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NIDCD Director James Battey's Testimony to the Senate Subcommittee on Labor-HHS-Education Appropriations

DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH

Fiscal Year 2012 Budget Request

Witness appearing before the Senate Subcommittee on Labor-HHS-Education Appropriations

James F. Battey, Jr., M.D., Ph.D., Director
National Institute on Deafness and Other Communication Disorders

May 11, 2011

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Mr. Chairman and Members of the Subcommittee:

I am pleased to present the President’s budget request for the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH). The Fiscal Year (FY) 2012 NIDCD budget of $426,043,000 includes an increase of $11,244,000 over the comparable FY 2011 appropriation of $414,799,000. This statement is submitted with the recognition of the Department’s notification to the Congress of an NIH reorganization that would establish a new National Center for Advancing Translational Sciences (NCATS).

The NIDCD conducts and supports research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Our Institute focuses on disorders that affect the quality of life of millions of Americans in their homes, workplaces, and communities. The physical, emotional, and economic impact for individuals living with these disorders is tremendous. NIDCD continues to make investments to improve our understanding of the underlying causes of communication disorders, as well as their treatment and prevention. It is a time of extraordinary promise, and I am excited to be able to share with you some of NIDCD’s ongoing research and planned activities on communication disorders.

Affordable Hearing Health Care

Hearing loss is a serious public health issue and has significant social and economic impacts. Approximately 17 percent of American adults, or 36 million individuals, report a hearing loss, and only about one in five of those individuals who could benefit from a hearing aid wears one. Additionally, hearing health care and hearing aids are only rarely covered by health insurance, and are not covered by Medicare. A recent industry survey found that the average cost per hearing aid to an individual is $1,600, and for many, the cost is much higher. Hearing aids are also consumable devices, often requiring replacement every 4-6 years, and frequent battery replacement. This makes hearing aids potentially the third highest cost item for an individual, following just behind the purchase of a home and car. In 2009, NIDCD sponsored a workshop, Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss, to examine the factors that contribute to hearing health care access, affordability, and usage; and to develop a set of research objectives which could be explored in the future. Based on the recommendations, NIDCD published several targeted research initiatives for hearing health care: to explore new approaches that could lead to improved access, assessment, and intervention; to develop methods to determine the success of new or improved approaches; and to create small business technologies to improve access for underserved patients. The research supported through these and other NIDCD-sponsored efforts will enhance the evidence-base for hearing health care decisions, and provide a strong research base for future policy decisions related to affordable hearing health care.

Tinnitus

Tinnitus—a perceived ringing, buzzing or roaring in the ears—is a major public health concern, affecting more than 25 million American adults. It can range in severity from a mild condition, requiring no medical intervention, to a severe debilitating disease with significant physical, emotional, and economic impacts. The Department of Veterans Affairs reports tinnitus as the most prevalent service-connected disability for veterans receiving disability compensation. More than 744,000 veterans received service-connected disability compensation for tinnitus in FY 2010, presenting a significant cost burden for the nation. Past research has shown that tinnitus is often associated with hearing loss; however, little is known about the specific neural dysfunctions that lead to the disorder. There are also limited treatment options available, and their effectiveness varies widely. In response to this need, NIDCD is supporting a strong research portfolio on tinnitus. In 2009, NIDCD sponsored a research symposium, Brain Stimulation for the Treatment of Tinnitus, to explore the potential translation of existing brain stimulation technologies for the treatment of tinnitus. Recently, NIDCD supported scientists have demonstrated that stimulation of the vagus nerve (a large nerve that runs from the head to the abdomen) with an implantable electrode, in combination with the playing of tones, is able to “reset” the brain, eliminating tinnitus in a rat model of the disease. (Vagus nerve stimulation is already in use for the treatment of epilepsy and depression in more than 50,000 individuals). By varying the tones played and the co-stimulation of the vagus nerve, scientists were able to abolish the tinnitus sensation and restore the normal function of the brain. These exciting findings are the first demonstration of a treatment that specifically erases the tinnitus, rather than simply masking the sound or providing coping mechanisms for the individual. Scientists are now working to translate these findings from the animal model into a novel therapeutic strategy for people with severe tinnitus.

Vestibular Prosthesis

Based on the recent 2008 National Health Inventory Survey, Balance and Dizziness Supplement, about 15.5% of U.S. adults, or about 33.6 million individuals, reported they had a problem with dizziness or balance in the past 12 months. Balance disorders are one of the reasons older people fall, and falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person’s life. One balance disorder which has been particularly difficult to treat is Ménière’s disease. This disorder causes severe dizziness (vertigo), tinnitus, hearing loss, and a feeling of fullness or congestion in the ear. NIDCD estimates that approximately 615,000 individuals in the United States are currently diagnosed with Ménière’s disease and that 45,500 cases are newly diagnosed each year. While many individuals are able to manage the symptoms associated with Ménière’s disease through diet, drugs, or surgery, up to 2 in 10 do not find adequate relief from their symptoms after exhausting all treatment options. NIDCD-supported scientists are working to adopt cochlear implant technologies to produce a vestibular implant that could counteract vertigo attacks that persist despite other treatments. Scientists have already demonstrated the ability of a vestibular implant to induce, and provide recovery from, vertigo attacks in animal models of Ménière’s. Most recently, scientists have translated this technology to humans and performed their first implantation into an individual. While clinical trials are still several years away, this recent breakthrough provides hope to many for whom traditional treatments have failed.

Stuttering

The popularity of the recent Academy Award winning movie, “The King’s Speech,” has brought to light the communication challenges faced by approximately 3 million Americans each day. Stuttering can affect individuals of all ages, but occurs most frequently in young children between the ages of 2 and 6, with boys 3 times more likely than girls to stutter. Most children, however, outgrow their stuttering, and it is estimated that less than 1 percent of adults stutter. For those individuals who continue to stutter into adolescence and adulthood, there are limited treatment options. NIDCD supports a research portfolio on stuttering to understand the underlying genetic, neurologic, and physiologic causes of stuttering, to predict which children will continue to stutter, and to develop novel and effective therapies for treatment of stuttering. Recently, NIDCD intramural scientists pinpointed the first specific genes that underlie stuttering. Building on previous studies which identified a genetic region linked to stuttering, and harnessing new technologies in genetic sequencing, the researchers found mutations in three genes important in the recycling of cellular breakdown products inside cells. Different mutations in two of these genes are related to severe metabolic disorders, called mucolipidosis II and III, which cause joint, skeletal, heart, liver, and other health problems, including speech problems. The findings may result in the development of new drug therapies for individuals who stutter.

Olfactory Deficits Early Warning of Alzeimer's Disease

For several years, it has been know that individuals with Alzheimer’s disease (AD) often exhibit an impaired sense of smell (olfaction), making a smell screening test an attractive opportunity for development as a biomarker of disease. However, it was not known why AD impacts olfaction. Recently, NIDCD-supported scientists used a mouse model of AD to identify pathological changes in the olfactory system very early in the animals’ lives, indicating a sensitivity of the olfactory system to this type of damage. These changes manifested well in advance of the onset of changes in other areas of the brain involved in memory, and were predicted by the animals’ performance on a smell discrimination task. In addition, NIDCD-supported scientists have used brain imaging of humans to examine changes in brain activity during smell discrimination tasks. These imaging studies have identified a significant blunting of response in individuals with AD. Both of these discoveries could lead to new, non-invasive tools to enhance the early diagnosis of AD, and better inform health care decisions for affected individuals.

New Strategic Plan for NIDCD

NIDCD has initiated the development process for a new Strategic Plan. In March of 2011, NIDCD convened a series of working groups of scientific experts in the smell and taste; voice, speech, and language; and hearing and balance fields to advise us on emerging scientific opportunities in four priority areas: understanding normal function of communication systems; understanding diseases and disorders of communication systems; improving diagnosis, treatment, and prevention of communication disorders; and accelerating translation of research findings into practice. In addition, we remain committed to continuing our leadership in fostering the development of new investigators in the communication sciences. Our staff is currently working to compile these priority areas into a document that will guide our research investments from FY 2012 through 2016. A draft will be made available for public comment later this year and we anticipate publication of our new Strategic Plan in January of 2012.

Mr. Chairman, I would like to thank you and Members of this Subcommittee for giving me the opportunity to present examples of recent research progress and to highlight some programs made possible through your support of the NIDCD.

Department of Health and Human Services
National Institutes of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
James F. Battey, Jr., M.D., Ph.D.

James F. Battey, Jr., received his Bachelor of Science degree in physics from the California Institute of Technology in 1974. He received an M.D. and Ph.D. in biophysics from Stanford University School of Medicine in 1980. After receiving training in pediatrics, he pursued a postdoctoral fellowship in genetics at Harvard Medical School under the mentorship of Dr. Philip Leder. Since completing his postdoctoral fellowship in 1983, he has held a variety of positions at the National Institutes of Health, serving in the National Cancer Institute, National Institute of Neurological Disorders and Stroke, and the National Institute on Deafness and Other Communication Disorders (NIDCD). Currently, he is the director of the NIDCD, and also serves as the vice chair of the NIH Stem Cell Task Force. He has been married for 29 years to Frances Battey, and has two sons, Michael and JJ.

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