Giants of Audiology: Interview with Robert DiSogra, AuD

disogra audiology
April 9, 2024

Dr. Robert DiSogra has had a diverse career spanning industrial, clinical research, teaching, and private practice. He owned and managed his Freehold-based practice for three decades until 2015. Dr. Disogra’s extensive teaching experience spans undergraduate, graduate, and doctoral levels, complemented by notable contributions through national and international publications and lectures.

Dr. DiSogra is widely recognized for his contributions to understanding the pharmacological effects on hearing and balance among audiologists worldwide. His interest in pharmacology began at Rutgers University over 25 years ago, where he observed a discrepancy between patients’ complaints of hearing loss and their test results indicating no peripheral loss. This prompted him to conduct a unprecedented review of evidence, uncovering the influences of pharmaceuticals and nutraceuticals on hearing loss and tinnitus.

In the past two decades, Dr. DiSogra has significantly influenced the field of audiology through a series of publications. He has identified over 400 adverse auditory and vestibular side effects associated with more than 2000 drugs. Furthermore, his pioneering efforts led to the development and teaching of the pharmacology/ototoxicity distance-learning course at Salus University. This initiative has played a crucial role in integrating pharmacology into audiology education, furthering the understanding of how drugs affect hearing and balance.

By 2019, Dr. DiSogra’s influence had led to 25 AuD programs offering dedicated pharmacology courses, underscoring the importance of understanding pharmacological connections to hearing and balance disorders. A sought-after presenter at state and national audiology association meetings, Dr. DiSogra has left a lasting legacy in the field.

Full Episode Transcript

Welcome to This Week in Hearing and our special series on Giants in Audiology. Hello, I’m Bob Traynor, your host for this episode code. And today is my special guest, Dr. Robert DiSogra, former owner of Audiology Associates of Freehold and an adjunct professor at many universities. His work is known for hearing and hearing rehabilitation, a lot of work in private and practice management but he’s really famous for implementation of pharmacology into audiology. Thanks so much for being with us today, Bob, and appreciate your participation in the Giants in Audiology series. Thank you, Bob. First let me tell you to say how flattered I am and how honored I am to be amongst other giants in audiology, that you have interviewed persons whose books I’ve purchased, whose articles I’ve read, whose lectures I’ve attended, and whose friendships develop because of that. And it’s a true honor for me to be here. And I’m excited that you found my professional history of interest to be included here. Well, the first thing I like to do is read your professional bio. And so that’s where we’re going to start this morning is with the professional bio. So it reads as Bob is a retired New Jersey audiologist from Millstone, New Jersey. His 45 year career, Bob has worked in a variety of audiology settings, including industrial clinical research, teaching and one of my areas, private practice as well which he owned his practice now for 30 years in Freehold, New Jersey until 2015. Bob received his doctorate of audiology degree from the Osborne College of Audiology at Salus University, where he developed and taught the pharmacology ototoxicity distance learning course. He holds a master’s degree in audiology from Hofstra University and a Bachelor of Science degree in speech education from St. John’s University. He has an extensive undergraduate, graduate and doctoral level teaching experience, a publication and lecture history, both nationally and internationally, on pharmacology and ototoxicity, diabetes related hearing loss and over the counter dietary supplements for hearing loss and tinnitus. Bob has served the audiology community as the consultant to the Audiology Project, which led our profession to being added to the Centers for Disease controls list of allied health professions as experts who manage diabetes related hearing loss. so quite a orientation, a very nice bio, but how did all this start? I mean, now Can we talk a little about the early years, Bob? most of us didn’t start off doing all these things we’ve been doing over our careers. We had to start someplace, and my understanding is you kind of started up in the New England area. Well, actually, it was New York. I was born and raised on Staten island. And did my grammar school education at Sacred Heart school, catholic school and during that time I was a kid just growing up in the 1950s, a very typical post World War II Baby Boomer type of family with I had three other siblings, a younger sister and an older brother and sister. And my mom and dad got us all involved in playing musical instruments and just being kids. And I developed a bit of an interest in singing and also an interest in motorsports and stock car racing as a young kid which led to something even further down the road, which I’ll address later on. And during a grammar school, what was interesting I was not aware of this. And in the 1950s, if you had any type of learning disability any academic problems that you ran into were basically your problem, okay? If you could not keep up with what the teacher was teaching, something was wrong with you. You were not studying hard enough. you have to buckle down. You had all these abstract types of phrases that were like, the words were like swiss cheese to me. But I had an undiagnosed learning disability that came to a head by the time I was in 7th grade, where I had my first summer school experience for math. And I did graduate grammar school, and was accepted into an all boys academic catholic high school where my older brother had attended and was very successful. And during that time the strategies that I used to get through grammar school, I brought into high school. And those strategies of studying and learning just failed dramatically. I wound up in summer school, freshman year into sophomore year for like four classes, mostly sciences, language. I failed an open book test in French very challenging time sophomore year. Same type of problems going on with language and math, science and science took biology. I passed the lab, hands on, real time, instant gratification, show me type of learning. But the academics I failed. So I had to go to summer school for the academics, even though I passed the lab. And sophomore year into junior year was also four more subjects that had to be repeated. And taking foreign languages. In addition, I took Latin, I took french and just could not function very well. I even tried to fail out of school deliberately so I would not have to put myself through all this aggravation, which created a lot of conflict with my parents. but the school kept me in, and I eventually graduated in the bottom half of my class in high school 1967 and as you know in 1967 if you were 17-18 years of age with the Vietnam war the way it was and you were not in college you were going to be in the army. It was not negotiable. You’re either in college or you didn’t flunk out of college like some of us had. Well what happened? I took those same horrible learning strategies and study skills that somehow got me through high school. I brought them into college. My brother and sister both went away to college. I wound up staying at home because I only got into one college which was St. John’s University. They had a two year school of general studies. Basically it was for kids that had the potential but they just didn’t have the academics to really get into the four year school. So I went into the two year college. I had my student deferment from the military and again it was like going to a glorified high school. I was commuting, I was living at home, had a girlfriend, had a car, was working part time as a driver for a, you know it was like this is not right. Something is just not connecting over here. So after two years at St. John’s I got a nice letter from the dean that says thank you for your two years at St. John’s but you’re out of here. So I was academically disqualified. I was academically disenrolled aka I got thrown out of college, lost my student deferment from the military a month later and I was 19 now. Okay so you know where all 19 year olds were going in 1969? Sure. that’s when I went into the navy. That’s when I went into the navy. Now before we get to the navy Bob I understand that you had kind of an interesting experience with a really famous baseball player. Yeah, as a young kid. Yeah, I completely forgot that. Thanks for bringing that up. my dad was president of the Italian Club on Staten island in the 1950s and Phil Rosuto from the New York Yankees had just retired and he was the guest speaker at this awards dinner that they had. And what had happened is that my dad made sure that I had my picture taken with Phil Rosuto. So here I am. I was like eight years old, nine years old. I’m going to have my shirt and tie and my suit on and I’ve got my picture taken black and white standing next to Phil Rizzuto. It was a posed picture, just the two of us. This has been a treasured picture for me. Fast forward he gets into the hall of Fame in 1994, and I said, I got to get this picture autographed. Well, fast forward. It wasn’t until like, 10-11 years later when he lives in New Jersey, and it turns out that he was going to be nearby at a sports store signing autographs. So I made arrangements with the owner. I told him what was going on. I said, it’s a personal picture. I’d like to get an updated picture with him. And they said, not a problem. So of know it wasn’t free, but that’s not the point, was that we were going to get together again. and I had a picture taken. Well, when I met him, I told him the story that we met at the italian club in staten island back in the 50s. So I showed him the picture, and he looks at the picture and he looks up at me and he says, your hair is different. Plus, I was powering another foot over that time, and it was a treasured picture that I have. So I got the picture signed and we took the picture. And so now I have two pictures of me and Phil Rizzuto, 1957 and 1985, in the same position, but I’m a bit taller than the guy. and I also understand that you had some roles in things like the music man and rainbow, these kinds of things in high school that were kind know, the other side of the brain kinds of things that worked really well for you. My brother sang in the glee club. my brother Charles is three years older than I, and he was in the glee club. And when I became a freshman, he was a senior, and he was present in the, you know, when, like a little brother, you follow in your big brother’s footsteps. So I joined the glee club, and at the time they started doing Broadway shows and they did Oklahoma. And then the following year, they did the music man. And I decided, well, I’m in the glee club. Let me try out for one of the parts. Well, I got the part of the bass in the barbershop quartet, and that’s when I fell in love with barbershop music. And that’s know I was singing in the church choir, and that’s when I fell in love with renaissance music. So now you start to see the musical background coming into play here with harmonies and all that other good stuff, which led me to the organization of the audiology chorus, which sings the national anthem at AAA every year. That’s down the. So I sang in the barbershop quartet at the music man. I played the sheriff in Finian’s rainbow. They let me grow my hair long at school, which was unheard of in a catholic school back in the day. I was a know we didn’t have money, having done all that. it was just a lot of fun. The music was there. I was still going to the stock car races, if I could, on Saturday nights. I was working for a fourth. I was just doing kind of stuff that you do as a teenager, just having some know. But the serious thing with Vietnam hanging over your head just really kind of changed the course for a lot of people in my age. know, I finally graduated and got into St. John’s, got out of st. John’s. and that’s when I went to the navy and I had this academic difficulty. I knew I was smart, so I thought. But I knew I had a learning style that was different than the teacher’s teaching style. And that was something that came to a head when I was in the navy. I learned in the navy that I am a hands on, real time, show me instant gratification kind of learner. So the navy sent me to radar school, and I got involved in radar and electronics and communications and radar navigation and charts. Everything was visual, was real time. It was instant gratification. It was bang, bang, bang, bang, cookbook, step by step by step. And I fell into a groove that my time in the navy went faster than most other people because it was always going on, always moving something. Well, as my time in the navy was getting short, I decided to reapply to St. John’s and say, hey, give me a second chance. There was like a four year gap between sophomore, junior, and they re accepted me back in. So they took me back in on probation. But I also understand that before you went to the navy, you also took some time on some ships out in the wilderness some of those kind of jobs that all of us have on our way to where we hopefully. Will end up, you know, my dad obviously sensed that I needed something to do. I needed maybe to get away. So what happened is that he knew someone that was involved with commercial cargo shipping and passenger ships in the New York area. One thing led to another, and I wound up joining the National Maritime Union at the ripe old age of 17. And one week after I graduated high school, I am now working as a bellboy on the SS Constitution, a passenger liner. Three weeks transatlantic into the Mediterranean. Portugal, Spain, France, Italy, North Africa. I am 17 years old, my first time away from home, and I’m doing room service, getting $0.25 here, $0.50 there. Well, I did two of those trips in the summer of 67 and made some nice money, bought some clothes for college. And then in the summer of 68 I went back to the National Maritime Union and got a job working on the SS United States. And it was interesting, one of the jobs that I had was cleaning the main ballroom on the ship. Okay. I had to just clean the ashtrays, polish the bright work, buff the floors, and so on. Well, the bartenders left the soda machine on, and this is something that I still remember to this day. and I’d like to tell this story because it’s inspirational. To me it was at the time, and to me, it still is to this day. So here I am. I’m in college. I had the academic stuff going on, and I’m working as a porter, doing maintenance work and cleaning and so on. Not exactly the stuff I wanted to do, but nonetheless, it was a job. I’m in the middle of the Atlantic Ocean somewhere. And in 1967 a lot of people traveled by ship before jet travel became as advanced as it was. And there were not a lot of black people on these ships. So I’m sitting at the bar by myself, 03:00 in the morning, and this black gentleman walks in wearing a tuxedo, sits down next to me at the bar, and looks at me, and he points his finger. Is this your regular job? I said, no. I said, I’m in college. Wanted to be a high school English teacher at the time. And he looked at me and he points his finger, and he goes, stay in school, because instead of cleaning up after the party, you’ll be at the party. And he got up and he left. Bob, I never saw this guy before that night on this three week trip. I never saw him again after that night. And you know how people say, an angel comes into your life every once in a while to guide you? That was my angel. Wow. That was my angel. And I can’t begin to tell you how many times I recall that story. And now, later on in my life, at my age, now I’m telling that story to other young people. Stay in school. Instead of cleaning up after the party, you’ll be at the party. And it was like, wow, what an epiphany for me, and so on. Well, I knew that was such a big one. We didn’t want to miss that in this chronological kind of a thing. Now, my understanding is that a lot of the things that you’re doing in the navy was kind of an inspiration to kind of move into audiology once you got back in school. and a serious mentor as well. Once I got back into school, I met Donna Geffner. And Dr. Geffner was my mentor. She PhD, speech language pathologist, audiologist City University of New York. And she was at St. John’s. And she saw that I was a returning student. I was older than most of the other juniors at the time. And she kind of took me under her wing. and she saw that I had more potential as an audiologist. Now, we just had the introduction audiology class. We had a small, little booth, little audio, little bell tone audiometer. Hands on, real time, instant gratification. It was like, wow, being back in the navy again. But the only difference, as I told you before, is that in audiology, the floor doesn’t move, which was nice. So I didn’t have to worry about having a bucket next to me getting seasick while I was trying to track ships in the middle of the ocean. So Donna took me under her wing, and she says, you’re going to be an audiologist. And from that point on, she mentored me into the profession. and then when I graduated St. John’s, and I went into Hofstra she was very supportive through the whole thing. And she still stayed at St. John’s. And when I graduated Hofstra, when I graduated Hofstra, after all was said and done, Donna was doing a program. She was doing a series of programs at NBC in New York. and NBC New York had the morning show. This is before 24 hours news. And all these other shows, like the farmer shows would be on it early in the morning. Well, this was a ten part series called our incredible Gifts, speech and hearing. And for ten half hour programs without commercial, Donna had specialists from the fields of speech pathology and audiology that she interviewed. And they had video and things like that. And it was just an educational program for the community, for people watching at that hour. And it was 06:00 in the morning. and they just talked about speech and hearing disorders and identification, intervention management and the like. One of the guests was Jerry Northern. And I had just had Jerry’s book and so on, like, know. And to me, Jerry was know, I am not worthy. And Jerry was an absolute just join the club, man. And then I found out that these other people were regular. Like, these are nice. so, and that was my first contact with Jerry was through Donna, through doing these tv shows. and we know we had quite a large number of well known people that she took on the show. One of the shows, the show that they did on stuttering was nominated for New York Academy of Arts and Sciences Emmy award. we didn’t win, but we got nominated and that was so, so Hofstra rolled around and Hofstra came and went. NBC was a terrific experience for the two weeks that I was with them in New York. I was working as their technical consultant. I was back with the producer director and the people with the blue book making sure that Essex, everything was set okay. And it was just wonderful. And Donna and I, we still talk about that experience back. That was 1977. I got a job working a combination of working for an environmental, an acoustic engineering company and mountainside hospital, get the CFY taken care of and the acoustic engineering company had a van and so we’re doing hearing screenings, industrial noise surveys and that kind of stuff. Got my first publication from that and that was pretty flattering for me to, wow, I just got So, so I started getting interested in industrial the. So I finished the CFY and then there was job opening, JFK Medical center in Edison, New Jersey. And they wanted three to five years experience. I had one year experience. It was my know and I was really desperate. I almost went back into the Navy because other jobs were just not happening. So I went on the interview and I thought it was a good interview. Came back home two days later I get a phone call saying that they hired somebody else. And it was interesting because they hired Robert DiSogra, not Bob DiSogra. They hired Robert. So they told me, Bob DiSogra, I didn’t get the job because Robert DiSogra got the job. And so I got the job. And when I went to human resources and so on, they told me, they said we had other people, okay, that had much more experience than you. And the reason why we hired you is that because you were a navy veteran, whoa, whoa. And that came out of the blue. I did not know that. The respect that they had for my service in the Navy brought me into this audiology job which I stayed in for like seven years. And so I was a clinical audiologist for seven years at this medical center. And it was time to move on. Like any other job you get time to move on. Down in Princeton there was a biomedical research company called Biostim that was doing cochlear implant phase two cochlear implant research with Blair Simmons. The late Dr. Blair Simmons at Stanford. I was living maybe a half hour from Princeton. So one thing led to another. I have dinner with the president of the company and he know write up a job description and it’s yours. And basically, that’s how I got this. So I left JFK, went to work for this biomedical research company doing phase two clinical trials, traveling around the country, trying to get doctors to come on board as co investigators. And it started getting my interest in all this research and stuff. It was a lot of fun. I really enjoyed it, but I really missed seeing the patients. So what I did is that I said, I need a break. I have nine years in audiology, almost ten years. I got to step away. Something’s just not working right here. So I had friends of mine. Rock and roll, big rock and roll. We’ll hit that just in a second here, Bob. But one of the things that also I think says a lot for yourself is the acceptance at Penn State for the PhD program. But we’ve talked a little bit about some extenuating circumstances and things like that that didn’t allow you to go. But I know that was a pretty motivating kind of a thing for you as well in our discussion. It was because I knew I had a learning style that was successful. However, the academic environments that I was in in grammar school, high school and in college did not teach the way I learn. Okay? And I carried that into my clinical practice and working with children with auditory processing disorders because like I said, I’m a hands on, show me visual structured cookbook, kind of now I come out of the navy, I get back into St. John’s. I finally get my bachelor’s degree. I get a master’s degree. And like Donna is saying, bob, you got to go on for your doctorate. Mark Framer, who was my mentor at know, they said, go for you’re. This is what you want to do. And I applied to Penn State and a few other schools, and Penn state offered me a scholarship with a mean, this was like flat. I can’t believe this has happened. This is in my PhD scholarship. When six years earlier, I’m academically thrown out of being academically unqualified. It finally came to a head. things in my life at the time were a little chaotic like everybody has. And I had to give up the seat. Reluctantly, I had to give up the seat. And by giving up the seat, it made me kind of rethink a focus on where I wanted to go and then I said, you know, I’m going to try private practice. I’m going to try private practice. Being accepted in a prestigious PhD program is a great motivator for people and probably allowed the contributions a lot for all the extra learning that we had to learn as audiologists to move into assessment for central auditory difficulties and all the other specific things that we had to learn as changes. I mean, we all had to learn about abr, we all had to learn about oa, we all had to learn about a lot of these things we’d never even heard of. In fact, almost were a figment of everyone’s imagination when we were in school. so I know that was a huge motivator to bring a person through some of the positions you just mentioned, as well as then taking this break that allows those breaks kind of allow you to kind of look at everything from a 30,000 foot view where you can kind of look at this and this and this and all these things. And my understanding is you were kind of a race car guy at Talladega and some of those places and had this band. I played the sack like a crazy guy and all these kinds of things. It was one of those things where I had friends of mine, had a rock and roll band, a cover band to play down the Jersey shore. I spent most of my summers in summer school, okay? Most of my summers working. And I never really had a real summer vacation until after I left biostim in 1985. So the summer of 85, I just said, I’m going to hang up the audiology for a while. This rock and roll. But these guys were friends of mine. They knew I played the saxophone, and I just said, can I just have some therapy? Can I just come out and hang out with you guys and play? And don’t even pay me? I did well with Biostom. I said, don’t even pay want. So I basically joined this rock and roll band down the Jersey shore that was a house band in a bar down in Stone Harbor, New Jersey. And it was the craziest summer of my life. And then I said, you know, I got to get back to audiology. One of the things that we did was a lot of fun because I brought audiology into the show that they did. They had a whole Motown show. And one of the things that they did, they did my girl by the temptations. So they’re doing my girl. I got up and I started signing my girl, and it turns out that every night they would do the show, and every night I would sign my girl. And then the regulars be there at 02:00 in the morning with big buzzes on, trying to sign my girl with me. To this day, there are people that I still stay in touch with. They say, every time I hear my girl, Bob, I think of you up on the stage doing all this stuff in sign language. Crazy. Absolutely crazy. But it refocused me to say that audiology is really for me. This is my calling. And then, so I went down to Alabama. I did the stock car racing. I got to know some drivers and stuff. I did some hearing conservation work, but I really needed to be back and seeing patients and being involved in evaluating in diagnostics, rehabilitation in the babies, the children, and the adults, just like I did at the medical center a couple of years earlier. And that was my calling, but I never ran a business before, so that was on the job training and almost gave that up. But I said, I’m going to just pursue it. And I did. And survived 30 years in Freehold, met some wonderful people, celebrities people, all different walks of life that didn’t want to be in my office. But the hearing loss got them there. And I did my best to improve the quality of their lives. But when I started to see kids with auditory processing problems, and I started saying, like, I remember that. I remember that. I remember my parents doing that. Well, when I turned 50, what I did is that I went to a psychiatrist who was specializing in learning disabilities and I told him, what’s going on? I had just gotten my AuD, and I said, how did I get here? How did I get here after all that stuff? And now with the doctoral degree, with all the learning issues that I described earlier went on the evaluation, and then he sent me to a neuropsychologist, and it was like two days of testing. And went through the two days of testing. I can’t do word problems. To this day, I can’t do word problems. Word problems is one of the subtests in this thing. I gave the paper right back to the psych. I said, I’m not doing this. I said, I can’t do these things. Well, what happened? I knew that I had this learning problem, but it was never formally diagnosed. Guess what? ADD, APD. Okay, no hearing loss, but all of the behaviors that are classic of attention deficit disorder in adults and auditory processing in adults that I had 50 years ago, 40 years ago, 30 years ago, whatever okay. It all came to a head and I cried. I’m reading this report and it’s like, okay, there it is. And from that moment on, whenever we had parents and the kids come in, I tell them that story. I said, your kid is going to do okay. Margie and Charlie DiSogra’s kid did okay. It’s a road less traveled and it’s a learning style that may not be in sync with the teacher’s teaching style. And I think that’s what we have to focus on. And I’ve gotten fruit baskets, I’ve gotten wonderful letters from parents that all these different things changed their child’s attitude towards school. So that came full circle because I remember in grammar school, the principal of my grammar school told my parents flat out, he’s not college material. And so when I got the award for aluminus of the year at Salus, which I was very flattered that they recognized that they said, well, you have to just say a few words, dedicate it, normal stuff. And I said, who am I going to dedicate it to? My parents? I said, no, I’m going to dedicate this to the principal that told my parents that I’m not college material because that was an incentive to prove this lady was wrong. Okay. And I did. So there. Okay, well, I understand that your time at was, was pretty significant for you as well. George – George Osborne was one of your mentors, as he was a mentor to many of us also. What had happened? When I had the private practice, I took a part time job teaching it at Rutgers University in the speech and hearing department. I was asked if I wanted to teach the undergraduate anatomy and physiology for speech and hearing, in addition to the introduction audiology class. and I said, fine, it’s not a problem. So I was able to supplement that with the ups and downs of private practice, especially early on. So what had happened? One of the honor students came out to me and she said to me, she goes, I’d like to do a program. I’d like to do a report on how drugs affect hearing. Okay? So I’m going to mention her name. Kristen Weir was her name. and Kristen was really interested in learning about how the drug goes from your mouth to the right part of the brain to the correct area where she was just interested in this stuff. So we really sat down and we said, okay, let’s take a look at the drugs that we know that can cause hearing loss. Because back in the 19 – I guess late 70s, everything was like ototoxicity okay. But we never really looked at the side effects of the other drugs that could have the same effect on vestibular testing and things like cognition and so on. So what we did I went through the drugs, she did all the other research on absorption and liver rates and all this other stuff. And we put this thing together, and it was really a great paper that she did. I just did the appendix. So I told her, I’m going to submit this Audiology Today, and I’m going to see if we can get this published. And I did. John Jacobson was the editor of Audiology Today at the time. and he said, hey, yeah, we’re going to do it. So this was like, I guess, 1997. Okay, fast forward. The AuD comes around. Okay? And it was all distance learning. Back in 1999, 2000, I got to know George Osborne because I was one of the co founders of the New Jersey Academy of Audiology. And George was starting up with the Pennsylvania Academy of. So George and I had some contact back and forth. And then he tells me that the Pennsylvania College of Ophthalmology is going to have an AuD program. And he’s describing the program, the six weeks on, two weeks off, and the cost and so on. And he’s rattling off all the incredible courses, and he says, pharmacology, ototoxicity. And I said, well, who’s going to be teaching that? Because I thought Kathy Campbell was going to be teaching that because she was our, and still is my mentor for pharmacology ototoxicity. And then George said to me, he says, wait a second. Bob said, you had that paper published back in 96, 97 on the drug side effects. He goes, why don’t you teach the class? I said, George, I don’t know that much about pharmacology. I’ve been in private practice all these years. And he said, Bob, if you were to go back to school and take a pharmacology ototoxicity course for six weeks, just six weeks, what would you want to learn in private practice? I said, gee, you know, and I kind of thought about it. I said I’d want to learn this, this and this as a private practitioner. And he goes, great, that’s the class. Let’s get it going. And that’s how it started at PCO. And now a couple of weeks later, I’m teaching a pharmacology class online. Of course, I’m one page ahead of the class ya know. But again, it was one of those things that it was brand new for the profession. And only a handful of schools at the time, and not many of them had pharmacology in the country. Not even today do they have that. leads to a task force that AAA had a couple of years ago that I was asked to be on. And it was during that time that we looked at pharmacology education in the profession. And it was kind of an overview. It was good. Some really good people were there. and what we wanted to do was to see where does pharmacology fit in audiology. Okay, so what had happened is while I’m doing the private practice, while I’m doing the distance learning, I get the AuD in 2003, the task force going on, Kathy Campbell is doing some wonderful stuff in clinical trials with her work out there in Illinois. And what George said to me, he goes, Bob, why don’t you update the list when I started the program in 2000, because why don’t you update that list from 97? And the number of drugs tripled. The number of side effects on the list doubled. Okay. And Jerry Northern at the time, was the editor of Audiology today. so I submitted it, the hold, the updated list to audiology today. And I submitted to Jerry, blah, blah, blah. Jerry gets back to me and says, you know, this is too big, because I can’t do this in the pages of audiology today. He says, what we’re going to do is that we’re going to put a special issue out, and it’s going to be a dedicated issue towards pharmacology and Ototoxicity. And your drug list. And the side effect reference list is going to be that special issue. Now, this was in 2000. 2001 rolls around. 9/11 rolls around. And the special issue, which was supposed to come out in September of 2001 gets printed in 2002. In January of 2002. And now every audiologist that’s a member of AAA now has a special issue of drug side effects of all drugs that could affect hearing balance, cognition, vascular issues, and anything related to speech and hearing perception, cognition, auditory processing. These drugs were listed, and the side effects were right there. That became a springboard. That became a springboard because now I’m getting phone calls from state academies, state speech and hearing associations. We’d like you to come on out, talk more about this. Talk more about that. And so I have to thank Jerry Northern I have to thank Jerry Northern for recognizing that work and putting it in a special issue. I think AAA only had maybe eight or nine special issues, okay. That they published. And this is one of flattered. Oh, geez. I was like, this is wonderful. Same kid got thrown out for being academically unqualified. Now, I got a special issue in audiology today from the American Academy of Audiology. And it’s like, wow, that uh was wrong. we got that done. And this was in 2001. I graduated 2003, and the lecture series started, the teaching started, all this adjunct stuff started, which was wonderful, very flattering. Got it to have the private practice. So I’m kind of like wearing two hats over here. Then I had so many requests for a third edition, and in 2008, a third edition came out. And that third edition had over 2000 drugs. 315 side effects that an audiologist would be interested in. 315? It’s not just hearing loss and tinnitus. Okay, yeah, they’re on the list, but there were 313 others. So this is springboarding into the whole thing. As far as my position in the profession with this background in pharmacology, from that, what springboarded was the over the counter supplements for tinnitus that were already out there. And I don’t think people understand just how significant these supplements might be, because when we first started talking about this, we talked about all the drugs and those kinds of things, and watched how that publication kind of stuff just went up and up and up and up. The lectures went up and up and up. But the supplements are probably just as big of a problem as some of the medications themselves. From what I. Absolutely. And what’s happened here, there’s a personal story here, and I have to thank my wife Suzanne, for this. Not that I’m thanking her because of her hearing loss and tinnitus, but because of the noise, coincidentally, out of the blue, I get this box in the mail of twelve bottles of lipoflavonoid. And with the little information sheet about. Try this with your patients who have tinnitus. And there was an information sheet, and there were references on the back. So I brought a bottle home and I spoke to my wife, and I said, yeah, they want you to take three a day. Okay, let’s see what happens. And she’s a little more conservative than I am. She goes, I’m going to do one a day, okay, so let me do one a day, see what happens. Okay. So she starts doing the lipoflavonoid once a day, and I’m checking, how you doing? Blah, blah. Well, about a month after she started this whole thing, she develops kidney stones. And I see, like, what? Nothing changed in her diet. Nothing changed at all, except we started to add this supplement. And then I started looking at the list of the references that came with the supplement that was supporting the evidence, their evidence. Everything was on Meniere’s disease, and there was nothing past 1965 in the literature. And this was, like, 2005. No, I’m sorry, 2012 or something like that. And it’s like, this is 40 year old data! and they’re marketing it. And one thing led to another. I started looking at the ingredients in lipoflavin in this chart. None of them. There was no published research at all on the specific ingredients that were in the pill. And then I started thinking, well, what else is out there? And with the Internet, I just started putting supplements, tinnitus supplements or supplements for tinnitus, and all of a sudden have, like, 45 products that came up. And then. So what I said is, like, I’m going to go see what’s in these products. And one thing led to another, and got a larger publication out of that. And this was privately published. And it was dietary supplements for hearing loss and tinnitus. And of all the ingredients that were in a combined ingredients, of all of those 45 products, only about 10% of them had published research, and most of them were for Meniere’s disease. And most of them are more than ten years old. Some of those things were pretty wacko. I mean, everything from ginko tree bark to other weird kinds of ginseng. okay, right? So here’s what I did. Okay. I put my science hat on. I contacted arbitrarily, 25 companies by mail. Not email, by mail. and I told them who I was. I wasn’t going to hide anything. Who’s on your advisory board? Who’s making the decision to put this in? And can I have the reference list? And by the way, do you have any longitudinal data on the success of the product? Two companies responded to me. One said, we’re too busy to answer your question. The other one said, oh, we’re going to take it off the market. Anyway. That was it. Okay, so, finding out through the FDA, dietary supplements are classified as food. And because they’re classified as food, they don’t have to go through the scrutiny of a pharmaceutical for evidence based research. They don’t have to do that. so, tongue in cheek, I used to tell in my lectures that my mother’s spaghetti sauce from her mother’s recipe, from the italian lady from Jersey City, cures tinnitus. Okay. All I have to do is make sure that what’s in the jar is on the label. I don’t have to prove efficacy and safety. Wow. Okay. So what I would do is I would ask anybody if they want the recipe, just send me $19.95. I’ll send you a wooden spoon and I’ll send you the recipe. Sounds like a great cure for tinnitus to me, which is as good as many of the cures that are out there online and various other places. None of them are FDA approved. There are no dietary supplements that are FDA approved for tinnitus. There’s no dietary supplements for COVID-19 side effects. No dietary supplements FDA approved for cognitive disorders. Okay. it’s not the wild west. It’s just that the FDA says that whatever you have in your pill or gel cap, whatever, the ingredients have to be listed. And lots of times they’ll give you the minimal daily requirement. And there’s always an asterisk. And the asterisk on the bottom, a small print says the minimum daily requirements have not been established. So why are you taking this now? I have patients that have said, oh, but it helps. Okay, my tinnitus hasn’t gotten worse. As a matter of fact, it’s better. And on the outside, I’m saying, well, I’m glad you found relief, but on the inside, I’m saying I have no clue what happened. And here’s the drug guru from audiology saying, I don’t have a clue what happened on the inside. you can bet the rest of us didn’t know. this is an open area of research for our colleagues. Are you interested? Because there are people that believe in dietary supplements. I did some lectures on CBD oil and that’s the same situation. It’s a plant based product, so it’s not FDA regulated. Other than making sure that what’s in the bottle is on the label and vice versa. Efficacy and safety do not have to be proven because it’s a plant based product. It’s food. Okay so caveat emptor, buyer beware. Okay? And if it’s working for you, I’m glad you found relief. If you ask me how it’s working for you, I have no clue. But Bob, it’s a $19 billion a year industry. Keep that in mind. Supplements are a $19B. It’s probably higher now. Billion dollar a year industry. Sounds like you really need to market the spaghetti sauce on this one. the comedian George Carlin, a. Little bit of that. George Carlin said it the best. He goes, if you take two boards and you nail them, together, you market it just right, someone will buy it. That’s probably very much. We all had pet rocks in the 1970s, didn’t we? Yeah. Really? I never did understand that one. Well, we’ve kind of talked a little bit about some of the things that have happened. You mentioned the 2013 Alumnus of the year award from Salas University. and let’s take a couple of minutes and kind of go over some of the fabulous awards that our colleagues have actually bestowed. like the 2020 Clinical Excellence Award in audiology from the American Academy of Audiology the Pharmacology Task Force, which you led from 2018 to 2019, and the pharmacology education for audiologists from the American Academy in 2018. also an audiology education committee, which probably did a lot to build pharmacology in the various programs that offer those kinds of courses. Now, in 2015 I guess that if you have some comments about those awards, those are great awards for someone who has taken the time, energy, and effort. And although a lot of the things that we end up doing is kind of by accident, however it is totally fitting that the academy has presented you with some of these distinguished honors. Well, I was flattered when I was selected for this. And one of the things that you’re looking at the growth of audiology and where it’s going as a profession, and there’s been a lot of emphasis with private practitioners, a lot of emphasis on the different hearing aid technologies and so on. And our diagnostic hats sometimes have to be dusted off a little bit more. When we did the pharmacology education survey about two years ago with Nancy McKenna and Colleen Lapel and Sam Atricen and Dana Litman what we tried to do was to. We surveyed all of the audiology doctoral programs, and only about a third of them are offering a dedicated pharmacology class and the others are not. And that was surprising, considering the AuD is 22 years old. Okay, 23 years old. And the future of audiology is not just in the hearing aids. and cochlear implants, which is wonderful. There’s nothing wrong. That’s excellent. The thing here is that what about prescriptive rights? What about being able to write a prescription? I’m not saying for heavy duty narcotics and stuff, but what about a contact lesion from an ear mold or a hearing aid? Or what about an otitis externa? Or what about a script to write it for an MRI? Okay, we have the knowledge. We have the knowledge. But what happens here is that state licensing boards, when you’re looking at opening up your statute to expand your scope of practice, they’re going to ask you, well, do you have a state organization? How many members do you have? Well, I. Granted, some states have smaller numbers of audiologists. Like New Jersey’s got like, 500 audiologists. So do all 500 audiologists belong to your association? Do all 40 audiologists in your state belong to your. So the numbers have to be there. The numbers have to be there. And for those that are watching this, get involved with your state academy, get involved with your state speech and hearing association. It’s imperative if you want to have this as part of your future. And our profession deserves to have it, because we are the experts in hearing and balance diagnostics and intervention and rehabilitation. we need to have that type of a base. But right now, the doctoral programs are not consistent with pharmacology education. Some of them lump it in, some of them have pharmacology, ototoxicity. Some of them have just ototoxicity. And they talk about pharmacology, but they talk about ototoxic management, ototoxic monitoring. And that’s all well and good. That’s wonderful. but there are some other basic things in pharmacology that we’re looking at when it comes to medications that are being used for cognitive dysfunction. We’re seeing. The literature is showing that long COVID patients that are long haulers, those that are been diagnosed, they were told they had brain fog. Okay? These are cognitive problems. There are medications that are being given for this. Why can’t an audiologist prescribe something like that? Okay, that’s a rhetorical question. We need to have that solid background. One course in pharmacology is not going to do it. One course in pharmacology, it’s like the appetizers. You haven’t got to the main course yet. And I think right now, that’s where the future has to be in the development and the improvement of pharmacology classes to be more expansive, to be more inclusive, and to work with allied health professions in nursing optometry to follow those models on their education in pharmacology and how we can model that. In New Jersey, it took the optometrists 20 years and about a half a million dollars in lobbying costs to get optometry, prescriptive rights for eyedrops. Okay? Now try and think of what it would take for eardrops. For an otitis externa. Okay. You have to be all in. My message to my colleagues that are watching this is that you have to be all in. You have to get everybody motivated that want to do this. And if audiology is a part time thing and you don’t have any skin in the game, you may not be motivated. Okay? And that’s the challenge that we have. And I think that if we’re able to get our profession together to really look at pharmacology as a critical part of our training and a critical part of what we do with pharmacological management, the professional will be better, and our colleagues will be better individually to better manage their patients. I can think of many times, as I’m sure you have in your practice. In my practice where, jeez, how come I have to send somebody over to the ENT guy to get some eardrops when you know really well that that’s going to work for them, but I can’t do anything about it. I got to send them over there. They have to get there. They have to be seen and evaluated and this and that. And they say, oh, yeah, you need some of these. Which we could have handled real easily in our clinics. Easily. Yeah. What’s interesting, I look at it this way. The audiologist owns the outer ear, the ENT owns the middle ear, and the surgeons own the inner ear. So there’s your turf war. Yeah, well, and there really isn’t any turf war with the middle ear and the inner ear on the medical kinds of things. And I don’t think any of us want to compete with our ENT colleagues in those areas at all. We just want to be able to have some autonomy in how we practice and that kind of thing. I might also mention that you’ve had the New Jersey Academy of Audiology Distinguished Clinical Service award and a number of other kinds of things. You were president of that group and really a spearhead with the New Jersey Academy for many years. and I think another award that is certainly worth mentioning is the Joel Wernicke award from the Academy of Doctors of Audiology, of which, which basically says, okay, here’s a guy who’s in practice and has all these kinds of things that are significant contribution to the profession. And I think all of us would give a big round of applause for all the work that has been conducted with you, even though a lot of us end up with all these things happening to us and get interested and move on and so kind of semi by accident. This all is a lot of hard work, energy, and effort, and it takes a lot of interest and digesting a lot of information and presenting it to us to tell us just how important it is. on behalf of the profession we want to thank you for that as well. But I understand that after 46 years in audiology it’s kind of like going back to that band and the acting and this and that, but you kind of decided to move on in addition to some of the lecturing that you still do through giving lectures on giraffes and rhinos and things like that at the safari off road adventure park. Yeah. Six Flags great adventure here in New Jersey is about 15 minutes from my house, and they’ve been there for, like, the last 50 years. And I don’t think there is anybody in New Jersey that hasn’t been to six flags. But they have a 350 acre safari park, and they used to have a drive through safari, but now they have these converted large trucks that hold, like, 30 people. It’s open air, and they’ve got the driver up front, and they got the tour guide in the back. And just talking about the animals from there’s like 1200 animals from 50 different species of animals from six continents. And it’s a 45 minutes tour, and we just educate everybody. And guess who’s in the back with his Dr. Bob name tag on. I love it. When I first started, it was like the best $10 an hour job I ever had. And I would tell people I would pay them $10 an hour to do this job. No, it is fun. It’s so not audiology. I asked the veterinarian about hearing loss and these exotic animals and stuff. I said, well, what happens in the wild when you have an animal that has hearing problem? And he said, they get eaten. Makes a lot of sense. Duh. I don’t know any other audiologists that are driving around in these things that look like military trucks and talking to audiences about all these different things. So it looks like it’s a beautiful diversion from some of the serious things that you’ve been performing in your career. As I tell my friends, it’s the most non audiology thing I’ve ever done, and it’s therapy. It really is. It’s just fun. It was interesting. They asked me in the interview when I first got the job, they said, do you have any difficulty speaking into a microphone? I don’t think you know me that well. No, it’s fun. It’s great therapy. It’s just a lot of fun. It gets me out of the house a couple of days a week for a bunch of hours. each tour is different. The animals are just wonderful, a lot of them on endangered species. Okay, I’m going to do a plug here. The giraffe went on the endangered species list about three years ago. They estimate years. There’ll be no more giraffes in Africa because of poaching and sport hunting. but in the safari parks around the world, they’re thriving. So they slowly reintroduce the animals after a period of time, see if they know there’s all sorts of things going on here. But come to New Jersey, come to the six flags, come to the off road adventure. And check with me first to make sure that I’m working. Okay. Well, now, let’s just take the last few minutes here, and I have a little segment. I kind of ask people, what’s the coolest moment to date in audiology for you? as a person who struggled to get your orientation to the profession, worked through the doc program, found some fabulous, interesting things that all of us really appreciate. plus now we even know that giraffes are on the endangered species list as well. what’s the coolest moment in audiology, at least till now, I think for. Everybody, it’s watching the faces light up when you turn those hearing aids off and you reconnect these people to their families. You get the babies to smile, you get the parents crying that the kids can hearing parents say, I thought my child had other neurological problems. No, it’s just hearing loss. And I don’t want to say just hearing loss. I mean, it’s hearing loss. This is the reason why. And you just never forget those events. And everybody’s got stories about the smiling faces, the tears the fruit baskets, all the gifts that would come through later on. Just any ways in which you provided some type of help to bring a quality of life back to these patients who were disconnecting themselves or have already disconnected themselves from their family. But especially with the kids and being in the New Jersey area, there’s a lot of celebrities here in New Jersey, and every once in a while, we get some celebrities that pop in and of course of HIPAA. I cannot say who they are. But you think of all the famous celebrities in New Jersey, there’s a good chance that you’ll pick out several of them that have been in my office and they’re just nice people. Usually it’s their kids that are there, but we try and get people in get entire bands in. We get people out of the opening acts for major performers and stuff. I remember I had an offshore boating racing team and so they all wanted green earplugs for their right ear and red earplugs for their left ear because those are the colors of the lights on the boats. Green is left. and you would appreciate that as a navy guy? Absolutely. I was in my, and probably the best experience, you know, in Coltsneck nearby here, there’s a navy SEAL team at the time that was stationed there and I got a call from them and they needed custom ear molds made for their radios. so there’s about seven or eight of them. And we made arrangements for them to come in after hours. They come in their civilian clothes and they’re nicest people, right? Knowing that they can kill you when you won’t even know you’re dead. But that’s a different story. And so we did the ear impressions. I got the eight pair of ear impressions and two weeks later I called them up and I say, got the impressions. Let’s all set something up. How about Thursday? They said, that’s great. We’re going on a practice mission and so on. We really could use it. I said, once you come on at about 730 in the morning, my office was in a medical complex on a Thursday. Now think about the scenario. Medical offices, Thursday, 730 in the morning. They pull up, they come on in, they’re in full battle gear, Bob. Okay. Everything with the makeup on, okay. They got their bulletproof. These guys were big. They come in, we fit them all up and so on, and they were very appreciative. And they leave. And as they’re leaving, I looked outside in the parking lot, not a car in the parking lot. 815 in the morning on a Thursday. There’s not a car in the parking lot except the big van that they came in. What’s on side of the van? United States Navy weapons ordinance disposal unit, the bomb squad, not even the freehold police showed up. The parking lot was empty because something’s going on. And everybody, I would say 7-11. And they came back later on when the truck left. I thought it was this great experience. Absolutely wonderful. But the last thing we have to talk about here, Bob, is from a giant point of view specifically with pharmacology and supplements and some of the research and so on that you’ve done. where do you see the profession going? And what kind of a future do you see for audiology? I see audiology still following the medical model and getting more involved. Right now, the hearing aid is the center of the universe for audiology. Diagnostics are a major player. Rehabilitation. Hearing loss is forever in most cases. I get it, I understand it, and I have no problem with that. But I really think that the diagnostic hat sometimes is not really on properly because why aren’t you looking at these drug side effects? Or maybe you’re not. The drug list has to be updated. The supplement list has to be updated. I’m hoping that someone would step up to reach out to me and say, hey, I really want to do this, and then take it to the next level. We need to have the support of the professional within the state organization, state speech and hearing, state academies of audiology get involved and look at your license. And again, opening a statute is a lot of time, effort, energy, and money, and you need the numbers. You need the numbers. You need the membership to do that. So I see the profession of audiology still being where we were 30 years ago as far as diagnosticians, rehabilitation specialists, and experts in balance, but expanding it with the technology that we have and contributing to that. And I’d like to see more people getting involved on the educational side of managing these kids in school. So the speech pathologists, the audiologists that are doing auditory processing or want to do it the way you go about it, the way I went about it, I contacted all the schools in my area, spoke to the speech pathology people, went to their meetings and said, what do you want from me? Because I can dictate stuff and tell you to get this equipment, that equipment. But what’s going to work, you know, the politics, you know what’s going on in your school system, what do you want from me? And you tailor your auditory processing program around the needs of the schools, as opposed to the schools finding what you want them to do, because what you want them to do is going to cost them more money than what they want you to do. And we all know about budgets, and I had a child study team director tell me a long time ago goes, Bob, they pay me to say no. I said, okay, I’m going to remember that for a long time, of course. Well, thanks so much for being with us. Bob, we really appreciate your time, energy, and effort that went into our preparation for our discussion today. Thank you. And to the group that’s out there, thank you for tuning in this week to this week’s discussion with a giant in audiology. My guest has been Dr. Robert DiSogra, former owner, audiology associates in Freehold, New Jersey, an adjunct professor of audiology at many universities, the person who taught audiology about pharmacology. And of course, he’s your audiologist at the animal park, a true giant in audiology. Thanks for your fabulous contributions to our profession, Bob. And next time, be with me when we get to know another giant in audiology. Thank you, Bob. It’s been a pleasure and an honor. I really appreciate it. Thank you.

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About the Panel

Robert (Bob) DiSogra, AuD, is a recently retired audiologist, following a 45-year career in the hearing healthcare field—30 years of which were dedicated to private-practice audiology in Freehold, NJ. Dr. DiSogra is a well-known national and international lecturer, teacher, and author on a variety of audiology topics, especially pharmacology and ototoxicity, as well as the effects of Covid-19 on the ear. Among many honors and professional achievements, he was chairman of the Osborne College of Audiology, served on the AAA Pharmacology Task Force, and was the 2020 recipient of the American Academy of Audiology (AAA) Award for Clinical Excellence in Audiology.

Bob Traynor - Co-Host, This Week in HearingRobert M. Traynor, Ed.D., is a hearing industry consultant, trainer, professor, conference speaker, practice manager and author.  He has decades of experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. He serves as Adjunct Faculty in Audiology at the University of Florida, University of Northern Colorado, University of Colorado and The University of Arkansas for Medical Sciences.



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