cortical potentials? And where do you see that going? I know it’s kind of it’s kind of they’re somewhat, still a little on the research side for for many people. Where do you see all that going? And I guess you could probably include The VEMPs in there as well. So I’m sure that the group would like to like to hear what your perception of maybe that is where the newborn hearing screening was, you know, 30 years ago? Who knows?

James Hall 21:08
Yeah, that’s a great question, Bob. And of course, I could wax on for hours about it. I’ve actually given some talks at at an international evoked response, meeting, international meeting, when I gave the talk was in Russia, but it’s, we’ve gone to meetings around the world on that very topic. You know, when I look back at OAE, is aural admittance measures, certainly ABR. I tried to assess what does it take to get a procedure from the laboratory into or from a research procedure into routine clinical use. And there are several ingredients that are critical. One is you’ve got to have a device that’s user friendly. You’ve got to have normative data you’ve got but you’ve also have to have clinical data showing that this really is an advance, you know, it’s really going to do things better than whatever you’re doing at the time. So clearly ABR was better than behavior. audiometry and infants and young children, always were providing unique information and oral admittance work, and you have to have somebody in for oral admittance, it was certainly Jim turgor, who would have one foot in the lab and one foot in the clinic and say, Okay, we’re going to take this equipment, we’re going to use it on 1000s of people. And we’re going to very simply describe a protocol and procedures for using it in the clinic. Well, that was done for ABR OAEs aural immittance, etc. But it’s never really been done for the cortical responses. And it’s ironic because they’ve been around since 1939. And as I mentioned at the outset, Jim Giorgio and others were using them in the 60s before ABR. So what we need is we need a piece of equipment, which would allow you or somebody who doesn’t have a lot of experience with with evoked responses to put the electrodes on the patient that’s easy. And to collect the data and either analyze it automatically or, or provide some guidance. And interestingly, Harvey Dillon in Australia at the NAL develop a very, that that very piece of equipment. But it’s not been marketed. Well, it was picked up by a real ear measurement company as a as the company that would market it. And it’s languishing, I don’t think it’s available. And I everyone I’ve talked to a degree if we had that type of equipment picked up by a major manufacturer and the price was right, people would start using it in auditory processing disorders. They’d be using it to confirm that the brains developing appropriately with cochlear implants or with hearing aids and infants, because Anu Sharma and others have done the research. It’s all there. So it’s really comes down to instrumentation and a equipment company. It’s a it’s a catch 22 that equipment company won’t develop the equipment until they know there’s a demand but you’ll never know there’s a demand until you have the equipment. And so that’s where we’re stuck right now.

Bob Traynor 23:56
Well, well. So, so the and that that more likely than not is the future of of the use of ABR at the various latency levels and so on for for what we what we’ve found so far. Now, I recall that in 2007, the Colorado Rockies believe in the Rockies now. We’re we’re in the World Series with the Boston Red Sox, which I know is your team.

James Hall 24:32
Yes, yes. A memorabilia on my Yes. And that reminds me Bob, I don’t know if this rings a bell here if we can get off of that.

Bob Traynor 24:43
And if you if those of our colleagues who don’t know this, that tire at one time was a little Colorado brewery here in Fort Collins was brewery here in Fort Collins called New Belgium and and they had a big bicycle as the as the logo went all that and, and of course, Jay and I had a bet that day that was was going to be might be for the Rockies. If I won, he would send me his favorite from Florida or Maine or East Coast someplace. And if if I want if if he wants that I would send him my favorite from Colorado. Well, about the history is there, of course where the Rockies lost, and probably should have. But but but the beer went on. And that’s where the glass came from. And I And I’ve always told Jay that it cost me more to send the beer a case of beer to Florida than it did to buy the beer itself. So

James Hall 25:52
that was Yeah, those were bottles not cans, Bob. And they were called bombers. There are big, big bottles. And so that was a heavy box delivered. And then in the box wrapped break carefully were two of these glasses one has not survived but one did with the Fat Tire emblem. It’s been used obviously a lot. Well, that’s, that’s what I learned by that you are a man of your word. You could have easily just blown it off and said, Well, I, I can’t ship it. It’s too expensive.

Bob Traynor 26:20
Well, we have to, we have to get more of those going. One of these days, the Rockies may they blink and end up there. So another time another time. So well. Now, while we’re here, what? What actually got you involved in OAEs employees work. They were kinda like something kinda like, ABR and this and that. But how did you get involved with OAEs? I mean, here’s a guy with two or three books on OAEs and know their right. To Know. Nice to know how you got started.

James Hall 26:54
jWell, just to set the timeframe, it was the early 1990s. Now OAEs had been discovered by David Kemp, and in the 1978. So I mean, it was really early, just actually during the heyday of of aural immittance studies.

Bob Traynor 27:10
But nobody even said that it was Thomas golden, right?

James Hall 27:13
Well, yeah, when we go back to Thomas Gould, so I’m in school, right? And in 1948, which is a special year for me, actually reported on these active processes in the cochlea and he was pretty much criticized roundly by everybody from von Bekesy down because they said no, no, the the ears incapable that all the tuning is going on in the nerves in the brain, it can’t be the ear. But Thomas Gould was convinced the ear was producing energy, based on his research and Cambridge, England, with with animals, and he ended up going into astronomy became a famous astrophysicist and ended up at Cornell University. But David Kemp had known about this and, and he started studying what led to the discovery of OAEs cochlear physiology in mid 70s. But nobody knew about it. Unless you are basic scientists. He published his article Kempton and JASA, Journal of the Acoustical Society and nobody, so I literally had never heard of it until the mid 1980s. And I started hearing articles by or listening to papers by Susan Norton and a few other clinical audiologist who were also researchers. And and I talked some basic science people who said, Yeah, we’re, we’re using these in the clinic more studying animals. So I said to myself, you know, if it’s from the cochlea, that actually reflects outer hair cell function, this may be the next ABR, this may be the next big electrophysiologic breakthrough. And so I started to study them. And I remember when Jim Jerger was retiring, or leaving braid, Baylor College of Medicine or celebrating his 25th year there, I was invited to a wonderful event in Houston came from then from Nashville down to Houston, to attend this and everybody had to give a paper. So I said, I’m going to be with a very, very high level group of people, I better come up with a topic that is novel, I’m not going to re re cycle some of my own old talks. So I studied about OAEs. And I my title was something like, are always going to be a clinically valuable technique or something like that. Chuck Berlin was in the audience. He’d done quite a bit of work with OAES or many others. And I basically said, these have great potential, even maybe for newborn hearing screening. Certainly, they do in diagnosis of hearing loss. There was enough information out there at this time camp had just come out with this is ILO 88 in 1988. And the more I read about him, the more I said, I’ve got to get a device to do this. And I put a little grant application in with a guy by the name of Tim Trine some people may know the name. He was at Starkey, very bright guy at that time. He’s a master student. He wrote the this little grant for local funds, right there at Vanderbilt a couple $1,000 To buy an OAE device, and we bought our ILO 88 And I did what Jim driger always did, he’d get a new device. And of course, this was before HIPAA was a real concern and the IRB, and we just started using this technique on every patient that walks through the door, whether they need it or not, we wouldn’t bill for it, but we just do it. I mean, we could do always in a couple of minutes. So people that didn’t know what was going on, where they just thought it was another test. And we started collecting data that was Jim Jerger strategies, collect the data and see what you get, I pretty much realized, you know, you’re going to discover some kids with profound hearing loss who have normal ways. That’s how we discovered auditory neuropathy, you’re going to have some, some patients of any age who have a appears to be hearing loss, really, it’s either psychogenic, or it’s malingering, or it’s a false hearing loss. But you’ll find that out. And you’re going to detect cochlear deficits in people with normal audiograms. Whether they have tinnitus and noise induced hearing loss ototoxicity, we realized instantly, I mean, within a year or two, that this device in this technique was going to provide information you couldn’t get any other way. So from then on, I said, Okay, now, I know this is going to be big, I want to write the first book on it, or at least one of the early books, and I’ll call it a handbook. And I already because when you use this technique, you’re going to have data on hundreds of patients, and you can illustrate anything you want about this new technique. And, and I’m still I’m still really on a crusade to get people to use away ease the way they should diagnostically in most patients, adults or children’s,

Bob Traynor 31:33
well, particularly, DPOAEs have have taken over a lot of the OAE kind of evaluations, you know, as as you know, as working with the three of earplug cases. And I have been as well, and many of our colleagues have done this. It’s DP o AES are huge in looking for hidden hearing loss and some of the other areas that are beyond the traditional hearing evaluation

James Hall 32:03
and their objective. So you brought up litigation, that’s, that brings up the issue of Is this a real problem? Or is it a false problem? Could the person somehow be the making everyone think they have a problem, but they really don’t? Well, oh, e’s are totally objective, as I say, objective tests don’t lie. Always trust the objective tests. And you’re right. So always we’re not even scratching the surface. Or when I say we clinical audiology, in terms of the clinical application of always is frustrating. Most people use it as a simple little screening tool, and don’t get the full diagnostic value out of it.

Bob Traynor 32:43
One of the areas when when you and I started team teaching, one of the one of the courses, the the actual counseling course, at Florida, one of your areas was always tinnitus. And I know you’ve been into tinnitus for a very long time. I hear some dog tinnitus going

James Hall 33:03
I wonder if that dog was taking issue with something I just said about OAEs No, no,

Bob Traynor 33:09
I’m sure she has some tinnitus. And that’s to do some, some sound therapy on her. But anyway, the deal is that you’ve been involved in tinnitus for a while. How did you get involved in tinnitus and doing some of the some of the research in that area?

James Hall 33:27
You know, it’s it’s, it’s, in some respects, the same story that I’ve been relating. Since we started talking. I took advantage of an opportunity. Back in the mid 1990s, I had been to England, and I had met a wonderful, wonderful guy, David Baguley, who sadly just just died last a couple months ago, within the last month, truly wonderful. For sure, much too early. Oh, just a shock. I’m still trying to recover from it. And David, and I hit it off right away. He’s about 10 years younger than me. And we went to pubs in Cambridge where he was and then I said, you know, if you’re ever in the United States, you got to come to Vanderbilt and visit our clinic and my wife and I will host you at our house. And he did and cemented our friendship. While David came in. Of course, he gives gotta give the customer a talk, you know, when you visit a clinic, and I promoted it with a huge crowd. And David talked about audiologist man assessing and managing hyperacusis and bothersome tinnitus. And most of and I would, I told David, just bluntly that I said, you know, when I hear that a patient’s got tinnitus, and the patient’s out in a waiting room, I try to run out the back door and give the patient to somebody else. I don’t know what the heck to do with these patients. Tell them not to drink coffee, maybe or something like that.

Bob Traynor 34:44
Yeah. That was the mode at that time. Absolutely.

James Hall 34:47
It was just you wanted to avoid these patients if you could, because he couldn’t help them. And obviously they had needs. Well, at the end of David’s talk. He looked me in the eye in front of the whole audience. And he said, you know Jay At a place like this Vanderbilt University Medical Center, you have to have a tinnitus and hyperacusis clinic. You’re the last resort. People expect you to be the expert on this topic and they are desperate. And that was that motivation. I took a Pavel Jastraboff course. Me and Roger Ruth. Few other people, John Jacobsen went the same time it was in Baltimore. And it’s a three day intensive workshop. And you come out of there knowing quite a bit about tinnitus. And then I did a lot of reading. And we opened a tinnitus and hyperacusis center at the Vanderbilt University is one of the first in the country in 1997. Well, one of my around that time, the local newspaper health reporter called and said, we want to do a story about hearing aids. We understand Bill Clinton just got some in the ear hearing aids. And we think that, you know, this would be a really popular story with the readership. And I said, Well, you know, I hate to tell you this, but I’m not a hearing aid expert. And in to be honest with you, we haven’t seen any change in our, in our hearing aid business since Bill Clinton got the hearing aids. And the writer said, Ah, anything else new happening there, I gotta get a story ready for tomorrow. And I looked up on a bookshelf as I was talking to this person on the phone, and I see this loose leaf binder from this Johnston golf course. I said, Well, you know, about a month ago, I went to this course, tinnitus and you know, it’s really bothersome to some people and we’ve started seeing patients and they really seem to be helped. Because if you think you can get a patient of yours to be interviewed by me, and he came to the clinic the next day, wrote a story about tinnitus and tinnitus management, tinnitus, retraining therapy, ran it in the paper that was in that was in about October. By the end of that morning, that the paper article came out, we were booked with Chronic tinnitus patients till the next March, solid, solid, the front desk people worse, they were ready to throttle me kill me because they were just answering the phone was ringing literally ringing off the wall. And so I realized, obviously this is a big deal. And that’s where I focused started to shift much of my clinical and research attention and, and continuing education efforts to get audiologist up to speed on tinnitus. One of my theories, Bob, and one of my themes, when I lectures, every audiologist should be capable of providing basic primary type care services to patients with bothersome tendencies, you don’t have to be attended to as expert. And if you do that, you will differentiate your practice, you’re going to generate a lot of revenue, but most importantly, you’re going to help a whole new population of patients.

Bob Traynor 37:39
You know, that’s kind of kind of the way things go though, you know, and I think tinnitus was kind of on the back burner for a lot of clicks for a long time. But then as there were more clinics and more competition and more, more, more competitive kind of interactive stuff to obtain patients for your clinic. Then people started seeing hearing loss and tinnitus in the in the title of their, of their clinics and and we’ve seen that that has gone gone almost like wildfire, as well because there’s so many patients that that do experience tinnitus.

James Hall 38:18
Yeah, I for one of my Salus university courses or advanced study, certificate program, and tinnitus, I have a course entitled How to develop a tinnitus clinic. And I asked the students to do just what you’d suggested just Google their area in the word tinnitus management. Now, the downside is that some of the people that are providing tinnitus services really don’t have any background in that area. So it’s clearly a marketing technique. But the bottom line is most areas now do have a tinnitus Center. My theory though is if you’re an audiologist, you are had your own practice in a relatively small town in Colorado, you can counsel the patient, you can offer them suggestions on management, you can suggest enriching the sound environment, perhaps the use of melatonin, you can do all of that. And 80 to 85% of the patients will go away happy and you’ll they’ll they’ll not need anything else. So it’s a golden opportunity for audiologist to snatch that market. You know,

Bob Traynor 39:21
what are the other one of the other things that that I that I, I think that we should we should bring up here j is you’ll remember a couple of years ago, you and I did a little piece for Karl Strom over at hearing review. And, and, and in my clinic, I had been doing a basic evaluation that was similar to a basic evaluation that you had been discussing for a long time, where we did air conduction, we did admittance we did DPOAEs and we were doing speech and noise testing. As our basic battery, and we brought that up and presented that to the, to the group and found that there were some people who really didn’t think that was a good idea.

James Hall 40:13
You know, and it really surprised me. And I think it surprised you. Because, you know, this is this is where I was brought up with Jim jirga you did whatever you needed to do based on the patient’s chief complaint, to to diagnose that patient properly correctly, you didn’t do what the insurance companies wanted you to do. You didn’t do what the physician neuroradiologist said you had time to do, you provided whatever assessment you need, you don’t have to use OAEs on every patient or speech and noise. But if a patient comes into your clinic complaining of problems hearing speech and noise, I would say you have failed to evaluate them if you’re just for example, using word recognition and quiet and if the person’s got any risk for for tinnitus, or for cochlear loss, or tinnitus, such as diabetes, or noise exposure, or potentially ototoxic drugs and many other number of risk factors, then you’re obligated to use OAEs, you have no choice, otherwise, you’re not getting at the location of the inner auditory system where the problem is likely to be. So I just, you know, I’m not going to tell somebody, you should do it this way. But I’ve never done it this way. This is the way I practice audiology is way you practice audiology, it works, you get reimbursed. And most importantly, you’re you’re doing right by your patients.

Bob Traynor 41:31
Well, I think you can even add extended high frequency audiometry absolute well, because that that combined with the OAEs is a is a huge factor in many cases,

James Hall 41:42
and is predictive of speech problems and noise to it turns out, yes.

Bob Traynor 41:46
Well, you know, to kind of wrap things up here a little bit, Jay, you know, I’m not going to pour any more beers or anything like that. We’ve already got one, it’s just barely noon here. Well, it’s, it’s it’s only it’s not even close here. So. So I think to wrap things up a little bit, um, what do you see in your crystal ball for the future of our profession? I think the profession has a huge future, although we’ll be doing a lot of things differently than we are currently. And I guess, the audience would be very interested to see what your perspective on the future of the profession would be.

James Hall 42:30
No, Bob, you have an advantage. And we both have this, this perspective of 40 years, you’ve seen a lot. And you’ve seen challenges before and you and you as a profession audiologist met those challenges. I think the future of audiology is very, very bright. And it’s just ours for the grasping, but we’ve got to adapt and change the way we do things. There’s, you hear a lot about disruptive technology and disruptive changes in healthcare. Those are great because they offer an opportunity to expand and to get into new areas. So I’m going to just state a handful of ingredients that I think audiologists need to latch on to, to assure that their future is bright. The first is, you can’t put your future in selling hearing aids. That’s part of the process. But we provide valuable valuable services. Aside from the products. We’ve talked about tinnitus, we talked about diagnosing hearing loss in infants, we didn’t get into auditory processing disorders, diagnosis and manage but that’s another area we would talk a little bit about Vamp and in vestibular, these are areas that there’s no other profession that can handle these things. If you encompass those valuable services, and include hearing aids as part of the process, both for tinnitus and for managing hearing loss, or cochlear implants, you’re gonna have all the patients you need. So that’s one ingredient. The other is we got to utilize automated technology whenever we have the opportunity. That means automated OES automated admittance measurements, I mean, there are devices where as soon as the probe makes a seal, you get a tip that runs a reflex, you don’t need an audiologist doing that. We’ll get to that, that brings up the third ingredient. But then the other automated is the automated audiometer. And Bob Margolis, as you know, developed a wonderful system called the amp test marketed by GSI. And he and I recently did some interviews, where I mean, I was already convinced that automated audiometry should be in every audiology clinic. And if you if you’d say that to an audiologist, they’ll say, Well, we can’t bill for it. Well, don’t go for it. Don’t even bother trying to bill for it. You know, it’s not being done by you focus on the services that only an audiologist audiologist can provide. So I want automation. And then the other ingredient is support staff. And I talked about OAES tympanometry automated audiometry. An audiologist doesn’t need to spend an hour doing that with a patient. We need assistants, audiology assistants and audiology technicians who expand and extend our services. And who can allow us to triple or quadruple the number of patients we see and reduce our overall cost dentists do it optometrist do it physicians do it, why the heck aren’t we doing it? So I think that with the right mindset, with an open mind taking advantage of opportunities that come along, like we’ve discussed in this last hour or so, the future is incredibly bright.

Bob Traynor 45:31
My sentiments exactly. And, and, and, and I know that we have a limited time with you today. And I certainly on behalf of this week in hearing, and my audiology colleagues out in our audience who may not have had the opportunity to kind of slightly get to know Jay just a little bit better. And again, so thanks for being my guest on this week in hearing and also for your contribution as the one of the Giants of Audiology.

James Hall 46:06
It’s been my pleasure, Bob, thank you so much.