Interview with Harold Pillsbury M.D., Department of Otolaryngology, University of North Carolina Medical Center
AO/Beck: Good Morning Dr. Pillsbury. It's an honor to work with you. I'd like to start with a little bit about your professional history please. Where did you go to medical school?
PILLSBURY: I went to college from 1965 to 1968 at George Washington University. From 1968 to 1972 I was in medical school at the same place. I did my internship and residency here at University of North Carolina at Chapel Hill. I spent four months in Zurich studying with Dr Fisch, and then I went on the faculty at Yale and I stayed there for five and a half years. In 1982 I came here as the Associate Division Chief and then I became the Division Chief in '83. We just became a department last year so I've been a Department Chairman for one year.
AO/Beck: Well that's a quick and impressive history. So you're going on 20 years now at UNC Chapel Hill. How big is the department?
PILLSBURY: We have 95 people working here; 15 faculty, 15 residents, 8 audiologists, 8 Ph.D. researchers, and the rest are technicians, nurses, secretaries, and that sort of thing.
AO/Beck: When did you start the cochlear implant program?
PILLSBURY: I took Bill House's course in Los Angeles in 1982, and then in 1984, soon after the FDA approved cochlear implants, I did my first one here.
AO/Beck: Can you tell me what you told patients about reasonable expectations 18 years ago, and perhaps compare that to what you tell them today?
PILLSBURY: 18 years ago I told patients it would be great if they were able to hear environmental sounds and knew where things were in space based on sound, you know, the ability to localize. I was going to be happy if they could just perceive a few things. The difference between then and now is just huge. It's unbelievable.
AO/Beck: Absolutely, I agree. I can recall being thrilled back in1984, if a cochlear implant patient could understand my voice with lip reading. Of course now, the majority of the patients can use the telephone. It really has come full circle. Who are the ideal cochlear implant candidates in 2003?
PILLSBURY: Well the ideal candidates are still people who are post-lingually deafened. In fact, we have a tremendous number of post-lingually deafened adults who really are poor candidates for hearing aids but now all of a sudden they've become great candidates for cochlear implants. And I'm very pleased with how most of these people have done. They have been remarkable and we've implanted many of them.
AO/Beck: Okay. What do you tell patients as far as the time between the surgical date and the initial tune-up date?
PILLSBURY: I usually tell them about a month but some of these patients are ready sooner. We've tuned up a few patients after only two weeks.
AO/Beck: Dr Pillsbury, what about post-op complications? How big an issue is that at this point and what are the most common complications?
PILLSBURY: Well, it's not a big issue these days because we're pretty good at doing them. We've done almost 800 cochlear implants here. The only problem we really worry about is hematoma, and we see that rarely. We have become meticulous with the bipolar coagulator and we really are in pretty good shape.
AO/Beck: And if you're going to have a hematoma, which is a pooling of blood under the skin, that's usually within the first 60 minutes of closing, isn't it?
PILLSBURY: Right.
AO/Beck: And what about post-operative pain? Is that a significant problem?
PILLSBURY: Well, that really isn't an issue any longer, because we inject the site pre-op, and that lasts for 24 hours, and we put a big dressing on these patients and the big dressing shields the wound against trauma.
AO/Beck: Of your 800 patients, Dr. Pillsbury, how many would you say you've implanted in the last year or so?
PILLSBURY: We've done between 100 and 120 a year for the last two or three years.
AO/Beck: What do you tell patients regarding telephone use?
PILLSBURY: I tell them they should probably be able to use a telephone after an appropriate amount of time and aural rehabilitation. I've had very few problems with that.
AO/Beck: What about bilateral implants - your thoughts on that?
PILLSBURY: It depends on who the child is and what the situation is. I've never had an adult patient with bilateral implants that ever wanted to give one back! All the patients I'm familiar with use both of them and they're grateful to have them. So I think bilateral implants would be the way of the future if we didn't have all the hassles with the insurance industry, that's where the real problem is. The benefit is unquestionable but the insurance issue is a real problem.
AO/Beck: Dr. Pillsbury, it's a pleasure speaking with you. I know you've got to run, but thanks so much for your time.
PILLSBURY: You're welcome Dr. Beck. Glad I was able to help.
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