Interview with Jay McSpaden Ph.D.
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AO/Beck: Hi Jay. Thanks for taking the time to speak with me.
McSpaden: Happy to do so Doug.
AO/Beck: Jay, I know you have a diverse and interesting background, and I know you're an excellent story teller. I was hoping you'd tell me a little about your professional history and your education? And then we'll play Twenty Questions - I'll give you a question or a topic, and you tell me your thoughts.
McSpaden: Sure. This sounds like a lot of fun.
AO/Beck: OK, let's start with your educational and professional background. Please tell me a little about how you got into the profession?
McSpaden: I actually started out to be an electrical engineer and I spent two years at the University of Kansas. Soon after that I decided to go into English Literature - because most of the engineers I knew couldn't write a straightforward sentence. Of course by the same token, most of the English lit majors couldn't screw a light bulb into a socket without written directions! I was one of those people who didn't know exactly what I wanted to do. Anyway, after 4 years of education, I got married and joined the Marines.
Making a long story short, I left the military in 1964, moved to Oregon and went to work as a security guard. After a little while I went back to school and graduated in 1967 from Mount Angel College. Later that year, the program director of the Teacher Preparation program for Teachers of the Deaf asked me what I was going to do for the next year, and when I told her I had no idea, she mentioned there was a grant available. I'm not one of those people that think things happen to me, I'm one of these people that believes people happen to me. It was during that time that I took my first course in audiology. I realized that I was far more interested in why people were deaf and hearing impaired, rather than teaching them academic subject matter.
My interest in audiology started there and grew like crazy. In fact it was about that time that a friend of mine stopped me and bet me ten bucks that I didn't have the guts to apply for a doctoral program. I needed the ten bucks - so I applied! Oddly enough, they accepted me, and I became a VA trainee in Seattle. All of a sudden, we were expecting our third child, I was working, going to school, and I was a doctoral student. It was great.
AO/Beck: So am I correct that you graduated in June of 1971 with your doctorate from the University of Washington?
McSpaden: Yes, that sounds about right, and I got my master's in August of 1968.
So then of course the next hurdle in the Spring of 1971 was to get a job!. I sent a copy of my vita to Dr James Jerger, and as it happened, he had an opening. In fact, my vita arrived on his desk one week after they decided they needed a new PhD for the VA in Houston. Dr Jerger called me, and I interviewed and I got the job. I was very happy to get the position because that VA hospital, at that time, was the third largest VA hospital in the world. So I started in August of 1971 and spent 4 days seeing patients, and 1 day a week with Dr Jerger in the lab. It was a fantastic situation and I did that for five years.
In fact, I probably learned more from Dr. Jerger in the first 6 months there, than I did in my entire academic and professional career up to that point. It was late spring 1976 or so, and I was in my mid 30s, I was the Chief of Audiology and Speech Pathology at the VA hospital, and I was at the top of the GS scale, and it was apparent to me that if I didn't do something drastic, I was going to spend the next 30 years pushing paper!
AO/Beck: So which drastic thing did you do?
McSpaden: I resigned - and I had no other job! But I just felt like I needed to get out of there, and, - I did. Soon after that I was teaching at the University of Maryland to cover for Dr.Hayes Newby - while he was on sabbatical for a year. It was a great place to be, and I really enjoyed it. So, that's a little about my beginnings, and that's probably more than you wanted to know!
AO/Beck: Well actually, that is a lot of information, but it's been fun to listen to. Nonetheless, I will switch subjects and we'll go to the Twenty Questions if you don't mind, and before we run out of time!
McSpaden: OK, let's do it.
AO/Beck: Very good. New subject - What do you recommend as test battery for CAP?
McSpaden: Obviously we need to do the standard audiometric evaluations, but after that, I like to do the following on every patient - and by the way, I use this as a CAP screening test - I do monaural speech discrimination testing (at MCL) with masking in the non-test ear, on the right, the same on the left, and, I also do binaural discrimination testing.(at binaurally balanced MCL)
If the binaural discrimination score is not equal to or better than the best monaural score, there's a CAP issue there. In 20 years of doing that, I have never seen this fail me. If a CAP problem is present, my first choice is the SSW to localize and characterize the disorder. As you know, there are an almost infinite number of tests you can do, and unfortunately, you have only a finite amount of time within which to do those tests, so I go to the SSW because it is quick, efficient, accurate and it has been normed .
You know how it was in grad school and maybe some university clinics...you might spend 2 hours testing the patient, and maybe two weeks writing the report, but in the real world, that doesn't work! You have to know what you're doing, and know how to do it quickly and efficiently.
AO/Beck: What are your thoughts on digital hearing aids?
McSpaden: I have been fitting hearing instruments for more than 30 years. I have fit analog, and hybrids, compression and linear. The history of hearing instruments ( up until 7 or 8 years ago or so) was a history of hardware! The future of hearing instruments is about the software! We need digital hearing imstruments to push everything forward and the learning curve can be steep. Of course, not everyone needs a digital hearing instrument.
There are still some good analog devices out there, and, there are good programmables as well. But - yes, digitals are the future and digital technology allows us to better satisfy the needs of the patients. The important thing is to realize that we don't fit ears, we fit the brain. That is a very important concept. Regardless of the hearing instrument, you need to set the instrument to the preferences of the patient, and to maximize the input so the brain gets a comfortable sound which it can use! Another issue is that many of us are often using 21st century technology, but we often apply it with 20th century fitting protocols.
I have no desire to practice the history of this profession. We need to better understand the technology, and the human auditory system. We need to continue to explore new and better fitting techniques. In particular, we need to fit the patient, NOT the audiogram!
I have patients with severe and profound hearing losses with thresholds of 100 dB or more wearing digital CICs, and they are doing a fantastic job. Conversely, I have patients with thresholds at 15 dB or better who have significant hearing problems - and I have also fit them with hearing aids. Again, it is not the ear - it's the brain!
AO/Beck: What can you tell me about tinnitus and hearing aid patients?
McSpaden: I try never to put an instrument on a patient with tinnitus unless the frequency response of the instrumrnt covers the center frequency of the tinnitus. I think one of the things we need to address, and this gets little attention, is the issue of the noise floor of hearing aids - and this is important for tinnitus patients! Some of the digital hearing aids don't do as well with some of the tinnitus patients because the hearing aid has too quiet of a noise floor. It would be great if we had the ability to turn the noise floors up and down for masking tinnitus in the appropriate patients (such as peripheral, tonal tinnitus patients).
Tinnitus is the analog of pain, along the auditory pathways. We can discuss this in detail at another time, but it is a very important concept. I have seen more than one patient threatening suicide in my years practicing, and almost everyone one of them has had severe, intractable tinnitus!
AO/Beck: I never have any idea what you are about to say! OK, next issue --
What about diabetes and hearing loss? Any thoughts there?
McSpaden: Sure, I know there is a very strong correlation between diabetes and hearing loss. In fact, we are coming to believe that what we often call phonemic regression may well be the central effects of long standing, severe diabetes.
Yes, I totally believe there is a strong relationship between hearing loss and diabetes, and also with other problems in the auditory system. For example, when their blood sugar gets out of control, there can be a sensitivity shift in hearing of some 15 dB, and the thresholds improve as the blood sugar gets more and more under control.
AO/Beck: Please tell me your thoughts on newborn hearing screenings?
McSpaden: I am very impressed with newborn screenings and I think the people involved should be applauded and I wish we had started it 20 years sooner! It is very important and effective and we should continue with it full speed ahead.
Additionally, we need to do full audiometric batteries on each and every patient who has a questionable result. - not just screenings. In fact, we really need to do OAEs on every hearing aid patient too, to help differentiate between those with peripheral damage and those with central damage. You know finding the answers isn't that hard. The hard part is learning what the right questions are!
AO/Beck: What about AAA, ASHA and the relationship between the professional groups?
McSpaden: Audiology is one of those rare professions that (unfortunately) likes to eat it's own young! We need to work together as a profession for the benefit of the patient. It's that simple. The only person that matters is the patient. I think when we focus on political squabbles and turf wars we are ignoring the important issue - the patient, their needs and well being! Politics really bores me to death, it is much ado about nothing. We need to learn the first rule of medicine First, do no harm .
We need to be professionals. Audiologists, Hearing Instrument Specialists and Physicians. We need to work together and focus on the patient, and nothing else really matters.
AO/Beck: Dr McSpaden, you are a joy to speak with. I hate to cut this short, but we are running out of time.
McSpaden: That's OK, I appreciate the opportunity to speak with you.
AO/Beck: It really has been fun and informative for me. Thanks for your time.
McSpaden: Happy to do so Doug.
AO/Beck: Jay, I know you have a diverse and interesting background, and I know you're an excellent story teller. I was hoping you'd tell me a little about your professional history and your education? And then we'll play Twenty Questions - I'll give you a question or a topic, and you tell me your thoughts.
McSpaden: Sure. This sounds like a lot of fun.
AO/Beck: OK, let's start with your educational and professional background. Please tell me a little about how you got into the profession?
McSpaden: I actually started out to be an electrical engineer and I spent two years at the University of Kansas. Soon after that I decided to go into English Literature - because most of the engineers I knew couldn't write a straightforward sentence. Of course by the same token, most of the English lit majors couldn't screw a light bulb into a socket without written directions! I was one of those people who didn't know exactly what I wanted to do. Anyway, after 4 years of education, I got married and joined the Marines.
Making a long story short, I left the military in 1964, moved to Oregon and went to work as a security guard. After a little while I went back to school and graduated in 1967 from Mount Angel College. Later that year, the program director of the Teacher Preparation program for Teachers of the Deaf asked me what I was going to do for the next year, and when I told her I had no idea, she mentioned there was a grant available. I'm not one of those people that think things happen to me, I'm one of these people that believes people happen to me. It was during that time that I took my first course in audiology. I realized that I was far more interested in why people were deaf and hearing impaired, rather than teaching them academic subject matter.
My interest in audiology started there and grew like crazy. In fact it was about that time that a friend of mine stopped me and bet me ten bucks that I didn't have the guts to apply for a doctoral program. I needed the ten bucks - so I applied! Oddly enough, they accepted me, and I became a VA trainee in Seattle. All of a sudden, we were expecting our third child, I was working, going to school, and I was a doctoral student. It was great.
AO/Beck: So am I correct that you graduated in June of 1971 with your doctorate from the University of Washington?
McSpaden: Yes, that sounds about right, and I got my master's in August of 1968.
So then of course the next hurdle in the Spring of 1971 was to get a job!. I sent a copy of my vita to Dr James Jerger, and as it happened, he had an opening. In fact, my vita arrived on his desk one week after they decided they needed a new PhD for the VA in Houston. Dr Jerger called me, and I interviewed and I got the job. I was very happy to get the position because that VA hospital, at that time, was the third largest VA hospital in the world. So I started in August of 1971 and spent 4 days seeing patients, and 1 day a week with Dr Jerger in the lab. It was a fantastic situation and I did that for five years.
In fact, I probably learned more from Dr. Jerger in the first 6 months there, than I did in my entire academic and professional career up to that point. It was late spring 1976 or so, and I was in my mid 30s, I was the Chief of Audiology and Speech Pathology at the VA hospital, and I was at the top of the GS scale, and it was apparent to me that if I didn't do something drastic, I was going to spend the next 30 years pushing paper!
AO/Beck: So which drastic thing did you do?
McSpaden: I resigned - and I had no other job! But I just felt like I needed to get out of there, and, - I did. Soon after that I was teaching at the University of Maryland to cover for Dr.Hayes Newby - while he was on sabbatical for a year. It was a great place to be, and I really enjoyed it. So, that's a little about my beginnings, and that's probably more than you wanted to know!
AO/Beck: Well actually, that is a lot of information, but it's been fun to listen to. Nonetheless, I will switch subjects and we'll go to the Twenty Questions if you don't mind, and before we run out of time!
McSpaden: OK, let's do it.
AO/Beck: Very good. New subject - What do you recommend as test battery for CAP?
McSpaden: Obviously we need to do the standard audiometric evaluations, but after that, I like to do the following on every patient - and by the way, I use this as a CAP screening test - I do monaural speech discrimination testing (at MCL) with masking in the non-test ear, on the right, the same on the left, and, I also do binaural discrimination testing.(at binaurally balanced MCL)
If the binaural discrimination score is not equal to or better than the best monaural score, there's a CAP issue there. In 20 years of doing that, I have never seen this fail me. If a CAP problem is present, my first choice is the SSW to localize and characterize the disorder. As you know, there are an almost infinite number of tests you can do, and unfortunately, you have only a finite amount of time within which to do those tests, so I go to the SSW because it is quick, efficient, accurate and it has been normed .
You know how it was in grad school and maybe some university clinics...you might spend 2 hours testing the patient, and maybe two weeks writing the report, but in the real world, that doesn't work! You have to know what you're doing, and know how to do it quickly and efficiently.
AO/Beck: What are your thoughts on digital hearing aids?
McSpaden: I have been fitting hearing instruments for more than 30 years. I have fit analog, and hybrids, compression and linear. The history of hearing instruments ( up until 7 or 8 years ago or so) was a history of hardware! The future of hearing instruments is about the software! We need digital hearing imstruments to push everything forward and the learning curve can be steep. Of course, not everyone needs a digital hearing instrument.
There are still some good analog devices out there, and, there are good programmables as well. But - yes, digitals are the future and digital technology allows us to better satisfy the needs of the patients. The important thing is to realize that we don't fit ears, we fit the brain. That is a very important concept. Regardless of the hearing instrument, you need to set the instrument to the preferences of the patient, and to maximize the input so the brain gets a comfortable sound which it can use! Another issue is that many of us are often using 21st century technology, but we often apply it with 20th century fitting protocols.
I have no desire to practice the history of this profession. We need to better understand the technology, and the human auditory system. We need to continue to explore new and better fitting techniques. In particular, we need to fit the patient, NOT the audiogram!
I have patients with severe and profound hearing losses with thresholds of 100 dB or more wearing digital CICs, and they are doing a fantastic job. Conversely, I have patients with thresholds at 15 dB or better who have significant hearing problems - and I have also fit them with hearing aids. Again, it is not the ear - it's the brain!
AO/Beck: What can you tell me about tinnitus and hearing aid patients?
McSpaden: I try never to put an instrument on a patient with tinnitus unless the frequency response of the instrumrnt covers the center frequency of the tinnitus. I think one of the things we need to address, and this gets little attention, is the issue of the noise floor of hearing aids - and this is important for tinnitus patients! Some of the digital hearing aids don't do as well with some of the tinnitus patients because the hearing aid has too quiet of a noise floor. It would be great if we had the ability to turn the noise floors up and down for masking tinnitus in the appropriate patients (such as peripheral, tonal tinnitus patients).
Tinnitus is the analog of pain, along the auditory pathways. We can discuss this in detail at another time, but it is a very important concept. I have seen more than one patient threatening suicide in my years practicing, and almost everyone one of them has had severe, intractable tinnitus!
AO/Beck: I never have any idea what you are about to say! OK, next issue --
What about diabetes and hearing loss? Any thoughts there?
McSpaden: Sure, I know there is a very strong correlation between diabetes and hearing loss. In fact, we are coming to believe that what we often call phonemic regression may well be the central effects of long standing, severe diabetes.
Yes, I totally believe there is a strong relationship between hearing loss and diabetes, and also with other problems in the auditory system. For example, when their blood sugar gets out of control, there can be a sensitivity shift in hearing of some 15 dB, and the thresholds improve as the blood sugar gets more and more under control.
AO/Beck: Please tell me your thoughts on newborn hearing screenings?
McSpaden: I am very impressed with newborn screenings and I think the people involved should be applauded and I wish we had started it 20 years sooner! It is very important and effective and we should continue with it full speed ahead.
Additionally, we need to do full audiometric batteries on each and every patient who has a questionable result. - not just screenings. In fact, we really need to do OAEs on every hearing aid patient too, to help differentiate between those with peripheral damage and those with central damage. You know finding the answers isn't that hard. The hard part is learning what the right questions are!
AO/Beck: What about AAA, ASHA and the relationship between the professional groups?
McSpaden: Audiology is one of those rare professions that (unfortunately) likes to eat it's own young! We need to work together as a profession for the benefit of the patient. It's that simple. The only person that matters is the patient. I think when we focus on political squabbles and turf wars we are ignoring the important issue - the patient, their needs and well being! Politics really bores me to death, it is much ado about nothing. We need to learn the first rule of medicine First, do no harm .
We need to be professionals. Audiologists, Hearing Instrument Specialists and Physicians. We need to work together and focus on the patient, and nothing else really matters.
AO/Beck: Dr McSpaden, you are a joy to speak with. I hate to cut this short, but we are running out of time.
McSpaden: That's OK, I appreciate the opportunity to speak with you.
AO/Beck: It really has been fun and informative for me. Thanks for your time.
