A Conversation with Chad Ruffin, MD!

Join me for a personal and professional discussion about how a personal journey of living with hearing loss created a professional path to becoming a deaf ENT surgeon with Dr. Chad Ruffin.  Dr. Ruffin was born with severe hearing loss and is uniquely equipped with the skills and experience to improve the lives of individuals who are deaf and hard of hearing.  Dr. Ruffin completed his surgical training at Indiana University.  He is passionate about using his journey as a deaf patient, surgeon, auditory neuroscientist, and hearing technology innovator to help others succeed. 

For more information or to contact Dr. Chad Ruffin visit his website at Chad Ruffin, MD | Cochlear Implant Surgeon and ENT (chadruffinmd.com)

You can listen to this episode wherever you listen to podcasts and at: www.3cdigitalmedianetwork.com/empowear-audiology-podcast

For more information about Dr. Carrie Spangler- check out her Linktree at https://linktr.ee/carrie.spangler.

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 51 of Empower Audiology with Dr. Carrie Spangler.
Carrie: [00:00:16] Welcome to the Empower Ear Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler. A passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. Welcome to the Empower Ear Audiology Podcast. I'm really excited to introduce my guest today. I have Dr. Chad Ruffin with me today. He was born with a severe hearing loss and he is uniquely equipped with the skills and experience necessary to improve the lives of hard of hearing patients. Dr. Ruffin completed surgical training at Indiana University, one of the most rigorous otolaryngology residency programs. He also completed advanced training and ear surgery and cochlear implant research as a faculty physician at Indiana University. He is passionate about using his journey as a deaf patient, surgeon, auditory neuroscience scientist and hearing technology innovator to help others succeed with hearing loss. So, Dr. Ruffin, thanks for joining me and the empowEAR Audiology podcast.
Chad: [00:01:44] Thank you very much for having me. Carrie I'm excited to be here. And that was quite the introduction. I'm really appreciative of it.
Carrie: [00:01:51] Well, I feel like in the last few years I circles, I keep kind of coming together and it was great to finally meet you in person back in May at the American Cochlear Implant Alliance Conference.
Chad: [00:02:08] Yeah, I know we've been talking for a bit, and when you came up after I asked a question, I was super surprised. It's been great meeting you and chatting from there.
Carrie: [00:02:18] Yeah. So. Well, thanks again for being a part of the podcast and I'm really excited to find out more about you today. But I thought we would maybe start out with going back on that trip down memory lane. And can you just share with our listeners a little bit about your own hearing journey and how that all started?
Chad: [00:02:45] So I think there was probably a revolution in hearing health care for children who are born deaf. But back in the late sixties and seventies, as diagnosis and treatment started to open up, then I was born with a severe hearing loss, and I actually wasn't identified until around three years of age because I wasn't talking. I didn't respond to my name was called behind my back, but I did follow commands and I understood people because I was a very adept lip reader. Indeed, I did so well that experienced audiologist pediatric audiologists didn't think I had a hearing loss. And so my mom eventually took us down on a four hour trip away from home because I was I was born and raised in the Louisiana country and we went to Baton Rouge for an auditory brainstem response test. And that's where we found that I had a severe to profound hearing loss. And I was fit with hearing aids and given lots and lots of speech therapy. And by the time that I entered kindergarten, I was probably ahead of my peers for reading and talking. I used amplification up to around the point of fourth grade as the only accommodation, if you will, or treatment for hearing loss. And then my hearing had a sudden drop in fourth grade and I started using wireless FM systems or what's the modern name for these things called.
Carrie: [00:04:24] We call them DM sometimes digital digital modulation system or remote microphones. There's so many names and acronyms. Right?
Chad: [00:04:34] Right. So I started using that. And with that device, I was able to understand the teacher, and I did really well in school. My parents were a little bit different because they were entrepreneurs, and even though they came from a very either impoverished or middle class background, they did very well for themselves and super resourceful. And they're the quintessential parents that you see of successful children with hearing loss, meaning they go out and they find things. If something isn't followed up on, they will follow up on it. And because of that, I was successful and. I was offered a cochlear implant in Memphis, Tennessee in 1989. I was about eighth grade at that time, but I was one of the one of the first of the computer generation. So I grew up on a computer I had one since I was in second grade, and I thought that it was probably a little bit too early to consider a cochlear implant because, you know, technology will get better. And I didn't get one until I was in my later year of college because I just my hearing just worsened and hearing aids were no longer beneficial. The remote microphone still worked well, so it was the only accommodation that I had, really. And I had the implant when I was 21, and it really did change my life. I was able to participate in conversations that I could not do before. You know, before an implant, one on one conversation was very difficult and much less a group. But now I can participate in a group conversation. And it was about then that I realized that I had the first inkling that it's not really about how much you hear, it's more about how well you communicate. And I probably shouldn't have gotten I probably should have gotten a cochlear implant when I was in eighth grade because I would have had a better social circle and probably better social skills through my life. And it would have made it probably would have made a demonstrable difference in the trajectory of my life. Police. On. Can we do that?
Carrie: [00:07:02] What? Good.
Chad: [00:07:03] No. What? Sorry. Then I turned you off. Sorry.
Carrie: [00:07:06] That's okay.
Chad: [00:07:08] Let me figure out how to meet this. Okay. Yeah, it was. It wasn't until I got my cochlear implant when I was 21 that I realized I probably should have gotten it earlier because I realized then or had the first inkling that it's not really about how well you hear, it's about how well you communicate. And you don't need perfect hearing to be able to communicate well. So I think that if I received an implant when I was in eighth grade, I would have had a better, more normal social circle and better social skills as I got older. And that probably would have parlayed into some different choices that I would have made for my life even at that early of an age. So. I didn't get my cochlear my second cochlear implant until I was 31, and I think we'll probably end up coming back to that later in the interview. Why I got that and how that changed so.
Carrie: [00:08:14] Yeah, well, that's a great history. And I love how you said about your family, your parents, that they were so resourceful. And that's a big key for success for a lot of our kids who are deaf and hard of hearing is having that family support along the way. And it sounds like you definitely did. And I'm impressed at age three and you were able to catch up. So you must have had some really good therapy to help you learn how to catch up with those auditory skills and communication skills at that point in time, too. But we see our kids now who have the newborn hearing screening and close that gap so much quicker than we did. I wasn't identified till age four, so I had a lot of catch up to do.
Chad: [00:09:06] Yeah, I had twice weekly speech therapy and then Michael and my boyfriend, who was the first kid in North Texas to get a cochlear implant, had much more frequent auditory verbal therapy, and I would say it was formal or AVT meaning was more than just getting the words, which is what I did and talking or doing actually forming the words correctly. Michael had a had a much more intense listening and learning to talk and hold a conversation, all of those skills. And I do think that his earlier intervention does play out a role in terms of how we verbally process the world. Mm hmm.
Carrie: [00:09:57] So you talked about you got your first implant around 21 and you were in college at that point. Did you know that you wanted to be an otolaryngologist at this point?
Chad: [00:10:09] No, I was in Backwater. Louisiana is where I grew up, so my exposure to the world was pretty small. And if you wanted to be successful, I think a lot of people thought about going to college and then becoming either a doctor or a lawyer. I don't think we really had much exposure to MBAs. So I think that my field of view was somewhat narrow. And I really I love science and I like the art of medicine and the art of bringing a science together with the real world, which kind of also happens with flying, because I'm also a pilot and. So I kind of discounted medical school after getting my implant because. I wasn't sure that I was ready for the level of commitment that it requires. So I taught high school for a couple of years and then I was in ultrasound tech for a year, and it made me realize that medical school really was probably the right choice for me. And it was been it was a very interesting journey because back in 2003, there really weren't many deaf people in medicine. We had the ADA passed only ten years before, and I mean, that's actually kind of shocking to me now, being the age of 45 and understanding that culture. Cultural change takes a while to come along, and it's kind of shocking that I started medical school at only ten years after the passing of the ADA, and some of the rights that people take for granted now are coming from the first people who went through medical school, like Dr.
Chad: [00:11:51] Phil Zazu and someone in my generation, Michael OGenny, who went to court over some for some of these rights. So it was a very inhospitable world, you know. So I remember I had a choice of medical school to go to, and I ended up going to a public one because I thought that the accommodations would be better there, but they actually weren't. And. After I was admitted to medical school, the dean of the medical school found out that I had hearing loss and was deaf. And honestly, it freaked them out and they seriously reconsidered my admission. And I went into a meeting with a lot of different people. And really, I should have had a lawyer present, but it went well. And I told them how I would plan to manage X, Y and Z problems that may come up. And what I remember one faculty member came. Said to me in the meetings like, Well, what happens if you go through all of this training and. And you're not able to perform clinical medicine. And I just looked at it. I was like, Well, medicine doesn't march forward without great research, and that is still an option.
Chad: [00:13:17] And so I went through my first couple of years of medical school, and I decided to be an ENT or Otolaryngologist ear, nose and throat doctor after I completed a two year research fellowship at the University of Washington. It was a fantabulous experience because that was there where like my. I was exposed to so much creativity. I mean, top class students in engineering. And I got to be in one of the premier laboratories for cochlear implants in the world. And it was just a truly amazing experience because it was there that I was able to see that the world is not a path you follow, but you can make that path. And so I really enjoyed cochlear implant research. At the time I was involved in understanding how implants changed excuse me, how the auditory nerve encoded speech, both normally and under electrical conditions with the electrical hearing of a cochlear implant. And that was super fascinating to me. At that time, everyone thought that it would be if you can produce a perfect encoding in the auditory nerve, that hearing loss is fixed. And it was a very exciting time for implant research because we thought that we had come to a model that would help us do that. And ultimately it didn't. But but that was my first exposure to cochlear implant research is how the how do we best encode the sound of an implant.
Chad: [00:15:04] And because I really enjoyed that, I decided to go into ENT because it was clinically it fit together. It's a really diverse field. Surgically, there are all kinds of different technologies you can work with, and you are working also with the science of communication and voice surgery for the communication of voice. So the interesting thing is I thought I had my implant. I thought that the challenges that I had getting to medical school were behind me and that wasn't the case, unfortunately. ENT is one of the routinely one of the most difficult specialties to get into because it's exciting. The lifestyle is great and it does well financially compared to other specialties. So it took it actually ended up taking me about 30 interviews over a couple of years to get in. I had to do a second internship. Another research fellowship to get in just to prove people that I had what it took. And that was really the first time that I realized that I was different from other people because I had given it my all. I had done a research fellowship. I think that is most analogous to doing a road scholarship for medicine. And I graduated very high in my class. But at the same time, people were not listening to reason and didn't believe that I could do this.
Chad: [00:16:43] So, I mean, like that is that was a pretty traumatic blow It took about. It's probably taken some now in my life to move past that in a meaningful manner. And it was the first time that I ever labeled myself as disabled or different. And it was then that I started realizing that you can hear everything in speech in terms of the lexical content or getting the words. But there's a lot more to communication that is not available to people with severe and profound hearing loss. And that's really what's changed the trajectory of my career in terms of what I what my mission in life is, is not to give someone perfect speech. We can't do perfect speech perception. We can't do that right now, even in the best outcomes of cochlear implants. And we even with better hearing aids, better cochlear implants. We are not making a dent in how deaf and hard of hearing people achieve meaning. The socioeconomic status of deaf and hard of hearing people hasn't changed in the nearly 40 years that the ADA has been passed. So there clearly is something more, and I think there's this missing piece of turning the conversation more towards how we help people communicate better and address gaps in care with better counseling. Because even the best hearing aids and best cochlear implants are not cutting it.
Carrie: [00:18:22] Mm hmm. Yeah, I agree with you there, especially being a cochlear implant user, too. There's much more to speech perception than the cochlear implant, and we'll get into that to how we can better manage that communication. But just kind of taking a quick step back to that medical school and going into ENT. Do you feel like that I know you said it took me a while to get to the place where you're kind of okay with the discouragement that you had, but do you feel like that was a springboard to maybe having more grit and resilience and passion for what you do because of that?
Chad: [00:19:05] Well, that's a grudging yes. I mean, I would never want to go through that again. But. Yes. I mean, I have a patient who is also a surgeon who flew in from across the country. And because she is a surgeon, she had been to. The best resources for her situation that. You know, the world could offer. She'd been to all the big centers and she said that no one would quite talk to her the way I did about how various ear problems affect the quality of life and mental health and. Accommodations and the whole spectrum of things. So, I mean, like that's something that I routinely see. And in the exam room, like when I have couples with you have when I have a patient with sudden hearing loss and they have their significant other with them, I will look at them and tell them I'm like, This is going to be difficult for you, too. It's going to be a big adjustment. And we address mental health issues. Make sure that they get counseling if they need it. So I think that hearing health care has historically not been great in America because audiologists and ENTs are not encouraged to play well together for a variety of reasons, both what's in the law and the just the history between the two specialties over time. And I think that really needs to change and we can accomplish a lot more if we move beyond that.
Carrie: [00:20:53] Yeah, well, I'm sure your patients appreciate the insight that you have as a cochlear implant user from a personal perspective. And then your professional expertise is, you know, obviously amazing. So it helps to have both of those. And I kind of had a similar experience going into grad school or in undergrad where they called me in to the clinic director and the dean called me in and said, I don't think some someone with hearing loss can become an audiologist. And I was like, What? Like wait. And so, I mean, I didn't have to go through, you know 27 other kinds of interviews, but I still left that meeting devastated, thinking what, like, this is our profession and you don't understand how to make some accommodations and supports. And I really wasn't ready to act. I was shocked and I'm not ready to respond with a good answer at that moment in time, I had to go back and process it and make another appointment and share how I could navigate through this. It might not be different. It might be a little different than my peers, but I can still have this perspective that my peers will never have.
Chad: [00:22:23] Right. Right. I mean it. Let me think. I think that coming from the background of my entrepreneurial entrepreneur parents and the confidence that that instills to be able to do something and being successful at every other part in my life, I question myself like, am I going to be a great surgeon? I mean, do I have that ability? And when I was out of training, you know, I mean, like, I still I did my surgeries. They went great. When I got around to cochlear implants, it was kind of like. Crazy, to be honest with you, because I did my first implant surgery as an attending and the patient calls me the next day is like, I can still hear. I can hear water splashing in my ear. And I was like, Well, I hadn't planned on that, but I that is awesome. And. I've since learned that my hearing preservation rates and implants are as good as they come. They're actually ahead of published reports in the literature, and I kind of learned why that is in terms of or suspected why that is. But it's great to have like a different and fresh eye about things and the diversity that having a different background brings to a job.
Chad: [00:23:57] Because I can tell you that I do my implant surgeries differently as a result of my own perspectives and thinking about it. So, for example, I mean, a lot of people don't get cochlear implants because they're scared to death of losing their residual hearing. And one of the reasons why I try to preserve hearing on every patient is to to allay that fear, even though in the end. If you had to calculate the percent of variance or how much preserving residual hearing helps the average person, it only contributes to 10% of their final performance. It's not much, but it contributes to a lot in the community. If you can tell them, you're probably not going to lose your hearing right after surgery. But I can't tell you what's going to happen in the next year. But right after surgery, it's probably going to stay pretty close to what you had before if I do it. And. Yeah. It's just it's been it's been fantastic to move beyond that initial huge blow to self esteem, you know.
Carrie: [00:25:05] So yeah well I can, I can relate from an audiology perspective that it brings a different perspective to the patients and the families that we have the opportunity to work with. Well, I thought I would go through some different common questions you might get as a CI surgeon with cochlear implants, but I thought I would ask you first. Do you is there like one question that you always get because you are a surgeon with cochlear implants where it might be the most common question.
Chad: [00:25:41] From my patients or in general from anyone.
Carrie: [00:25:44] Like just because you have a cochlear implant and you are a cochlear implant surgeon. Is there like a question that people are always curious about?
Chad: [00:25:57] On. I think it probably you can divide it into two categories, like people who are in the office with me and then people who talk to me outside the office. In the office. I think it's kind of funny because people are like, do implants work? And I'm like, Hello? I know I'm relatively a star performer, but I'm talking to you. So I think that's probably the most one  that I get. The one outside the office is usually students coming up to me and saying they want to go into medicine or they want to go into surgery. And I think right there, they. Let me back up. The most common question I get outside of the exam room is from students and parents who are wanting the best for their child or wanting to go into medical school or become a surgeon. And they will ask me, So how do I hear in the operating room. And a lot of these people have not even gotten to medical school yet. And I really just turn the question around and I said, you're. That's not really the question. Being able to communicate in the operating room, if you have some hearing, was probably going to be fine. You may require some accommodations and you may have some resistance. But the real question is how do you communicate with people? And I don't think that people realize the intensity of communication when you are in medicine because you are talking anywhere from someone who has the very, very low or no educational background.
Chad: [00:27:43] Maybe they're illiterate to someone who is a CEO, you know, and those conversations happen daily. So you have to have the communication skills to be able to rapidly bridge all that entire spectrum an trying to get the students to have some insight into that. Really, anyone is really difficult and I have to be really careful when I try to bring up like how they may communicate or something. I'm like and I feel like I have that responsibility because no one ever told me, you know, like I was probably a little weird in my twenties, to be honest with you, as a result of my hearing loss and interpersonal skills. But no one ever really took the time to say that and to help me understand. What they meant because this is not hearing loss is an invisible diagnosis. The ways that it affects people is invisible. There's no tangible quality to it that you can just point to outline and this is how it's affecting you. So there's no language for laypeople or really even professionals to describe some of the issues around hearing loss other than language deprivation or social deprivation. And that is something that I think is a really hard skill to have, and it's still something that I'm working on in developing with both my patients and students. So.
Carrie: [00:29:15] Yeah. No, that's that's good. Kind of that other perspective that people don't get because it is invisible and it's hard to figure out what some of those nuances are along the way. So I'm going to just ask a few other questions. As for a surgeon, so one question would be. Since you are a surgeon that has a cochlear implant. How would a patient or a potential patient choose a surgeon? What? What? What should they be looking for in a cochlear implant surgeon?
Chad: [00:29:54] I think I would probably have to answer that based on if I needed a cochlear implant, what I would do. I would find first just the technical qualifications of the surgeon. I would look for someone who has a hearing preservation rate of 90% or greater. That tells me that they had the skill to get the electrode in the exact right place at the cochlea and that they care, because not everyone does. The second thing I would look at is not just the surgeon but the audiologist. For me, I would want to walk in an office and see that hearing assistive technology is offered and encouraged to patients because 80% or eight out of ten patients will get better with a cochlear implant, get better hearing, but about 20% won't. And you really have to be prepared to be in that 20% where you don't get increased benefit relative to your hearing aid. So I think that having a surgeon and an audiologist who looks at that big picture is super important. I think it shows that they have the foresight and the care to invest in these resources for their clinic. I think also I want a team that understands what I do for work and can relay to me what it's going to be like after an implant and help me prepare for that, for example. So some of my patients are fortunate to be able to work remotely and they have questions about, Well, what am I going to do if one of my ears is down and I really need that ear? How am I going to hear, you know? So I think that having a surgeon who understands that and an audiologist who understands that as well is really, really important. So you have to look at the whole patient when you make these decisions. And I think that is super essential. Mm hmm.
Carrie: [00:31:59] Yeah. Because I think sometimes the layperson thinks that you get a cochlear implant, you get it activated and you just go and there's that was the easy part, right? Everything afterwards is the hard part of getting a cochlear implant. So I think that is great advice of looking at a clinic that that is looking at the whole person and the audiologist and surgeon are in good connection with each other and communicating with each other to. What? I'm going to ask another question. Are you ready?
Chad: [00:32:34] Sure.
Carrie: [00:32:37] All right. So should someone wait? If they are a true candidate for something better to come along? So they went through the whole like consult and the the clinic says, Hey, yep, you're definitely a candidate. And then the patient or the family is like, Well, I think we're going to wait because maybe stem cell research or hair regeneration or technology is going to get better.
Chad: [00:33:10] No, I don't think people should say.
Carrie: [00:33:13] Yeah. What would you say.
Chad: [00:33:16] For stem cell? Hair cell regeneration therapies? I would say definitely do not wait there consistently. Is it going to be another ten years? Another ten years? So the other thing is, if you're young and you get one of these therapies, say you're in your twenties, you have another. 50 to 60 years of life ahead of you. And that's a long time that a complication from one of those therapies could develop, you know. For some medicines, we don't see their complications come out until like 30 years later. So this is a real this is a big deal if you're in your sixties or something and, you know. These therapies were actually available. It's a different story, but there's nothing really on the horizon horizon for the immediate future in terms of benefits. There's only one. There's only one important advancement and that may be coming out. And I honestly don't know what the status of this is, is having steroid eluting electrode arrays. And the reason that's important is when we do implant surgery, we can give you steroids around the time of surgery. We can put steroids right by the electrode. But there's that's really actually absorbed pretty quickly when we do that to try to preserve residual hearing, decreased scar formation inside the cochlea. And because that clears up so rapidly.
Chad: [00:34:54] The real loss of hearing, if it occurs, happens in the next year usually, and as a scar builds up. So there have been some steroid eluting or steroid releasing electrode arrays that are designed to release steroids for a while until the body stops its activity against the scar formation. And that would be the only thing to wait for in my mind. But even then, people who have residual hearing and they keep it for a while and they lose it, they're still going to be doing better than they are with their hearing aids. So it really depends on how long are you going to wait, because a lot of people don't realize how their quality of life is meaningfully impacted. And to be honest with you, I don't. I, I don't think that I would wait. But that decision may be different for someone who has a lot of residual hearing and maybe they're a musician and they need that actual acoustic hearing that could be benefited from a steroid eluting array. But at the same time, they could get an implant in one ear, a standard one, and then wait till they implant the other ear. It really, really just depends on the patient and what their priorities are.
Carrie: [00:36:18] Yeah. Sometimes being in more pediatric educational, I get that question from parents a lot. And for I think children waiting isn't really a good answer if they're truly a candidate because of the neuroplasticity of the brain and language development and education that goes along with it. But I see a point for an adult who has a lot of residual hearing and maybe going bimodal might be a great option to.
Chad: [00:36:49] Right. You bring up a good point because kids with hearing loss, if they're born to hearing parents and they don't sign, that is the goal is not hearing the goal is language development. And they have to have access to all speech and language. And if they need an implant, they need an implant. If the parents sign is a different story, especially if the kid is embedded in the signing environment, because they will be getting language, the community with which to which they're exposed to may be smaller, but they're still going to be developing language. And that's a good thing. Mm hmm.
Carrie: [00:37:24] All right. You ready for another question?
Chad: [00:37:27] Bring it on.
Carrie: [00:37:28] All right. So you touched on it earlier, but what are the limitations of a cochlear implant?
Chad: [00:37:37] So the limitations of a cochlear implant, I think you can think of it as really as we hear. Because we hear changes in pitch and rhythm across many frequency bands. And the cochlea is kind of like a piano keyboard. It has a spatially separate sound out from low to high frequencies. And a piano keyboard has 88 keys. And we hearing people can very easily tell the difference between each one. They can tell whether it's a happy or sad note. They can tell whether what the melody of something is. If you just leave, pitch in there, remove all the timing cues, meaning each key is pressed for the same amount of time. There is a defined interval between each key presses called asynchronous melodies, and people with cochlear implants can't hear that. Identify those well. So music is primarily heard or pitch is primarily heard is changes in volume across several frequency bands, and that is a big limitation of cochlear implants. They actually do really well in quiet for picking up words, but when you start moving over into complex listening environments, noisy speech, particularly when that speech is competing speech, then the pitch information becomes crucial. You need to be able to segregate various audio streams based on their pitch, and that's how normal hearing people can pick out a voice can pick a voice out of a crowd. They hone in on that fundamental frequency, they pick that voice out, and their brain will silence or become inattentive to the other voices. On people with cochlear implants because they don't hear pitch well, they have 16 to 24 electrodes and really you need about 64 if you're going to start getting up into being able to hear pitch better.
Chad: [00:39:46] But it's not possible with the cochlear implant to deliver that much information. It's a different story. But because you don't hear pitch, you don't hear music. Well, you don't hear speech and background noise as well. I think those are the two main limitations for implants. That also translates into another limitation, which is we think of hearing speech as hearing the words. But really they're and that's called lexical speech. But really, there's an entirely other different property of speech, and that's called indexical speech, where we hear the emotion, the tone, the gender, who the identity, who is speaking. Are they healthy? Are they tired that day or are they physically fit? You can tell all sorts of things, dialect where a person comes from, how much money they make. You can tell all kinds of things from Indexical speech and people don't hear people with cochlear implants don't hear an indexical speech problem. Excuse me, Do not hear Indexical speech cues very well. And I think this leads to some of the communication issues that we have because normal hearing people, they are enveloped by another person's voice. It's like going out and looking at a mountain vista. There's no there's an emotive quality to it and there's no processing of it is something abide that hits them and they're processing both the words and speech at the same time. And even the words. People with normal hearing don't hear an individual words, thoughts pop in their head. They have a vibe associated with that based on the indexical properties of speech.
Chad: [00:41:26] And people with cochlear implants are using so much energy to hear and trying to figure out every individual word. And that's just the word that they may miss out on these indexical properties that communicate what a speaker means beyond what they actually say, the hidden part of speech, so to speak. So this is where the communication problems of hearing loss arise from is not having the complete picture. And that is not communicated to our patients as well as it should be. I think it's one of the reasons why people find it hard to access a higher career as competitive careers because they're not explicitly taught this information. The deaf community in it's. In his desire to be seen as equal on. I think wants to believe that you can replace this information visually. But we know that that's not the case, that people either don't identify it or if they do, they don't process it in real time just by seeing the emotions on someone's face. So I think that we're having a greater insight into understanding that how well someone hears emotion in voice has more to do with quality of life than actually how much the implant benefits their ability to hear the words of speech. So basically, the improvement in quality of life after your cochlear implant is more correlated not with how well you hear the words of speech or how much you improve, but how well you can identify the emotion in people's voices. And that's a big finding. And it's not really harped on or communicated to our patients enough.
Carrie: [00:43:16] Mm hmm. And on that topic, do you think there's ways that as the professionals, we can teach that differently. Or do you think that's just the final limitation of the cochlear implant as we speak today? Maybe it would be different in the future with advancements in technology, but do you think that some of these skills can be taught to help with communication better?
Chad: [00:43:47] I think that some people naturally get this stuff. I mean, we have different personalities and temperaments and they naturally get this. So not everyone is going to have this problem. So I think that's one thing. And two, I can't tell you how we teach this better to our patients. But I can tell you what I do when I'm in a situation. If I'm not sure what the tone I'm hearing is, I will say, tell the person I'm hearing this. Is this what you mean? And when it's a really complex situation, even in quiet and quiet, I will stop listening to the person and just watch their body language and take a second to take it in. And I also explain to people in complex situations that I have a problem hearing tone and. And this also brings in to a second thing that we don't think about the limitations of cochlear implants is that we're talking about getting the information that expressing yourself well, like having the soft skills is really important. So what I actually found is there are some stressful situations in private practice when we're talking about financial issues and accounting issues where, I mean, that is that affects like my pocketbook at the end of the day, you know, like how much I'm able to live on. So that's super stressful sometimes. And I've had to learn to be to be very careful, even even if I'm very upset inside, to not let it come out in my voice, because I've since learned that hearing people hear that very different, where it's like mildly upset to me, like it is like cutting and abrasive to the hearing person. And you laugh, but I mean, like, it's something I've had to learn.
Carrie: [00:45:38] Know. Well, that's a good insight to have about yourself. But you bring up another good point that I had a question about, too, is advocacy and being able to kind of share, you know, with others when you do, you know, need someone to repeat or you want to know their tone or things like that. What advice do you have for individuals about being a better advocate? Because that can be really hard and like you said, a stressful situation or with people you don't know well.
Chad: [00:46:09] I think that on. Advocating for yourself is difficult because even though there's a legal framework around it now, at the end of the day, it's just someone else asking another person for help. And I think going in there with the right frame of mind, that is the initial most important thing. No one owes you anything. I mean, at the end of the day, no one has to provide you anything in terms of like emotional support or. Yes, they will have to do that. I mean, what I mean by that is you can't go Yes, you have the legal rights, but you can't go in expecting someone to drop everything and help you, you know. Other people have lives, too. The second thing is, most people want to help. 95%, 19 times out of 20 people will help you. But you have to be able to make exactly make your need known. Exactly. And tell people how they can help. For example, these are two different science findings and not necessarily correlated. But they struck out to me because if you look at people with hearing loss, women out earn men. And usually there's a 20% difference where men are outearning women by that to $0.20 on the dollar. So in hearing loss, it's reversed. Also, if you look at how people manage hearing loss, women manage it differently. Men will say, I have hearing loss, Women will say, I have hearing loss. I need you to repeat this for me. So telling people exactly what you need is really important because. People can't figure out your problems for you. You have to think about think about it. The other thing that I would do is you don't ask a question unless you know. Sorry, tell me. The other thing is when you frame a request for an accommodation, you ask it in a way that a person cannot say no.
Chad: [00:48:12] For example, if you give someone a remote microphone and they don't want to wear it, they just say, I'll talk louder or something. They may be your boss and you really can't correct them. So one thing you can say is that. I had this example example with a medical student like I was in that situation myself and I didn't know what to say because of the power differential. They had a medical student come up to me and ask the same thing, and I immediately came up with an answer. It's kind of crazy how getting out of that stressful training environment changes things. But I told the student, I said. You tell the on the attending physician like you are a great surgeon and I want to learn everything I can from you so that I can be a great surgeon, too. And if you are if you don't wear this microphone, then I am spending all my time, time working to hear and not working to learn. And those are too. And I can't become the best surgeon if you don't do that. That's what I mean by asking a question in a way that someone can't say no. The other thing is you need to think What? What they may say. No, no to kind of like set your request up so in a manner which answers their questions or cuts off avenues for denial. And then you need to smile and say thank you because people are helping. You know, if you help open a door for someone in a wheelchair, they usually say, thank you. You know, this is the same thing. So. It's work on their part.
Carrie: [00:49:52] Yeah. I like what you said about practicing some of those responses, just kind of anticipating maybe what someone might say and then practice some of those responses so that they are flipped into a positive way and they can't say no. But it takes a lot of practice and.
Chad: [00:50:10] Thought it does.
Carrie: [00:50:11] Courage really to say it.
Chad: [00:50:14] And it's unfortunate because no kid with a hearing loss should have to practice that their audiologist or their doctor should tell them or point them towards resources. Like, here are the most important things you need to know about your hearing loss and how to manage them. But instead, we have kids, adults constantly reinventing the wheel with every new diagnosis of hearing loss in a vocational age person. So it's terrible.
Carrie: [00:50:44] Yeah. Well, maybe we can. We can change to that.
Chad: [00:50:49] Maybe.
Carrie: [00:50:51] So I'm trying to think if I have any other questions. What do you envision for the future of cochlear implants to be like? Do you have any wishes?
Chad: [00:51:20] So I think my vision for the future for cochlear implants or for people with severe and profound hearing loss is more holistic health care where people are given the tools they need to. Thrive with their hearing loss rather than giving tools for maximum speech perception. It's a subtle difference. Not rather than let me back up on. So my vision for cochlear implants or treatment for people with severe and profound hearing loss has to do mostly with a lot of the things we've touched on today, like getting better counseling for patients because what people need are the tools to thrive with hearing loss. And that's going to go beyond what the tools you have for getting maximal speech perception. Those are two different things. And for example, for today, I mean, I would probably trade 10 to 15% of my hearing now to know the things that I know now, but know those when I was a kid. I think the second thing as far as implants go, I mean, we have as a medical device, we have a lot of things on the horizon which are super interesting. I think the nearest one is going to be the application of deep learning, filtration of noise out of a speech signal and where where people will go into a restaurant and they will hear as well as they do in quiet. I think that's going to be amazing.
Chad: [00:53:04] And these. Things are being developed right now. They just can't be put into a teeny, tiny ear level of processor. The most interesting thing as a medical device, I think has to do with light based electrode arrays where we instead of using electricity that is spreads inside the cochlea and stimulates channels next door and degrades information or degrades the sound of an implant. We're probably going to move to light based arrays that stimulate the cochlea with very fine stimulation, and those may it may or may not involve genetic therapies to make certain parts of the cochlea sensitive to different kinds of light. But those are still very early in their development. I don't know where it's going to take us, but I think right now I think the deep learning algorithms will be really important. I think that there are other things where things that may develop as we get into augmented reality and can have computer assisted interpretation of the environment. For example, kids with autism can wear Google glasses that help them identify the emotions on faces, and that teaches them how to communicate a little bit better. So I think some of those things may come for treating hearing loss too, and improving communication skills. So there's a lot of things out there. I don't know what the future is going to look like.
Carrie: [00:54:44] It's exciting to be part of it and to be on the receiving end of some of the excitement to every time something new comes out. I really excited about trying it out and seeing the difference in the real world, which is fun as well. So is there anything I didn't ask you that you wish I would have that you would like to share today?
Chad: [00:55:11] I don't think so.
Carrie: [00:55:13] Anything else that I that our listeners might be like? Dr. Ruffin, with his experience as a cochlear implant user and as a surgeon. Any advice for anyone?
Chad: [00:55:31] I think I would just tell people to be assertive. You're not the first person to go through some of these things. And having having a an illness or a disability that affects communication, both receptive and expressive so profoundly is hard to overcome. But I mean, like people have done it, you know, and the number of people who are achieving great things despite having severe and profound hearing loss, you know, more and more people are doing it. So it's not they're not reinventing the wheel. So I think the I think a key thing is to seek out people who have had an experience similar to yourself and look in advocacy organizations, because I think that will improve quality of life.
Carrie: [00:56:23] Mm hmm. Yeah, I agree that peer to peer connection of others that are in your shoes really motivates you and gives you a lot of insight too. So I'm thankful to know you as well from a hearing care professional point of view and then also as a fellow cochlear implant user. But we can share a lot of great ideas, but I just want to say thank you for being part of the EmpowEAR Audiology podcast today. It was a great conversation.
Chad: [00:56:53] Thank you for having me. I really enjoy your positive energy and enthusiasm and all the work you're doing. I'm super glad you said hi at that meeting at ACIA in May.
Carrie: [00:57:03] Well, and I'm super glad that you said yes to being on the empowEAR Audiology podcast. So listeners, I hope you enjoyed the podcast today and please share it with others. I encourage you to visit the Facebook page and engage as well.  Transcripts for this episode are available on the 3C Digital Media Network website and thanks for spending time listening today.
Announcer: [00:57:26] This has been a production of the three C Digital Media Network.