Hello and welcome back for another episode of the Future Ear Radio podcast!
For this week’s episode, I had the pleasure of speaking with Gabrielle Merchant, Au.D. & Ph.D. – Scientist II & Director of the Translational Auditory Physiology and Perception Laboratory at Boys Town National Research Hospital.
During our episode, Gabby and I discuss:
– Her backstory, obtaining a joint Ph.D. from MIT & Harvard in Speech & Hearing Bioscience, and then acquiring her Au.D. from UMass Amherst
– The many mentors Gabby has had along the way, including Susan Voss and Jill de Villiers
– How and why she decided to leave her home in New England for Nebraska to join Boys Town National Research Hospital
– Her passion and work around wideband tympanometry
– The advantages that wideband tympanometry provides clinicians, especially within the pediatric population
– What it’s like working inside a translational research lab and the many reasons that make Boys Town so special to Gabby
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp
All right, everybody, and welcome to another episode of the future your radio podcast. I am very thrilled to be joined today by Gabby merchant. So Gabby, thanks for being on today. How you doing?
Gabby Merchant, Au.D., Ph.D.
I’m good. How are you? Thanks for having me.
Dave Kemp
Absolutely doing well. So you and I met at the Missouri Academy of Audiology show the West meeting in Kansas City. Shout out to Liz Fuemmeler, who is the president of MAA this year and is doing an awesome job, you know, with corralling the troops and getting, you know, a lot of people back into the fold here in the Missouri Academy. But you were one of the speakers there. And I had the opportunity to get to know you a little bit and thought that you would be a great guest on the podcast. So why don’t we kick off with just some introductions? Do you mind sharing a little bit about, you know, your background, how you came into audiology, and kind of the path to Boystown more or less.
Gabby Merchant, Au.D., Ph.D.
Yeah, for sure. So, I am originally from the East Coast, I’m a New England girl. And I had kind of an atypical trajectory into the field, in that I didn’t kind of start out thinking I was going to be a speech language pathologist, which I feel like is the default for many audiologists, and then go to undergrad condis program and kind of find my passion for Audiology along the way. So I went to a small liberal arts college in Worcester, Massachusetts called Smith College. And I had some exposure to audiology prior to going to college just in that my aunt was an audiologist. And I had a guidance counselor in my high school whose son was born with hearing loss. And I remember hearing her talking about kind of their experience with that. And he actually, you know, him getting hearing aids and things I just always was kind of intrigued by it. But it was not thinking like I want to be an audiologist at that point. And when I got accepted to Smith, they accepted me through a program called stride, which stands for Student Research and department. And they basically pair you with a research mentor starting your first year. And so I had a pretty unique opportunity to start doing research really early on in my training. And so as an undergrad, you know, before my first year even they sent me this long list of like projects that different professors were involved with in New York had to like rank them and send them back and they would pair you with a mentor. And there was a project on that list at Clarke School for the Deaf, which is an oral school. For children who are deaf and hard of hearing in Northampton. It’s like adjacent, essentially, to Smith College. And there were a couple professors there, Jill and Pierre de Villiers, who were studying kind of theory of mind and deaf children’s psycholinguistics and deaf children there. And so I was like, oh, that sounds interesting. Like, it just kind of like elicited some of my memories of like my aunt teaching me sign language when I was young, and things like that. And so that’s what I put down. I was like, my first choice, didn’t really put that much stock into it, how I’m old. And I did end up getting paired with Jill and Peter. And Joe was my primary mentor. And she was just amazing. And so I got to do research at Clarke School, starting really early on and so I was exposed to a lot of kids with cochlear implants with hearing aids. I met an audiologist there and I was so intrigued by like, the merging between like pediatrics and healthcare and technology and science and like, I just got really interested in I said, Joe, I want to be an audiologist. Like, okay, but you asked a lot of questions. And she was like, I think you should consider a PhD and I was like, Nope, I want to be an audiologist. And she was very convinced, I would not be intent as a full time clinician. And so and we didn’t have like an undergrad comm this program. It’s meant so many liberal arts colleges don’t have like a speech and hearing science undergrad. So I was a psych major at the time. And she found this Ph. D program called the Speech and Hearing bioscience and Technology Program, which was a joint program between Harvard and MIT. She was formerly formerly at Harvard, so she like got it from like an email on a listserv. And she was like, Gabi, look at this PhD program. Like it’s perfect for you. It’s got a big clinical focus and Audiology and Hearing science put, it’s a PhD like, I think you’d love it. And I was like, okay, kind of intriguing. And so she was like, Okay, if you’re interested, you can’t be a psych major, like, it’s not going to prepare you this had like a huge engineering focus because of the MIT half of the program. She’s like, I think you need to take some engineering classes. And so I waltzed into the engineering building at Smith, not knowing anything as a sophomore, and I found a random door of a faculty member that was open and I knocked on the door and she was having office hours. And I was like, Hi, I’m not an engineering major, like you don’t know me, but I’m really interested in this like very small, specific PhD program that you’ve definitely never heard of. But I’m looking for some advice on what courses I should take. And she was like, Oh, well, what’s the program? Like? We definitely never heard of it, but can I or the program s and she looks at me and laughs and says, I was in the first graduating class of that program who was So I was in the office of Susan boss who is an amazing hearing scientist and was in the first graduating class of shpt. And it was so serendipitous that and like Joe didn’t know that Susan was there, like, she just got this like, more like forwarded email. So it was really funny. And I quickly kind of shifted my research focus from working with gel to working with Susan, I ended up self designing a major. So Smith does allow that, which is pretty cool. So we combined in some of the engineering courses, some of the courses I was taking in psychology and education. And Smith has a master’s in deaf education. And then you also can take classes at the other five colleges in the area around Smith. So UMass Amherst is one of them. And they do have an undergrad Tongass program. So I took a few classes from there. And so I like probably the only person from Smith with a speech and hearing science degree. And so I also kind of pigeon holed myself into like, hoping I get into this Ph. D program because I set up a whole trajectory to hopefully get in. And so thankfully, I did get accepted to that Ph. D. program. And I did apply to AUD programs, like I was still very committed to like having both degrees, like I wanted to do translational research. And at the time that I was looking for kind of an AUD and a PhD, ideally, a combined program, that AUD was really new. So I was looking for programs around 2008. And I think the ad started in around 2006. And so most of the ad programs, were still just trying to figure out how to go from a master’s to an AUD into like, we have a PhD into it. They hadn’t quite figured it out. And so when I got into shpt I just decided that like I knew I would get really strong research training there. But I was like, I’m still doing an ad after this or in conjunction with it if I can find a way and most people were like, Okay, we’ll see about that. So I went to us HPC I spent five years there. I finished there in 2014 and I went straight into an ad program at UMass Amherst because I was convinced I would stay in New England forever. And Susan, then a couple years into that AUD program, I ran into Laurie libeled, who is the Director for the Center of human research here at Boystown at a conference and she was like, What do you think about coming to Boystown or like start allowed there? Now like I don’t know where Nebraska is, like, there’s no chance like no way she was like about it and I actually had a close collaborator who was an advisor on my PhD who was at Boystown Stevie lay. So like I knew about Boystown. I had known about Boystown since my undergrad like I used to read Mary Pat molars work and Padstow Markowitz and Michael Gorga, and I was like, very inspired by their translational research and like, I literally never being like, chill, I want to be them, like, but the idea of like, going to Nebraska was like, so out of the realm of anything I thought I would consider because I was so committed to staying in New England forever. But eventually, Laura was like, just compare visit, see what you think. And I was like, okay, small field, don’t wanna burn bridges. Like, we’ll go for a visit. We’ll tell the Nebraska is not for us to cornfields. And we’ll fly home back to our little New England bubble. And we got here and I was very surprised about how cool Omaha is at the city. But I remember walking into Boystown and like, I must have met people for like five minutes. And I just it’s like this really hard thing to explain. But like, I just knew they were my people. Like, I knew I had found my place and my people and I’ll never forget that feeling. But I was like, Oh no, this is where I belong, like, so level of translational research that’s done here. But like you could just tell how collaborative and supportive the environment was and the bridge between audiology in the clinic and and research is so amazing and I knew I just had to come and so somehow along the way, I got convinced that this was where I was supposed to be. So I was very fortunate to be able to come into my externship here. So I finished my you know, at coursework, and then came and did my externship here at Boystown, and while I was doing my externship wrote a grant and built a lab and got to like oversee construction of a brand new lab space and and then I just very easily transitioned from being in the clinic to directing a research lab. So now I don’t see patients clinically currently, I’m a full time research scientist, but my research is very translational recruiting patients directly out of clinic. And so I still feel like a strong connection with clinic and do plan to go back into clinic formerly formally at some point. But yeah, I run a full time research lab now studying hearing loss, which is kind of what initially got me inspired in the field. So that is a very long winded trajectory.
Dave Kemp
Very, yeah, like a lot of serendipity there. It’s funny actually, just a quick side note, the last episode that I just recorded a I was with an SLP at Clarke schools. So what is it? What are the odds there? Right? And that’s funny. Yeah. So I mean, I’m learning about that program. And you know, that’s, I guess, school system. And then like all of the online support materials that they have, but you know, what are the what are the odds that, you know, that was part of your Genesis more or less? Yeah,
Gabby Merchant, Au.D., Ph.D.
and a big part. And actually, that guidance counselor, I mentioned her son was connected to like, I think he was getting services in sunlight for clock, I remember them talking about Clarke, even though we live like an hour away, like where my high school was, like an hour away from Smith. And so I like that was one of the links where I was like, oh, like, he got services here, like Clarke school. Like, that’s what the trigger was for me. And it’s changed so much, because it used to be like an institutional school, like kids lived there. And with technology, like, they don’t need to be there most of those kids, you know, like, so the programs have changed that much. So I’m sure now I’m gonna have to listen to that one. Because I want to hear all about it.
Dave Kemp
Yeah, no, it’s really interesting. But I mean, I think it kind of dovetails into a lot of what we’ll talk about today, which is like, you know, I think that there’s just so much opportunity. And I think there’s so much focus now on, like, I keep saying, like, it almost feels like that there’s like this portion of audiologists that have done this amazing job of championing, you know, the efforts behind mandating newborn screenings. And it’s, you know, it’s like, that was like a huge, monumental effort. And it’s almost kind of like Mission accomplished, because of to a certain degree, you know, like that. For the most part, newborn screenings are pretty mandatory across the country. And I think most people are at least getting that initial screening. And so I think that we’re, it’s, it’s sort of like focusing now, like along the age spectrum, you know, and I think that like, for the kids that fall through the cracks, or you know, that they aren’t referred on properly, or whatever, it’s like this interventional audiology, space seems to be gaining a lot of momentum. And I just hear more and more focus on that. So I think it’s a really positive thing. So I just want to go back to your story for a little bit. So like, you, you go in when you’re at Smith, and you’re self designing your major and all this. Yeah, you’re you’re having to take some of these engineering classes and stuff like that. So help me understand what was the first major that you were getting? Or what was the first PhD I guess? Right?
Gabby Merchant, Au.D., Ph.D.
Well, so I spent this my undergrad and so I came in, and Joe and Peter are psycho linguists. So they study like, you know, the how children learn language and understand language and other people’s like, theory of mind is basically like, how, like, does a child understand what you know, like, at what point do we understand what other people are thinking? So if like, a child watches me put, you know, a block in a bucket, and they no longer see the block? Like, does the can the child know that I know that the block is in the bucket, because I know I didn’t put in or those types of things. So that’s theory of mind. And, and so they were trying to understand that until like, how that might differ and children who are deaf and hard of hearing. And so which was so interesting to me, but I definitely did always have like, I liked math, I liked hard, like, the harder sciences, if you will, as opposed to just the social sciences. I kinda like bridge. I like medicine a lot in general. I was a, I’m a first gen. And so at one point, I considered like thought about medical school. And I honestly was like, Why could never afford to go to medical school because like paying for college myself. So which, in hindsight, was not probably the best mentality. But it all turned out just fine. Because I feel like I found this nice niche. And I was able to combine medicine and technology and science on it. And so I was a psych major. And then yeah, like the shift to engineering. So like the engineering students that have like an engineering degree from Smith, like you have to start your first year, like, it’s a very strict, like course sequence. And so I really just wanted to take the engineering courses that applied to hearing science, which is a lot of like, circuit signals and systems, acoustics, differential equations, there’s a lot of, you know, quantitative aspects to all of that. And so Susan helped me like, kind of figure out what courses I would need to prepare me best for shpt. But it was weird, because I didn’t have all the same background. Like, you know, I again, didn’t learn to code like the other engineering students. So I’m like, trying to play catch up and I hadn’t done calc since high school and so it definitely was a ship like a really big ship and then I’m also taking these classes like education like about how we, you know, how, just like general classes about like hearing loss and thing to consider when working with these populations. So it was a hodgepodge in a lot of ways.
Dave Kemp
Yeah, for sure. So, then I guess like, it’s really cool that you found your way to Boystown, I’m happy to hear that the Midwest was able to win your heart over, you know, it’s, we I’m not surprised to hear that you had some preconceived notions that were immediately dispelled. But you know, you found your way there. And tell us about this lab. And tell us about what you’re doing now. And, and then I think we can, you know, that will kind of bring together all of these like pieces along the way. Because it sounds like everything sort of was building toward this lab. And it all culminated together all of this disparate background that you have. It all kind of congealed.
Gabby Merchant, Au.D., Ph.D.
So, honestly, like, so the first project I worked on with Susan, so I’m still at Smith, was a study and you mentioned newborn hearing screening, which is interesting, because it was kind of related to newborn hearing screening. So a large percentage of the kids that refer on newborn hearing screening, so say, you know, you know, 10% of kids, and these stats are old off the top of my head. So I think they’re better now. But say 10% of kids refer out a newborn hearing screening of that 10% of kids that refer, the majority of them do not have permanent hearing loss, like 90% of them are referring because they have leftover gunk in their ear canal and their middle ear, they’ve been floating in utero for you know, nine and a half months. And so it’s this transient, basically conductive hearing loss that’s causing them to to refer. And so there’s a lot of improvements in the hearing screening programs, our re, like, do a second screen before discharge, if we can, you know, they wait as long as they can or not, you know, try not to screen like the minute the baby is born to let some of that residual, mesenchymal and kind of burn nicks and things like make its way out of the ear. So hopefully, that we’re not getting as many of those referrals. But that was a big interest of Susan is could we improve newborn hearing screening programs by assessing whether there is something going on like in the ear canal or the middle ear that’s causing that referral, now, that wouldn’t rule out a permanent hearing loss. So it doesn’t necessarily change things. But like, if you know that there’s not a conductive component, and a kid is referring a newborn hearing screening like that raises red flags that like this is very likely a permanent sensory neural hearing loss, and we cannot lose this child the follow up, right. So my project was to use a technology that is similar to tympanometry, which looks at how the eardrum is moving, but called wideband acoustic commands, and to kind of get some normative data and little babies. So I made measurements at a local pediatric office, and newborn and one month old to look at kind of how age affected these measurements so that maybe we could utilize that to compare to kids who we knew had this residual meson time in their ear, that’s really these transient conductive hearing losses to see if that maybe is a tool that could be added to newborn hearing screening programs. So that was my very first kind of like, project very focused in this area. And now I use why Banach is to come into my lab to study kids with ear infections, which is another very related, you know, condition like, also basically stuck in these kids middle years. So, yeah, they really have all come full circle, and a lot of ways. Well,
Dave Kemp
I think it’s so when when you were presenting at the Missouri Academy of Audiology, you presented on wideband tympanometry, something that I’ve only heard about, I’ve never really understood what the methodology is and why it differs, and what the, you know, like, basically, the the rationale behind why this might be complementary to the current procedures, or even superior in some ways. So for someone like me, that’s not an audiologist, what’s the easiest way to kind of wrap my head around? What makes wideband unique, and maybe why it’s compelling for some of these different kinds of diagnostics that you’d be performing?
Gabby Merchant, Au.D., Ph.D.
Yeah, that’s a really good question. So if you’re familiar with standard tympanometry, that’s a measurement that’s done very routinely in clinic replay, usually a low frequency sound, and we pressurize the ear canal at the same time, and kind of look at how the eardrum responds to that low pitch sound. So we assess hearing across across a wide range of pitches or frequencies, low pitches, medium pitches, high pitches, right, we do that when we do our basic hearing tests. We do it when we do otoacoustic emission testing, which is kind of an objective way to assess how the inner ear is functioning. We assess a wide range of frequencies when we do a BR, usually, especially diagnostically, but when it comes to assessing middle ear function, we’ve always just done this kind of single low frequency measurement, which is interesting because again, we’re assessing all of these other things across a wide range of frequencies. And so wideband tympanometry, as the name sort of implies, is basically assessing the middle ear system across a wide range, a range of frequencies as opposed to just that low frequency. That frequency that we test standard tympanometry that was actually chosen because it made the calibration really simple. Like it wasn’t necessarily like the most diagnostically informative frequency, it was just that at the time was developed many moons ago, right? It made the calibration easy, which made the math easy you wish made the equipment, easy to you know, develop. And so, and that just has really persisted. And I will say a lot of the things that go wrong in the middle ear can be detected with a low frequency stimulus. So our ear without getting too too nerdy on you like our outer and middle ear system is kind of like a mechanical circuit. And so there are like mass and stiffness effects that can influence things. So literally physically, your ear can be stiffer, because you know, a bone is, you know, kind of not able to move in the same way as it could because of a disorder like otosclerosis or stapes fixation, where you get this abnormal bone growth, and now your middle ear bone can’t move as well. So this system is physically stiffer, where you can have physical mass added to it, because you have fluid in the middle ear, which is also making the eardrum not move as easy. And so you have both mass and stiffness effect. So our ears naturally have these mass and stiffness properties and pathologies change the mass and stiffness properties of the ear. And when we look at just a low frequency, like we do in standard tympanometry, we’re only assessing the stiffness properties of the or we’re not considering the mass or the resonance, or all of these other features that could be changing with different pathologies. And by looking across the rock a wide range of frequencies, we can look at math and stiffness effects and resonance and things like that. And so in my head, and this is not I don’t think even help people who have developed Vyvanse epinephrine necessarily think about it, but like, in my translational head, like tympanometry is almost a screener to me, it often can tell me that there’s something going on in the middle ear, but it’s not really good at telling you more beyond that, that like what is going on. And wideband can often be much more diagnostic. And so we can start to differentiate, there’s something wrong and this looks like otosclerosis or there’s something wrong and this looks like otitis media, a certain subset of otitis media, or there’s something wrong and this look like superior canal dehiscence, which is actually in the inner ear, and mimics a lot of middle ear pathologies. So yeah, I think the diagnostic versus screeners? No, that’s
Dave Kemp
very helpful.
Gabby Merchant, Au.D., Ph.D.
I think about it.
Dave Kemp
I mean, cuz the closest, like, I guess parallel that I’m drawing here is like, again, going back to newborn screenings, a lot of programs, they, you know, the default method is the you know, odo acoustic emission, and then you fail that, and then you get referred on to an ABR automatic brain response. And so then it’s like, is that kind of the same idea here in your mind is that I mean, because like, it’s, I guess you could just default to using wideband, but do you see this as something where the, it’s almost like, you do a standard temp, and then that sort of flags? Okay, maybe I need to do the more advanced wideband temp, which is going to tell me more.
Gabby Merchant, Au.D., Ph.D.
So that like, oh, Evers ABR, like those really tough different components of this system. And so like ABR is gonna tell you a lot more about like the brain stem, like always only go out to like the level of the outer hair cells. But I think ABR is a good parallel, because we use as a screener, we’d like a click, which is just kind of this like wideband, you know, stimulus that really kind of tells us about the mid frequencies really well. And that’s what’s used in these automated aprs that are done a newborn hearing screening. But when you have a diagnostic ABR done, we do the clip, but we also do these like tone bursts. So we’re looking at frequency specific responses. And so that’s what I kind of think of it’s, you know, with wideband tympanometry, you’re still getting the standard tip, you’re getting information at 226 hertz, and you’re getting information to all these other frequencies. So that said, the difference between a br where you can do a click, or all of these kind of frequency specific tone bursts is that the frequency specific tone bursts take a lot longer, right. So that’s why we kind of isolate, let’s pick specific people who can refer on our screener to get the diagnostic protocol, there’s almost no difference in time between a standard tip and a wideband tip. Okay, and so for that reason, I don’t think that we need to screen of the standard temp, I think we just make a shift from doing standard temps to wideband tympanometry on everyone where tympanometry would be indicated. Because really, you’re going to get at least as much information as you would have gotten with the standard temp. And in cases where it’s di not diagnostically helpful, you’re gonna get more information. So it’s not that in every case, you’re going to learn extra, but in a number of cases you will and it’ll be useful in those cases.
Dave Kemp
No, this makes total sense. It’s a more robust type of diagnostic, I get that you’re testing at different frequencies in addition to the low frequencies. So again, just in my layman’s mind, what what are the kinds of things that you might be detecting, with these middle and higher frequencies? You know, as a clinician, like what what are some of those things where Maybe standard tympanometry is not going to, you know, give you a clearer picture of what’s going on, whereas wideband will at least give you some clues in what would those clues maybe indicate?
Gabby Merchant, Au.D., Ph.D.
Yeah, that’s a really good question. So there have been a number of kind of pathologies that have been identified in the literature to kind of that wideband has been identified to be sensitive to. So there’s one kind of clinical scenario, I guess, where wide band seems to be helpful is in more adult populations, but I guess it could be pediatrics. If you have kind of an intact eardrums, you don’t have a perforation, there’s no obvious pathology of your eardrum, and you have a well aerated middle ear, so no fluid, and you have a conductive hearing loss right now, the assumption in that setting is often that you have something called otosclerosis or stapes fixation, which is probably the most common cause of that presentation. But several other things can cause that. So you can have a disarticulation or break in one of the ossicles. Or you can have a fixation somewhere else in the ossicular pathway. So people can be born with like fixations of their Malleus or one of the other bones. So it’s not the CDs, it’s you know, something else in the pathway is fixed. Or you can have a problem in your inner ear called superior canal dehiscence. And that’s a hole in your superior canal that energy gets shunted out of and so it’s a true conductive hearing loss. But when we think conductive hearing loss, and audiology, we think middle ear, people don’t think inner ear and so there are people who have SCD who had operations on them to fix their stapes fixation because it was thought that, you know, the all the test results pointed to like this person probably had the same expectation they bought a prosthetic put in, and then like nothing improved, their hearing didn’t improve, none of their symptoms went away. And so wideband seems to be more sensitive to kind of differentiating between those pathologies. And my lab, we are really interested in otitis media and kind of infants and toddlers. So I kind of alluded to the newborn hearing screening application early on, and that’s been extensively studied, people are still actively working on that, like identifying hearing loss, kind of differentiate between conductive and sensory neural very early on in newborn hearing screening programs and NICU babies and things like that. And I’ve been seeing kids who kind of are in that six month to, you know, five year old range, who get kind of recurrent ear infections, or kind of a persistent state of fluid in their middle ear. So when we talk about an ear infection, I think people think like, red raging eardrum, tin has a fever, upper rest, that is absolutely an ear infection. I call that acute otitis media, you have this acute state of infection. You know, antibiotics are often indicated. But there’s also something that people often say, is an ear infection, where there’s no actual infection present. And that’s in the fluid in the middle ear just kind of persists for a long period of time. And that can be the fluid that resulted from an episode of acute otitis media. But sometimes people can end up with this persistent fluid without infection, because of dysfunction of the Eustachian tube, or allergies, or all sorts of reasons. And it’s those kids that I’m really interested in as an audiologist, because those kids have this fluid in their ear for three months, six months, nine months, 12 months. And often you don’t even know it’s there. Because there’s no symptom other than potentially some hearing loss in kids are really great at reporting. This is why the age of identification of hearing loss prior to newborn hearing screening was so late, because kids aren’t good at reporting that they have a hearing loss, they out, they don’t know if anything’s wrong, like, okay, the world sounds like it’s underwater, but they don’t have a comparison unnecessarily, or they don’t have the language to articulate what’s going on. And so these children are often found kind of incidentally, like they fail a screening at school or the pediatrician happens to notice that something looks weird about their ear at a routine checkup, or whatever. And so those kids can be walking around for long periods of time with hearing loss from that. And our diagnostics are not as sensitive to it. So tympanometry can often tell us if there’s fluid present or absent, but there’s lots of variables about these ear infections and fluid in the middle ear that can differ. And so some kids have fluid in their ear have absolutely no hearing loss. And some kids have 15 DB hearing losses, so moderate hearing losses, and kind of everything in between. And so I’ve been really interested in how wideband might be able to help us understand kind of how much blue had been in the middle ear, how does that affect their hearing? Kind of what are the characteristics of maybe that state that might suggest that it’s going to persist for a long time, like if we could predict that that fluid gonna stay for a long time, then we might say, this child needs tubes. But if we could say, oh, this is one that’s going to clear really quickly on its own, we are not going to want to send that child to surgery as quickly. Right. So those are the types of things that we’ve been looking at and finding that wideband is sensitive to at least some of this dairy ability because it’s so much more sensitive to variations and kind of the broad mechanics of the middle ear. Um, so that’s another and I think, you know, in pediatrics that and newborn hearing screening are the two biggest application because that I mean, for ear infections, I mean, they affect such a large percentage of children. Like there’s a huge, I think population of kids that could benefit from improved diagnostics in this area. For sure, yeah, those are those I think are like cut some of the big ones, there have been studies that have looked at things even like increased intracranial pressure right now, which has to be monitored with like a shunt in your skull. But intracranial pressure, like can also change then shown to be like, you can actually measure changes in an integrated no pressure in your ear canal because of how it changes the pressure and your middle ear space. And so like Susan boss has looked a bit at that and looking at both wideband tympanometry note acoustic emission. So there’s some really interesting applications like that for it as well.
Dave Kemp
Yeah, no, I think this whole thing is like, it’s absolutely fascinating that in 2023, it feels like we have relatively robust diagnostics. You know, again, like to your point. I, you know, prior to the discovery by my namesake, Dr. David Kamp, the much more famous one who discovered the unknown acoustic emission, you know, like, how do you objectively determine these things. So it’s cool that there are like these anatomical functions of the body that that like really do sort of tell a story. And what’s really cool, though, is that there’s still so much more that we haven’t fully learned and that we continue to learn and that like with today’s medical technology, you have the ability to kind of like discern this information. So I imagine as an audiologist, as a researcher, that’s going to be really, really exciting. I want to go back though, now that I have a better understanding of like, where your road ended up. I’m curious, like, I get the, you know, you obviously had this kind of like meandering journey that led you to Boystown, but why did you initially glom on to wideband? tympanometry? Like what was the impetus for why that became the more or less like your passion?
Gabby Merchant, Au.D., Ph.D.
Yeah, so I mean, and I do use more than wideband to panache, but it has asked been, like, the thing that has followed me kind of throughout my career, if you will. And part of it is just that, like, it’s what I had expertise in. So like, when you get a PhD, like, you’re becoming an expert in something, right. And so as an undergrad, I you don’t have a lot of say in the projects you work on. So Susan had a fun bid project, and you’re a student. So like you do whatever your mentor is working on. And so that’s one of the projects he was working on, I really wanted to do something very translational with human patients like, and that’s what we could come up with that was like, funded under whatever funding she had at the time. And then when I got to shpt, I wanted to work with humans. And so the labs at Eaton Peabody are many of them are very basic science labs. So they use animal models, and I tried to do an animal lab, and I literally cried sacrificing the mouse like, I just can’t do animal research it I’m I just I learned that about myself very quickly. And there were honestly limited labs where like, I could do work with humans. And I still wanted a really basic science speaks or ended up doing research and human patients, and then simulating patients and categoric preparation, which didn’t bother me at all, because the person had already passed and who’s counting? Exactly.
Dave Kemp
But they’re like the little mice, the pygmy mice, you can’t do it. You can’t do it
Gabby Merchant, Au.D., Ph.D.
like my chinchilla has like, and I’m so grateful for animal research. Like I think we can learn so much from animal models. So this is not like, I actually am involved now with a cross species studies where they were using an animal model, like my best friend was doing animal research at the time, like it very valuable. I just personally could not do it myself. And so there were limited options on projects that I could work on, on the auditory system on humans. Plus, in addition, like, though, I think you can absolutely be like an audiologist and hearing scientist who does basic research in animal models. I wanted to do very translational research, like I wanted to take questions from the clinic, and like study them and patient populations. And so that’s just where I felt like, you know, my passion was and so being able to work in human populations. And so the lab I ended up in with Heidi Nakajima and genres ASCII and sama merchant, which is actually the lab that Susan trained in, which wasn’t like she wasn’t like, you’d have to go to my lab, it just it all kind of fell together. They were just starting to get interested in using my band in their lab. And so I’d had this experience with the wideband from working with Susan and so it kind of became a good fit that we would learn how to kind of study and learn more about wideband acoustic emissions or wideband tympanometry together, and I could utilize what I had learned about it already to benefit the lab in some way. And I had access at Mount Sinai here to the most interesting patient populations, right? Like they see the most unique patients like I was able to study superior canal dehiscence, you know, when there were not cohorts of these patients that like any other hospitals other than maybe like Johns Hopkins. And so to be able to study kind of wideband in these very unique patient populations, where it could be beneficial to have access to those patient populations was so unique and really cool. But my passion was always P. It’s like, I wanted to get back to pediatrics. And so that lab was studying adults. And so, like, Boystown sort of allowed me to like bridge everything where I was like, Okay, now I can really get back to pediatrics, but utilize everything I’ve learned about wideband and apply it to this population of children who also have a conductive hearing loss or conductive pathology going on. Where I think wide band would be beneficial. So
Dave Kemp
okay, so you’ve mentioned the term interventional arm, sorry, translational, like a translational Lab, which was something that I wasn’t totally familiar with until we met and you were telling me about what that means like particularly in the Boystown setting. So I think this is really cool how Boystown sort of allows for you to kind of take the research and then immediately apply it. But can you speak to like how how Boystown is designed? And, you know, from this standpoint with the translational lab piece,
Gabby Merchant, Au.D., Ph.D.
yeah, for sure. So, I mean, I think people define translational research in a number of ways. And so it’s kind of one of those buds where it’s like, I think about basic science research, a lot of like, the bench work, the animal models, the, you know, people in labs and beakers and you know, that type of what you think of it that though there’s certainly basic science research that happens in humans, asking very basic questions about mechanisms and things. Whereas translation, I think, like you said, it’s like, there’s this question that camping clinic, and now I’m studying it, so, but it’s not like an intervention necessarily. That’s like a next step where you’re really applying it back to the clinic. So it’s, I don’t know, to me, it’s like kind of that bridge of like, they’re very clinically driven questions that you’re then studying, even though like some of the questions I’m asking my lab are probably more basic, like, how does fluid volume influence hearing loss in otitis media? That’s probably a more basic question, but I’m studying it in a very translational way. So I don’t know that terms are all like very interchangeable. But I’m coming from a place that was like amazing at basic science, but didn’t have as much translational research. Like when I recruited patients at Mass pioneer, I was recruiting them primarily from our otolaryngology clinics. There were several otolaryngologist on staff who like worked, had labs, collaborate with labs. You know, there was a lot of interest in otolaryngology. But there wasn’t like a strong tie with audiology, the audiology department at the time. And so the otolaryngologists were amazing. I benefited so much and learned so much from them. And honestly, they saw the coolest, most unique patients. But like, I wanted to be an audiologist, like I wanted to study hearing loss and, and so like that tied to audiology, I hadn’t experienced a place where like a with like a very strong bridge to audiology, I guess, if you will. And so I like coming to Boystown was amazing because there was this incredible bridge between our audiology clinic and research like all of our audiologists are have like this city training, it’s called it’s like a biomedical research training, so that they can help in research labs, content participants that they need to like, they literally support the research program in that way they help recruit patients, like if we have protocols you want to roll out in clinic to like test them out. Like that’s something that they will collaborate with us on like, you know, many people on staff, like have a role in research and in clinic. So we have multiple people who like are part time clinic part time research. And so that bridge between audiology and research is just so strong. It’s not like you’re just coming knock at our door and being like, Hey, can you help me recruit participants like, and there’s nothing in it for you because like, they really believe in the research program. Like we have a lot of these like lunchtime talks where like the audiologists come, their scientists come like it’s just so integrated, and I am certainly biased. But I honestly think it’s the best place to do translational research because you don’t like it’s just it’s hard to do. It’s hard to recruit patients like it’s harder to recruit these populations. So if you don’t have access to the clinic, you don’t have buy in from the clinicians, like you can’t do it. It’s like banging your head against a wall. And so as a scientist, and an audiologist like to be able to bridge my worlds like that in a way where like the infrastructure already is there with just people who are genuinely passionate about improving hearing healthcare, and advancing hearing healthcare like it’s just what’s amazing. So like,
Dave Kemp
are these types of translational translational research translational lab These kinds of settings are these are these typically were like the forefront of like new diagnostic procedures in general sort of spawned from, like the research. And then it’s kind of like it starts here. And if it’s successful, then it kind of cascades to other clinicians, because to your point, they’re not maybe as well equipped to, I don’t know, trial, these new diagnostic methods, and then so it’s almost like you’re kind of validating for the field. Here’s an entirely new method or procedure.
Gabby Merchant, Au.D., Ph.D.
Yeah, I mean, that’s exactly right. And so when you get to the point of a clinical trial, like it’s usually places like this, unless it’s like an industry company who’s like running a clinical trial for like, an investigator, right, drug or something, but yeah, I mean, like Boystown had a big role in both OES and ADRs, like establishing normative datasets. And, you know, and that’s a relationship between clinic and lab, right, like that is, you know, that was Michael Gorga. And Pat, so Mapquest did a lot of that. And so they bridged, like, they actively saw patients in audiology, like their offices were in the ideology clinic, but they also like ran research labs. And so I think that is exactly what happens. It’s like we, you know, we think about with evidence based practice, like we we are trying to build the evidence to then provide, you know, clinicians with that evidence base so that they can practice using that evidence base. And so, but you need, you need the clinicians to be part of that, like, you need people who are full time clinicians who are actively seeing patients who are hearing certain complaints, or patients or who were testing these protocols, like, there’s so many things that like, are developed in research that they’re like, this will never fly in a clinic, like, I don’t have an hour to do this speech where I can test like, There’s no way that’s clinically feasible. And so when you’re not pushing, and you haven’t worked in clinic, and you don’t have that, like in the back of your head all the time, or clinician like in your ear testing out, like, you know, we really need the clinicians to be like, Yeah, this is not feasible, or like kids can’t do this, or what have you. And so you need those, that bridge to facilitate a lot of that. I don’t know if that answers your question. No,
Dave Kemp
that totally does. I just I find this to be so interesting is where do these new methods and diagnostics come from? And I think that makes a lot of sense that it would start as research, obviously. And then like, where are the first implementations at the clinics? And I think that this helps me to better understand like, what makes you know, like an institution like Boystown so unique is this, like translational piece, which I feel like, as a researcher, that’s got to be a really exciting environment to be in, because it’s like, not just you, but it’s all of these other sort of translational fields that are, you know, in the midst of sort of, like undergoing this discovery of like, are we at the forefront of all of these different kinds of methods and procedures, that’s gotta be just there. I feel like a really exciting for somebody that has that kind of aptitude that is sort of like this scientist that is trying to kind of bring things to life. That’s got to be I think, a really exciting setting. Super
Gabby Merchant, Au.D., Ph.D.
exciting, and there is like great basic science that happens at Boystown, too I think like our translational research is kind of our what makes us special and unique in a lot of ways but there’s certainly a lot of basic science and actually I think wideband tympanometry and why when it comes to Goodman’s is, like a really good example because Doug Keith, who recently retired from Boystown, but was at Boystown for many, many years like his basic science research like really is what created wideband tympanometry so like what is in the inner acoustic Titan device, and now the GSI Tempstar like the math behind wideband tympanometry, which is real complicated. Like there’s, I understand why they were like, Ooh, 226 broke down. This is simple. Let’s do this, like the math behind my main tip. And symmetry is super complicated. The calibrations are super complicated, like it is not a trivial thing. And he did I mean years and years and years and years and years of development to like, figure that out and make it happen. And so like it’s also really cool to be someone who now a studying wide band but also in a very like trying to really figure out like okay, how do we get this into the clinic like to have this deep appreciation that I could do none of this had it not been for the work of this person is that Boystown for all of these years right where like it all that came and it wasn’t any there are other people at other places who have significantly contributed to kind of wideband tympanometry and wide minimalistic events being where it is and Susan with a lot of the early work John Allen like a lot of people have contributed but like having someone at Boystown who was such a big contributor to that was really special and cool too. And it’s nice to be able to kind of hopefully, continue pushing that work
Dave Kemp
that he needs standing on the shoulders of giants
Gabby Merchant, Au.D., Ph.D.
literally standing on the shoulders of giants. So seriously big She used to fill which I will never fill, but it’s not it just it’s special to like, see it really all come full circle like that, but over like a 30 year time span?
Dave Kemp
No, that’s really cool. I mean, so like, you’re, it seems like you know, you’re kind of still just getting started, like, I know that you’ve built the lab and like your, I’m sure it doesn’t feel like you’re getting started. But it seems like you’re kind of at the, you know, the earlier portion of, of your career and your journey and all that. So like, where do you sort of see the next you know, phase of of your career as like a scientist like what’s next for you? If if you know, not saying like after Boystown, I’m just saying in general like with what you’re focused on now, obviously, you’re you’re kind of in the midst of, of doing a lot of this work around why being tympanometry? Do you have kind of a line of sight into like, you know, I really hope that I can achieve this phase and then that would allow for me to move on to this thing. And I want to explore this facet, whether it’s with wideband or if it’s with something related, like what is the future kind of hold for you from that standpoint?
Gabby Merchant, Au.D., Ph.D.
I think, you know, if by the end of my career, when I would agree that I’m very much on the earlier end of that career, if we have transitioned to using wideband instead of staring tympanometry like, I will feel Mission accomplished, mission accomplished, right. But realistically, like, I think that transition not like really to see it, like regularly implemented in clinic might take my whole career and not that that’s the only thing I’d be working on. But like, so throughout my career, I hope to find ways to contribute to that, and both like kind of academic research ways, but also in doing things like coming to the Missouri Academy of Audiology and talking about it like, you know, really translating to clinic means like boots on the ground with the clinicians. And so, you know, I can go to these big research meetings, but like, most audiology clinicians do not have the funding or time or support to be able to be going to the big meetings. And so I really think it’s like state meetings, I did a mini course we’re in our acoustics, like things like that, or I’m hoping can provide some education and training and like, so doing things like that, I think will continue to be something that feels important to me and helping translate because ultimately, like, I can do all the research I want and publish all the papers I want and get all the grants I want. But like if it never gets applied to clinic, and what’s the point? So
Dave Kemp
have you felt like, you know that you’re making some headway in that regard, that you’re getting positive reception from clinicians that are at least inquisitive about this and saying, Please tell me more. And I’m, I’m interested in, I’m really interested in what you’re doing.
Gabby Merchant, Au.D., Ph.D.
I think so I think we’re starting to see more uptake. So, you know, it’s new equipment. For most people, it requires buying new equipment. Up until very recently, there was, you know, only two devices on the market that were FDA approved, that could do it, and one of them does not pressurize. So just as we’ve been acoustic Amantha ambient pressure doesn’t do the pressurization, which I think for clinicians is gonna be important. So really, it was just the tight end that I was seeing people use. And so if you didn’t have a tight and you can’t do it, and so, you know, people aren’t learning about during their AUD and most programs. And so I just I think that that’s part of why it’s been slow. But yeah, I feel like, even like after the Missouri Academy of Audiology meeting, I had a few emails with people who are like, Okay, what do we need to do this? Like we shouldn’t do it? And so talking about like, well, here’s your equipment options. And, you know, I’m have some relationships with some of the people in the companies that, you know, are supporting and selling these devices. And so just making sure that they feel like they have what they need to talk about the advantages of it. I mean, it’s new to a lot of them too, right, like all the manufacturer reps like, and so, yeah, I think, you know, that’ll be a big piece. But the other piece of that broadly, like, as much as I use Wi Fi to my research, like, like, my research program as a whole is not just about wideband tympanometry, right. So I am really interested in improving diagnostic tools and kind of figuring out how we can individualize health care, get more objective measures, or pediatric populations, because those are the populations that are often pretty difficult to test. So you know, a 10 year old with an ear infection, we can do a hearing test on them and understand how their hearing very easily they can raise their hand when they hear the beep. But you know, an 18 month old does not raise their hand when they hear the beep. And so we have a lot of strategies to test kids. Clinically, there are still limitations to those, especially if you want to get like really understanding how each year is hearing. And so the better objective measures we have that can tell us kind of what’s happening in the ear and how kids are hearing would really improve health care, generally, but also like if you think about places where you don’t have a boy’s town down the road, so rural clinics Like, you know, they don’t have pediatric audiologists, and play partners and all this specific expertise. But if they can put a microphone in a kid the ear and say like, this is how this kid is hearing without the kid really having to do anything without a lot of extra time and resources, that could be really powerful at improving kind of health care. Broadly.
Dave Kemp
Yeah, I mean, I agree with you that it seems that that’s sort of the macro theme right now with healthcare is this move toward more personalized medicine in every kind of way, shape and form, including the diagnostic procedures? So it seems like this kind of boats, you know, our I guess it’s it jives with the broader push in that direction. And it’s cool to kind of hear specific applications of that, within this industry. So I think that’s really interesting. And, and I’m sure that there’s still again, there’s so much more that we can learn. And there’s, you know, like you said, the, the fact that like wideband has existed for a while it’s only available and a select few amount of pieces of equipment today. But I think that like it’s kind of a it probably is a little bit of a chicken and egg thing where it’s like, there needs to be demand. And how do you generate that demand? Well, you need to have the people that are actually doing this today, and something like a translational lab that are showing evidence of like this works, there’s a lot of interesting things that you can find. And then, you know, then the manufacturers might be more incentivized to make this more of their offering, you know, because I’m sure like you said, it’s, there are trade offs. Like it seems like it’s a complex feature that you would have to add. But the benefit could just be that the type of diagnostics that the audiologist can perform are that much more robust, which we think in like the in a real big, roundabout way, it allows for the audiologist to elevate themselves and the greater Stinney not just with the patients, but with the broader medical healthcare community as well.
Gabby Merchant, Au.D., Ph.D.
Absolutely. And I think that it, you know, and there’s so much more that we need to do to understand like, the patient population has gotten most benefit, like even with my work on otitis media, like, you know, right now, you know, kids with otitis media kind of all lumped together in one big group. But there’s so much variability and how an episode of otitis media is affecting an individual child. And we don’t really consider that at all in our, you know, diagnostics and our management. So some kids with om like, are likely going to end up with some sort of speech and language problem down the line problems with binaural processing, which means they’re not going to hear speech and noise as well in a classroom, like they’re gonna have trouble localizing sound. But it’s a subset of these kids. And we don’t know how to identify that subset. And we don’t know what the features of those kids are. Yeah. And so if we could figure those out, so we have to, like understand what that subset is and how that subset looks. And then can we diagnose that subset? You know, so that’s this, it is a chicken and an egg in some ways, but I think as we learn more, you know, so for me, that’s a big piece of my puzzle is figuring out who are the kids with om that are most at risk for these long term deficit? And then how do we identify them early on to make sure that they’re getting intervention and as soon as possible, right. So it’s not all kids with otitis media that are going to have these problems. And so, you know, but if we knew that a child was likely to end up with probably because of our diagnostic tools, then like, it would be such a bigger justification to like get tubes placed, right. Let’s resolve this as soon as possible. And as child, let’s monitor this child a lot more closely. You know, right now, there’s still like, you know, I think we do the absolute best, like our pediatricians are EMTs, like they do the absolute best to decide how to manage kids with as much information as they have. I just want to give them more information so that they can individualize it even more.
Dave Kemp
Love that. Very cool. So as we come to the close here, you know, for people that are listening that want to learn more, they want to get in touch with you, what’s the best way to connect with
Gabby Merchant, Au.D., Ph.D.
you? Yeah, so my lab has an Instagram it’s the tap lab, I think is the I shouldn’t know like the act. But anyway, we’re on Instagram, the translation, Audrey physiology and perception lab at Boystown. And I’m linked there, there’s a Lab website to that we’re not as good at keeping updated but my email is on there. I love talking to people about wideband about my research, like I love doing guest lectures on wideband for a TV program so that you know, again, students are getting some of this training along the way. But yeah, I am happy to always chat there’s anything that’s of interest or someone has like an atypical trajectory to audiology or is considering not following that very traditional trajectory and also talking about that, okay, so we’re like you didn’t add after your PhD
Dave Kemp
like That’s so weird. That is I don’t think I’ve know anybody else it’s done. They’re
Gabby Merchant, Au.D., Ph.D.
very select few people. I know a few and I’m not the only person out there but they’re few and far between. And so it’s, but it won’t work out just
Dave Kemp
to get all worked out. Um, Curious like in your lab now like how many people work with you in this in your specific lab?
Gabby Merchant, Au.D., Ph.D.
Yeah, so I have been amazing research audiologist she’s been with me since day one Sara oscillating like the only reason the ship sail. And then I really am very fortunate to have a part time research audiologist who spends the rest of her time in clinics. So she actually was one of our add extra to stayed on. And she spends, you know, the bulk of our time in clinic but 12 hours a week she’s spending in my lab and that keeps my Thai clinic really, really strong. Since the lab open, we’ve collaborated closely with an EMT, Dr. tempo and so he is both, you know, he helps us recruit but he also contributes a lot to our scientific ideas and you know, thinking through to the otolaryngology piece, I’m not aware oncologist, those things we study are very otolaryngology related. And so that input is really important. Another really cool thing about Boystown right with the audiologist in my lab, I got an e and t in my lab like and then z and AUD external. So voice sounds externship program has an option to do a research track to it. And so I have an awesome add extra new started this summer who will spend part of her externship working in the lab. And then I have a research assistant who is an undergrad actually psych major like I was once upon a time and will be probably hiring another RA in the near future. So it is Boystown labs are a little bit different than you know labs at universities because we aren’t at university so we don’t have access to like undergrad and graduate students quite as readily. But still lots of amazing people that work with me and honestly like I couldn’t do any of this without them. So plus like the support of our research program as a whole our audiology department like our otolaryngology department, like so many people contribute to the stuff that I do.
Dave Kemp
Well, it has to be pretty awesome if it was able to sway you away from your beloved New England home. So it is it’s pretty
Gabby Merchant, Au.D., Ph.D.
Basho place and like, you know, New England and Boston will always have a very, very, very special place in my heart and like it’s also like COVID If anything has taught me how easy it is to collaborate virtually remotely and from afar. And so I there’s a meeting that I have once a month that includes Susan, my undergrad advisor, my PhD mentors usually on that call Heidi Nakajima like I collaborate with Heidi and Suzanne, like my atypical trajectory. As a typical it was like I am still very close with everyone I like text with like mentors from my youth,
Dave Kemp
I was gonna say, it seems like you’re so very close with all these people.
Gabby Merchant, Au.D., Ph.D.
Very close, let’s be honest, small. But I also just think that like my journey came so full circle in my lab that I still do things that like apply to all of these people in different ways. And so it keeps all those pieces I have all my New England ties are still very strong. And so and so it’s nice, I get to still work with and talk with all of these amazing people who made me who I am really.
Dave Kemp
That’s awesome. Well, on that note, Gabby, thank you so much for coming on today. I’ve thoroughly enjoyed your story. It’s it’s an interesting one a little abnormal. But I think you’ve found the right the right home for you and Boystown in what you’re doing. It’s, it’s really, really interesting. And I’m excited to kind of like continue to monitor it and see the progression. Now I know a little bit more about why Ben tympanometry
Gabby Merchant, Au.D., Ph.D.
I’m so glad thank you so much for having me. I know I was a little hesitant that I’d have nothing to talk about somehow you found things for us to talk
Dave Kemp
about here. We are an hour in and you, you captivated me so I’d be more than capable of speaking about your very interesting life that you told me wasn’t interesting. And I, on the contrary, I have to disagree.
Gabby Merchant, Au.D., Ph.D.
Oh, well. Thank you for having me. And I just love what you’re doing in the podcast. I feel fortunate and humbled to be able to be a part of it.
Dave Kemp
I appreciate that. And on that note, thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers
