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Hearing Journal:
doi: 10.1097/01.HJ.0000403506.88088.ce
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The legacies of Robert Galambos and Judith Gravel

Kileny, Paul PhD; Seewald, Richard PhD

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Paul Kileny, PhD, is Director of Audiology and Electrophysiology and Director of the Hearing Rehabilitation Program at the University of Michigan Health System. Richard Seewald, PhD, is Co-Director of the National Centre for Audiology at the University of Western Ontario.

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ROBERT GALAMBOS

Robert Galambos was one of the most important and innovative hearing scientists of the 20th and 21st centuries. His work spans seven decades, and ranges from elegantly structured fundamental research to essential translational research (before the existence of the term) that changed the face of pediatric audiology.

Figure. Robert Galam...
Figure. Robert Galam...
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Bob was born in Lorraine, OH, on April 20, 1914, to Hungarian immigrant parents. He received a bachelor's degree from Oberlin College in 1935 where he was a pre-med student, and then went on to earn a master's and a doctorate in biology from Harvard University in 1941, and a doctorate of medicine from the University of Rochester in 1946. Bob had appointments at Harvard, Emory University, Walter Reed Hospital, and Yale University, as well as the University of California, San Diego, where he cofounded the department of neuroscience with Robert B. Livingston and Theodore Holmes Bullock.

Bob established the high-frequency range of bat hearing by measuring cochlear microphonics based on Hallowell Davis’ discovery of this auditory phenomenon with his colleague, Don Griffin, in 1939. He also established how bats navigate in space using echolocation. Following World War II, he collaborated with Davis on experiments establishing the deleterious effect of loud sounds on hearing, laying the foundations of noise-induced hearing loss. Both he and Davis exposed their own ears to high-intensity acoustic stimuli, which culminated in exposing Davis’ right ear (his poorer ear) to wide band noise presented at 130 dB SPL for 32 minutes.

Soon after the discovery of the auditory brainstem response in adults by his student, Don L. Jewett, Bob went to work to implement this newly recognized audiological tool in newborns and infants. In 1975, he and Carol Schulman published a seminal paper entitled “Brainstem Auditory-Evoked Responses in Premature Infants” that described the configuration of the auditory brainstem response in premature infants, and recognized their risk for congenital hearing loss. He and Schulman also established the effects of maturation on the latency of the auditory brainstem response from prematurity (34-35 weeks) to full term (40-42 weeks) by showing that the latency of wave V decreases with gestational age.

Based on these norms, the duo initiated a newborn hearing screening program in the NICU at UC San Diego for the early detection of hearing loss. In 1979, they built on their work with another influential paper, “Brainstem Evoked Response Audiometry in Newborn Hearing Screening,” comparing responses from normal newborns to newborns cared for in the neonatal ICU. They further compared latency intensity functions for wave V between NICU infants, normal newborns, and adults.

Of particular interest in this work was their early understanding of the effects of risk factors on congenital hearing loss. They described one infant born to a congenitally deaf mother in whom no auditory brainstem responses could be obtained below 60 dB and two kernicterus babies with serum bilirubin levels exceeding 35mg per dL. These observations are particularly interesting today because we know that some of these newborns present with a test result configuration consistent with auditory neuropathy spectrum disorder. They also recognized the effect of neonatal asphyxia on hearing loss, referring to an infant admitted for the condition who presented with significantly elevated auditory brainstem response thresholds. They also established a high incidence of congenital hearing loss among babies with these risk factors (5.3%) in this initial sample of 75.

Carol Schulman and Robert Galambos firmly established the use of newborn hearing screening in the 1970s, and Early Hearing Detection and Intervention would not exist without their innovative work. In The History of Neuroscience in Autobiography, Bob explained how the team first implemented the program: “By 1976, our pilot studies had repeatedly demonstrated that hearing loss is common in the ICN and exceedingly rare in the normal newborn nursery. Armed with these facts, we proposed to deliver the ABR test to all ICN graduates and to follow-up those found to have hearing loss at the Speech and Hearing Center. The hospital administration agreed, and in 1977 we installed the clinical program that has continued without interruption to the present day” (1996;1:178).

In 1981, along with his students, Scott Makeig and Peter Talmachoff, Bob published the first study on steady-state auditory potentials: “A 40-Hz Auditory Potential Recorded from the Human Scalp.” In this paper, they describe how the configuration of the middle-latency auditory evoked potential changes when increasing the stimulus rate from 3.3 per second to 10 per second, to 20 per second, and finally to 40 per second. Based on the natural frequency of the peaks that compose the middle-latency response, at a stimulation rate of 40 per second, they observed a sinusoidal response that followed the simulation rate. He also demonstrated that the amplitude of the response peaked at a stimulation rate of 40 Hz and then rolled off as the rate was further increased. This response could be used to determine auditory thresholds for low-frequency tone bursts such as 250 Hz and 500 Hz.

On a personal level, Bob was kind and generous with his knowledge and advice. He was instrumental in helping me personally learn about newborn hearing screening and to participate in establishing an auditory brainstem response newborn hearing screening program in Edmonton, Alberta, Canada in 1979. He was an inspiration to many of us who grew up professionally in the late 1970s and early 1980s, and also trained many of the premier clinical auditory neurophysiologists such as Terry Picton, Kurt Hecox, Paul Despland, Gayle Hicks, and David Stapells. He taught us the importance of basic neuroscience and ideally, its seamless continuum with clinical neuroscience.

For the last 20 or so years of his life, Bob turned his attention to the visual system and carried out visual neurophysiology research with a colleague in Hungary. He is survived by his wife, Phyllis, of whom he said in his memoir: “I have known more peace, order, comfort, and companionship than a person has any right to expect.”

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JUDITH GRAVEL

Dr. Judith Gravel passed away on Dec. 31, 2008, following a courageous two-and-a-half-year battle with cancer. The field of pediatric audiology will be forever strengthened by her wisdom, passion, and personal integrity. Those who knew Judy not only loved and respected her, they were inspired by her.

Figure. Judith Grave...
Figure. Judith Grave...
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One characteristic that I most respected about Judy was her humility. I can still hear her talking about her heros, Dr. Fred Bess and Dr. Mark Ross, who had inspired and supported her throughout her career. Judy's work was never about Judy; it was about her heros, her family, exciting new developments in the field, and helping children with hearing loss and their families.

We heard through Judy's words the incredible passion she had for her work with children. Over the course of her 40-year career, Judy was a master clinician, a gifted teacher, an individual who was strongly committed to the advancement of our profession, and a creative and highly skilled researcher.

It was the passion she had for this work that drove her to the highest standard regardless of the task at hand. Nothing fed Judy's soul more than to see a new program developed or a new set of evidence-based procedures implemented with children. There is no one I know of who contributed more through a wide range of scholarly and professional activities to the development and implementation of new, scientifically-based hearing screening, diagnostic, and habilitation programs for children.

Judy completed her bachelor's degree in communication disorders in 1970 and a master's in audiology in 1971 from the University of Massachusetts at Amherst. After earning a doctorate from Vanderbilt University in 1985, she went on to a distinguished academic career that included faculty appointments at Columbia University, Albert Einstein College of Medicine, the City University of New York, and the University of Pennsylvania. At the time of her passing, Judy was the director of the Center for Childhood Communication at the Children's Hospital of Philadelphia where she held the William P. Potsic Chair in Pediatric Otolaryngology and Childhood Communication.

Throughout her career, Judy focused intensely on many aspects of pediatric audiology. When it came to hearing and children, Judy either knew it or was driven to learn about it. As a result, she presented and published widely on diverse topics, including the language-learning sequelae of otitis media, newborn hearing screening, behavioral audiometry, minimal hearing loss in children, genetics and hearing loss, amplification, and children with auditory neuropathy spectrum disorder.

In addition to her impressive record of scholarship, Judy provided outstanding leadership and service to her profession. Just a very few of her activities included chairing the Joint Committee on Infant Hearing (2003-2005) and the New York State Department of Health Working Group for the Development of Clinical Practice Guidelines-Hearing Loss in Children 0-3 Years (2000-2003). Judy was also a member of the National Institute for Communicable Diseases Epidemiology and Biometry Research Program Advisory Working Group (1997-2001); the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences (2004-2008); and the Phonak Pediatric Advisory Board (1999-2008).

Judy received many awards in recognition of her work in childhood hearing, including the inaugural Antonia Brancia Maxon Award for Early Hearing Detection and Intervention Excellence, the Distinguished Achievement Award from the American Academy of Audiology, and the 2008 Leadership Award of the League for the Hard of Hearing in New York City. In November 2008, Judy was awarded the Honors of the Association by the American Speech-Language-Hearing Association. With this award, she was recognized for a lifetime of innovative clinical practice, insightful and rigorous research, creative administration, effective legislative activity, outstanding teaching, and other distinguished professional contributions. The Society of Ear, Nose and Throat Advances in Children honored Judy with the 2008 Sylvan Stool Award for her innovative research on otitis media in children, and Salus University also recognized Judy's contributions with an honorary doctorate, awarded posthumously, in 2009.

For those of us who were blessed to know Judy, the first thing we most often recall and deeply miss is her beautiful smile. It was a full-body smile that always reminded us of a little girl on Christmas morning. When Judy was really happy, her smile could light up an entire room. It was impossible to feel anything but her joy and enthusiasm.

Judy was beautifully unique. She was a scholar, a scientist, a teacher, and a clinician whose career exemplified the highest standards of professionalism and ethical conduct. Above all, she was a warm and caring person with a remarkable way of bringing out the best in the lives of everyone she touched.

Although Bob Galambos and Judy Gravel were of different generations, they shared a deep concern for the early detection and diagnosis of hearing loss in children. Indeed, much of Judy's work was built upon and evolved from Bob's contributions years before.

At the 2011 American Academy of Audiology Convention in Chicago, two sessions were devoted to the contributions of six recently departed colleagues in the profession. In July, The Hearing Journal featured the stories of Ira Hirsh and Robert Jirsa (http://bit.ly/recentlydepartedpt1). This month, we pay tribute to two more of the six luminaries.

Dr. Paul Kileny summarizes the career of Dr. Robert Galambos, drawing from his professional and personal relationship with him. The contributions Bob made to audiology and hearing science are long-standing and far-reaching. I never begin a lecture on early identification of infant hearing loss without paying homage to Bob's pioneering work on newborn hearing screening and the application of the auditory brainstem response in hearing assessment of children. Here, Paul succinctly summarizes the enormous impact this hearing giant had on auditory science and audiologic practice.

Dr. Judith Gravel's varied and valuable contributions to pediatric audiology are unequalled. Judy was truly a renaissance woman in audiology as she tirelessly served our profession and improved the lives of the young patients throughout a highly productive career. Judy Gravel's professional life is summarized well from the perspective of Dr. Richard Seewald, her close colleague and dear friend.

A later issue of The Hearing Journal will highlight the impressive professional work of Drs. Roger Ruth and Margo Skinner. Once again, I urge you to read each of these brief tributes, and pass these articles along to students or young audiologists so they, too, will appreciate the impact of these audiologists on our profession.

—JAMES W. HALL III, PHD

Figure. JAMES W. HAL...
Figure. JAMES W. HAL...
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Clinical Professor, Department of Speech, Language, and Hearing Sciences

University of Florida

© 2011 Lippincott Williams & Wilkins, Inc.

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