Dr. Will Dade recalls the moment he decided to become an audiologist instead of a speech pathologist. He was in graduate school studying the latter at Ohio State University and, as part of a lesson plan, worked with one female patient all semester.
"I could tell she was quite an intelligent lady and she had had a stroke," Dade said. "She was a paralegal or legal secretary and I worked all quarter with her trying to get her to say refrigerator."
That's when the Ohio native realized that the milestones achieved by those with speech problems were often so slow coming. At the same time, he was involved in audiology practicum.
"You pick out several hearing aids and the patient comes in and you try them on, and just immediately you see improvement," said Dade, 57, a Midland resident.
So change gears he did, setting out on a career path that would include 25 years in the U.S. military -- six on active duty and the balance in the Army Reserves -- and three decades as a Department of the Army civilian. He would spend plenty of time at medical facilities in Würzburg, Germany -- three years as a military chief of a clinic -- meeting his future wife, herself a speech pathologist.
After working a year for the Department of Veterans Affairs in Panama City, Fla., he landed at Fort Benning's Martin Army Community Hospital in 2005. He retired from there two years ago, but had already started a private practice on the side on Woodruff Road.
"I was just seeing patients here and there, moonlighting to see if this is what I wanted to do," he said. "It's a needed profession, and our brand is we try to meet the needs of everybody, regardless of income. I do it as a business, naturally, to make money, but I also like to help."
That assistance includes offering his audiology services at various health fairs, part of what the doctor calls his "help ministry."
In January, Dade relocated his Hearing Diagnostics & Solutions clinic to 3645 Gentian Blvd., tucked inside a small strip center. It is there that the Ledger-Enquirer visited with him recently to discuss his job as an audiologist.
For those considering the profession, the U.S. Bureau of Labor Statistics says there are about 13,000 audiologists practicing nationwide in various health-care facilities, hospitals and schools. Another 4,300 audiologists will be needed by the year 2022, the BLS estimates, making the occupation's growth "much faster than average," with a current median salary of $69,720 per year.
Statistics compiled by the National Institute on Deafness and Other Communication Disorders show about 2 percent of adults between the ages of 45 and 54 have hearing loss considered "disabling." The rate increases with age, with nearly 25 percent of those between 65 and 74 in that category. For children, about two to three out of 1,000 born in the U.S. have some "detectable" hearing loss in one or both ears, a dilemma that can negatively impact speech development.
This interview with Dr. Dade is edited a bit for length and clarity.
It sounds like you've been fortunate to have good assignments?
I really have had a wonderful career, and been stationed in different places and worked with a variety of populations, from pediatric to geriatric. It's just been rewarding working with family members, with children with developmental delays, and with soldiers, getting them combat ready and preserving their fighting strength.
What kind of patients do you see in Columbus?
It's a pretty good mix here. We see lots of patients from the base, children as well as retirees and active-duty soldiers. And we take care of people here in the community with no affiliation with the military.
Do people take their hearing for granted for the most part?
Hearing loss is very insidious. It's so gradual that people don't realize they have it until it's too late. It's really significant others that are first alerted to the patient's inability to hear. The person who can't hear, it's easy for them to say: 'Huh? What did you say?'
I think people sometimes say 'huh' simply out of habit?
That's true, too. But oftentimes hearing-impaired individuals are the last to realize it. Everybody else mumbles. They turn away. They whisper. They talk softly. And they've got a number of complaints about others. They never think, 'Perhaps I can't hear.' So many people are reluctant to get help because there's still a stigma with hearing aids. They feel those are mostly for older people. That's not the case.
Do youths sometimes get hearing aids?
We put hearing aids on infants, as soon as we identify the hearing loss. Georgia now is one of the states where it's mandatory for infant hearing screening. Within the first three months, a child should be tested and intervention started.
It's critical to get on top of any problems quickly?
Exactly. The prognosis is always better if you intervene early. You can get the children aided and get them hearing sounds, whereby they will develop speech.
What's a classic case when a child doesn't get diagnosed early or properly?
There are critical periods for speech and language development. And if they're not diagnosed, if they're outside of that critical window, then their speech development is going to be delayed.
Once you lose hearing, is it gone forever?
That's the case depending on the type of hearing loss. If it's a conductive type of hearing loss, say there's blockage of ear wax in the canal or otitis media, or fluid behind the eardrum, that can be recovered. That's a temporary type of hearing loss and it's corrected through medicine, or either the doc or myself going in and removing impacted ear wax. Or the doc drains the ear and puts pressure equalization tubes into the ear, and then the child is able to hear.
Are there crystals inside your head that can affect balance and cause dizziness?
Those are the otolith crystals and those are associated with balance. I see some of those patients. There's the Epley maneuver where you position the patient's head to put the crystals back in place. The way I explain that to people, I compare it with a level, and you've got an air bubble in there and when you've got it between the lines, you're level. Well when those crystals come out, it sends a message to the brain that you're moving and you're off balance. It just happens. Sometimes it's associated with a head blow.
What about the military and weapons firing. Is hearing impacted? Are loud concerts just as bad?
It could be any and all of the above, or a combination. You've got war fighters here at Fort Benning with the Armor and the Infantry, and usually it's the large guns or IED blasts (that cause hearing loss). They come in and there's typically a high-frequency hearing loss, depending on the amount of exposure. And it goes down into the mid- and low frequencies. You were asking if hearing loss is permanent. That type of hearing loss is permanent; noise-induced hearing loss is permanent.
Today, mobile devices are prevalent with ear buds. Is damage from loud music from that something you're seeing more of these days?
Yes, we see higher incidences of hearing loss in adolescents and teenagers based on that. Here's what I tell the children. It's not the device that is causing the hearing loss. It's the volume. So if you're wearing ear buds and the person next to you can hear it, then it's too loud. If you're listening to a personal listening device, you should be the only person who can hear it, and that's usually appropriate.
What about tinnitus, ringing in the ears -- is that growing in prevalence?
It is. I think people are more noise-exposed. Our society is so much more inundated with noise than it was. I heard a presentation at a conference several years ago about the bird song. It used to be that you could go just about anywhere and you could hear nature. You could hear the birds sing. And now if you do hear them, you also hear an airplane going overhead or something like that. There's no pure natural sound anymore. Everything's adulterated with some type of equipment going, fans blowing or generators.
How many patients do you see on average?
It depends on the day, but a day for one audiologist is about 10 patients. That's pretty busy, because it takes about 35 to 45 minutes to see a patient and then 10 or 15 minutes to bill and code.
What's the most challenging aspect of your job?
I think the most challenging thing for me is when you get someone and they have profound hearing loss, and although technology is advanced and very improved, you still can't take a profoundly impaired hearing person and have them hear like they did when they were 20, no matter what level of technology you put on them.
Now there are cochlear implants. Science has improved to where if you're completely deaf, you can get a cochlear implant and you can still hear. It's not like what you and I hear. But you can still make use of this device and the auditory nerve to hear.
But what's really frustrating is when I get that patient who's not quite ready for a cochlear implant, but they're profoundly hearing impaired, and trying to get the hearing aids right for them to be able to function on a day-to-day basis. That's challenging.
How do you accomplish that?
It's a long process and it's a trade-off. You trade off gain for tolerance. At times a patient needs more gain (volume), but as soon as you take the gain up, they complain that it's too loud. And not always does the volume give the patient comprehension because the clarity is lost sometimes when you drive so much sound into the ear.
What is most rewarding about your job? What do you enjoy most?
When I put amplification on someone and their eyes light up, particularly children. I remember when I was working in pediatric audiology, a developmental pediatrician had misdiagnosed a child and said that she was autistic. The consult read: 'Oh, she kind of just looks through people, with no responses or verbalizations.'
That's why early intervention is multidisciplinary. If a child shows up in a clinic with one problem, then they're to be evaluated for everything.
So after the child came to my clinic and I did the hearing examination, I found that she was severely and profoundly hearing impaired. I put the hearing aids on her and all of a sudden she was smiling and started to verbalize. I explained to (staff) in a team meeting that the reason she was staring was she was trying to read lips. People were making mouth movements.
This child was aided late because no one knew what was going on. We got her and she was about 2 and half year old. That's kind of late to start getting sound. But within a year she had started developing speech.
Is technology changing in audiology or have we gone as far as we can in the near future?
Oh, no. These digital instruments that we're putting on patients today, it's like having a laptop on each ear. The technology is just so sophisticated. And you can (program) those devices to meet the exact needs of those patients in terms of gain at various frequencies, compression to keep the hearing aids from getting too loud, or boosting the sound up at some frequencies.
Hearing aids are now like computers. The technology is changing at least every six months. With the Bluetooth technology, you can have hearing aids where you can stream information from your computer, your iPod, your iPad. You can answer the phone with your hearing aids. Technology will advance to infinity. As computer technology advances, so will hearing aids.
Part of your philosophy is to make care affordable for the average person. Are those high-tech aids out of the reach of some people financially?
Yes. But we are now putting digital aids on everybody. And just 10 years ago, everybody couldn't get a digital hearing aid. So the prices are coming down, and I try to see that everybody is amplified and there's some level of technology for everybody.
I also support the Hear Now program, whereby I do so many pro bono cases a year. So if someone comes in and they need hearing aids and they just absolutely can't afford anything, there's a $200 application fee and I'll get the hearing aid from the Starkey (Hearing Foundation) manufacturer, and I'll put the hearing aids on, provide my services for free so they can hear.
And we've got CareCredit for people who can't pay all at once. Over time they can pay. So we provide that for them.
Of course, we accept most insurances. A lot of people have insurance plans that cover hearing aids, and yet they're unaided and saying hearing aids cost too much. My message to them is come in, let us vet your insurance plan and see if the insurance will cover it, and you may pay nothing or some. But at least come in and let's start with an examination.
How is your hearing? Is it 100 percent? Do you test yourself?
I have not tested myself. But I told you I have 25 years in the military, so I have had some noise exposure. I'm a right-handed shooter. I've got a noise notch in the left ear, about 45 to 50 db (decibels). Normal conversational speech is 50 to 60 decibels; that's the loudness, the volume of the speech. So at 3,000 or 4000 hertz, my hearing is about 45 to 50 db. That means I miss some high-frequency information in the left ear, from firing a weapon.
Finally, what basic piece of advice do you have for folks about their hearing and preserving it so they can hear the birds chirping in the spring and other beautiful sounds?
Respect noise ... just as you would respect fire or any other hazard.
And with firing a weapon, I'm still seeing a lot of the Vietnam vets and every now and then a World War II vet. Of course, back then if you're were worried about your hearing, you were a sissy. We're smarter than that now. Anybody can be affected by loud noise.
So there's a three-foot rule. If you're trying to talk to somebody and you're three feet away and you have to say, 'huh?' or shout, it's too loud. Whenever you find yourself in that situation, you need to use hearing protection, or turn it down when you can. Of course, sometimes people are out mowing or sawing logs and stuff, so you can't turn it down. So use hearing protection.
Name: Dr. Will Dade
Hometown: Columbus, Ohio
Current residence: Midland area
Education:1974 graduate of Columbus South High School in Columbus, Ohio; earned his bachelor's degree in speech and hearing science from The Ohio State University in 1987; earned his master's degree in audiology from Ohio State in 1989; and earned his doctorate in audiology from Central Michigan University in 2002
Previous jobs: Spent 25 years combined in the military serving on active duty in the Army and with the U.S. Army Reserves; retired from Martin Army Community Hospital at Fort Benning after 31 years as a Department of the Army civilian
Family: Wife, Sheila R. Dade, and daughter, Alexandra Dade
Leisure time: Enjoys playing golf, fishing and bicycling
Of note: Loves international travel and appreciating various cultures; enjoys helping others and giving back to the community through volunteering in health fairs throughout Columbus and Phenix City; he is board certified in audiology, and is a member of the American Speech Language and Hearing Association, the American Academy of Audiology and the Military Audiology Association