Fabry Files: Interview with Darrell Rose, Ph.D., Former Section Head of Audiology, Mayo Clinic Rochester
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Topic: Use of Short Word Recognition Lists, Early Cochlear Implantation and the First Audiology Satellite Conferences
Editor's Note: In this series of interviews, we're exploring a little bit about what it takes to be a mentor. Everyone should be fortunate enough in their career to have a mentor; I was lucky enough to have several, and I am now at the point in my life where I have the opportunity to help provide guidance to future audiologists. But it is not just a matter of "showing up" in the workplace; it takes a great deal of patience, energy, and dedication to be a role model. Furthermore, it is often a pretty thankless job - take the time today to reflect on who has influenced your career, and give them a call or send them an email to let them know that you appreciate them. - David Fabry, Ph.D., Associate Editor. Audiology Online.
Dr. David Fabry: I'm here today with Dr. Darrell Rose, who was Section Head of Audiology at Mayo Clinic in Rochester, Minnesota from 1970 to 1986. Subsequently, he headed for warmer climates in 1986 when Mayo Clinic Jacksonville opened, and he "retired" in 1994. More about that later; welcome, Dr. Rose, and thanks for taking the time to speak with us today.
Dr. Darrell Rose: Thanks, Dave. Time is one thing that I have plenty of these days.
Fabry: I know you better than that. First of all, tell us a little bit about your education - where did you get your Ph.D?
Rose: I received my Ph.D. from the University of Oklahoma Medical Center. Gerald Studebaker and Howard Ruhm served as my mentors, and Ruhm directed my dissertation but couldn't finish it as his son was in a bad accident and he had to take time off from work. Bruce Pierce, who was also on the faculty, assisted me with completing the dissertation.
Fabry: Boy, that couldn't have been an easy task for him, because you are the second-worst speller that I know.
Rose: I feel sorry for the worst then!
Fabry: That would probably be me, actually. Seriously, though, it couldn't have been easy for him to step in at that point and help you write up something that he didn't direct.
Rose: No, it wasn't, and he bled red ink all over numerous drafts of my dissertation, and we finally got something done that was acceptable to the graduate school and I finally convinced them to graduate me in 1964.
Fabry: After brief stints in California, Colorado, and Illinois, you found yourself in the sunny southeastern tropical portion of the state of Minnesota at the Mayo Clinic in Rochester. What do you consider your greatest accomplishment during your tenure there?
Rose: Well, I have long said that the best thing I ever did was to hire Wayne Olsen. He truly helped shape the profession in so many ways, and we were fortunate to persuade him to leave Northwestern University.
Fabry: Yes, you guys made quite a dynamic duo, and I was fortunate enough to land a CFY there. Among other things, you taught my about how to test hearing aid performance under earphones. I recall that during my first week at Mayo, I was supposed to be observing you in clinic, and you brought an 80 year-old lady down the hall, put her in the booth, and instructed me to do the testing. Air conduction testing provided an asymmetric loss with a very unusual configuration in the affected ear. This was, however, "the" Mayo Clinic, so I continued with word recognition testing, which was terrible in the poor ear. At this point, the butterflies in my stomach started fluttering madly, as I suspected that she had a tumor, Meniere's disease, or some unusual syndrome. When I walked in the booth, however, to change over to bone conduction, I could hear a faint whistling coming from under the right earphone, and when I removed it, discovered that she was still wearing her hearing aid on that side. All I could think to tell her was that she should remove the device so that we could retest and compare to the aided results, so that we could determine how well it was working for her. When I came out of the booth, you were rolling on the floor with laughter, and have maintained to this day that it was all part of my education. So, now is your opportunity to 'fess up - did you really mean to put the headphones on over that lady's hearing aid?
Rose: I'll never tell, but I do think that you learned a thing or two that day about clinical practice, right?
Fabry: Point taken. One thing that I will never forget was your very pragmatic approach to audiological testing, and your question of "How will what you do change the course of treatment?" guide me to this day. For example, I have always felt that the Mayo "short" lists, which were developed from 50-word W-22 lists, were an incredibly clever and efficient clinical modification. Can you explain how and why you developed them?
Rose: Well, there were a couple big challenges that we faced when I came to Mayo Clinic in 1970. The first was that, similar to many other medical centers at the time, the otologist dictated which audiometric tests were conducted, and the patients often "ping ponged" several times back and forth between Audiology and ENT during each visit. We felt that was very inefficient, and maintained that the audiologists should be given more authority in the decision process, with the understanding (and expectation) that I would take responsibility if we "over tested" the patient. It took time, but we developed an environment of mutual respect, and we improved clinical efficiencies dramatically. In effect, we moved from "prescriptive" to "best practices" audiologic evaluation. As you mentioned, another thing we investigated was the utility of 50-word speech recognition lists, especially when patients scored highly. So we did an item analysis of around 400 patients, and re-ordered the word lists to include the most difficult words first. If a patient got eight or more correct out of the first ten words, we found that that their score was not significantly different from the score obtained after all 50 words were delivered.
Fabry: That certainly makes sense, and must have saved a lot of time clinically. How was this received by the academic world?
Rose: I recall some rather heated debate after we presented the results at an ASHA convention in the late 70s. Drs. Carhart and Tillman were both present at the session which was chaired by Dr. John Gaeth, and Tillman argued that it is not possible to present a "phonetically balanced" word list with only 10 items. Carhart was a little more open to the idea, however, and suggested that it deserved further study. When I retired from Mayo they had been using them for around 30 years at Mayo Clinic, and to my knowledge patient care was never compromised.
Fabry: Another thing I have always admired is your willingness to take a stand on an issue that you believed in, especially if it challenged conventional wisdom. You were involved in a lot of the early cochlear implant work, and I remember being present at the initial stimulation of the first patient fit at Mayo with the Vienna extra cochlear implant.
Rose: Yes, and when we turned the current up enough for her to hear, her face twitched and she tasted metal; she was crying and I didn't know if it was because she was in pain or that she was hearing sound for the first time in years. Fortunately, it was the latter, and we were able to lower the current to eliminate the facial twitch. We did some good work, and implants have certainly improved since then.
Fabry: True, but I do recall a controversial paper that you published in 1994 regarding the use of cochlear implants with prelingually-deafened persons. Do you still stand by that paper?
Rose: Yes, it was an AJA Viewpoint paper, and it is as true now as it was then. Candidly, the goal of the paper was simply to challenge people to take time to stop and look at the data on cochlear implantation with pre-lingually deaf persons, on the basis of Lennenberg's Critical Stage Theory. MacCay Vernon had asserted that if you do not implant a child until age 7 or 8, they are unlikely to develop adequate speech and language skills to benefit substantially from cochlear implantation. In fact, in our simple survey we found that over half of the recipients with prelingual deafness that we contacted were no longer wearing their implants. In our opinion, this indicated that either the selection process, the habilitation process, or both, are flawed. Despite the improvements during the past 15 years, I still stand by that conclusion today. Fortunately today they have developed some tests that give a pretty good objective indication of how will a person will do with an implant. I am amazed at the progress they are making in that field.
Fabry: You also were a pioneer in the area of remote conferencing, having established the Mayo Video Conference twenty years ago. Some 100 presentations later, it is still going strong, and the faculty reads like a "Who's Who" of audiology. What inspired you to start this meeting, well before AO and internet conferencing were a gleam In Bill LaCalle's eye?
Rose: Well, I had long been the beneficiary of Mayo's travel policy, which in my opinion, remains the best in the profession, and enabled me as a busy clinician to hear some of the brightest minds in the field by attending conferences all over the country. That said, I knew that this was a privilege that a lot of others would never have, and I also never really cared to travel that much, so I thought it would be interesting to try to broadcast a high quality audiology meeting via satellite. Our best meeting, again in my opinion, was one devoted to hearing aids and the hearing aid industry, we enrolled over 100 recipient sites, but they have consistently averaged around forty locations. In the last couple years, they have even started to webcast, so Mayo is keeping up with the times and a new generation of audiologists. It's hard to believe we started this over 20 years ago!
Fabry: Yes, and I spoke at the first one, so you know what that means - we're both old! I know that you don't let any moss grow under you - what did you do to keep busy after you retired from Mayo?
Rose: First, I went on a Mormon mission to India, and I also taught at Osmania University in Hyderabad, where we helped start the master's degree program in Audiology there. My wife and I have served on several missions which has taken up a good deal of time and has been very rewarding for us at least. I also have done some work with the hearing aid industry, with Sonic Innovations.
Fabry: Yes, I seem to recall some early work that you did with a little "blue box" that housed a prototype of an early digital hearing aid in the mid-1980s. Hard to believe that things have progressed as they have - we even did a debate on the topic of digital noise suppression in 1992 called "In Search of a Digital Toaster".
Rose: Yes, and all these years later, I am still using an analog toaster, so your arguments weren't very persuasive.
Fabry: No doubt you still burn toast too. Well, that said, I think that it is time we wrap this interview up, but I want to close with a section we'll call "Quick Hits" by asking you to choose as quickly as possible between the two alternatives.
Rose: Fire away.
Fabry: PC or Mac?
Rose: I use PCs, although my first personal computer was an Apple IIe, and I think that they have always had better graphics.
Fabry: BTE or ITE?
Rose: I really like the new mini BTEs
Fabry: PTA or SRT?
Rose: have always found the PTA to be of more use
Fabry: Brett Favre or Steve Young?
Rose: Religious bias for Steve Young, but I think that Brett Favre will be judged as one of the best, if not the best ever, by the time he retires
Fabry: Paper or Plastic?
Rose: If you are talking about money, then paper. I was one of the last people I know to get a credit card, and once a hotel refused me service because I wanted to pay cash instead of using a credit card.
Fabry: Wow, and I'll bet that the room cost all of $20, knowing how frugal you are. Bone conduction: Mastoid or Forehead placement?
Rose: Mastoid, but I'm not sure I can defend anymore.
Fabry: baseball or hotdog
Rose: (laughs): I always started with baseball
Fabry: Inserts or Supra-aural?
Rose: Inserts, but it took a long time for me to get there.
Fabry: Stay up till 4 am, or get up at 4 am?
Rose: Get up
Fabry: Favorite pure-tone frequency?
Rose: 2000 Hz
Fabry: "Say the word" or "You will say"?
Rose: Neither - I never used carrier phrases
Fabry: Monaural or binaural?
Rose: Binaural
Fabry: Duct tape or Velcro?
Rose: Velcro
Fabry: Yes, I've seen your booth. I want to thank you for taking the time to talk with us today, and even more importantly, I want to thank you for being a mentor to me all these years. I don't know if you remember, but during the early stages of my CFY, I came into your booth and closed the door. I was feeling pretty insecure about my abilities, and you had teased me virtually every day about my lack of skills. Do you recall what you said when I closed the door and asked for your advice?
Rose: Yes - start worrying if I ever stop teasing you.
Fabry: Exactly. Fortunately for me, you never did!
Rose: My pleasure, Marfan Man.
Dr. David Fabry: I'm here today with Dr. Darrell Rose, who was Section Head of Audiology at Mayo Clinic in Rochester, Minnesota from 1970 to 1986. Subsequently, he headed for warmer climates in 1986 when Mayo Clinic Jacksonville opened, and he "retired" in 1994. More about that later; welcome, Dr. Rose, and thanks for taking the time to speak with us today.
Dr. Darrell Rose: Thanks, Dave. Time is one thing that I have plenty of these days.
Fabry: I know you better than that. First of all, tell us a little bit about your education - where did you get your Ph.D?
Rose: I received my Ph.D. from the University of Oklahoma Medical Center. Gerald Studebaker and Howard Ruhm served as my mentors, and Ruhm directed my dissertation but couldn't finish it as his son was in a bad accident and he had to take time off from work. Bruce Pierce, who was also on the faculty, assisted me with completing the dissertation.
Fabry: Boy, that couldn't have been an easy task for him, because you are the second-worst speller that I know.
Rose: I feel sorry for the worst then!
Fabry: That would probably be me, actually. Seriously, though, it couldn't have been easy for him to step in at that point and help you write up something that he didn't direct.
Rose: No, it wasn't, and he bled red ink all over numerous drafts of my dissertation, and we finally got something done that was acceptable to the graduate school and I finally convinced them to graduate me in 1964.
Fabry: After brief stints in California, Colorado, and Illinois, you found yourself in the sunny southeastern tropical portion of the state of Minnesota at the Mayo Clinic in Rochester. What do you consider your greatest accomplishment during your tenure there?
Rose: Well, I have long said that the best thing I ever did was to hire Wayne Olsen. He truly helped shape the profession in so many ways, and we were fortunate to persuade him to leave Northwestern University.
Fabry: Yes, you guys made quite a dynamic duo, and I was fortunate enough to land a CFY there. Among other things, you taught my about how to test hearing aid performance under earphones. I recall that during my first week at Mayo, I was supposed to be observing you in clinic, and you brought an 80 year-old lady down the hall, put her in the booth, and instructed me to do the testing. Air conduction testing provided an asymmetric loss with a very unusual configuration in the affected ear. This was, however, "the" Mayo Clinic, so I continued with word recognition testing, which was terrible in the poor ear. At this point, the butterflies in my stomach started fluttering madly, as I suspected that she had a tumor, Meniere's disease, or some unusual syndrome. When I walked in the booth, however, to change over to bone conduction, I could hear a faint whistling coming from under the right earphone, and when I removed it, discovered that she was still wearing her hearing aid on that side. All I could think to tell her was that she should remove the device so that we could retest and compare to the aided results, so that we could determine how well it was working for her. When I came out of the booth, you were rolling on the floor with laughter, and have maintained to this day that it was all part of my education. So, now is your opportunity to 'fess up - did you really mean to put the headphones on over that lady's hearing aid?
Rose: I'll never tell, but I do think that you learned a thing or two that day about clinical practice, right?
Fabry: Point taken. One thing that I will never forget was your very pragmatic approach to audiological testing, and your question of "How will what you do change the course of treatment?" guide me to this day. For example, I have always felt that the Mayo "short" lists, which were developed from 50-word W-22 lists, were an incredibly clever and efficient clinical modification. Can you explain how and why you developed them?
Rose: Well, there were a couple big challenges that we faced when I came to Mayo Clinic in 1970. The first was that, similar to many other medical centers at the time, the otologist dictated which audiometric tests were conducted, and the patients often "ping ponged" several times back and forth between Audiology and ENT during each visit. We felt that was very inefficient, and maintained that the audiologists should be given more authority in the decision process, with the understanding (and expectation) that I would take responsibility if we "over tested" the patient. It took time, but we developed an environment of mutual respect, and we improved clinical efficiencies dramatically. In effect, we moved from "prescriptive" to "best practices" audiologic evaluation. As you mentioned, another thing we investigated was the utility of 50-word speech recognition lists, especially when patients scored highly. So we did an item analysis of around 400 patients, and re-ordered the word lists to include the most difficult words first. If a patient got eight or more correct out of the first ten words, we found that that their score was not significantly different from the score obtained after all 50 words were delivered.
Fabry: That certainly makes sense, and must have saved a lot of time clinically. How was this received by the academic world?
Rose: I recall some rather heated debate after we presented the results at an ASHA convention in the late 70s. Drs. Carhart and Tillman were both present at the session which was chaired by Dr. John Gaeth, and Tillman argued that it is not possible to present a "phonetically balanced" word list with only 10 items. Carhart was a little more open to the idea, however, and suggested that it deserved further study. When I retired from Mayo they had been using them for around 30 years at Mayo Clinic, and to my knowledge patient care was never compromised.
Fabry: Another thing I have always admired is your willingness to take a stand on an issue that you believed in, especially if it challenged conventional wisdom. You were involved in a lot of the early cochlear implant work, and I remember being present at the initial stimulation of the first patient fit at Mayo with the Vienna extra cochlear implant.
Rose: Yes, and when we turned the current up enough for her to hear, her face twitched and she tasted metal; she was crying and I didn't know if it was because she was in pain or that she was hearing sound for the first time in years. Fortunately, it was the latter, and we were able to lower the current to eliminate the facial twitch. We did some good work, and implants have certainly improved since then.
Fabry: True, but I do recall a controversial paper that you published in 1994 regarding the use of cochlear implants with prelingually-deafened persons. Do you still stand by that paper?
Rose: Yes, it was an AJA Viewpoint paper, and it is as true now as it was then. Candidly, the goal of the paper was simply to challenge people to take time to stop and look at the data on cochlear implantation with pre-lingually deaf persons, on the basis of Lennenberg's Critical Stage Theory. MacCay Vernon had asserted that if you do not implant a child until age 7 or 8, they are unlikely to develop adequate speech and language skills to benefit substantially from cochlear implantation. In fact, in our simple survey we found that over half of the recipients with prelingual deafness that we contacted were no longer wearing their implants. In our opinion, this indicated that either the selection process, the habilitation process, or both, are flawed. Despite the improvements during the past 15 years, I still stand by that conclusion today. Fortunately today they have developed some tests that give a pretty good objective indication of how will a person will do with an implant. I am amazed at the progress they are making in that field.
Fabry: You also were a pioneer in the area of remote conferencing, having established the Mayo Video Conference twenty years ago. Some 100 presentations later, it is still going strong, and the faculty reads like a "Who's Who" of audiology. What inspired you to start this meeting, well before AO and internet conferencing were a gleam In Bill LaCalle's eye?
Rose: Well, I had long been the beneficiary of Mayo's travel policy, which in my opinion, remains the best in the profession, and enabled me as a busy clinician to hear some of the brightest minds in the field by attending conferences all over the country. That said, I knew that this was a privilege that a lot of others would never have, and I also never really cared to travel that much, so I thought it would be interesting to try to broadcast a high quality audiology meeting via satellite. Our best meeting, again in my opinion, was one devoted to hearing aids and the hearing aid industry, we enrolled over 100 recipient sites, but they have consistently averaged around forty locations. In the last couple years, they have even started to webcast, so Mayo is keeping up with the times and a new generation of audiologists. It's hard to believe we started this over 20 years ago!
Fabry: Yes, and I spoke at the first one, so you know what that means - we're both old! I know that you don't let any moss grow under you - what did you do to keep busy after you retired from Mayo?
Rose: First, I went on a Mormon mission to India, and I also taught at Osmania University in Hyderabad, where we helped start the master's degree program in Audiology there. My wife and I have served on several missions which has taken up a good deal of time and has been very rewarding for us at least. I also have done some work with the hearing aid industry, with Sonic Innovations.
Fabry: Yes, I seem to recall some early work that you did with a little "blue box" that housed a prototype of an early digital hearing aid in the mid-1980s. Hard to believe that things have progressed as they have - we even did a debate on the topic of digital noise suppression in 1992 called "In Search of a Digital Toaster".
Rose: Yes, and all these years later, I am still using an analog toaster, so your arguments weren't very persuasive.
Fabry: No doubt you still burn toast too. Well, that said, I think that it is time we wrap this interview up, but I want to close with a section we'll call "Quick Hits" by asking you to choose as quickly as possible between the two alternatives.
Rose: Fire away.
Fabry: PC or Mac?
Rose: I use PCs, although my first personal computer was an Apple IIe, and I think that they have always had better graphics.
Fabry: BTE or ITE?
Rose: I really like the new mini BTEs
Fabry: PTA or SRT?
Rose: have always found the PTA to be of more use
Fabry: Brett Favre or Steve Young?
Rose: Religious bias for Steve Young, but I think that Brett Favre will be judged as one of the best, if not the best ever, by the time he retires
Fabry: Paper or Plastic?
Rose: If you are talking about money, then paper. I was one of the last people I know to get a credit card, and once a hotel refused me service because I wanted to pay cash instead of using a credit card.
Fabry: Wow, and I'll bet that the room cost all of $20, knowing how frugal you are. Bone conduction: Mastoid or Forehead placement?
Rose: Mastoid, but I'm not sure I can defend anymore.
Fabry: baseball or hotdog
Rose: (laughs): I always started with baseball
Fabry: Inserts or Supra-aural?
Rose: Inserts, but it took a long time for me to get there.
Fabry: Stay up till 4 am, or get up at 4 am?
Rose: Get up
Fabry: Favorite pure-tone frequency?
Rose: 2000 Hz
Fabry: "Say the word" or "You will say"?
Rose: Neither - I never used carrier phrases
Fabry: Monaural or binaural?
Rose: Binaural
Fabry: Duct tape or Velcro?
Rose: Velcro
Fabry: Yes, I've seen your booth. I want to thank you for taking the time to talk with us today, and even more importantly, I want to thank you for being a mentor to me all these years. I don't know if you remember, but during the early stages of my CFY, I came into your booth and closed the door. I was feeling pretty insecure about my abilities, and you had teased me virtually every day about my lack of skills. Do you recall what you said when I closed the door and asked for your advice?
Rose: Yes - start worrying if I ever stop teasing you.
Fabry: Exactly. Fortunately for me, you never did!
Rose: My pleasure, Marfan Man.
