Interview with James F. Battey, Jr., M.D., Ph.D., Director, National Institute on Deafness and Other Communication Disorders (NIDCD)

Carolyn Smaka: I'm speaking today with Dr. James Battey, Director of NIDCD. Dr. Battey, it is such an honor to have you with us at AudiologyOnline. Thank you for taking the time to speak with us.

Dr. James Battey: It's a pleasure to speak with you.

SMAKA: Can you begin by telling us about your background and how you came to NIDCD?

BATTEY: I received a bachelor's degree in physics from the California Institute of Technology, and then a medical degree and a Ph.D. from Stanford. I received postdoctoral training in genetics in the Department of Genetics at Harvard University and have spent the last twenty-six years here at NIH serving in a variety of capacities.

In 1995, I was appointed the Director of Intramural Research at NIDCD by Dr. Harold Varmus, who was the Director of NIH at the time. Subsequently, with the retirement of my predecessor, Dr. James Snow, I was delighted that Dr. Varmus appointed me the Director of NIDCD in 1998, and I've been serving in that capacity for a little over ten years.



SMAKA: It looks like a very exciting year for NIDCD, celebrating its twenty year anniversary. Would you begin by discussing the mission of NIDCD?

BATTEY: Yes, the institute's mission is quite broad and encompasses research into the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language. Of particular interest to audiologists is the hearing component of our mission, which actually comprises about 55% of our budget.

SMAKA: Why is that?

BATTEY: That's because from a public health standpoint, hearing and balance disorders are one of the biggest challenges confronting the American public right now although certainly voice, speech and language disorders are also a major challenge as well.

SMAKA: And we know how interconnected hearing, speech and language disorders often are, especially in the pediatric population.

BATTEY: Yes, in fact, we are particularly concerned with hearing loss that takes place at or before birth. We know that about 2 to 3 out of every one thousand children in the United States are born deaf or hard-of-hearing with enough hearing loss to significantly compromise the development of normal spoken language skills.

We have learned that the early identification of newborns with hearing loss can make a tremendous difference in the academic, social and career potential for these children. And that's because the NIDCD sponsored research about 10 years ago that showed us that early education with amplification devices and other educational services can help these children with hearing loss to develop language skills at the same rate as their hearing peers. We learned that these interventions are most effective for language development when the child is identified as having hearing impairment before the age of six months. So, the newborn hearing screening programs that have been implemented in virtually every state in the U.S. and are capturing roughly 81% of newborns within the first month of life, are a crucial new step forward for NIDCD and for helping these children with hearing loss.

Prior to the newborn hearing screening programs, deaf and hard-of-hearing children often missed this crucial window for language development because the diagnosis of hearing impairment wasn't made until maybe one or two years of age. The crucial window of opportunity for language development had already gone by, and it appeared that there was no way to go back and recapture that opportunity.

The early hearing detection and intervention program is a collaboration between the National Institute on Deafness and Other Communication Disorders, which provides the research arm for this initiative, the Centers for Disease Control and Prevention, which monitors the progress, and the Health Resources and Services Administration Maternal and Child Health Bureau, which provides seed grants to the various states to put in place the state-based newborn screening programs across the United States.

There is no question that this program would not have been as successful without both the efforts of the NIDCD and the audiology community. In fact, the NIDCD sponsored audiology research in the late 1990s which demonstrated the value of early hearing identification and validated two strategies for identifying children with hearing impairment within the first few days of their life.

So, this area has been one of a number of very exciting developments for us. It also provides a remarkable research opportunity for us because newborn screening identifies a cohort of young children who are candidates for evaluation of the efficacy of different intervention strategies.

SMAKA: 81% of newborns screened within the first month of life is remarkable progress. Where are further efforts of the NIDCD focused in terms of infants with hearing loss?

BATTEY: Well, there are two major challenges that emerge as a consequence of newborn hearing screening. First and foremost is the challenge of follow-up, because although we are quite efficient at detecting hearing impairment within the first few days of life, sadly, roughly half of the identified children are lost to follow-up. It does little good to identify hearing loss in children if we don't follow up with proper intervention to help them optimize their language development potential. This is an area where we need to understand better why so many children are lost to follow-up, which cohorts are particularly likely to be lost, and what we can do to improve our follow-up percentage as we move forward with this program.

The second big challenge is one for pediatric audiologists, and that's to develop the optimal intervention strategies and protocols for fitting amplification for children as young as one month old. At NIDCD, we are currently sponsoring research to try to develop and validate optimal intervention strategies for this cohort of young children.

SMAKA: That is excellent to hear and a perfect segue to talk about advances in amplification - hearing aids and cochlear implants - made possible by the NIDCD over the past twenty years.

BATTEY: Yes. Hearing aid technology has improved significantly over the past two decades. NIDCD has supported research on how hearing aids can enhance speech signals and improve understanding. As you know, hearing in background noise is particularly challenging for people with hearing loss. To help address this issue, we are currently supporting researchers who are working to revolutionize directional microphone technology, which allows sound to be amplified from one direction rather than background noise that might come from other directions.

It's quite clear that such technology enhances the ability of an individual to carry on a conversation in a noisy environment, which has been a major limitation of hearing aids, and there is still much room for improvement. This new NIDCD-supported research is based upon the ears of a parasitic fly called Ormia. This fly despite the amazingly small size and short distance between its ears is able to rapidly pinpoint the location from which the sound of a potential host, such as a cricket, is coming even in a noisy environment.

The intriguing mechanism that enables Ormia to accomplish this feat has provided a model for scientists and engineers to develop miniature directional microphones for hearing aids that we hope will better focus on speech in a single conversation, even when surrounded by lots of other background voices and noises.

The audiology community is absolutely crucial here, because it serves as the direct link for individuals with hearing loss to the latest and best new developments in hearing aid technology. We depend on audiologists to validate new technologies, determine which patient populations are gaining the greatest benefit from either new or old technologies, and by helping us with clinical studies as new technology becomes available.

In addition, we hope that we can sponsor future research with the audiology community to optimize the value of hearing aids for hearing-impaired individuals. It is estimated that only roughly one person in five across the age span who would benefit from using hearing aids actually uses one regularly. We hope that we can improve this number, both by improving the technology and by reducing the economic burden of hearing aids by either driving down the cost or further engaging third party payers.

SMAKA: Those are definitely shared goals. Dr. Battey, can you talk about NIDCD's research in the area of cochlear implants?

BATTEY: Yes, over the last twenty years, there's been a revolution in multi-channel cochlear implants. Twenty years ago, a cochlear implant was a device that was a useful aid for lip reading, but really didn't allow speech discrimination. It mostly was just a noise detector at that time. But, with the advent of the multi channel implant, which directs specific frequencies of sound to the appropriate area of the cochlea, along with new speech processing algorithms, we now have cochlear implants that allow many adult individuals who wear them to use the telephone. This means that they are able to comprehend speech with no visual cues whatsoever.

In addition, we are now learning that children with profound hearing impairment who receive a cochlear implant at a very early age - say at around one year of life can be on grade level with their normal hearing peers, developing language skills at more or less the same rate. This has completely revolutionized the educational experience for children with profound hearing impairment, many of whom can now be mainstreamed in public schools and no longer need to be educated in schools for the deaf.

SMAKA: What are some of the current topics in cochlear implant research at NIDCD?

BATTEY: We're studying bilateral implants right now to determine exactly how much benefit is obtained from cochlear implants in both ears as compared to an implant in only one ear. The jury is still out on whether or not that makes the most sense economically because as I'm sure you're aware, a cochlear implant is not an inexpensive intervention. We estimate that it costs somewhere in the neighborhood of $55,000 for the surgery, the device, and the necessary rehabilitation that takes place after surgery, which is absolutely critical for a successful outcome.

We will depend on collaboration with the otolaryngology and the audiology communities in order to establish this important information moving forward.



SMAKA: Can we switch gears and talk about noise-induced hearing loss? The NIDCD's It's a Noisy Planet. Protect Their Hearing (www.noisyplanet.nidcd.nih.gov/) campaign for children is getting a lot of deserved attention.

BATTEY: NIDCD estimates that approximately 15% of Americans between the ages of 20 and 69, or 26 million Americans, have high frequency hearing loss due to exposure to loud sounds at work or as a consequence of leisure activities.

This relative incidence probably has not changed much in the last twenty or thirty years;at least we have no evidence that it has changed much. It remains a very important area for us because noise induced hearing loss is 100% preventable.

We share a mutual interest with the audiology community in preventing this disability, as you can see by the health education campaigns that have been launched both by NIDCD and by the American Academy of Audiology.

The American Academy of Audiology launched a campaign in January called Turn it to the Left, to encourage kids to turn down the volume on personal electronic devices.

We estimate that if you are standing an arm's length away from a young person who is using one of these personal electronic devices, and you can hear what's coming from the device, then it is loud enough to potentially damage the hearing of that young person's ears.

And as you know, that damage most likely won't be appreciated immediately, because noise induced hearing loss is a cumulative problem. When that individual gets to be 40 or 50 years old, the first signs of hearing loss may appear;the individual may be turning up the television set and having difficulty understanding other people in noisy restaurants. As the individual's age progresses, the hearing problems will continue to progress as well.

NIDCD's new campaign, called It's a Noisy Planet. Protect Their Hearing, will help parents of 8 to 12-year-olds teach their children how to avoid hearing loss from overexposure to loud noise.

Our goal through this campaign is to increase awareness among parents and children, so it will become second nature to use protective hearing techniques when they are exposed to loud noise, much in the same way as it is second nature for many people to wear a sunscreen when they go to the beach or to strap on a helmet when biking.

Working together with the audiology community, NIDCD is hoping to create a bridge from what we have learned about noise-induced hearing loss through cutting edge research to improved ways to prevent and treat hearing loss in individuals throughout the United States.

It's the partnership between the NIDCD-supported research community and the audiology community that helps us implement this new knowledge and that - ultimately - will get us to the point where we can help all individuals with hearing loss.

SMAKA: It's a Noisy Planet. Protect Their Hearing is a very engaging campaign. Can you tell me a little bit about the creative process behind that?

BATTEY: From the beginning, we felt it was very important to deliver an honest message. For example, personal electronic devices themselves are not per se the problem. The problem is turning them up too loud. If used properly, there is nothing wrong with personal electronic devices for young people to play and enjoy music.

I think it is very important to be clear in the area of noise induced hearing loss and to indicate that not all levels of noise are necessarily toxic to the ear. It's not a good idea to scare people when there is, in fact, no evidence that all levels of sound from these devices are damaging to the ears.

SMAKA: That's a great point. Vilifying the devices would be a turnoff to the kids you are trying to reach. There is a lot of enjoyment that comes from personal electronic devices;it's all about how they're used.

BATTEY: Exactly. Young people, like everybody else, just need some guidance. If the device is turned up so loud that the person using it can't hear someone else conversing in a normal voice at arm's length, it is probably too loud and may well be damaging to his or her hearing.

SMAKA: We look forward to the continued success of that campaign.
Dr. Battey, I don't want to take up more of your time today, but I do want to say thank you again for giving an overview of the progress of NIDCD's hearing initiatives over the past 20 years to AudiologyOnline and the audiology community.

BATTEY: Thank you. It was a pleasure.

About NIDCD

NIDCD, which celebrates its 20th anniversary in 2008, supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs, see the Web site at www.nidcd.nih.gov.

The National Institutes of Health—The Nation's Medical Research Agency — includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov