Inside the Stanford Initiative to Cure Hearing Loss: Cutting-Edge Science and Innovation

Welcome to This Week in Hearing.

I’m Shari Eberts,

co author of Hear & Beyond

Live Skillfully with

Hearing Loss.

And this week Our guest is Dr.

Tina Stankovic,

the department Chair of

Otolaryngology Head and Neck

Surgery at Stanford University.

In this role,

she also runs Stanford’s

Initiative to Cure Hearing Loss,

or SICHL for short.

Tina has a very impressive

career as an academic and

also in research.

She was trained as an ear and

skull based surgeon at Harvard

and as an auditory

neuroscientist at MIT.

And she was also recently

elected to the prestigious

National Academy of Medicine for

her scientific contributions

into the field of hearing loss.

So thank you Tina for being here

to talk about the incredible

work of SICHL and all that

you’re doing to move the field

of hearing research forward.

So thank you,

thank you for having me.

Really appreciate having the

opportunity to chat with you.

Absolutely.

So before we dive into

the discussion,

I would love to learn a little

bit more about you and how you

got interested in studying

hearing and how that sort of led

your career path to your current

role at Stanford.

Thank you for that opportunity.

Like so many of us,

I’ve been inspired by remarkable

people I’ve had the privilege of

learning from over the years.

My love of music drove me into

the field of hearing.

I played the piano semi

seriously before school and

before high school,

and since then have remained

a dedicated listener.

And of course to appreciate

music,

we must be able to hear it.

As an undergraduate at MIT,

double majoring in physics

and molecular biology,

I looked for a project that

would allow me to combine these

two disparate majors with my

passion for music and my budding

interest in medicine.

So I chose to work in a cochlear

implant lab at Massachusetts Eye

and Ear and was fascinated,

realizing that some people can

do remarkably well in terms of

their ability to understand

speech and others don’t.

So that led me to pursue my PhD

studies in how the brain

controls the function

of the ear.

And then during medical studies

which I pursued at Harvard

in parallel with my PhD,

I maintained that interest in

hearing and actually studied

for my thesis

fluid and ion balance

in the inner ear.

And I was inspired by the

kidney. And you could say, well,

how similar are these

two organs?

Because they are so different

in terms of scale. However,

they do share many similarities

because they both regulate

fluids and

ions very tightly,

and they develop around the

same time during embryonic

development.

And they are similarly

susceptible to certain

medications that can be

Toxic to both organs.

So then it was natural for

me to pursue residency

in otolaryngology,

head neck surgery during which

I did a formal postdoctoral

fellowship studying how

supporting cells in,

in the inner ear promotes

survival of both the hearing

nerve and the sensory

cells in that organ.

During my clinical fellowship in

neurotology and skull

based surgery,

I became really fascinated by

vestibular schwannomas,

which are these intracranial

tumors that typically

cause hearing loss,

and was really moved by the

suffering these caused because

currently there are no drugs

that can eliminate these tumors.

After completing my

long training,

I joined faculty at Harvard

as a surgeon scientist,

focusing on ear and skull based

surgery and opening my lab

focused on hearing restoration.

A dozen years later,

I came to Stanford,

which is now my new home.

I’m inspired by the vibrant

culture we have here and our

core values of kindness,

creativity,

innovation and collaboration.

I love that. You are a

well educated woman.

That’s very impressive.

Thank you for sharing those

details with us.

I appreciate that.

So research into a cure

for hearing loss,

I feel like that’s been ongoing

for many years,

but sometimes it feels like

progress can be a little bit

slower maybe than compared

to other fields.

Do you agree with that?

And why is hearing loss such

a tough nut to crack?

You are correct, of course.

Research progress is

never fast enough.

1 and 1/2 billion people

have hearing loss.

Half a billion of them

are disabled by it.

And the cost of unaddressed

hearing loss is the staggering

nearly trillion dollars

annually.

And as you say,

the hearing loss has been a

difficult nut to crack,

both literally and figuratively.

Literally.

This is a tiny and fragile organ

embedded in the hardest bone in

the body, deep within the skull.

So how tiny is it?

If you look at a penny,

you’ll notice that Lincoln

is on a penny.

And the human organ of hearing,

called the cochlea in cross

section is the size of Lincoln’s

upper face on a penny and the

total fluid volume within it

is just three raindrops.

But because of these challenges,

we have been at the forefront of

technology development

and adoption.

In that respect, we are really,

truly standing on the shoulders

of the giants. For example,

it was two ear surgeons who were

the first to introduce a

microscope into the

operating room.

This propelled all of surgery,

from neurosurgery to

microvascular reconstruction.

Moreover,

hearing researchers developed

the cochlear implant,

which is the most successful

neural prosthesis.

With more people wearing this

device than all others.

Neural prosthesis combined and

the modern multi channel

cochlear implant was enabled by

the work of a physicist and a

Nobel laureate, von Bekesy,

who described the place

frequency map in the cochlea.

And what I mean by that is

that it’s a coiled organ.

So now if you uncoil it,

then every place along the

length of the cochlea

corresponds to a different

frequency,

which means that it’s

a tuned system,

just like the strings on guitar.

So Stanford played a seminal

role here with an ear surgeon,

Blair Simmons,

collaborating with an electrical

engineer, Bob White,

to contribute to the first multi

channel cochlear implant.

And they chose a winning

strategy,

which is a digital signal

processing.

Today we are addressing

the new frontiers,

and they include cellular

imaging of the inner ear,

regenerative therapies that are

based on stem cells and small

molecules, and gene therapies,

as well as alternative modes of

stimulating the auditory system,

including magnetic and

optical stimulation.

We are focused in developing

medical therapies for hearing

loss because currently there are

no drugs that are FDA approved

for hearing loss,

despite the enormity

of the problem.

Thank you for that.

It is a tough nut to crack,

but it’s great to see that there

are so many avenues that are

being explored currently.

One of my favorite things about

SICHL is the collaborative

research approach that

you guys use.

And maybe you can talk a little

bit about if this is different

from the way scientific research

is typically done,

and then what impact that

philosophy is having on the work

that you all are doing.

So, like many human activities,

research is an elaborate dance.

It involves students,

postdoctoral fellows,

junior colleagues,

and senior faculty.

And each of these groups is a

constituency with slightly

different needs and

expectations.

So the role of an institution is

to help research groups function

as orchestras of varying sizes,

from a chamber group

to a big band.

And I really love how it’s done

at the Stanford Initiative

to Cure Hearing Loss.

We have a constantly varying

stream of people with diverse

backgrounds and interests,

and they are held together by a

common belief that together we

can make a difference in the

lives of the current and

future patients.

Wonderful.

I understand the researchers

work on projects together

many times.

Do you think that contributes to

the success of the projects or

why is that such an important

part of the philosophy?

Oh, absolutely.

We strongly believe in synergy,

which means that two people

working together is more

than addition.

So it’s more than adding

component parts. And of course,

when you add even more people,

then we can really solve

challenging problems that have

remained unsolved for so many

years and decades and

literally centuries.

And because these are

challenging problems,

they require a multidisciplinary

approach to solve them.

And we have experts in a variety

of different fields that

literally range from math and

physics and basic biology to

structural biology and

engineering and genetics

and molecular biology,

regenerative biology and

clinicians. And at Stanford,

we have all three components of

research, basic research,

which if you think of a tree,

these would be the roots of the

tree that are feeding the trunk,

and that’s translational

research that then leads

to branches,

which is clinical research.

These branches then bear fruits.

There are multiple feedback

loops at every level where

clinical insights may inform

what is being done at the bench.

And in return,

basic science discoveries can

lead to major breakthroughs in

how we treat patients

with hearing loss.

So it is a tree that

we think of.

And as you know the redwood tree

is in the Stanford University

logo with multiple feedback

loops to allow us to collaborate

in the most productive

and most fun way.

I love that. All right,

so let’s get to the

fun stuff then.

Maybe you can give our listeners

some hints or some exciting

advancements that you all are

working on in hearing science

and you know,

maybe a couple of the most

promising projects.

Absolutely.

So let me first start with

the imaging probe.

Because the human inner

ear is so tiny.

We cannot get clear images of

it on MRI and CT scans.

Therefore,

we cannot tell any person

exactly what is wrong

in their inner ear.

We are changing that by

developing a tiny micro

endoscope whose diameter is

equivalent to a bundle of

just 10 human hairs.

And it can provide 100 fold

better resolution than what’s

available today.

So,

after more than 10

years of work,

we are eager to move into

clinical testing of this device.

And the impact could be

revolutionary because it would

enable us to establish precise

diagnoses for various causes of

hearing loss and thereby

guide personalized,

very tailored therapies.

A second example is that our

investigators have developed a

pipeline for access to the human

inner ear tissue that’s still

living and that is obtained

from organ donors,

as well as from patients

undergoing ear surgery.

This is remarkable because

currently the primary source of

information regarding the

cellular origins of human

hearing loss comes from studying

autopsy specimens.

These specimens are obtained

when individuals who pass away

from completely unrelated causes

generously donate their ears

for research purposes.

Now,

when organs are harvested

for transplantation,

our teams have the opportunity

to collect human inner

ear tissue,

allowing us to study at both the

cellular and the molecular

level.

And this has major implications

for future development of

regenerative therapies.

I’ll just give you two examples

within this category.

One is that our investigators

have defined the first molecular

atlas of the normal and diseased

sensory organs within

the human inner ear.

This atlas now serves as a

roadmap to accelerate the

development of regenerative and

restorative therapies for

human hearing loss.

Also,

studying this living human inner

ear tissue has allowed our

investigators to observe the

evidence of regenerative

responses within the diseased

human inner ear.

Although the process

is incomplete,

this is really significant

because previously we thought

that only lower species,

such as birds and reptiles,

were capable of spontaneous

regeneration.

The next step is to determine

how to sustain this regenerative

process in humans and bring

it to a full blown effect.

Of course,

our strategy will be informed by

what our investigators and

others across the world have

learned from studying

birds and reptiles.

And then I’ll give you a third

example of our researchers

making antibiotics non toxic.

So it turns out that many

widely used medications,

such as certain antibiotics,

have the potential to cause

permanent hearing loss.

And our researchers are

developing innovative methods

to enhance safety of these

antibiotics by altering their

chemical structure.

So these are just a few

examples. There are many more.

And I could talk them,

but talk about them for

hours and days.

I’m sure you could.

That is very exciting.

Thank you for sharing those

snippets with us. And people,

I’m sure,

can learn more about the

projects on your website

as well.

Yes, absolutely.

So I have noticed,

and I’m sure you have as well,

that it can be hard to get

mainstream news coverage

about hearing loss.

But SICHL’s really been in

the news a lot lately,

and we have a legendary musician

Paul Simon to thank for that.

So can you talk a little bit

about how Paul got interested in

SICHL’s work and what impact

his support is having

on that work?

Absolutely.

Paul has been very public about

having come to Stanford

as a patient,

and that’s how he learned

about our research.

His impact has been tremendous.

He performed benefit concerts

for us here in California

and in New York.

He spoke about the Stanford

Initiative to Cure Hearing Loss

when he appeared on Stephen

Colbert’s show.

And he brought his friends from

CBS News to visit our labs and

to film the segments that

were aired in November.

Through his advocacy

and ambassadorship,

our network of friends and

donors has expanded greatly.

Last year was a whirlwind of

publicity and new opportunities

for the Stanford Initiative to

Cure Hearing Loss

because of Paul,

and his impact still continues.

Most importantly,

I think we have drawn attention

of many people to hearing loss,

which is an invisible and

stigmatizing disability.

Well,

I love seeing him and others

talk so openly about

their hearing loss.

Part of it is just the

expression of how it’s

challenging for them,

and so it helps people better

understand that there are a lot

of challenges people with

hearing loss face.

Even if it is invisible,

it’s always there in

the background.

And I love his positive attitude

about it as well. Right.

That he’s still out there

finding a way to perform his

music and to use his celebrity

and his reputation to help

move the field forward.

So it’s really wonderful to see

that incredible partnership

you have with him.

Yes.

We really feel lucky and blessed

to have him on board.

Absolutely. Absolutely.

So this podcast is often watched

by consumers in addition to

hearing care professionals.

And so I was wondering if you

had any advice for consumers who

might be worried about their

hearing and what can they expect

down the road from.

SICHLs work

At this point,

hearing protection is key.

This implies using ear

protection if you are attending

loud music events or loud

sporting events,

or using power tools

if you develop tinnitus

after a loud event.

And even if it goes away

the damage that has occurred

has already happened and may

manifest itself years

and decades later.

So this really highlights the

importance of protecting

our hearing.

And there are Other important

ways to protect it such as

eating a healthy diet or having

a healthy lifestyle that

includes regular exercise,

avoiding medications that can be

damaging to the inner ears,

such as certain antibiotics,

certain blood pressure

lowering medications,

certain

chemotherapeutic agents.

It’s also important to control

the underlying health issues

that are strongly linked to the

increased risk of hearing loss,

such as high blood pressure

or diabetes.

And avoiding smoking is

really important.

And we have learned about the

importance of these preventative

measures from large scale

epidemiologic studies that have

involved hundreds of thousands

of people,

followed over years and decades.

Oh, that is very good advice.

Thank you for sharing that.

I know that I always try and

wear big headphones whenever

I go to a concert,

but are earplugs enough or how

can we be sure that we’re doing

the right type of protection?

Earplugs can be enough depending

on the intensity of sound and

how much attenuation

they provide.

So we really have to be

quantitative about it.

And you can very easily get

a field for how loud your

environment is by using an app

on your phone. It’s free,

it’s called dB app for decibel.

And you should check how much

attenuation the earplugs that

you get in any pharmacy over

the counter provide.

So how much attenuation

do they provide?

Is it 15 or 20 or 30 decibels?

And I’ll just give you a rough

rule of thumb to use when

considering how much attenuation

you need.

So it’s generally agreed that

sounds of 80 decibel for

eight hours are safe.

But then for every three decibel

increase in sound intensity,

you have to half the

safe exposure. So,

so that means 83 decibels

is okay for four hours,

86 decibels for two hours,

89 decibels for one hour,

92 decibels for half

an hour and so on.

And to give you a flavor for

what that means in real life,

many music concerts are well

above 100 decibel.

And in fact it’s not uncommon

that they are as loud

as 110 decibels.

And some sporting events

are ridiculously loud.

And in fact the US is in the

Guinness Book of World Records

for having achieved the highest

noise levels at a football

stadium.

That’s not a good thing.

Which was in Kansas and it was

more than 140 decibels.

This was just from the crowd

cheering on and that’s louder

than a jet engine.

So most surely everyone there

who was not wearing hearing

protection ended up with some

permanent hearing loss,

which is a scary thought.

So the bottom line is we

have to be proactive.

We need to educate everyone from

little kids in preschool

to mature adults,

how delicate this organ is and

how important it is

to protect it,

because today we don’t yet

have curative therapies.

Well,

thank you for that important

warning. I agree.

That’s really good information.

So my family and I have been

supporters of SICHL’s

research for many years.

And if others are interested

in doing that,

what’s the best way for them to

learn more about the research

and how they can be helpful?

We’d be delighted to connect with

your audience members who are

interested in supporting

our work.

Philanthropy makes a huge impact

on accelerating our advances.

I encourage people to go to our

website at sichl.stanford.edu.

so that’s sichl.Stanford.edu

for details about research and

for information about

how to make a gift.

We always try to accommodate our

potential partners using

different modalities from zoom

to in person visits.

And as you know,

we are blessed with gorgeous

weather and a magnificent

campus here,

so I strongly encourage people

to come visit us in person.

Absolutely. Wonderful. Well,

thank you so much, Tina,

for being on the podcast today

and sharing these exciting

updates.

It’s been a pleasure

to talk with you.

Thank you so much, Shari.

Thank you.