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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
ACS Award Helps Surgeon-Scientist Reverse Hearing Loss
Tony Peregrin
May 10, 2023
The “finesse required when operating in the head, neck, and ear” is what attracted Dr. Nelson to the field of neurotology.
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Ask Rick F. Nelson, MD, PhD, FACS, what attracted him to the field of neurotology and he will tell you, in an almost hushed and reverent tone, that it’s the “finesse required when operating in the head, neck, and ear.”
“When we do a reconstruction of hearing bones, we measure an ossicular prosthesis in fractions of a millimeter, which can make all of the difference between good hearing and not-so-good hearing,” said Dr. Nelson, a surgeon-scientist developing new treatments for congenital and adult-onset hearing loss. “It’s a technical challenge every time.”
Based on his innovative research in this area, Dr. Nelson received the ACS/Triological Society Clinical Scientist Development Award in 2017, which is intended to facilitate the research career development of otolaryngologists–head and neck surgeons, with the expectation that the awardee will have sufficient pilot data to submit a competitive R01 proposal. The grant provides financial support of $80,000 per year for up to 5 years to supplement a K08/K23 award.1,2
The intricate anatomy associated with otologic surgery may have initially sparked Dr. Nelson’s interest, but it’s the experience of helping patients regain their hearing that provides him with a deeper sense of purpose.
One case that he found particularly inspiring involved a fellow healthcare provider who was struggling to communicate with her patients due to her own hearing loss. Dr. Nelson performed a hybrid cochlear implant in both ears to save her low-frequency hearing, and she went from understanding 10% of words correctly to more than 95%.
“She’s an outstanding performer,” Dr. Nelson said. “She has minimal issues communicating with her patients now, and she’s very happy. Obviously, you can imagine that this is why we do what we do. It makes us smile, and it’s what gets us up in the morning.”
According to the World Health Organization, 430 million people (more than 5% of the world’s population) suffer from hearing loss.3 By 2050, more than 700 million people (1 in every 10) will have some form of disabling hearing loss. Unaddressed hearing loss could potentially impose an annual global cost of $980 billion, including healthcare and educational support costs, as well as losses associated with decreases in productivity.3
Dr. Nelson examines a patient.
Nelson Lab Driven by Innovation
In 2014, Dr. Nelson joined the faculty at Indiana University (IU) School of Medicine in Indianapolis.4 Soon thereafter, he received supplemental support from the Department of Otolaryngology to start his lab, which focuses on understanding the mechanisms of sensory cell degeneration in the cochlea and is the principle cause of sensorineural hearing loss.5
Receiving the ACS/Triological award was a turning point in Dr. Nelson’s career, supporting his work in the Nelson Lab.
“The ACS/Triological award was a capstone on the National Institutes of Health K08 award, which is a mentored grant for junior clinician scientists that I received. While the K award supports a little bit of our salary and laboratory, it’s not as much funding as typical R01 research grants—so the supplemental funding from the ACS and The Triological Society provided extra support to increase the number of people in my laboratory and allowed me additional time outside of clinic to write papers and grants.”
Dr. Nelson and colleagues are currently studying a gene (TMPRSS3) that is one of the more common genetic causes for both congenital and childhood-onset hearing loss. TMPRSS3 is essential for the survival of hair cells in the cochlea, and more than 50 deafness-causing variants have been reported that are associated with this gene. It has been more than 20 years since the first variants in the TMPRSS3 gene were linked to hearing loss, yet the biological function of TMPRSS3 in the inner ear remains elusive.
“We have preliminary data that show how TMPRSS3 is working in the ear, although we have more work to do. Our lab will be the first to discover this mechanism of the gene, something that’s been an enigma for the last 2 decades,” Dr. Nelson said.
In early 2023, Dr. Nelson’s lab secured an R01 grant for a project that is designed to understand the mechanism of how the protein encoded by TMPRSS3—the “human deafness gene”—leads to ear hair cell death and hearing loss.
“This R01 grant is a direct result of the seed funding and support from the ACS and The Triological Society,” said Dr. Nelson.
A primary aim of this research is to eventually develop therapeutic approaches for deafness and balance disorders.
According to Dr. Nelson, one major obstacle with treating hearing loss is related to the fact that when the sensory cells (hair cells) die, they do not regenerate either in mouse models or adult humans.
The challenge involves placing the TMPRSS3 gene into the inner ear to prevent hair cell degeneration early, although the inner ear is surrounded by the strongest bone in the human body (the otic capsule), making this procedure difficult to say the least.
“How do we get the gene into the ear, and then how do we transduce those cells effectively so that all the cells can be preserved? It’s a continuous challenge that we, as scientists, face,” he said. “I’m optimistic, but we have more research to do so we can improve our access to the ear, transduction efficiency, and timing.”
Collaboration and Mentorship Lead to Success
Dr. Nelson, an associate professor of otolaryngology–head and neck surgery at the IU School of Medicine, credits a network of mentors and partners who study inner ear disorders as a primary driver in his work to advance the field.
“I have a wonderful team of collaborators, including Eri Hashino, PhD, professor of otolaryngology at Indiana, and Alan Cheng, MD, FACS, professor of otolaryngology and surgeon-scientist at Stanford University in Palo Alto, California. These collaborations create a heightened intellectual environment that’s not just my lab, but several labs that provide not only me, but also my postdocs, technicians, and research assistants the opportunity to think outside the box and come up with new ideas.”
In fact, mentorship played a notable role in Dr. Nelson’s early career trajectory while he was pursuing a PhD in neuroscience at the University of Iowa in Iowa City.
While working in the laboratory with Henry Paulson, MD, PhD, professor of neurology and clinician-scientist at the University of Michigan in Ann Arbor, Dr. Nelson started investigating a mouse model with a genetic disorder that he hypothesized was going to result in a neurologic phenotype since the gene was expressed in the brain.
Employing a learning task in which mice are placed into a cage where a tone is presented followed by a foot shock, it was assumed that the mice would learn the tone was going to be followed by the shock. The following day, the mice were placed back in the cage and the tone was presented, after which the investigators measured the freeze response of the mice in anticipation of the foot shock.
In fact, the gene-mutant mice learned that the cage was “bad,” but they failed to pick up the significance of the tone—because they were deaf. This discovery led Dr. Nelson into the field of auditory neuroscience where he started collaborating with Richard Smith, MD, a surgeon-scientist and professor of otolaryngology at the University of Iowa.
“The phenotype was actually in the inner ear, and that led me into auditory neuroscience, genetic causes of hearing loss, and auditory pathways—and then I became really interested in ENT and otolaryngology,” he said. Eventually, Dr. Nelson completed his neurotology surgical fellowships at the University of Iowa Hospitals.
“Throughout my career I have been fortunate to be mentored by highly successful clinician-scientists who are passionate about patient care and scientific discovery.”
Dual Role of Academic Clinician and Researcher
In an era marked by limited time and financial resources, surgeon-scientists sometimes struggle to balance taking care of patients with conducting scientific research, even though both are complementary: Doing one can make you better at the other.
“There’s always the potential for ‘clinical creep’ into your academic pursuits. You know patients need to be seen in a certain timeframe and that periodically takes precedence over your academic work. But I think you can take on this dual role with a very focused clinical practice,” said Dr. Nelson, while also urging academic departmental leadership to ensure there are enough providers to support patient care, and then ultimately, academic research.
Surgeon-scientists also must navigate diminishing sources of funding along with meeting clinical hour requirements to generate revenue.
“We’re competing against scientists who exclusively do research—individuals who are PhD scientists and research is all they focus on,” he said. “We are all in the same pool of applicants for grants. So, your science has to be just as good, yet we are spending less time on research, potentially, because we have a clinical aspect to our practices.”
Nevertheless, this dual role has its advantages such as access to clinical patients, and perhaps, human tissue samples.
“Being a clinician-scientist is not easy,” said Dr. Nelson. “But I have a self-driven passion for discovery and to advance our field forward. If that is your passion, then you can make it happen.”
Indiana University School of Medicine. Nelson Lab. IU School of Medicine Office of Research Affairs. Available at: https://www.hashinolab.com. Accessed March 25, 2023.
