Brian Gruber: Dr. Thomas Roland, Director of Otology and Neurotology, how was your field changed since you first gone into it?
Dr. Thomas Roland: It's a good question, my field initially ENT Otolaryngology, the ear part didn't get a lot of claim and it was it was a filed where you would take care some chronicle ear disease Mastoidectomies put tubes in children's ears. And over last sort of 30-40 years we have now advanced in and we have crossed brain barrier and we now are taking care of regions that might occur between the brain on the nerves of brain and the ear and the nerves of hearing imbalance. We are curing profound hearing loss which just 20-30 years ago was unheard of. And we are getting involved in lots of new devices and techniques that it can have profound effect on people's lives. My sub specially called Otology Neurotology just evolved. Just a few years ago we just had our first board examination that really defined on especially what body of information that we possess and skills that we have acquired. And it's a fascinating feel full of lots of nice gizmos and gadgets and also a lot of technology that really can benefit people on a big way.
Brian Gruber: And is NYU known for any particular advances in your field?
Dr. Thomas Roland: Yes, NYU is the first center in the East coast to implant a multi-channel cochlear implant back in the early 80's we are the largest probably the most productive of cochlear implant center in the country, in terms of numbers and in terms of the research that comes out of you that adds to the progression of the field. We also have one of the largest skull base surgery Acoustic Neuroma Centers in the country. There where we take care of patients that have tumor have grown in the nerves of hearing, imbalance in the facial nerve with very good outcomes, very short hospital stays where little disabilities from those procedures and we also just recently being designated as a nerve fiber Mastois type 2, centre of excellence where we trying to provide a comprehensive care involving all specialties and all aspects of the medical center to help these patients that have a very debilitating problem.
Brian Gruber: One another thing is that you have been focused on this the area of one sided hearing loss. What advances are there in that area?
Dr. Thomas Roland: Well the there is a couple of things that happening, number one is just a recognition of those things that can cause a single sided hearing loss. So what I am talking about is a patient no more healthy person wakes up one morning and one ear just doesn't working, its dead, it's ringing, there is a little bit of dizziness, something of that nature, and the idea is early intervention. Don't go to the go to your inter listening and encourage them to get to an Otolaryngologist right away because the earlier that you are intervening the better chance of positive outcome. And that require some testing, some some evaluation, maybe even some imaging to make sure that one doesn't have these tumors that I was talking about, and then early intervention to try to being back the hearing. Now if you do all those things and there isn't a tumor and that isn't really a substance that you can put your finger just because its most like the viral infection in your ear and we initiate anti-inflammatory treatment right away and sometimes we can get 70 percent of time we can bring back the hearing. But you have to be started early some like take all messages, if something is wrong with the ear, it's ringing while the ear the hearing isn't as good, the phone doesn't sound that same get attention early by someone whose getting that feel and you may have a better outcome and if you wait before too late.
Brian Gruber: And are there only certain medical centers where you have that level of specialization and talent or this is pretty these treatments pretty widespread across the medical community in the country?
Dr. Thomas Roland: Most good ENT specialists should know how to mange those problems initiate the workup, and then refer if you want to the sub specialists if they need crisis.
Brian Gruber: What is an Acoustic Neuroma?
Dr. Thomas Roland: Acoustic Neuroma is a benign tumor that grows a long side on the nerves of hearing imbalance between the brain where they out of the brain and ear where they end up. It usually grows on Schwann cells which are the insulating cells of a nerve. Every nerve has an insulating cell, which helps the action potential progressed on the nerve to central nervous system. So a gene goes or either and a clone of Schwann cells overgrows and just keeps growing until you do something about it. The first symptoms of Acoustic Neuroma could be ringing in the ear or sudden hearing loss or progressive hearing loss or some slight imbalance and you chose it diagnosed by some audiologic testing and an MRI with gadolinium enhancement. Sometimes we don't do anything about Acoustic Neuromas if they are small and sometimes we do something about them and the treatment options therefore could be observation, there are types of radiation therapy that is more commonly used and surgical removal.
Brian Gruber: How does a cochlear implant work?
Dr. Thomas Roland: A cochlear implant is a device that basically bypasses the inner year so in a normal individual, the sound goes down your ear canal strikes the drum it is transmitted through the drum to three bones of hearing to the inner ear so everything from the inner ear out is a conductive problem many problems there are whole in the ear drum in middle ear fusion, bad infection wax in the ear canal can all cause a conductive hearing loss and then from the inner ear in used to call that nerve deafness or sense we know we have hearing loss the cochlea doesn't function inside the cochlea there are delicate cells special cells called hair cells that convert a mechanical sound wave into electrical signals so that the brain could understand it. And that's where the problem is with most hearing loss most children are born deaf people loss hearing of lifetime from trauma or toxic effects or infections, old people loss their hearing with ageing its because the hair cell stop working so until recently when someone sort of reach the point where hearing aid no longer help you use to kind of try your hands up and said them sorry and may be go learn sign language and may be learn lip reading abilities and do your best and people grew very powerful and noisy hearing age and tried to get something out of it. So now what we do is we bypass the inner ear we put an electrode right into the cochlea and it takes the sound signal, it processes it stimulates the nerve directly and bypass the hair cell so presenting the sound to the central wiring directly so that one can hear.
Brian Gruber: That's sounds very complicated how does a procedure like that get developed, is that a a joint venture between outside companies, between universities, between scientists how does something that complex get resolved?
Dr. Thomas Roland: It is exactly what you said, it's a fusion of a lot of specialties of speech and language therapists, speech and language scientists, engineers and of surgeons and other professionals in the field of hearing have come together and they really helped advance this field. In the very early days someone had an idea if that see if we implant this if we can stimulate the central nervous system and get hearing, Volta in the 1700 I think put a an electrical rod in each ear, turn on a battery and got a shock inside he heard sound and that was probably the first recorded evidence of what later became may be a cochlear implant, that if you electrical stimulate inner ear you can actually get sound and over the - until late 60s that people actually started early trials of implanting electrodes in different parts of the artery system thus trying to get information, about 1984 the first cochlear implants became FTA approved for generally used in adults and in 1988 for children and these were devices that had multiple channels, that would access the tunnel topic organization of the cochlear meaning that there is high sound, high tones in one area and low tones in another so if you get electrodes in their to access those sets, you might be able to improve someone hearing ability, the very early devices may be people got some sound awareness the early devices may be people got some sound awareness, got some tone but now our expectations are much greater than we expect a child who is born deaf implanted to main stream in the school to abnormal hearing and normal speech and really stay on power with language development as a normal hearing peer.
Brian Gruber: Broadly speaking are there forms of prevention or lifestyle that can aid one in keeping good hearing into old age?
Dr. Thomas Roland: Yes. In general what's good for the body is good for the ears so keep blood pressure and blood sugar and cholesterol those things under good control. Secondly the single biggest cause of hearing loss in this country is noise exposure so if you think about the I pod generation and the lap - if you are standing next to someone who has an I pod in their ears and you are hearing their sound, it's too loud and they are bumping off hair cells they are damaging their ears so it's good feel to be in - No because they are all future no just - no but there is there is some interesting aspects for example i-pods sold in Europe have a setting where they can't go more than 80 decibels. Americans don't have that law. You can actually program your i-Pod to have a upper cut off. Most people don't. So
Brian Gruber: So if you are an American who went to a lot of rock concerts in your youth and you have a great stereo system and you listen to a lot of loud music that may have an impact as you get old age.
Dr. Thomas Roland: It most likely will.
Brian Gruber: So change of music is one that
Dr. Thomas Roland: Or change in volume is the most important thing. Any thing over about 95 decibels for prolonged periods of time is damaging.
Brian Gruber: Things on the horizon that you are excited about in your field?
Dr. Thomas Roland: A couple of things, the advancements in cochlear implants for example they are getting smaller. They are getting smarter, we are getting better and better results, more implanting people with more and more hearing so in another words in the early days you had to be sort of stone deaf and cannot hear a thing. And may be you are lucky if you could understand a few spoken words, now we are implanting people with relatively you know, better degrees of hearing that you get some benefit from hearing aids still getting great results, we are working on hybrid devices, so the people who have lets say low frequency hearing but no high frequency hearing, they still could enjoy music and the qualities of sound that the normal hearing mechanisms can give them. We now implant a small electrode that we are giving back the high frequencies and speech understanding and they keep their laws So you can do auditory and electrical stimulation in the same ear. So there may we may see more and more people become candidates for this technology as it advances for these nerve neuromatosis kids for example, they lose their nerves of hearing so they can't get Cochlear implants. We have something called an Auditory brain stem implant and a mid brain implant. So we are looking at other places along that auditory pathway that we can get a signal into to try to help them, if they can't benefit from Cochlear implants.
Brian Gruber: What do you like most of that when your work?
Dr. Thomas Roland: It's nice not to say take things away from people but to give something back. So to give someone back hearing is a quite remarkable thing. Adults who have lost hearing and get a Cochlear implant uniformly become tearful during their first activation because they can't believe it, they can talk to their grand children and their family again and understand speech. To see an anxious, nervous parent who brings an infant and who can't hear and they are looking and they suddenly say "what do we do with the deaf child, then how do we educate this child" and all the things that must counter up. You now can intervene us well, wait a minute, we think we have something for you. lets do some testing and then you watch that child progress and three years later, you say "don't forget to come back and see me next year" and Billy turns around and says "don't worry doctor, Ronald I won't" and it's really quite remarkable so that's part of the most rewarding thing on a day to day basis. I think our other work in the neuroforum prometosis world is is the different end of the spectrum, we are dealing with a really debilitating orphaned disease doesn't get a lot of attention. We are trying to make some head way, trying to may be stay well off the progression of this disease, provide hearing, prevent hearing loss, take out tumors may be they are a very small one, that are less aggressive surgeries with less bad outcomes, most defects from the surgery.
