On episode 35 of All Ears at Child’s Voice: A Hearing Loss Podcast, Wendy and Elise are joined by Dr. Matthew Bush. Dr. Bush is the University of Kentucky Endowed Chair in Rural Health Policy and professor and vice chair for research in the Department of Otolaryngology, head and neck surgery at the University of Kentucky. He completed his otolaryngology residency along with doctoral and master’s degrees at the University of Kentucky, and otology neurotology fellowship training at the Ohio State University. He is an NIH-funded hearing health disparity expert. Dr. Bush cares deeply about health disparities in the medical field, specifically when it comes to hearing loss. He is a wealth of knowledge who’s passion drive his research.

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Episode Transcript:

Intro (Haley with music):

Welcome to All Ears at Child’s Voice, a podcast discussing all things hearing loss. We aim to connect parents of children with hearing loss with the professionals who serve them. And now, to start the show..

Wendy:

Hi, this is your co-host Wendy Deters

Elise:

And I’m Elise

Wendy:

This week on All Ears at Child’s Voice. We are talking to Dr. Matthew Bush, Dr. Bush is the University of Kentucky Endowed Chair in Rural Health Policy and professor and vice chair for research in the Department of Otolaryngology, head and neck surgery at the University of Kentucky. He completed his otolaryngology residency along with doctoral and master’s degrees at the University of Kentucky. And otology neurotology fellowship training at the Ohio State University. He is an NIH funded hearing health disparity expert, Dr. Bush. Thank you so much for joining us.

Dr. Bush:

Thank you, Wendy. And thank you Elise, for having me on the program.

Elise:

All right. Before we jump into the main discussion we like asking our guests for a story from the past week, it could be anything, something cute, something funny, something heartwarming. Does anything come to mind?

Dr. Bush:

Absolutely. I’m a father of five children, so my days, and sometimes my middle of my nights are filled with a funny, and in retrospect, heartwarming things in events. I have four boys and one daughter, daughter is the youngest. Our fourth child, Lincoln is seven and Lincoln I think is well on his way to become an automotive engineer. As long as Legos are involved in that engineering career. He is someone who has a bit passionate to try to recreate different vehicles with Legos. I’ve purchased a new vehicle in February of this year. It’s a new vehicle type. It’s a new brand to, you know, a series of, Yukons or other people movers that we’ve had. So my son has been just so busy and engrossed with trying to recreate this exact vehicle in every fashion with Legos. And I’m inevitably greeted at the end of my day and when I arrive home with a new prototype, a new version that perhaps is a little bit different on the color, a little bit different on the contours or a little detail. And he’s just producing some pretty amazing prototypes. This weekend’s prototype had a missile launcher and, I was able to thank him for being creative and innovative, but I just had to let him know that I don’t think a missile auncher will likely be necessary for dad’s vehicle moving forward. We can leave off the weaponry, but just carry on with the contours and the, and the color usage. That’s

Elise:

That’s So fun.

Wendy:

Yeah, you should take pictures of all of those. So when he grows up, you can show him how he has evolved in his design skills.

Dr. Bush:

The truth, and it’s not too far away from what actual engineers do, you know, using different tools and different ways to try to design and create innovate and put an idea into reality. So he may be well on his way. So, so we’ll see.

Wendy:

Well, thank you for sharing a little bit about your family. But we, we also want to learn more about you and your history as a doctor. We’ve had a few otolaryngologists on, and we’re always interested to hear how you came to the decision of specializing in that particular field of medicine.

Dr. Bush:

Well, my pathway into otolaryngology was definitely a unique one. I thought when I went, decided to go into medicine, I was going to be a country doctor, a primary care doctor. I grew up in West Virginia. Neither of my parents went to college in a generation where we were the first graduates of a higher institution of learning. As I was considering my roots, my family, my connections, I was thinking primary care and rural community was likely where I was headed. While I was in, undergrad. And while I was pursuing a career potentially in medicine and then in medical school, I became fascinated with head and neck anatomy. This really came to a culmination point when, as a first year medical student, our head and neck anatomy professor wanted some people to work in the gross anatomy lab, work on to developing different dissections that would demonstrate some of the complexity of the anatomy of the head and neck and the skull base. And this professor was just infectious with his excitement and zeal love for the anatomy and the complex function of hearing and all the unique senses that come along with it with the head and neck. And I worked with this researcher and this anatomist in his anatomy lab during the summers and just became absolutely enthralled with head and neck anatomy. And I really didn’t realize at the time that otolaryngology was the primary field in medicine to manage and take care of disorders of the head and neck, very clear. It was crystal clear as I then became, I became involved in the clinical rotations that otolaryngology was really going to focus on this region of the body that, you know, I had studied inside and out backwards and forwards and really became some so accustomed to, so it really was a love for anatomy that and function that goes along with the complex anatomy that led me into the field. So it was a different direction than I expected. I, again, my heart and my, love was for caring for people and for the needs of the community. But, you know, it was really the complexities and the complex disorders that really drew my attention.

Wendy:

Well, it sounds like now you’ve sort of incorporated both of those things, so we’ll definitely get into more of your involvement in the community.

Elise:

Yeah. It sounds like that was really helpful to have such a passionate, mentor or professor to help you get there too,

Dr. Bush:

Yeah. So the people that have passion in your life that love what they do they act like getting paid is extra, you know, where they just would do it if even it was for free. Those are the people that really are influential and change career trajectories.

Elise:

Yeah, that’s so true. We have a recent one of our recent episodes with Dr. Lartz. She was my professor training to become a teacher of the deaf. And it was very similar where just so much passion gets you inspired and motivated to do your own work and find your own path. It sounds like the field of ENT is very broad. You probably see a wide variety of patients and all of your different colleagues. What are your main interests in that field, or what do you enjoy most?

Dr. Bush:

So my primary area of interest in my practice is focused on otology neurotology and cranial based surgery. So that’s basically the E of ENT or the ear side of ENT, and that involves hearing and balance disorders. And my fellowship training was in that. I knew as a resident in otolaryngology here at the university of Kentucky, when I was in training, I loved all the fields. So I really inspired by all of my different mentors and teachers, but it was really the ear side of the ENT world that just really captured my attention as well. The complexities of the types of surgeries, the types of conditions that we could treat. So, as a physician, I’ve just absolutely loved taking care of adults as well as children that have conditions that affect their hearing and their balance. And those conditions may be caused by congenital disorders, tumors, complications of infections, or some other type of disease process that causes it. But the sense of hearing is such a personal and important since it influences communication and identity within society in many ways. And then balance dysfunction and balance disorders dramatically affect people’s quality of life and ability to function ability to work. So I feel like as a physician working in a field that involves those two particular senses of balance and hearing it has a lot to do, and I have an important role to play a positive impact in their life to hopefully improve their quality of life and, and address those conditions.

Wendy:

Absolutely. So often our patients or the children and families that we work with, the medical team is their first point of contact. And that really sort of sets up how they will interact with the early intervention system and the school system. And, it’s such an important relationship. So we tend to really focus in on, on cochlear implant surgeries, but we know that that might be only a piece of what you do in your day to day life. What does your typical day or week look like in your clinic?

Dr. Bush:

Well, you’re preaching to the choir here. I love cochlear implants as well. And I love people who are thinking about cochlear implants and people that get cochlear implants, and trying to help them navigate that process. My day is pretty varied as a clinician scientist. I love the variety that’s in my life and in my career and what I’m able to do. I try to be in the present and try to really stay focused on the task at hand and if I’m in clinic, seeing patients, I want to just work as hard as I can and take the time that’s really needed to work through some challenging situations. So often, for example, an average week for me, Mondays are usually a full day of clinic. And my policy is see anyone and everyone who wants to be seen or needs to be seen because I may be less available on other days. And so, Tuesdays like today, for example, is an academic day. I dress different. I act different. I find myself in different place to try to wear a little bit more of a research or academician hat that involves perhaps writing grants or working on a paper or things like that that a researcher, may be engaged in, especially in clinical research is, I’m focused in, so I usually wear bow ties on Mondays in my clinic and a khaki pants and a collared shirt on Tuesday for research. Wednesdays may or may not be research as well. And I’m about 50/50 as far as clinical activities and then research activities on the NIH funding that I’ve been fortunate to acquire, has helped to support that effort. Thursdays is almost always a surgery day, so we’re scrubs on Thursdays. And I have, a practice that again has adults and pediatrics involved as, and primarily focuses on neurotology, as far as the services I provide surgically and Fridays are often go along with academic meetings. It seems like a lot of meetings that have occurred involved Fridays, in the hearing, research world. So often it’s a travel day for, for research, but not anymore. So Fridays are used for, what anybody wants, whether it’s maybe patient needs or, research activities.

Wendy:

I love that I’ve never heard anyone describe their week based on what they wear, but that’s such a great visual of your different roles in the hospital. That’s great.

Dr. Bush:

I love tennis shoes and I usually wear tennis shoes on every day, except when I’m in clinic. So I’m kind of a sneaker head. So that’s that, that’s the first part of, you know, deciding what you weren’t aware of that day.

Elise:

I love that. Yeah. It’s like, it’s like you have different jobs throughout the week. It’s, changes up your schedule. That’s great. We wanted to take advantage of our time with you to talk about your work in healthcare disparities and children with hearing loss. What brought you to this particular aspect of medicine?

Dr. Bush:

Well, I think, my career choice in my research trajectory related to health disparities and healthcare disparities was pretty much set for me based on where I trained, where I grew up. My background and my family influence has definitely affected the direction I’ve gone with research. It was very clear that I would pursue something along these lines when I was a trainee. And I was in my residency here at the University of Kentucky, which is in Lexington, Kentucky, it’s in central Kentucky. It’s a beautiful place, horse farms and bourbon distilleries abound and influence our tourism industry here in central Kentucky, but amidst all the beauty of rural America sets a backdrop of health disparities. And as a resident, it was very clear when I was seeing patients, especially children that would come from rural Eastern Kentucky. And that region of Kentucky contains some of the most socioeconomically depressed counties in the entire United States. And we’d have patients that had fallen through the cracks. The ball had been dropped in diagnosis of hearing loss and/or delivery of services or quality of services that were provided or available. And patients were just lagging behind. So to see a five-year-old show up on our doorstep, who was profoundly hearing impaired, congenital hearing impaired, who had no means of communication who had been mislabeled as autistic, or some other type of cognitive delay or decline. It left an overwhelming impression on me as a physician, as a father, as a human being when you see these kinds of things and you just kind of question, how does this happen? How does this happen in the United States? You know, where healthcare resources seemingly abound. So, that research trajectory really started to then take shape, that passion to address some needs to help those who perhaps don’t know to help themselves or aren’t able to get the help that they need that started to take shape as I was in my fellowship and had an opportunity to do an additional year of research training and research mentorship during my fellowship. And that really helped to hone my academic brain to figure out how can I ask scientific questions and write grants and do things that might move the field forward and hearing healthcare disparity really is what I kind of landed upon. And, I’ve been dancing with the one I’m with for just over 10 years now in this, in this journey to explore hearing health disparities.

Wendy:

Yeah. That’s why we wanted to talk with you. We have all of these studies that show early identification and the amplification and intervention is what creates success or meets outcomes. But I think that this is really the absolute biggest issue. It’s access it’s how people access healthcare and how they get into the system in the first place. So like I said, that’s why we wanted to talk to you. So we’re really excited to dive more into this. So just so everyone kind of starts off on the same page in terms of our listeners. What are the current recommendations for identifying and treating hearing loss in the United States?

Dr. Bush:

So our recommendations have really had a multidisciplinary input that have come from a variety of different specialists and providers coming from speech language pathology, pediatricians, audiologists, otolaryngologists, a joint committee on infant hearing had influenced the formation of kind of our EHDI standards or Early Hearing Detection, Intervention standards. So, and, EHDI is the short term phrase for that system of identifying infant hearing loss. And the goals are 1, 3, 6, basically that every child should have screening of their hearing, by one month of age, for most children, thankfully that occurs in a newborn nursery setting. But those that may not be born in a traditional hospital or have a newborn nursery exposure, they still can get screening services, that should be provided through each of the 50 states through their EHDI program to be screened for hearing loss that involves a noninvasive test and should be administered no later than one month of age, if that testing is abnormal, then that child should undergo formal diagnostic testing. And that diagnostic testing is typically performed by an audiologist and also non-invasive, but should occur no later than three months of age. And in that scenario, if hearing loss is identified with that diagnostic testing, then intervention is recommended and access to intervention services should be provided no later than six months of age, following a medical line of treatment and evaluation that may involve a physical examination by a physician, perhaps their primary care provider or a specialist like an otolaryngologist like myself with, or without potentially hearing aids or other medical intervention for, management of whatever is causing the problem. So really 1, 3, 6 is our mantra. I mean, it’s on coffee mugs and t-shirts, I think at EHDI conferences and, and other, situations where folks have like-mind that are, that are promoting this type of public health initiative, are really trying to get that message out. And that timeline of 1, 3, 6 is not something that even though we may kind of take that for granted, for those of us that are involved in the intricacies of hearing health care and rehabilitation and habilitation of hearing loss, those that are in medicine and those that are our specialists actually may not even realize that. I’m surprised how many otolaryngologists, my colleagues couldn’t articulate that timeline, and aren’t aware of that, and I’m not sure that even as a resident that I had that firmly fixed in my brain. So this is something that perhaps is not a universally known by just patients or people in the community.

Elise:

It wasn’t laid out to me as an educator in the field, but that is so valuable to have that mantra or that clear timeline of events for people, everyone to know.

Wendy:

Well, not to make things less clear, but I’ve heard 1, 2, 3 or 1, 2, 4 mentioned recently, which seems very aspirational and aggressive, but amazing at the same time, if we can make that happen.

Dr. Bush:

Yeah. I mean, certainly I guess our mantra should change from 1, 3, 6, to the sooner, the better in everything and almost any healthcare condition, you know, the sooner that you could identify diabetes type two, the better the outcomes long-term the sooner that you can identify whatever the condition may be. And, and when we’re dealing with pediatric hearing loss access to timely diagnosis and timely services is at the heart of everything that we want to do, regardless of the direction of family may choose regarding communication methods and the direction that they go. We just want to make sure that families are well-resourced and are receiving the information, the diagnosis that they need.

Elise:

What are some of the statistics you have found for families in rural areas receiving timely diagnosis and treatment?

Dr. Bush:

So I feel like after 10 years of hearing health disparity research, I feel like we’re just scratching the surface. So it’s an area of research that needs, a variety of different people to be involved and to engage in work. We’re one of the first groups to investigate pediatric rural hearing loss and some of the timing and some of the factors that have influenced disparities and some delays. But in some of the work that we started with initially, we partnered with our state EHDI program and our administrators to try to investigate the data that is always tracked that is eventually reported to the CDC, but not much was done with that data on a research side. And we wanted to investigate those that come from a rural community and those that come from an urban community, is there a difference in those that perhaps fail a newborn hearing screen and then follow up for diagnostic services? And we, we found a statistically significant difference at that time. It was about, 25% of the rural children were failing to follow through with diagnostic testing. Whereas about 15% of children that were from more urban or suburban communities were failing to follow up. We then pair that with some data from our own institution, looking at children who had received a diagnosis of hearing loss and looked at the timing, you know, within sort of the tertiary primary referral center for a large geographic region and kind of the backstop for all of the rural communities that were in the Eastern part of the state. And we found that, that children were being diagnosed with hearing loss from rural communities at about seven months of age children from the more urban or suburban communities at about five months of age. And the goal was, you know, of course with that 1, 3, 6 mantra about three months is what we were expecting. So we felt like we were missing the ball on for all the children, as far as the timing of diagnosis, but the rural children were even more so delayed. That then led to further research to look at timing of other services beyond diagnosis and in a 30,000 foot view statistic. It essentially takes children from rural communities about twice as long on average, to get any specific type of hearing health care. So if you look at it as a metric of when did they receive a hearing aid for those that used hearing aids, it takes about twice as long for those that needed a cochlear implant. It took about twice as long. And it was really when we published a paper that looked at some of the timing of cochlear implantation in children that were from rural communities. That’s when I had reconnecting with my resident self from seven, eight years prior when I thought, “wow, I should do something about this. I’m seeing a five-year-old don’t show up on our doorstep”. We published a study that looked at children that came from rural Appalachia were implanted at around five years of age, compared to about two and a half years of age for more urban or suburban children from central Kentucky. It was, it was really an “aha” moment. Like, we have, you know, described what I felt was the case that we were seeing, just within the clinic setting, but research is powerful. Research goes much further than just the observations of one person with one patient in one clinic setting. So that’s the value of research is to try to articulate that, Hey, there is indeed a problem, and there’s lots of different aspects that influence a disparity, not necessarily just geographic location, but race, ethnicity, a variety of different factors that influence their health and healthcare outcomes. But we were able to at least show that geography does matter,

Wendy:

So what are some of those other factors or barriers that you’ve found outside of just geography? Cause I the more that we understand what those factors are, perhaps we as clinicians, that’s where, and I’m sure this is your hope as well. Once we understand all of this, this is where we can hopefully try to get information out and services out. What else are we up against besides geography?

Dr. Bush:

So I think when we begin to look at access to care and who’s getting care, and who’s not getting here, what’s influencing outcomes, we have to begin to have conversations with colleagues in public health that look at health care and health conditions on a broader scale, on a broader basis. And borrowing from the public health field, the social determinants of health that have these major domains or areas that kind of influence how and when, and if patients actually receive care, those involve domains such as the health care system and can you access it? And geography is one of those factors within a healthcare access area, but also within healthcare access and quality. There are other factors such as racism and, or ethnic preferences or differences or inequitable practices in medicine that might prevent some people, even if the service available to not receive care. But there’s other factors such as education, education plays a big role on one on what patients know influences, what they do. And that certainly involves parents that involves pediatricians. That involves a lot of people that are involved around a pediatric hearing loss world. There’s factors such as their neighborhood and their environment. What is the safety of the environment or the condition of the environment, proximity to services or the way that, a neighborhood is sort of set up to promote health? How else does health disparities influence by the culture of the social culture and the community context that also very much influences where people go and what they do. And then of course the economic stability, the socioeconomic status of individuals, and perhaps the type of insurance influences those things. And we’ve seen at least when you study rural populations, we’ve seen each of those social determinants of health having a role in having an impact in pediatric hearing health care. So from the lack of local providers influencing delays in care to lack of understanding or education of the patients or the parents, or the pediatricians or other providers about the EHDI guidelines and even in a community context. This may be the only child, perhaps within a neighborhood or community that might have something wrong with their hearing, and perhaps it might be dismissed or dealt with in a way that might be preventative to timely healthcare. So all of these things have had nuances and influenced and you pick this up through different methods, whether that be qualitative research or quantitative research, there’s different ways that you can understand it.

Wendy:

So when, when you talk in, in that way, it seems so overwhelming. There’s so many different factors that we have to take into consideration, and it seems sort of insurmountable, which I’m sure you’ve had those feelings as well. You know, my mind is just spinning, we need more diversity in speech, language, pathology and education in our students, we need a wider range of diversity in our field. We need all of these things, but what are some things that you feel are important that we can do right now to improve outcomes for families in rural areas? What can we as clinicians do?

Dr. Bush:

Well, the first thing is just, don’t let feeling overwhelm lead to just inactivity or lethargy or just defeatism. To do nothing is clearly the wrong thing. So do something and do something positive is I think what I definitely have learned. And as I mentioned before that even after 10 years of kind of devoting myself and, and instead of doing the cool research, like everybody else of doing this type of basic science work on a cochlear protein or this kind of novel device development, you know I’ve been a weird public researcher in otolaryngology. First of all, listen to your community, listen to your patients and see where there are some similarities with some of these findings. And some of these areas, these social determinants of health domains and say okay, in our community, we feel like we’re just really dealing with just true economic disparity. We’re really just dealing with the oppression of poverty to overcome this particular area. The patients know, they understand that there’s a need, they just can’t afford the care and it’s the socioeconomics. And so what can we do to leverage some interventions and some support to address that socioeconomic depression. If it’s an access issue, we don’t have, you know, an audiologist. We don’t have a speech language pathologist in that community or within a 100 mile radius. What can we do to either get someone there or take ourselves there through telehealth or telemedicine? I guess I had a surgeons approach when I was first thinking about pediatric hearing health disparities, I’m like, we’ll publish one paper that shows there’s a problem. And then we’ll fix it through some intervention. We will just heal with steel. We’ll bring in a surgeon’s mindset and fix this problem. And thank God I’ve had some really bright anthropologists and public health researchers to just help me to just relax, think, breathe, and just listen to the community and then learn about what might be culturally acceptable to try to help address some of these needs. And really there’s, there’s a multi-pronged approach, and it’s just about a matter of some methodology and some planning and connection with the community that determines what’s the next best step.

Elise:

Just out of curiosity. I don’t know if this would have belonged, um, earlier in the discussion, but in your research, was there anything that you found as to what the average amount of mileage people are traveling to get services? Or is that really not something you’re aware of?

Dr. Bush:

Exact number as far as, you know, an average distance that a patient travels to see me? I don’t know that I know that particular number, but we did some analyses that, that basically, correlation coefficients to try to address, what’s the distance to the provider and the timing of services. And so those are directly correlated and the greater the distance from a provider is going to be directly related to the timing that it takes for a child to either get a diagnosis or to get a hearing aid or to get a cochlear implant. So that particular relationship is pretty consistent across the different aspects of time points of these medical model of hearing healthcare. When you consider, you know, when I think about the state of Kentucky, for example, mileage doesn’t necessarily equate to distance traveled so I’m sure that you could be in Chicago traffic for only a couple miles, but have an incredibly long commute, but in Kentucky I might be 20 miles, but it might take me an hour or an hour and to make that trip. If it’s winding roads through the Appalachian mountains and poor quality roads, perhaps. So absolute mileage doesn’t necessarily always relate to that in sometimes it can be a lot more complicated just depending on the development of that particular area, where that patient lives. But I know many of our patients will routinely the travel, well over an hour of travel time to be able to see any type of provider, that’s an audiologist, that’s a speech language pathologist. And if you’re talking about a cochlear implant surgeon, then it’s maybe more of an hour and a half to two hours, that that’s fairly routine for a lot of patients that are living in rural communities.

Elise:

Yeah. And then on top of that, it’s multiple visits in order to get your, your end goal of a cochlear implant or what have you. So that correlation is seen.

Dr. Bush:

Yeah. Yeah, absolutely. I mean that frequency of appointment, especially where that maintenance of care and really making progress with audiology and speech language pathology, some other types of rehabilitation services that just need consistent touch points, their compliance, you can see how it just will plummet as those that compounding barrier continues to of overwhelm them. And, you know, what has been the most informative to me? It’s the statistics that help, you know, write papers and statistics that help drive grant applications, but it’s the qualitative research that hits you like a ton of bricks and the statements that people make that says my father and my husband has to take off work to be able to take us to the doctor. And it is a major ordeal and economically and socially, the impact that just one appointment can make on the entire family. This is research is about putting yourself in somebody else’s shoes and learning a perspective that someone else has. And there’s nothing quite like qualitative research and qualitative evidence that really shows you where people live and what they’re experiencing.

Wendy:

So in looking at those things, have you changed any policies or anything that you do clinically maybe with like longer time slots for audiology appointments or co-treating. Have you been able to modify anything based on what you’re hearing from patients?

Dr. Bush:

There’s a lot that we do to really try to get out in the community and work with people in the community that perhaps their practice hasn’t been focused on pediatrics to see how that we can help them, or perhaps let’s say, in a speech language pathology, they were more school-based.. And to see if they would be willing to provide some more consultative services for people in the region, if they realize that there is a need, if it makes sense as far as their practice goes. But, you know, I think when it comes to our, to our approach, we have to be nimble and flexible as far as giving patients the benefit of the doubt. And there’s no pediatric hearing loss patient that ever gets fired from a practice, or send a letter that we’re gonna have to dismiss you. We want to also make ourselves more readily available by finding ways to be in satellite clinics. Even if that doesn’t mean turning a profit for our clinic, it’s doing the right thing. It’s helping to really meet the need for a population that needs it. And just being smart about how we try to influence our care. But I do think that that type of research finding then influences the work that we do. Like, can we develop an intervention that says, okay, maybe we can’t physically be there, but what we can do is try to provide some intervention that will then help that patient or help that family get the care that, that we need. That’s currently the phase that we’re in now is doing a bit more of interventional research and specifically with a patient navigator program.

Wendy:

You talked a bit about pulling in other disciplines like anthropologists and other people that you’ve worked with. What suggestions do you have for people like us that we’re in early intervention, we’re in schools, we tend to be in our bubble of hearing loss. How do we branch out? What other professionals should we be working with to get some of this information about our community?

Dr. Bush:

Well, if you look at fields of medicine or fields that are trying to address problems that might have some connection to some of these same social determinants of health. So for example, if you’re dealing with diabetes care, or if you’re dealing with some other kind of chronic care, what does some other discipline do and who all do they bring into their multidisciplinary planning? The oncology services and cancer hospitals seem to really lead the way because they’re dealing with end of life care and/or disease that threatens their mortality. So oncologist and oncology programs are really trying to think in a very multidisciplinary way. They’re involving social work. They’re involving community resources and community partnerships. They’re involving tele-health and other providers such as radiation, oncologists that may be outside of the mothership or outside of the cancer hospital that could provide care because that cancer patient won’t come the hour and a half to the university cancer center, they will be willing to travel 15 minutes to the more local regional cancer care center. So one of my mentors is a head neck oncologist who has a background in public health. And it was some of his ideas of some things that they were doing to help their cancer patients. I thought, totally different disease condition, a different population, but we could apply some of these same principles. And even that patient navigation is a prime example that was born out of an oncology field and we’ve professionally plagiarized it. And I say in a joking way, but borrowed that, that methodology and say, could we adapt this and make this appropriate for pediatric hearing loss?

Elise:

Yeah, that sounds like that might be part of where a lot of different fields can be evolving to. Are there any other thoughts you have on where you see the field of ENT evolving over maybe the next 10 years?

Dr. Bush:

Obviously I’m biased as I say this, but I have been involved in bench research. I’ve been involved in basic science and sort of the traditional wet lab research. And I certainly think that’s a need for us to continue to innovate and discover and explore the intricacies and the complexities of the human body and the disease conditions that affect it. That’s certainly the intricacy of the anatomy and some of the physiology function is what drew me in the field to begin with as a medical student. However, I feel like we’re going to be called upon to look beyond the microscope and the bench lab and push ourselves into the public health arena. We have treatments, we have options to be able to provide for patients that can improve outcomes that can improve quality of life. It’s going to take a matter of getting those types of interventions into the hands, or perhaps into the ears of the patients that need them. And so moving towards a more public health approach, is it going to involve research in prevention of the development or the development of noise induced hearing loss, perhaps in an aging population or teenagers that are exposed to recreational noise, but also population health. And how do we develop programs such as how the EHDI system was developed and administered within each state, all that is continuing to evolve and change, and then how do we influence and address policy related to that? So I think it’s going to be incumbent upon not just the ENT’s or otolaryngologists, but every discipline that’s interested in hearing healthcare and the hearing of a child and any individual to address this in a public health approach. And to think like public health researchers. I think we now have a generation who’s willing to consider public health as we’ve all been facing surges and pandemic research that has come from these have been in the classrooms of public health, but public health has more to do than just pandemics, COVID and the Spanish flu. It’s involved in how we think about hearing loss.

Wendy:

As you mentioned that I’m thinking back to an episode, we did with someone from the national CMV foundation and all the work that she’s done to try to get screening protocols put in place. And lot of that came from parent led legislation parents working with professionals, public health and medical professionals to get more awareness for CMV, and we still have quite a long way to go, but the awareness also seems to be driving some of the technology. I know they’re looking into a vaccine for CMV, so I think sometimes it’s so easy to be overwhelmed and think about how big these issues are and all of the work that needs to be done. But like you were saying, if we take a step back and look at what we can do and what we’re motivated to do, all of these things sort of tied together,

Dr. Bush:

Timing is everything, you know, and awhen I was jumping into this research field, initially, I we’ll publish a paper, we’ll define the problem. And then we will do tele-health, we’ll do telemedicine and we’ll do tele audiology and we’ll do tele everything. It’ll fix a problem. It will be easy. And it was very, very clear that that’s not the solution, it’s not the holy grail. And the time wasn’t right with a specific population I was studying. I do feel like, you know, the patient navigation work that we have been involved in investigating currently evolve from ideas and input that were coming from the community. Now telemedicine and telehealth very well could be a key part of the future in that discipline and in, within this community, in this population that we studied because a pandemic has pushed everyone to a virtual and tele everything. And so we are now having many, many rural families who have had to either purchase a device or increase their bandwidth, literally and figuratively to be able to facilitate education of their children or interaction with coworkers and maintain employment. So that type of, rapid technology development and access to the internet services has changed dramatically in the last two years with the pandemic within rural communities. So that the time may be right now to investigate that further within our particular community.

Wendy:

Yeah, that’s fascinating. That’s maybe it’s small silver lining to the pandemic, realizing how important it is to have kids in classrooms and other innovations, just as you mentioned with technology,

Elise:

Any general advice you have for our audience?

Dr Bush:

Well I’ll tell you this is a time where it seems like a world’s being pulled apart by disease distrust discord. It’s assumingly a dangerous place to live. it’s always important to be kind, to just be gracious and to be kind, take care of and, and demonstrate daily, simple, uncommon kindness to everybody that you come in contact with. It’s never anything that I would regret or look back on with discouragement, but I think as you think about kindness and how you address that in a proactive way  is to be intentional and directional with your kindness. To be very focused on the people that you overlook and the people that you don’t consider. I think if anything we learn from disparity work is to consider people that are not like you to consider people that don’t come and see you as a provider, as a clinician, that they may never, grace the threshold of your doorstep, be intentional and be directional about who you’re trying to be kind to, and how you’re trying to display that, and then really move forward in a very directional way in how you proceed.

Elise:

I love that. Thank you so much for joining us today. It was so great to hear about all your research and your perspective. And I think what you said earlier about banning together and working together, all of the professionals to help the public health is, is great. That’s such a awesome perspective to have.

Wendy:

Thank you for all of your insight and your expertise. It was really inspiring. Like I said, a couple of times, a little overwhelming to think about all of the things that we could do, but you’ve given us a lot of things to think about and some different directions that we may want to go into better serve our community. And given us that reminder to think just beyond, you know, our small community here in Wooddale in Chicago, Illinois. So thank you so much for your time today.

Dr. Bush:

Thanks for having me on here. And thanks for listening and let’s continue to bond together to make a better tomorrow.

Elise:

Thank you for joining us for another episode of all ears at child’s voice. Be sure to join us for our next episode. We release episodes once monthly,

Wendy:

You can follow us and this podcast on Instagram with the handle at @child’svoicepodcast

Elise:

We’d love to hear from you. Please send us an email at podcast at childsvoice.org, and you can find episodes, show notes and archived episodes at our child’s voice website, childsvoice.org.

Wendy:

And if you’re interested in learning more about Child’s Voice, we are on Facebook as well as Twitter with the handle at Childs underscore voice. No apostrophe.

Elise:

Thanks for listening. Bye

Wendy:

Bye!

Dr. Bush:

Bye!