Comments of Dr. Nadol
Workshop on Temporal Bone Histopathologic Research: Laboratories and Research Training
September 12, 2003. Bethesda, Maryland
Training for temporal bone research, funding and needs
Joseph B. Nadol, Jr., M.D.
On the basis of a survey conducted for a workshop on human temporal bone research in 1988 (Nadol JB Jr: Current status of training of temporal bone pathologists and technicians. Ann Otol Rhinol Laryngol 1989;143:47-48), the average temporal bone laboratory at that time was a small operation with less than 2 investigators, 1-2 fellows or residents, and less than 2 technicians. It is probable that the current status is not significantly different. Less than 50% of research fellows in temporal bone laboratories continue to make otopathologic investigation part of their professional commitment. In addition, many are international fellows who return to their native country where it is often impractical to continue this type of investigation.
Otopathology remains relevant to current practice and future developments in otology. The principal and irreplaceable functions include the understanding of the pathologic basis of disease, confirmation of the applicability of animal models for human disease, and the evaluation of medical and surgical treatment protocols. The maturation of molecular techniques in pathology offers new opportunity for understanding the pathologic basis of disease, but requires new specimens, which are collected in a way to maximize investigation by these techniques.
Funding for stipends for research fellows is less of a problem than the recruitment of young investigators who will commit to otopathologic studies during the course of their research training and in the course of their professional career. Otopathology suffers from the perceptions that (1) all or most of what can be learned by pathologic study of the temporal bone has already been done so that it is of historical rather than contemporary interest and (2) funding a research protocol involving human otopathology is difficult, if not impossible. These perceptions must be changed by the concerted efforts of a variety of institutions, including NIDCD, our senior otologic societies, and the Academy of Otolaryngology-Head and Neck Surgery. For example, the AAO-HNS can underline the importance of otopathology in its Home Study Course and In Service Examination.
The "traditional" otopathologist is a clinical otologist. While this background is valuable in providing clinical insight into human pathology, it may limit the scope of otopathology given the newer techniques that are becoming available in auditory neuroscience and clinical pathology. Partnering, co-investigation, or otherwise involving auditory neuroscientists, clinical pathologists, and clinical neuropathologists in temporal bone research will be important to enhance the relevance of this discipline in the future.