Celebrating Dr. Jack Katz: A Legacy of Audiology Innovation and Education

Dr. Jack Katz, a luminary in audiology, shares his extensive journey from a childhood marked by otitis media to becoming a trailblazer in auditory processing disorders. This episode is a treasure trove of insights as Dr. Katz recounts his academic and professional milestones, enlightening us on the evolution of audiology and his lasting contributions to the profession.

Listeners will be fascinated by our discussion on the correlation between middle ear problems and auditory processing and the serendipitous creation of the Staggered Spondaic Word (SSW) test, a key diagnostic tool that emerged from a chance conversation with an ENT in the early 1960s). Dr. Katz's recollections of using Bekesy audiometry and other early diagnostic tools offer a captivating look at how audiology has progressed over the decades, underscoring the importance of continuous innovation.

As we honor Dr. Katz's, we also explore the significant advancements in audiology education and practice. Dr. Katz's personal stories, including the manual indexing of the first Handbook of Clinical Audiology by his wife, Irma, add a heartfelt dimension to the conversation. We celebrate his remarkable 69-year marriage and his enduring contributions to the field, making this episode a must-listen for anyone interested in the history and future of audiology.

While we know all hearing aids amplify sounds to help you hear them, Starkey Genesis AI uses cutting-edge technology designed to help you understand them, too.

Click here to find a provider near you and test drive Starkey Genesis AI!

Chapters

• 0:19 Legends in Audiology
• 8:48 Evolution of Audiology Techniques
• 16:11 Legacy of Audiology Education and Practice
• 27:24 Audiology Legends

Transcript

Blaise M. Delfino, M.S. - HIS:

You are tuned into the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a global epidemic, hearing loss. Before we kick this episode off, a special thank you to our partners: Redux, faster, dryer, smarter, verified; Sycle, built for the entire hearing care practice; OtoSet, the modern ear cleaning device; Fader Plugs, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters podcast. I'm your founder and host, Blaise Delfino, and as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

This is Dr. Douglas Beck, I am an audiologist with the Hearing Matters podcast, and today it is a distinct honor and pleasure to introduce my mentor, Dr. Jack Katz. Jack, thanks for being here.

Dr. Jack Katz:

Thank you so much. I really appreciate this opportunity.

Dr. Douglas L. Beck:

Well, I appreciate everything that you did for me. You were my chairman when I was an undergraduate, and somehow you let me into my graduate program, and gosh, that was just over 40 years ago. And since then, audiology has changed quite a bit, as have I. When I go back to look at your intro, here's what I came up with. Since 1962, Jack Katz has given hundreds of talks, lectures, demonstrations, and workshops in the US, Canada, Central and South America, Europe, Asia, and the Middle East. Most of his workshops deal with Central Auditory Processing or the SSW. And let me amend what I just said. These are not things I came up with. These are things that I found on your website.

So in 1956, you got your bachelor's from Brooklyn College. In 1957, you got your master's of science in audiology and speech path from Syracuse University. 1961, University of Pittsburgh, that was your PhD. 1956 through '57, you were a speech therapist in the Department of Health at Syracuse. 1957 to '58, speech and hearing therapist for the Board of Cooperative Educational Services in Cayuga County, New York, which is in the Finger Lakes. '61 to '62, assistant professor at DeKalb in Northern Illinois University. '62 through '65, assistant professor at Tulane University School of Medicine in New Orleans. 1965 to 1974, 9 years, director of Hearing Speech Education Department at Menorah Medical Center in Kansas City, Missouri. In '72 to '73, senior Fulbright lecturer [inaudible 00:02:45] in Turkey.

And I want to say, Dr. Katz, I don't know if you remember this, but about 44, 45 years ago you were giving us a talk, a lecture, on how people remember language and thoughts and things, and you were teaching us that if you're going to learn a foreign language, you should never do things like teaching fork, knife and spoon all at the same time. You just teach one or the other, and usually fork is a good one to go with. And then you gave us this word in Turkish, which I remember to this day, which was [Turkish 00:03:14], which I think just means paper.

Anyway, in 1974 to 2002, professor of communicative disorders and sciences at State University of New York at Buffalo. 2002 to 2003, distinguished visiting professor at Hearing and Speech Department, University of Kansas Medical Center. 2003, research professor at University of Kansas Medical Center. And 2004, forward last 20 years, auditory processing service in Prairie Village, Kansas.

Did I get that right?

Dr. Jack Katz:

Yes, but we have to update it a little bit. The people that I was renting in my private practice sold the building. I had one month to leave, so I was working with Julie Teefey, who was an audiologist, on a revision of one of the books, and as we were talking, I said, "Oh, by the way, I have 30 days to figure out what the heck I'm going to do with my life," I said, "I have to leave here." And so I said, "'87, and I don't know exactly how I'm going to do it." She said, "Wait a minute," and she typed into her phone something and 10 minutes later, she looked at her phone and she said, "You now have an office." So she contacted obviously her boss and found out if they could provide an office for me in Merriam, Kansas.

Dr. Douglas L. Beck:

Good to know. And tell me, I'd like to have you just tell us about yourself, because I think you're a legend. You're one of the few legends in audiology. I was so honored when I was admitted to that program and your stature in the community at the university and the profession, unmatched, and I was just so delighted to be there, and I still am. But tell me about your education.

Dr. Jack Katz:

Thank you so much.

Dr. Douglas L. Beck:

Your early education was not typical. You were a struggling student, as best I recall.

Dr. Jack Katz:

Yes. Now, to understand all my problems, we have to go back to when I was three years old. Over the years I've thought back about those years and then I start to understand what my issues were. When I was three, I had a tonsillectomy and adenoidectomy, and in those days they had no clue what otitis media in young children does to them. I don't remember anything before going to the hospital for that surgery. I remember a little bit when my mother checked in and I remember where I was lying down in this room, and then when they did the surgery, I still remember the doctor telling me to count to five, as if I could count to five, and then he put the mask on and I don't remember the rest.

Dr. Douglas L. Beck:

The benefit of ether anesthesia.

Dr. Jack Katz:

So our family was poor, but my parents had to give me ice cream for the first few days, so that was a benefit.

Dr. Douglas L. Beck:

You had otitis secondary to all of these infections because when you have a tonsillectomy and adenoidectomy, which is lovingly called a TNA, when you have that done, most often, I have to think 97% of the time, that child or that adult is also going to have a lot of eustachian tube problems giving you otitis secondary to that. And so you had that removed when you were three and the shocking thing to me is that you can remember that. That's extraordinary. My youngest memory, I think I was 57, I don't remember.

Okay, so you had the tonsillectomy done, and how does that relate then to auditory processing? What's your thought on that?

Dr. Jack Katz:

The amygdala in the brain holds on to extreme events in your life. So even when your memory goes, very often, unfortunately, that amygdala still remembers them. I'm quite sure that that's holding on to that information for me.

Dr. Douglas L. Beck:

I think you're right about the hippocampus, the amygdala. A lot of, in particular, traumatic thoughts will remain when other things have faded. When you speak about having a TNA at such a young age, age three, then did that relate in your experience to auditory processing and to receiving a highly variable acoustic signature?

Dr. Jack Katz:

I didn't think about my history until much, much later. In more recent, well, could have been 30 years ago, but in the olden days, I forgot completely about my own problems. My doctoral dissertation was on otitis media.

Dr. Douglas L. Beck:

Well, and so this is really stretching my memory a little bit, but when we were undergraduates, so we're talking about, gosh, I think it was '78, '79, something like that, 45 years ago, I remember you shared a theory with us that you said was a theory, but I think it's proven itself in the last couple of decades, that children with untreated otitis media, because they're getting a fluctuating signal, some days they hear louder, some days quieter, some days more clearly, some days more distorted, so their brain doesn't have that constant repetition of speech and language. And your theory back then, this is 45 years ago, but you had said that might have a lot to do with auditory processing disorders as the child grows up.

Dr. Jack Katz:

I would agree, but now I would think that the most important thing is deprivation. You deprive the ear of sound, then that's going to affect the auditory system. In our study, we found this correlation between otitis media, or middle ear problems, and tone decay. That people, right after having these problems, they showed tone decay, it interfered with how the system was operating. We've given up on tone decay.

Dr. Douglas L. Beck:

We have, yes. I think the younger graduate students may have read about it, but I don't think they do it on a regular basis.

Dr. Jack Katz:

And Békésy audiometry was so effective-

Dr. Douglas L. Beck:

Yeah, it was.

Dr. Jack Katz:

... because we could monitor how things were going over time, which was just beautiful. So we did studies like that.

Dr. Douglas L. Beck:

And at University of Buffalo, we had a von Békésy audiometer, it was the size of a car, but it was very accurate. You would see these patterns over time, which gave you a lot of information, all the way from the lowest lows to the highest highs, and it was brilliant. I think we've lost a lot. We've gained a lot. We have things now go to acoustic emissions, which are brilliant. As time goes on, we tend to lose many of the older tests that had diagnostic meaning. So let me ask you a question. This is the one that I think everybody's interested in. How did you come up with the SSW? Where did that come from?

Dr. Jack Katz:

Well, let's see. I was doing my doctoral dissertation gathering data at a hospital in Pittsburgh, and the audiologist was going on vacation and she asked me if I would like to take her place during the summer to take this month and be the audiologist there. And I said, "Well, great," because I was a new father, our first baby, and we could use a few more bucks, and so we jumped at that. One afternoon during lunchtime, an ENT came in and he said, "Have you heard about the work that they're doing in Europe identifying temporal lobe tumors in patients using hearing tests?" I said, "What?" In school, we were taught that you can't test the auditory system beyond the eighth nerve because of all the decussation. Couldn't imagine that.

So then he started to read what they did. This particular study, they took a word and they took a band of high frequency, sent it to one ear, they took a band of the low frequency, sent it to the other ear, and the person had to come up with the word, and that's how they identified and said exactly how. But that's what they found, that they could identify temporal lobe tumors, see on which side it was. And then very last sentence in the article was, unfortunately, it didn't work if the person had a hearing loss. Out of my mouth came, "Why don't they use spondees?" I thought of it. He said, "Hey, that's a good idea. Why don't they use spondees? Do you want to do this project with me?"

Dr. Douglas L. Beck:

That's brilliant.

Dr. Jack Katz:

He said, "Oh no, you go ahead." At night, I was feeding my son. I had a 12:00 and 2:00 feedings, had to be fed every two hours, day and night, because he had had surgery and he had just come home from the hospital, and in order to give Irma some time to sleep, I took those two hours. So she got about six hours of sleep in there. At midnight, as I was feeding him, everything was so quiet and so restful, and I start to remember what happened at lunch, and I thought, how could you use spondees? Now these people were taking part of the word here and part of the word there, there's no way in the world I didn't have any equipment. So I said, "Maybe we could just put two spondees, one in each ear, and maybe that would work."

Dr. Douglas L. Beck:

What year was this, when you were thinking this through?

Dr. Jack Katz:

1960, July. Late July in 1960. The reason why I know is because Mark was born in June.

Dr. Douglas L. Beck:

And so for those who don't know, I'll do my best to describe this, but you correct me. For those who are not necessarily up to speed on the Staggered Spondaic Word Test, a spondee is a two syllable word, equal emphasis on both syllables. So you have hundreds of them, words like upstairs, downtown, baseball. So what you did is you started to put a two syllable word, upstairs, here, and a word like downtown on the other side, and upstairs, downtown, could be converted by the person. They could repeat it exactly as it was, or they might take a little bit of each, they might say, "Uptown, downstairs." So there are lots of ways that you could say those back and the pattern that the patient would repeat it, that was where the information was revealed.

Dr. Jack Katz:

So yes, so when I was thinking about that, when I was feeding him, start to think of what kinds of spondees? And as soon as I put them down to sleep, I start to write down all these different spondees, and that one would go on one ear, one would go to the other ear, and then I thought, wouldn't it be interesting if we pushed one up a little bit?

Dr. Douglas L. Beck:

They would overlap a little bit.

Dr. Jack Katz:

Yes, one word overlap. I said, "Wouldn't that be interesting? Because then you can compare competing and non-competing and see what the influence is of the competition or no competition."

Dr. Douglas L. Beck:

And then you're thinking there about ipsilateral pathways and contralateral pathways.

Dr. Jack Katz:

I don't think I was thinking pathways. All of those little things that we did turned out to have significance of people who repeat. They say, "Yes," after each one, for example. So that's a TFM sign, tolerance fading memory sign. So anyway, so then once we had that, I think we had the entire thing.

Dr. Douglas L. Beck:

And what year was the first formal recording? I was thinking it was about '62 or '63?

Dr. Jack Katz:

It was, if that was '60, then I finished my degree in '61 and then it was '62. '62, it was. Yes.

Dr. Douglas L. Beck:

Yeah, the final. And that one, none of them were originally digital, right? That was not a digital recording originally, it was an analog recording, but it's still available. And that's the one I think upon which most of the standards for interpretation have been collected. And for people who are interested, and I think that's going to be most of us, you gave us a definition in 1978 of auditory processing disorders. And it's still my favorite, but I wonder what your favorite-

Dr. Jack Katz:

It's what we do with what we hear.

Dr. Douglas L. Beck:

Yeah, I think that's brilliant. It makes it so simple and so easy, and it is still something we have to talk to patients about because so many of them confuse hearing with listening. And they're not synonyms, they're very, very different. And what you do with what you hear, that nails it, I think, for so many people.

Jack, I know you did a lot of work also on phonemic synthesis, and I'll give an intro. Phonemic synthesis was, if we take the word cat, so it actually has three phonemes, cuh-ah-tuh, and dog would have three phonemes, duh-oh-guh. And what we used to do 40 years ago, 45 years ago, in class, that was a standard therapy for children who had difficulty understanding words in general, but speech and noise in particular. Are you still doing phonemic synthesis and do you still think it has a place?

Dr. Jack Katz:

Absolutely. When people have otitis media, it screws up our understanding of speech sounds. There was a student who worked in the lab and he told me that we could take an animal and actually put fluid in the ear and see what electrophysiologically was going on. So that's what we did. We took W22s, put a loudspeaker a foot from the chinchilla's ear. There was a electrode right next to the over window where he had it. And so then he filled the bullae, the middle ear, with fluid similar to otitis media, similar thickness [inaudible 00:17:30]. And then we played it again.

Now the first thing I wanted to know is if there was evidence of a hearing loss, there had to be a hearing loss. It indicated it was. And I wanted to see what the relationship was between the intensity of the two so I increased the intensity, was probably about 20 decibels. I increased the intensity. I didn't want to see how much hearing loss there was. I wanted to see what was happening, what the relationship was, so I kept them at the same level. And so that's when we got to see the crazy things that were going on.

Dr. Douglas L. Beck:

Yeah, lots of distortion, I'm sure.

Dr. Jack Katz:

There was so much noise, and we don't think about conductive hearing loss and noise, but it's just like the ocean is noisy, the fluid is making noise. So that's one thing that we see in there. Kim Wilcox, I don't know if you know who Kim Wilcox...

Dr. Douglas L. Beck:

I think I do. Yeah.

Dr. Jack Katz:

And when he heard the recording, he made at least one spectrogram.

Dr. Douglas L. Beck:

I think it makes good sense and I think that that's turned out to be the issue is that when you have otitis, of course you have the attenuation of all sounds, but then you have distortion of most sounds. And then you also have the sound of the fluid, which we don't really think about, but it's there, and it has to be dealt with. And unfortunately, the brain is getting a signal that varies so much it's quite a challenge to make any sense of it at all.

All right. Well, let me change subjects here. So about 30 years ago we started putting together the AUD programs. Not me personally, but we audiologists. And I wonder what your thoughts are, looking back now, the AUD programs, has that been a success or do you think that it still needs to be adjusted for the benefit of clinic or patients or what are your thoughts on the AUD programs?

Blaise M. Delfino, M.S. - HIS:

Let's take a quick break. While we know all hearing aids, amplify sounds to help you hear them, Starkey Genesis AI uses cutting edge technology designed to help you understand them too. Using innovative Neuro Sound Technology, Genesis AI mimics how a healthy auditory system hears. This allows the hearing aids to better replicate how the human brain processes sound. By mimicking the cerebral cortex of your brain, Genesis AI fills in the gaps when your hearing is impaired. This helps you hear those missed sounds quickly and accurately so you won't miss a life moment. By repeating this process up to 80 million times per hour, Genesis AI allows you to enjoy better hearing wherever you are or whatever you're doing, without having to do anything.

Whether you think it's time to do something about your hearing loss or are ready to upgrade your current hearing aids, now is the time to experience Starkey Genesis AI for yourself. If you don't have a hearing care professional yet, simply click the provider locator link in our show notes and enter your ZIP code for a list of providers in your area. They can demonstrate Genesis AI and let you try them risk-free for at least a month. Professional fees may apply. Now, let's get back to the episode.

Dr. Jack Katz:

Now, I haven't been in academia for 22 years, so I'm not up-to-date on that, but when it first came out, I was at UB, I thought that it was not necessary. I thought our students with MAs and MS, so great in school and work at what they need it for. After about a year, I changed my mind. They got to have a lot of experience and research and all kinds of things that would've enabled them to be better audiologists than before. So I think that we're very fortunate to have a clinical degree that would be for people who are interested in doing auditory hearing research or hearing work.

Dr. Douglas L. Beck:

There are still people, every now and then I get in the conversation where people tell me that the AUD was a mistake and it's very problematic, but I would take the opinion you just spoke of. I had an extraordinary education because of you, quite frankly. But even when we were in our master's program, we would go to the medical school and do human brain dissections. But when I was in my graduate program, to my knowledge, we had the first tympanogram and reflex machine that was commercially available. We were doing ABRs in the operating room for children who were getting tubes put in their ears, and that was all being done at UB 40 years ago. I think the problem is that most programs didn't have access to that technology and that knowledge, and I think that the AUD degree, for most situations, does provide an awful lot more skills, knowledge, research to the clinicians and to the researchers.

I think back on that, when I got to the House Ear Institute, this is before cochlear implants were FDA approved, and it was a few years after I got there until they were approved, I remember thinking through so many of the problems that we were having with cochlear implants in those days and facial nerve studies and all of these advanced things that we did 40, 45 years ago. And it was because I had dissected human brains and because I had participated in temporal bone drilling that I think I had a better three-dimensional orientation as to how all these things work together because we had seen them, we had felt them, we had worked on them. And I think now more of the programs are doing that.

And I think it's so important that audiologists have an extraordinarily good understanding, not only of audiology, but of otolaryngology, because we work with them all the time. And for the few patients who have medical problems, about 5, 6, 7% of people with hearing loss have a medical issue, but that does mean 92, 93, 94% don't. They are strictly hearing and listening problems. And so I think the thing about the AUD is it's allowed more people to have a greater depth of understanding of their area of expertise. What are your thoughts on OTC, over-the-counter hearing aids? Because this has just come about almost two years ago, the FDA approved them, and I'd like to get your perspective.

Dr. Jack Katz:

Yeah, I have very little perspective. I don't know people who have gotten them and I don't know what they went through to get them. I don't know if the evaluation was, I don't know who tested them. And what I would say is that if they just got them over-the-counter, that would be atrocious. If they had somebody who was well-trained with the equipment and hearing loss and the benefits of amplification who not only could help them, because for me, when I get my new hearing aids, let's say, I'm always going back a second or a third time. I said, "I need more high frequency. I'm having trouble with such and such." If the person is not sophisticated and not interested, if it's not part of their work, they're just there to sell a hearing aid. So that's just going to be awful for the person.

Dr. Douglas L. Beck:

I can't disagree. One of the things that I was urging the FDA to do six or seven years ago when all this started, 2016, 2017, not just me, but many of us, we were saying the thing is, if you're going to have OTC, that's a matter of what product to wear. But what we had said is, wouldn't it make more sense for the FDA to either strongly advise or to mandate that they get a test and the test interpretation, counseling, recommendations from a licensed healthcare professional, and then buy whatever you want to buy. But at least now you have the knowledge to know what you're looking for. As you know, that didn't sell. They didn't do that.

Anyway, let me close on this question, Jack. You've been very generous with your time and I totally appreciate that. But for the hundreds or thousands of people, professionals that you have personally motivated and inspired, I think each of us knows that Irma has been a rock and supportive and integral to all of these products and processes. And I could tell you stories. When we were graduate students, we would have parties, and that's how I met Irma. She would come to the parties, we would go after clinic sometimes to a local restaurant called Chee Chee's in Buffalo, and Irma would meet us there. And she was always a big part of our education back in those days, and of course your life. So can you share for us your thoughts about marriage, children and the keys to a happy, joyful, and productive life? Because it seems to me you are an exemplar of all of that.

Dr. Jack Katz:

Well, thank you so very much. And when I got engaged to Irma, I was in college and in my last year, suddenly my grades went up, and they've gone up since we've been married. And I think her family was so education oriented, her parents, father had a PhD, mother had, I don't know what training, but they were very smart. So they were very school oriented, and I think that had an effect on me.

But Irma has all the skills. I didn't get to tell you about all of my difficulties, but I have memory difficulties and I have speech and language and reading and other difficulties. All the things I'm weak, she's strong in. So to this day, I have to say, "Who is such and such?" And, "Do you remember this and this?" And when I wrote the first end book, in those days, there was no fancy equipment and it was my responsibility to do the index, and how could I possibly do the index? And so she has a degree in library science and she went back for a special course in indexing, so she indexed the first three issues of the end book. And for spelling, to this day, my spelling is so poor, so I'm constantly asking her. So she has helped me immeasurably. Now that my kids are grown up, they are just terrific, helping me in so many ways. And we're such a close family and take really good care of each other.

Dr. Douglas L. Beck:

How many years have you and Irma been married and what date did you get married?

Dr. Jack Katz:

We're married 69 years. We got married in 1956 on June 24th.

Dr. Douglas L. Beck:

Oh my goodness. Jack, I think I speak for the entire profession, which I rarely ever have done, but if I were to speak for the entire profession, I would have to say that your contributions have inspired and motivated all of us. And it's just astounding, between the SSW, the competing environmental sounds, the phonemic synthesis, the many, many editions of the Handbook of Clinical Audiology. We didn't get to the Handbook of Clinical Audiology today because we don't have time for that. That's tens of thousands of pages, I think, if we put them all together. But it is the backbone of so many audiology programs. And you used to refer to it as HOCA, H-O-C-A, Handbook of Clinical Audiology. I think now it's in its seventh or eighth revision, right?

Dr. Jack Katz:

Yes, it's the seventh, and I am hopeful that somebody else is going to do the eighth.

Dr. Douglas L. Beck:

All right, Jack. Well, listen, I'm going to let you go, but love to you and thank you so much for being the person you are. I've often said you're one of the kindest, gentlest, most loving people I've ever known in my life, and I so appreciate you.

Dr. Jack Katz:

Thank you so much, dear friend. That was so wonderful to hear that. Thank you very much. Best of luck.

Blaise M. Delfino, M.S. - HIS:

Thanks again for tuning into the Hearing Matters podcast today. I'm your host, Blaise Delfino, and on behalf of our entire team, thank you so much for the support, truly, it means so much to us. Head on over to the Apple Podcast app and share your thoughts. What did you like most about this episode and what do you like most about our podcast? Five-star reviews are always appreciated. And also, head on over to Instagram, hit that follow button, and let's connect. And as a team, we can continue to help our community hear life's story.