Interview with Audie Woolley M.D., Pediatric Otolaryngologist

Beck: Hi Dr. Woolley. It's a pleasure speaking with you again.

Woolley: Hello Dr. Beck, thanks for the opportunity.

Beck: I should explain ...Our paths have crossed many times. We met about a hundred years ago when I was on the faculty of one of the finer medical schools in St Louis and you were completing your residency at the other fine medical school in St. Louis. Where did you go to actually attend medical school?

Woolley: I went to medical school at the Health Sciences Center at the University of Texas in San Antonio, and I graduated in 1988, and of course, that's where you live.

Beck: Correct. And you completed your residency at Washington University in the mid-1990s?

Woolley: Yes. I finished in 1994 and then did a pediatric ENT fellowship at St. Louis Children's Hospital and graduated in 1995. I'm now at the Children's Hospital at the University of Alabama at Birmingham.

Beck: Excellent. I'd like to focus on direct bone conduction implants if you don't mind? I believe you've been implanting those for about three or four years, and I was wondering, based on your clinical observations, who are the best candidates for these devices?

Woolley: That varies quite a bit. Nonetheless, the ideal candidates are children with syndromes in which the outer or middle ear is unusual or perhaps absent -- and the inner ear is normal. In other words, we might have a child with bilateral atresia, or perhaps a syndromic child with middle ear/outer ear abnormalities.

Beck: So basically any maximal or significant conductive hearing loss is treatable with the direct bone conduction?

Woolley: In general, yes. Children with unilateral sensorineural hearing loss are candidates too, but those children are rare. I would guess that in the last three years, we've only implanted two children with unilateral sensorineural hearing loss, out of some 25 or so children we've implanted.

Beck: And I should clarify that children with unilateral deafness are also referred to as having "single sided deafness" (SSD), which I believe is a term that shows up more in the adult literature?

Woolley: Yes, that's right. Generally we think of SSD adults as being post-op acoustic neuroma patients, or perhaps head trauma patients, but yes, the term SSD applies to children and adults.

Beck: What do you anticipate as far as outcomes for people implanted with the direct bone conduction device?

Woolley: We've had wonderful results. Generally, we anticipate that implanted children will get within 10 or 15 decibels of normal hearing.

Beck: Wow! That is quite impressive. Have you had the occasion to use bilateral implants?

Woolley: Yes. I think we've done about 7 or 8 bilaterals, and the results have been good.

Beck: How do you decide whether to implant one or two devices?

Woolley: Well, I hate to say it, but it boils down to their insurance. If the child is covered for two, we prefer to implant both units because the child will get a better hearing result. But, if they're only covered for one, that's we do.

Beck: That's a pragmatic approach! I totally understand and I appreciate your frankness! I doubt anyone could build an argument indicating one is better or equivalent to two, but you're right, insurance is often the primary issue, not audition!

Woolley: That's how it seems to me. Certainly bilateral implants produce a better perception of sound and they allow the patient to understand better in noise, allow them to hear more naturally, and of course, bilateral hearing gives the patient some directionality...all of which are very important.

Beck: I agree. We face the same issue with respect to cochlear implants. It's clear from just about every patient that's been through it, that two cochlear implants are indeed, vastly superior to one, but insurance companies don't want to pay for them-- if they can avoid it. And of course, the same thing happens with hearing aids, too. There is no comparison between monaural and binaural results, binaural is vastly superior in every respect, but the "rate limitng" factor is often the insurance company.

Woolley: Yes, that's been our experience too. Another important benefit for both middle ear and cochlear implant patients is the better word recognition and speech discrimination scores, in quiet and in noise.

Beck: What's the FDA's minimum age requirement for implantation?

Woolley: Five years old, but we have gone under age 5 when the skull thickness is OK; meaning at least 3 millimeters or greater -- and we can confirm that with a CT scan. So yes, sometimes we go "off label" as long as the child is an appropriate candidate medically.

Beck: What about device failures?

Woolley: We had two children that we had to re-implant due to trauma to the site of the implant.

Beck: I'd bet that was a boy playing football?

Woolley: Well, yes, that's a pretty close guess. But , even in girls, we place "sleeper screws" so if the first one is damaged, there's another one in the same area and it can be used if and when needed. We put them both in at the same time, and that way we have a back-up, if needed.

Beck: That's a great idea. I've not heard of that before.

Woolley: Yeah it's pretty clever, and it's pretty much the standard these days.

Beck: I have to admit, I like the idea of having a spare. And I guess with kids, all the procedures are done in the OR? Not in the office?

Woolley: That's right. We like to have the child under general anesthesia and the procedure takes about 30 minutes. I highly prefer having the child under general, and it's really the only way to go with children.

Beck: Any osseo-integration issues?

Woolley: We had two cases of osseo-integration failure at the primary fixture. We used the "sleeper screw fixture" in both cases with good success.

Beck: Dr. Woolley, for patients who might want to get in touch with you, what's the best way to do that?

Woolley: Our office telephone number is (205) 824-4949 and the website address is www.chsys.org and all you have to do is follow the links to Pediatric ENT Associates.

Beck: Thanks so much Dr. Woolley, it really has been a pleasure working with you.

Woolley: Thank you too, Dr. Beck.

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For more information on the Children's Hospital at the University of Alabama at Birmingham visit their website.

For more information on Entific's direct bone conduction system, for use in people with chronic ear infections, congenital hearing loss and single sided deafness, visit the Entific website