Thomas Babcock, MD, is a pediatric otolaryngologist — an ear, nose and throat specialist, commonly referred to by the acronym ENT. He joined Nemours Children’s Health, Pensacola in December 2022 with a specific task: rebuild a much-needed pediatric cochlear implant program to serve the needs of children throughout Northwest Florida and Southern Alabama.
Dr. Babcock was born and raised in the Gulf Coast Region. Serving his community as an ENT specialist has become his mission, one that began just steps from the specialty clinic in Pensacola where we conducted this interview.
Carol Vassar, producer
Guest: Thomas Babcock, MD
Nemours Children’s Health, Pensacola
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Nemours Children’s Health, Well Beyond Medicine Episode 21, Transcript
Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here let’s go.
Well Beyond Medicine!
Dr. Thomas Babcock is an otolaryngologist, an ear, nose, and throat specialist, commonly referred to by the acronym ENT. He joined Nemours Children’s Specialty Health in Pensacola, Florida, in December 2022 with a very specific task: rebuild a much-needed pediatric cochlear implant program for Northwest Florida and Southern Alabama. Dr. Babcock was born and raised in the Gulf Coast region, and serving his community as an ENT has become his mission. It’s a mission that started just steps from the Nemours Pensacola Clinic, where we conducted this interview. Here’s Dr. Thomas Babcock.
Dr. Thomas Babcock, Nemours Children’s Health (01:10):
My start in medicine actually began in high school. I was part of a pilot program for high school students here in Pensacola. I grew up here, where as a senior in high school, got to leave high school early and explore different career paths, and one of them was medicine. I was actually following an anesthesiologist here at, was Florida Hospital at the time, now HCA Florida West Hospital, right across the parking lot. So I got my experience and initial exposure to medicine in the operating room in high school. So I went into college knowing that I was interested in medicine with that career path in mind.
And so, after my undergraduate studies in Orlando at Rollins College, I started medical school at Florida State University and did my third and fourth years of medical rotations here in Pensacola. And my mentor at the time and the director of the surgical clerkships here in Pensacola was an ENT and was actually an ENT with Nemours, Dr. Jeff Chicola. So he was my first exposure to ENT and really was an excellent mentor for me. I had known his son from growing up here, so he knew the things I was interested and knew my personality. And from very early on, he was pushing me to do ENT and he almost had the vision before I did that I would enjoy ENT, and the breadth of what you can do in the practice, the lifestyle you have with the practice in a surgical practice and kind of knowing my personality really pushed me forward to explore it.
After residency, I did a Neurotology fellowship, which is kind of a sub-specialization in ear and skull base surgery. So after fellowship, I came back to practice in Pensacola and I was previously in adult and pediatric practice here in town since about 2017, and started a primarily adult cochlear implant program at my prior practice. But in doing that, I realized and gleaned a lot of information about the lack of a pediatric cochlear implant program at Pensacola, which was previously here and part of Nemours, but the infrastructure and system around that had kind of gone by the wayside because it wasn’t a focused effort. So joining Nemours in December of last year that’s my main effort to kind of bring back a multidisciplinary consolidated, efficient cochlear implant program here.
Carol Vassar, podcast host/producer (03:59):
And I think a lot of people have heard what a cochlear implant is, but give us the rundown, just generally what is it, and for what sorts of conditions are children in particular eligible for a cochlear implant?
Dr. Thomas Babcock, Nemours Children’s Health (04:15):
Sure. Cochlear implants in children are an implantable hearing device for children with severe to profound hearing loss. And basically, what a cochlear implant does is, it converts sound energy into an electrical signal that directly stimulates the hearing nerve. So a child with a congenital hearing loss that they’re born with or a progressive hearing loss that reaches the point of a severe to profound hearing loss would be a candidate for a cochlear implant. And there’s kind of two subsets of patients that we think about when we talk about children with hearing loss and possible cochlear implantation. There’s those that are born deaf or prelingually deaf and children that are postlingually deaf or postlingual cochlear implant candidates that have learned speech and language.
Carol Vassar, podcast host/producer (05:12):
So you’re picking up a program that had sort of gone by the wayside. You said it was multidisciplinary. What other disciplines are required to be part of, say, a child getting a cochlear implant?
Dr. Thomas Babcock, Nemours Children’s Health (05:25):
In a lot of ways, putting in the cochlear implant is the easy part. I’ll tell people a lot of times I’m kind of the cochlear implant technician. The real driving force behind success with the cochlear implant are the pediatric audiologists, speech and linguist pathologists for special training to teach spoken language to children with a hearing loss in cochlear implants. They’re really the foundation of an efficient and successful cochlear implant program. In addition to that, a lot of times, we have audiology assistance that helps with coordination of care, social workers that help with coordination of care. So the system needs to be a collaboration between all these different subspecialists and ancillary services for it to be successful.
Carol Vassar, podcast host/producer (06:18):
So as you said, you’re the technician, you do the implant. There’s a lot of post-operational post-op work that needs to be done therapeutically, socially, so it really takes a team.
Dr. Thomas Babcock, Nemours Children’s Health (06:30):
Absolutely. And putting in a cochlear implant, a lot of people have seen videos on YouTube of cochlear implants being turned on and activated in kids where they’re hearing for the first time. To a child that’s either prelingually deaf or even postlingually deaf, the hearing that they’re receiving with a cochlear implant when it’s first activated, it’s not necessarily meaningful hearing to them. It’s not natural hearing. So it takes training and adjustments of the cochlear implant working with a speech and language pathologist for that unnatural sound of a cochlear implant to become a more natural sound to the child. And it’s amazing that the plasticity of the brain to be able to take that information that’s being provided an electrical signal and understand it in a way that’s meaningful speech.
Carol Vassar, podcast host/producer (07:26):
Is there a minimum age for somebody to get a cochlear implant?
Dr. Thomas Babcock, Nemours Children’s Health (07:30):
So yes and no. There’s different indications for cochlear implants, and in a child with a congenital hearing loss or a hearing loss since birth, we typically try to have the child implanted by nine to 12 months of age. But if a child has hearing loss secondary to something like meningitis, we may implant younger than nine to 12 months of age because oftentimes, after meningitis, you get ossification of the cochlear. So a lot of times, you want to do them as soon as possible after they’ve had meningitis at a very young age. Otherwise, the cochlear becomes unusable for insertion of a cochlear implant.
Carol Vassar, podcast host/producer (08:10):
Younger is better. Is that what I’m hearing?
Dr. Thomas Babcock, Nemours Children’s Health (08:13):
Younger is better. And that was going to be kind of my next point. And we’ve done a lot of studies since we began cochlear implants, looking at the impact of timing of cochlear implants on a child’s success for the cochlear implant, success being spoken language. And we know the earlier the implantation with regard to nine to 12 months of age, the more likely that child is to catch up to their peers by school age. And that’s kind of our goal is for them to be integrated into a normal classroom with spoken language. And kind of the critical stage for speech and language development is that one to two years old. So what your child is hearing as they’re starting to develop speech, that really sets the foundation for further speech development moving forward. So if we’re not able to get an implant performed by 12 months of age, oftentimes we’re kind of behind the [inaudible 00:09:17]. As you get further from 12 months of age, two years old, three years old, you start to seek the degree of performance with the implant taper off.
Carol Vassar, podcast host/producer (09:28):
But sometimes, adults will also get cochlear implants. How is that different? I’m curious.
Dr. Thomas Babcock, Nemours Children’s Health (09:33):
So adults will get cochlear implants with progressive hearing loss in adulthood, and so the difference primarily is those adults have learned speech and language and they had a progressive hearing loss. Here in Pensacola, I was doing a lot of adult cochlear implants in my prior practice. This is a big military community. We had a lot of people progressive hearing loss due to military noise exposure. So the programming and language acquisition and hearing with a cochlear implant was much easier for an adult typically because they have a reference of what things should be sounding like. Children, this is all new to them that are born with the hearing loss, and a cochlear implant, the sound awareness with that is a very foreign idea to them. So to take that sound awareness and convert it into meaningful sound of receptive language is a much bigger endeavor than adults.
Carol Vassar, podcast host/producer (10:35):
So not having that frame of reference in children makes a huge difference.
Dr. Thomas Babcock, Nemours Children’s Health (10:39):
Carol Vassar, podcast host/producer (10:41):
You do the surgeries locally right here across the parking lot, essentially. Talk about the importance of having this service in the panhandle.
Dr. Thomas Babcock, Nemours Children’s Health (10:51):
This was really the driving force for me coming to Nemours. I was finding at my prior practice that children that would be referred to my practice really wouldn’t reach our office for consultation until they were a year and a half, two years old. I think it was partly because of the lack of awareness of providers in the area and the parent and provider education on the piece to know the importance of early referrals to an audiologist or a cochlear implant surgeon. So starting that process behind in many of these children, we want to be able to create a flagship program here in the area so people know as soon as hearing loss is diagnosed, we can refer these patients and get them into the system that prevents referrals to an academic medical center, the closest being UAB, University of Alabama at Birmingham or Shands in Gainesville. So the local program makes the time to referral and consultation optimal, and it really provides resources to parents locally, which oftentimes is much needed.
Carol Vassar, podcast host/producer (12:12):
And it sounds like it addresses that intervention issue, intervening being earlier is better.
Dr. Thomas Babcock, Nemours Children’s Health (12:18):
Carol Vassar, podcast host/producer (12:19):
Let me ask you this. This program being renewed here. Who’s on the team? Specifically, who are the audiologists you’re working with and the social workers you’re working with, and how is that team coalescing under your leadership since you got here?
Dr. Thomas Babcock, Nemours Children’s Health (12:36):
So currently, it’s myself and two audiologists, Keena and Tonia. And we had a relationship prior to myself coming here because we were sharing a lot of patients through my prior practice and their practice here at Nemours. So it’s kind of a seamless transition for me to come work under the same roof because we were already sharing these patients. We’re still early in the process of creating this comprehensive program. So we currently don’t have a dedicated social worker, and we currently don’t have a speech and language pathologist. The speech and language pathologist is a very important component of the program.
And a lot of what we’re trying to do is a model that’s been implemented at Nemours Children’s Health, Orlando. I have been in talks with Dr. Cedric Pritchett, who’s the ENT and the director of the ear and hearing program in Orlando. And he’s kind of provided this framework for a working program within the Nemours system. And probably upfront, as we kind of move forward, and this becomes a system where we’re moving children through it, we’ll probably have to lean on some of those resources at Nemours Children’s Health, Orlando, and use some of the telemedicine services available at Nemours who they’re kind of a champion of. So we’ll utilize these resources to bring care to Pensacola until we have a better infrastructure here locally.
Carol Vassar, podcast host/producer (14:15):
You have been at this your entire career. Is there a patient story? I know we’ve seen the videos on YouTube when the child hears mom’s voice for the first time, and everyone is in tears. Have you had that kind of a moment, or you’ve had an experience with a family or patient that is moving and stays with you as you do your work?
Dr. Thomas Babcock, Nemours Children’s Health (14:39):
There was a family when I was in fellowship at University of Miami, that was a family of, I want to say, five kids, and they have a genetically inherited form of congenital hearing loss, which is part of a larger syndrome. And this family came from Puerto Rico to get cochlear implants at the University of Miami. And as a program, we became very close with this family, and this family kind of stuck with me for a few reasons. One, the age range of the children was from about nine months of age to six or seven, and the oldest children really wanted the cochlear implants, more so for sound awareness. And the younger children were prelingually deaf. The older children were using sign language primarily at that point, using hearing aids for some sound awareness. But the older children did very well with the implants because they had more of a progressive hearing loss and had some hearing that was serviceable at a young age with a hearing aid. So they had speech but hearing-impaired speech.
So this entire family got cochlear implants, and it was amazing to see these normal-hearing parents have children that they can now more readily communicate with. But probably the most significant thing that I gleaned from it was the difference in performance for these kids that were implanted at a different age. And it was almost like a internal study within this family where the children that were implanted at 12 months of age, I think the youngest were twins. The youngest two were planted at about 12 months of age, and they did fantastic and had no difficulty with speech articulation that you would classically associate with hearing impairment. But the older children did really well with the implants, and although they had some difficulty with speech articulation due to their history of hearing impairment, they all did fantastic. But the clarity of speech of the youngest children as opposed to the hearing-impaired speech of the oldest, that just shows how much the age of implantation can impact performance.
Carol Vassar, podcast host/producer (17:24):
Again earlier, having worked out better even though all the kids seem to have had a great outcome.
Dr. Thomas Babcock, Nemours Children’s Health (17:30):
Carol Vassar, podcast host/producer (17:32):
Let me ask you this. We’ve championed the idea of well beyond medicine, and I would love for you to talk globally about your practice here in Pensacola and the ways in which you and your team go well beyond medicine, and what well beyond medicine means to you.
Dr. Thomas Babcock, Nemours Children’s Health (17:48):
For me, it has a lot to do with returning to my community and providing a resource that was not previously available here at this time. A lot of times across the nation, neurotologists and cochlear implant programs are in large metropolitan areas or at academic medical centers. But I think in particular, after COVID-19 and difficulty with traveling, I think bringing this subspecialty care to your community and providing these services is really going to be kind of the healthcare of the future in a lot of ways. Being able to provide these services to families locally when this is such a labor-intensive process with a lot of follow-up appointments and traveling, if you were to have it performed at an academic medical center three, four hours away, I think it provides such a profound impact on the family’s ability to weather that. A lot of times with children with hearing loss and cochlear implants, the children really a lot of times weather it much better than the parents. To me, this is a resource and a success and a reduction of burden on the family unit as a whole.
Carol Vassar, podcast host/producer (19:14):
They don’t have to go as far. They’re right here in the community, and you’re serving the community where you grew up. Dr. Babcock, is there anything else you’d like to share with our listeners today on the podcast?
Dr. Thomas Babcock, Nemours Children’s Health (19:26):
It’s kind of funny, in a way. I’m actually here in the role of what Dr. Chicola used to do previously with Nemours, my mentor as a medical student. And basically, this is a resurgence of his practice, and it’s almost come full circle. So you never know what opportunities arise and what visions people can have before you even have them.
Carol Vassar, podcast host/producer (20:00):
Thanks for listening to our conversation on cochlear implants with me, Carol Vassar and our guest, Dr. Thomas Babcock. Going well beyond medicine means taking pediatric services to where they are most needed, like Florida’s panhandle. What does well beyond medicine mean to you? Let us know. Leave us a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. While you’re there, check out our other episodes, subscribe to the podcast, and leave a review. Thanks to Che Parker, Cheryl Munn, Susan Masucci, and Dr. Mary Mehta for this week’s production assistance. Join us next time as we discuss treatments of anaphylaxis in children with a worldwide leader on the topic, Dr. Tim Dribin from Cincinnati Children’s Hospital Medical Center. Until then, remember, together, we can change children’s health for good well beyond medicine.