Inner Ear Treatments Cochlear Implants Hearing Loss and More: Advances in Otolaryngology
Summary
TLDRIn this Brain Channel interview, Dr. Jeff Harris, a distinguished professor of Otolaryngology, discusses his extensive career and groundbreaking research. He shares insights into his work on autoimmune ear diseases, the development of innovative drug delivery systems, and the transformative impact of cochlear implants on hearing loss. Dr. Harris also highlights ongoing research in hair cell regeneration and the challenges posed by HPV-related cancers. The conversation emphasizes the significance of translational research and the future advancements in otolaryngology that aim to improve hearing and quality of life for aging populations.
Takeaways
- 🔬 Dr. Jeff Harris is a distinguished professor of Otolaryngology and has been at his current institution for 38 years.
- 📚 Dr. Harris originally trained in Boston at Harvard and holds a PhD in Immunology.
- 🦻 His research shifted from general head and neck surgery to ear diseases, specifically exploring the immune responses in the inner ear.
- 🧪 His lab discovered that the inner ear is not immune-privileged and has a robust immunological response, particularly in the endolymphatic sac.
- 💉 Dr. Harris developed a new treatment involving a sustained-release gel for drug delivery to the inner ear, leading to the creation of a company called Autonomy.
- 👂 Dr. Harris was involved in the development of cochlear implants, which have significantly improved the quality of life for deaf patients.
- 🧠 Functional MRI studies have shown brain plasticity in patients with cochlear implants, indicating that the brain can adapt to new auditory inputs.
- 🔬 The Otolaryngology division is also focused on HPV-related oropharyngeal cancers and developing rapid screening tests.
- 👴 Hearing loss is a major issue among the elderly, with ongoing research into regenerating hair cells and neurons to improve hearing.
- 🛡️ Prevention of hearing loss through protective measures is crucial, as noise exposure is a significant factor in developing deafness and tinnitus.
Q & A
Who is Dr. Jeff Harris and what is his current position?
-Dr. Jeff Harris is a distinguished professor of Otolaryngology in the Department of Surgery and the head of the division of Otolaryngology.
What is Dr. Harris's background in terms of education and training?
-Dr. Harris completed his training in Boston at Harvard, has been with his current institution since 1979, and holds a PhD in immunology.
What was Dr. Harris's initial area of specialization when he started his career?
-Dr. Harris started his career as a head and neck surgeon, not as an ear doctor.
What discovery by Professor Bryan McCabe influenced Dr. Harris's research direction?
-Professor Bryan McCabe discovered that some ear diseases and hearing loss might be autoimmune in origin, which influenced Dr. Harris to investigate this area.
What significant finding did Dr. Harris's laboratory discover about the inner ear?
-Dr. Harris's laboratory discovered that the inner ear has a robust immunological response, particularly involving the endolymphatic sac, which acts as the lymph node of the inner ear.
What innovative treatment method did Dr. Harris help develop for ear conditions?
-Dr. Harris helped develop a sustained release gel for drug delivery into the ear, which is thermo-reversible and can hold drugs like dexamethasone.
What is the name of the company that Dr. Harris helped found, and what is its purpose?
-The company is called Autonomy, and it focuses on developing treatments and drug delivery methods for ear conditions.
What is a significant milestone achieved by Autonomy?
-Autonomy developed an FDA-approved antibiotic suspended in a gel for children with middle ear infections, which allows for sustained drug release and eliminates the need for ear drops.
How does a cochlear implant work, according to Dr. Harris?
-A cochlear implant consists of electrodes surgically placed in the inner ear that stimulate surviving neurons to transmit sound signals to the brain, allowing deaf patients to hear.
What advancements have been made in the indications for cochlear implants?
-Cochlear implants are now used not only for patients with bilateral profound deafness but also for those who can still hear with a hearing aid, providing a full range of auditory fidelity.
What current research is being conducted on the brain's response to cochlear implants?
-Researchers are using functional MRIs to study how the brain's circuits adapt and change in response to cochlear implants, showing plasticity in tone-atopic organization.
What new area of concern in Otolaryngology is related to HPV?
-There is a growing epidemic of HPV-related oropharyngeal cancer, affecting people who are not traditional smokers or drinkers, requiring new treatments and surveillance methods.
What innovative screening method is being developed for HPV-related cancer?
-One of the faculty is working on a rapid spit test for screening individuals at risk for HPV-related cancers.
What is the future direction of research in hearing loss prevention and treatment?
-Future research aims to regenerate hair cells and neurons using growth factors and drug delivery methods, potentially restoring hearing in aging populations.
What common causes of hearing loss are highlighted by Dr. Harris?
-Noise exposure is a significant cause of hearing loss, and prevention includes using ear protection in noisy environments to prevent hearing damage and tinnitus.
Outlines
🎓 Introduction to Dr. Jeff Harris and His Work
Bill Mobley introduces Dr. Jeff Harris, a distinguished professor of Otolaryngology at the University of California, San Diego. Dr. Harris shares his extensive background, including his PhD in immunology and his career spanning 38 years. He discusses the unexpected direction his research took, focusing on the immunological aspects of ear diseases and hearing loss. His work includes significant discoveries about the ear's immune responses and the development of treatments for autoimmune-related hearing loss.
💉 Innovative Treatments for Ear Conditions
Dr. Harris describes the development of a new drug delivery method for treating ear conditions, involving a thermo-reversible gel that stays in place upon reaching body temperature. This gel can be used to deliver drugs like dexamethasone directly into the ear. This innovation led to the creation of a company called Autonomy, which now employs 160 people and has developed FDA-approved treatments such as a sustained-release antibiotic gel for children with middle ear infections.
🦻 The Evolution and Impact of Cochlear Implants
Dr. Harris talks about the groundbreaking technology of cochlear implants, which he first performed in San Diego in 1985. These implants have evolved from crude devices to sophisticated systems with multiple electrodes that stimulate specific neurons, allowing deaf individuals to hear. He explains how the brain adapts to these implants, interpreting the signals as sound, and highlights the transformative impact they have on patients' lives.
🔬 Future Directions in Otolaryngology and Brain Adaptation
Dr. Harris discusses future projects in the field of Otolaryngology, including the treatment of HPV-related oropharyngeal cancers and the potential for regenerating hair cells in the ear to combat age-related hearing loss. He emphasizes the importance of preventing hearing loss through noise protection and explores the possibilities of using growth factors to stimulate hair cell and neuron regeneration. The conversation concludes with reflections on the ongoing challenges and advancements in hearing restoration and protection.
Mindmap
Keywords
💡Otolaryngology
💡Immunology
💡Inner ear
💡Endolymphatic sac
💡Autoimmune
💡Cochlear implant
💡Translational research
💡Thermo reversible gel
💡HPV (Human Papillomavirus)
💡Hair cells
Highlights
Dr. Jeff Harris is a distinguished professor of Otolaryngology with 38 years of experience.
Started training in Boston at Harvard, moved to San Diego as a head and neck surgeon in 1979.
Developed research indicating that the ear has a robust immunological response.
Identified the endolymphatic sac as the lymph node of the inner ear.
Investigated immune responses in the ear, leading to diagnostic methods and treatments for ear diseases.
Developed a method to inject drugs through the eardrum for better absorption into the inner ear.
Co-founded a company, Autonomy, that developed a sustained-release gel for drug delivery in the ear.
Created an FDA-approved antibiotic gel for children, eliminating the need for ear drops.
Performed the first cochlear implant in San Diego in 1985, significantly improving the lives of deaf patients.
Cochlear implants stimulate neurons in the inner ear, allowing the brain to interpret sound and other auditory information.
Research shows brain plasticity allows adaptation to cochlear implants, even with frequency shifts.
Ongoing work includes treating HPV-related oropharyngeal cancers and developing rapid screening tests.
Exploring regenerative treatments for hearing loss, focusing on hair cell and neuron regrowth.
Emphasizes the importance of hearing protection to prevent noise-induced hearing loss and tinnitus.
Predicts future advancements in drug delivery systems and treatments to improve hearing in the elderly.
Transcripts
[Music]
greetings bill Mobley for the brain
channel happy to be with you today and
to be with Jeff Harris dr. Jeff Harris's
distinguished professor of
Otolaryngology in the Department of
Surgery and the head of the division of
Otolaryngology Jeff it's great to have
you here I wanted to have you tell us a
bit about your background and about the
work that you and your division do and
also about the exciting research that's
going on in your group happy to do so
well I've been here I'm one of the
senior seniors now hard to believe that
I've been here 38 years started 1979
having finished training in Boston at
Harvard and came here with a PhD as well
and immunology where I thought
immunology was going to take me in my
training has ended up being completely
different of course
what's interesting was when I finished
my training in Boston I came to San
Diego as a head and neck surgeon not as
an ear doctor and right about that time
there was a professor at University of
Iowa named Bryan McCabe who's very
well-known professor in those days who
serendipitously came upon the idea that
ear ear diseases and some some hearing
loss might be autoimmune and origin and
he wrote a classic paper then that I
read and with my background in
immunology I said well that's an area
that I ought to be investigating and so
I set about doing some basic science
research on whether the ear like what
was thought to be the brain whether it
was immuno privileged and turns out that
it isn't and it turns out from the basic
science studies that our laboratory did
that the ear has a relatively robust
immunological response that there
appears to be in the inner ear a organ
called the endolymphatic sac which is
what is thought to be responsible for
fluid resorption but it turns out that
it's the lymph node of the inner ear and
we did studies to
look and see whether or not that organ
if disconnected from the ear surgically
in experiments that we were doing might
it prevent the ear from responding and
Mina logically and in fact it did so we
developed this new area of research and
scientific investigation that involved
the inner ear immune responses it turns
out that patients also have conditions
that are immunologic rheumatologic viral
that provoked the immune response and
affect their hearing and so over the
years we've developed methods of trying
to diagnose them including an antibody
test I developed and also ways in which
we can begin to give them better
therapies as you know with many
rheumatologic diseases you have to treat
them with high-dose steroids steroids
have a lot of systemic side effects and
so we began to look at could you develop
a treatment where you would be injecting
these in these drugs directly through
the eardrum and get absorbed into the
inner ear it turns out that if you take
drugs that are off the shelf and inject
them through the eardrum and have the
patient lay on their side and try to
have that drug absorbed into the inner
ear what happens as soon as they swallow
it goes down the eustachian tube and the
drug dissipates or as soon as they stand
up it comes out through the hole that
you use to inject the drug in the ear so
I had the good fortune to run into a
venture capitalist in San Diego who had
an inner ear problem and we talked about
a new therapy for his condition whereby
we would inject a drug into his ear so
he underwent the treatment that I did
and in fact it it helped him
tremendously and he came back and he
said to me well you know that's a great
idea why don't we sit down and think
about how we can develop a company that
might be able to develop these kinds of
treatments and in drug delivery that
would be much more satisfactory to help
patients so it turns out that with a lot
of preclinical research that
he and his people that were hired to
investigate this and our own expertise
and help and guide them as to how to do
this we developed a sustained release
chemical a gel that is thermo reversible
meaning that if it's in the out here
it's in a liquid form but as soon as it
hits body temperature gels so we can
then embed into this gel a drug such as
dexamethasone and have it as a liquid
form injected into the ear and then as
soon as it hits the body's temperature
it forms a gel and stays there for
several weeks and so we've now developed
a company in around this idea
it's called autonomy and here in San
Diego it's a now company that has 160
employees and it now has a antibiotic
that we have suspended in this gel that
allows children to get one injection
through and timpanist amitabh those
little tubes that you use for fluid that
builds up in the middle ear of kids and
they don't have to use air drops and so
this is an antibiotic that will stay
around for two weeks and they know the
parents don't have to put drops in their
ears
there's no screaming it's just a
sustained release drug and it's now FDA
approved and it's being commercialized
today so an example really of having a
basic interest in science but also a job
that brings you to the to the care of
patients and you put those two things
together and some pretty surprising
things can emerge yes I guess that's
what's translational research you know
in the true sense of the word Jeff
you've been involved in a number of
projects the cochlear implant is an
interesting really interesting not just
from a therapeutic perspective but
interesting and in terms of the way the
brain interprets the information coming
from the implant speak a little bit
about that if you will yeah it's it's a
miracle really I can't think of anything
that is equivalent to it that we
currently have I mean a lot of things
happening in the eye but there's nothing
as advanced as cochlear implants for
patients that are deaf
and I did the first cochlear implant in
San Diego 1985 it was in those days a
very crude device electrode that you
would put surgically into the inner ear
with the notion that these electrodes
would lay up against the neurons that
were still surviving within the inner
ear of a deaf patient because as you
know hearing is a conductive the eardrum
the ear canal the little bones and that
takes sound into the inner ear that
stimulates hair cells the hair cells are
what create an electrical impulse and
that gets transmitted through the
neurons to the brain and in many deaf
patients the hair cells go
but the neurons survive or a portion of
the neuron survive so and because the
cochlea is a snail shell in terms of its
anatomy in the way it's designed it's a
perfect in atomic configuration to allow
an electrode to lay up against a
surviving neuron at a specific frequency
and so these current devices have 22 to
24 electrodes each one lays against the
center of the cochlea and it stimulates
a neuron with a specific frequency that
it's capable of receiving and at that
point the brain will pick up what is now
a different way of hearing and be able
to interpret that as sound and in case
in some cases music and in some cases
everything in their environment it's
it's absolutely fascinating that you see
a individual who has been deaf for many
years and was once a hearing person and
you turn this device on and within a few
weeks they even immediately they'll say
I got back into my car and I couldn't
believe what what was the sound I was
hearing and it was the turn signal that
they were hearing for the first time in
15 years so it's a device that works
beautifully well in people who are
deafened and now the indications have
been extended to people not only who
have bilateral profound
toughness but who can still hear with a
hearing aid and you are able to implant
an electrode that
augments the high frequencies and they
have preserved low frequencies so that
can wear a hearing aid and the Allah in
the device itself so it gives them a
full range of fidelity that they would
not get in previously you know it's it's
very clear that the brain learns how to
listen to the implants it learns how to
listen to all kinds of other information
coming in orally that are it's pretty
indistinct but you teach it a little bit
and it'll earns a lot what do we know
about how the brain changes in people
with a cochlear implant do we know how
the brain circuits are modified is there
some inference I'd into that there are
places that are doing functional MRIs
with people who have been implanted and
have looked to see whether or not there
are certain areas of the brain that have
taken over and what's interesting is
that you can take an electrode that
should be only for the high frequencies
and it doesn't reach into the areas of
the low frequencies and yet once the
patient gets the ability to listen and
learn in the it'll fill in these areas
and they will actually be getting low
frequencies where the electrode should
be laying up against a mid or high
frequency fiber and so there's some
plasticity that occurs and allows there
to be a shift in the tone atopic
organization of the brain to you know
reinterpret what they're hearing as
higher frequencies or lower frequencies
it's great stuff it's really so
fascinating I mean this is the brain
channel so we're obviously extremely
excited about the brain and and I think
we've just scratched the surface on
understanding how it takes in sensory
information talk about the near future
for your own work and for the work of
the division what what are the projects
you have in mind well Otolaryngology is
a big field it's we think of ear nose
and throat but in fact we do head and
neck can't
we take care of all of the serious
cancers that develop in the
oropharyngeal areas the larynx the face
and in deep to the face we do skull base
surgery which is sort of a no-man's land
between the inner ear and the
neurosurgical parts of the skull and
right now what's really become
fascinating is the the epidemic of HPV
as a cause for or pharyngeal cancer it's
become very well recognized that HPV
affects people who are not the smokers
and the drinkers and so we have a whole
cadre of people who have developed or
pharyngeal cancers that are due to a you
know human papilloma virus and so the
treatments that we can now afford them
and the surveillance that we now have to
do has changed immensely in the last
five years and so there's going to be an
onslaught of more patients who come
through with HPV related cancers and you
guys are developing the special
abilities necessary to be the expert
site for evaluating and caring for those
patients we one of our faculty is in
fact working on a spit test that would
allow us to do rapid screening of people
who may or may not be at risk for HPV
cancer interesting
Jephthah works exciting interesting it's
hard to believe that Otolaryngology is
is is going to go out of style one of
the one of the major challenges that I
think will face us after we've dealt
with these degenerative diseases of the
brain and after we've dealt with stroke
I think of course we're going to we're
going to have better ability to manage
all that maybe even prevent it we're
still going to have old folks that have
trouble hearing and seeing and my guess
is that hearing is going to be just as
much it just as important seeing for
those folks that are in their 90's or
you know beyond 100 any thoughts about
what that looks like what are we going
to have available for those folks as
they age well it's interesting because
greater than 50 percent of people over
75 are have hard our hard-of-hearing you
have
and between the ages of 64 and 7075
there are about a third of people who
have significant hearing loss so we're
we're all looking for ways to regenerate
hair cells find growth factors neuro
neuro growth factors that will stimulate
the regrowth not of just the hair cells
but of neurons as well and what we're
finding is that the supporting cells
that lay underneath the hair cells can
regenerate hair cells so with the proper
stimulation they can be turned from just
supporting cells to new hair cells and
in lower species this happens all the
time
in chickens for instance if you wipe out
their hair cells they will greet grow
new hair cells and there are some
mammals that we're beginning to tease
apart the signals that prevent them from
regenerating so that their hair cells
can regenerate and it's only a matter of
time we hope that we will be having drug
delivery like I mentioned earlier for
growth factors that can be put into a
person's middle ear get absorbed into
the inner ear and within you know months
their hair cells start sprouting so to
speak and that would be the greatest way
we can regenerate hair cells and in
people who are beginning to lose their
hair cells as they age one of the
important things of course is prevention
of hearing loss and many people create
their own problem by noise exposure and
we know that that's a big factor for the
development of progressive deafness and
patients and people who you you see
every day out there on the streets
they're workers they're construction
people and they're in there with the
jackhammers and they don't wear hearing
protection or they're carpenters are
working in shops where they you know
don't protect themselves and all they
have to do is wear some ear protection
and they will prevent not only hearing
loss but the other thing that's so
plaguing of people is tinnitus the
ringing part of the
symptomatology that goes along with
deafness Jeff great to talk with you
great to hear about all the advances and
here's looking forward to a great future
in which all of us are able to hear a
little bit better yes I hope some we do
good thank you bill mably for the brain
channel
[Music]
[Music]
you
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