2018 HRRP Programmatic Panel Member Vignette

Title: Advancing Effective Hearing Restoration Therapies

Col. LaKeisha Henry, U.S. Air Force; Defense Health Agency Hearing Center of Excellence; Hearing Restoration Research Program Programmatic Panel Chair

I am an ENT Surgeon in the Air Force. I’m also currently the Air Force Surgeon General Consultant for otolaryngology. And I’m a General ENT by trade.

The prevalence of hearing loss and auditory and vestibular disorders associated with our Service members is something that we are becoming more and more aware of, and certainly we understand the prevalence to be high in the active duty population in addition to our Veteran population.

The combat environment poses unique challenges associated with noise exposure that you wouldn’t necessarily have near your home here in the United States.

There are different types of noises that you can be exposed to without the ability to predict that noise, such as IEDs or other types of blasts, unexpected mechanisms of warfare, whether it’s gunfire or artillery. So exposure, whether it’s in a training environment or exposure in an actual battlefield environment, is very different and very unique.

The impact of noise and blast as a specific type of noise does not always present in a Service member right away. Sometimes the need to provide other forms of care may take a higher priority, and so hearing loss may not necessarily be noticed right away? Or the ability to evaluate it far forward at the point of injury, which can be polytrauma or multiple different types of injuries, and not just noise exposure or blast exposure.

Traumatic brain injury is a particular concern in terms of processing disorders and other central pathways that are affected by the actual injuries that they have. Hearing restoration includes, not just the cochlea itself, but also central pathways. And hearing restoration is a bit different than, say, a peripheral nerve, in which you might be able to place a graft or reconnect a peripheral nerve when it’s injured.

The auditory and vestibular system in general is very complex. So hearing restoration has multiple avenues of which we can focus our therapies. So those therapies that are aimed particularly at the cochlea and neuronal components of the auditory system, the hearing system, are certainly important. We have not had quite this opportunity before, in terms of Congressional special interest, like we have for this particular, where we have funding associated with this focus and making sure that we have tried to cover the intent and also looking at the science and making sure that the science that’s out there would be prioritized in terms of the best way to focus those limited dollars.

Additional research needs to be done in terms of delivery that is closer to the time of injury. A therapy that requires something that’s very invasive would be difficult to push far forward on the battlefield, but something that’s less invasive may not necessarily provide a therapy that is as effective. So we have that whole balance.

So, whether it’s delivery mechanisms or the actual therapies themselves; whether they are cross gene therapy, stem cell therapy, nanoparticles, or other pharmacotherapies; whatever those therapies are, we still have quite a bit of research to do across all of those, and further mechanisms.

I would encourage future PIs to think about the particular patient population that we serve. The Service members and Veterans are a very unique population in regards to exposure to noise and different mechanisms of hearing loss. But it’s not exclusive. So I would certainly encourage PIs to not be discouraged by the uniqueness of the population, but to embrace that and to really push the science so that this becomes an achievable goal, not just for Department of Defense and Veterans populations, but for our population as a whole.