FY 2025 Congressional Justification

Device Detects Loss of Smell After COVID-19

Loss of smell affects up to 80 percent of people who get COVID-19, depending on the variant of SARS-CoV-2 viral infection. Tests have been developed that measure total (anosmia) or partial (hyposmia) loss of smell. However, these tests are difficult and costly to carry out on a widespread scale during a pandemic. To make screening for olfactory disorders more affordable and accessible, NIDCD has supported investigators to develop rapid, inexpensive, and self-administered smell tests that can detect and discriminate between different types of olfactory disorders. Similarly, these smell tests may also be used to detect early signs of other serious health conditions like Parkinson’s disease, where hyposmia is a frequent symptom, so that patients can receive early treatment.

FY 2023 Facts and Figures

• 134 Full Time Equivalent Employees
• 212 Principal Investigators
• 27.1% Success Rate (R01)
• 23.8% Early-Stage Investigator Success Rate (R01)
• 183 Competing Research Project Grants
• 51 Competing Individual and Institutional Training Awards

Brain Computer Interface Technology

Conditions such as stroke and neurodegenerative disease can cause people to lose the ability to speak. Researchers have been working to develop brain-computer interfaces (BCI) technology that help these people regain their ability to communicate. BCI technology uses electrodes to analyze brain electrical activity as an individual thinks about speaking or writing, and decodes words and sentences based on the activity. NIDCD-funded researchers have developed BCI algorithms that enabled a paralyzed woman to speak through a digital avatar and decode speech approaching the speed of natural conversation. This proof-of-concept trial is a significant advance to restoring more natural communication to people who have lost their ability to speak due to injury or disease.

Tackling Acquisition of Language in Kids (TALK) Initiative

In early 2023, the National Institutes of Health (NIH) launched the Tackling Acquisition of Language in Kids (TALK) Initiative. It has since grown into an initiative with engagement across five institutes co-led by NIDCD and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The purpose of the TALK Initiative is to advance understanding of why children with various conditions or risk factors are late to talk; define developmental trajectories that lead to better outcomes; and evaluate the effectiveness of clinical approaches to improve language outcomes. The goal is to provide parents, caregivers, educators, and health care professionals with the information they need to help late talking children grow and thrive in school and life.

Strategic Focus on Data Science

The 2023-2027 NIDCD Strategic Plan was developed using an iterative and public process engaging scientists and community partners. New to this plan, NIDCD challenges researchers to harness biomedical databases, artificial intelligence, and machine learning to improve the lives of those with deafness and communication disorders. The goal is to maximize the value of data generated through NIH-funded research by prioritizing efforts to share biomedical and behavioral data. Shared and meaningful scientific data gives researchers the opportunity to accelerate biomedical research discovery, enable validation of results by independent groups, improve accessibility to large datasets, and promote data reuse across research studies. This effort will also provide meaningful measures to assess benefit of newly developed therapeutics.

Major Changes in the Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanism and activity detail and these highlights will not sum to the total change for the FY 2025 President’s Budget for the National Institute on Deafness and Other Communication Disorders (NIDCD), which is $1.6 million above the FY 2023 Final level, for a total of $535.9 million. Within this funding level, NIDCD will support a diversity mentoring program and a new contract to enhance clinical trials oversight and analysis.

Competing Research Projects (-$3.3 million; total $84.5 million):
NIDCD will fund 177 Competing Research Project awards in FY 2025, a decrease of 6 from the FY 2023 Final level.

Research Centers (-$2.8 million; total $15.7 million):
NIDCD will fund 6 Research Center awards in FY 2025, a decrease of 1 from the FY 2023 Final level.

Other Research (+$2.8 million; total $22.9 million):
NIDCD will fund 123 Other Research awards in FY 2025, an increase of 12 from the FY 2023 Final level. This increase will support NIDCD’s mentored research pathway for otolaryngology residents and medical students program which targets under-represented communities.

Research & Development (R&D) Contracts (+$3.0 million; total $26.3 million):
NIDCD will fund 45 R&D Contracts in FY 2025, an increase of 1 from the FY 2023 Final level. This increase will be used to fund a new clinical trials support contract.

Appropriations Language

NATIONAL INSTITUTES OF HEALTH
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $535,929,000.

Budget Graphs

Fiscal Year 2025 Budget Graphs

History of Budget Authority and FTEs:

Distribution by Mechanism:

Change by Selected Mechanisms:

Organization Chart

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.

Overall Budget Policy: The FY 2025 President’s Budget request for the National Institute on Deafness and Other Communication Disorders (NIDCD) is $535.9 million, which is $1.6 million over the FY 2023 Final level. This funding level will support basic, translational, and clinical research across all of NIDCD’s mission areas, as described below.

Program Descriptions

Hearing and Balance Program
Loss of hearing or balance imposes a significant social and economic burden upon individuals, their families, and the communities in which they live. Hearing and balance disorders cross all ethnic and socioeconomic lines. The prevalence of hearing loss increases with age, with nearly 25 percent of adults aged 65–74 years old having a disabling hearing loss and up to 50 percent for those who are 75 years old and older.¹⁴ Nearly three out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears that can affect their speech, language, social, and cognitive development.¹⁵ Further, according to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury for adults 65 years and older.¹⁶ Accordingly, NIDCD supports research that will lead to improved treatments for, and prevention of, hearing and balance disorders. Research projects in hearing and balance encompass a little over half of NIDCD’s grant portfolio.

Individuals with Usher syndrome (USH) have variable loss of hearing, balance, and vision because the sensory cells in the inner ear and eye develop and function abnormally. Gene therapy is a potential treatment as it can modify a person’s genes to allow for normal sensory cell function. NIDCD funded scientists are examining ways to use gene therapy to restore hearing and balance in individuals with USH. Researchers use viruses to insert corrected copies of genes into target cells. However, some USH genes are too large for this approach. In a recent study, scientists successfully designed and introduced a “mini-gene” for one type of USH.¹⁷ This novel approach successfully rescued hearing in mice. The researchers believe this same approach could be used to restore balance and vision. They will next test this gene therapy in other animal models. The findings support growing evidence that gene therapy could be an effective treatment for inherited types of hearing loss and balance disorders.

Ear infections, or otitis media (OM), are the most common childhood bacterial infection, and the number one reason children visit the doctor in their first year of life. Overuse of antibiotics in the treatment of OM can contribute to antibiotic resistance, a significant global health issue. Repeated episodes of OM can contribute to hearing loss and possibly delayed language ability. Further, OM represents a substantial societal burden, incurring over $5 billion in direct health care costs and indirect out-of-pocket costs, such as lost wages.¹⁸ To address this critical public health concern, NIDCD funds research to accelerate the development of innovative and effective ways to prevent and treat OM. One NIDCD-research study seeks to elucidate the molecular mechanisms of the innate (inborn) immune response to OM infection.¹⁹ This information can help identify new therapeutic targets and novel ways to control mucus overproduction, which underlies hearing loss from some types of ear infections. Another NIDCD-funded study is developing ways to deliver drugs across the intact ear drum.²⁰ Local drug delivery would be a highly effective approach to treat OM, and it would also serve to avoid unnecessary side effects of systemic antibiotic treatment and decrease the development of antibiotic resistance.

Individuals who visit the emergency room with symptoms of vertigo or dizziness may be misdiagnosed, resulting in unnecessary, expensive tests and incorrect treatments. Benign paroxysmal positional vertigo (BPPV), or positional vertigo, is a common balance disorder that results in sudden onset of dizziness, spinning or vertigo when moving the head. BPPV can be corrected through a series of simple movements, such as the Epley maneuver, to help dislodge the otoconia (tiny rock-like crystals) that have become lodged in an incorrect location in the inner ear, causing vertigo with certain movements. NIDCD is supporting a clinical trial that tests a strategy to guide clinicians toward evidence-based practices to diagnose and treat dizziness, including BPPV in a real-world setting such as emergency rooms.²¹ This type of translational research bridges the gap between scientific advances and real-world uptake to improve public health and potentially reduce health care costs.

Budget Policy: The FY 2025 President’s Budget request for the Hearing and Balance Program is $243.3 million, an increase of $0.6 million or 0.3 percent compared with the FY 2023 Final level.

Taste and Smell Program
NIDCD supports studies of the chemical senses — taste (gustation), smell (olfaction), and chemesthesis (chemically provoked irritation) — to enhance our understanding of how gustatory and olfactory cues from the external environment are processed and how human chemosensory disorders can be diagnosed and treated. NIDCD places a high priority on research aimed at identifying the underlying mechanisms important for both normal development of taste and smell and for developing treatment and prevention strategies for taste and smell disorders.

Food choice has a profound impact on our overall health. NIDCD is supporting research to understand how what we taste changes our brain to influence adult food choices and achieve progress to enhance nutrition.²² The gustatory cortex (GC) in the brain specializes in taste-related functions, such as anticipating taste and identifying safe and spoiled foods. Using a mouse model, NIDCD-supported researchers found evidence that neural circuits in the GC change based on early taste experience, thus establishing sweet preference. They identified a critical period during early life when sweet preference is established and described how early taste experiences influence GC circuits to maintain this preference in adult mice. These findings highlight the importance of early taste experiences both for adult taste preferences and for establishing normal taste circuitry in the developing GC.

The World Health Organization estimates that vector-borne illnesses account for more than 17 percent of all infectious diseases worldwide and are responsible for more than 700,000 deaths annually.²³ Mosquitos use their sense of smell to identify the source of their next blood meal. The Aedes aegypti mosquitos prefer to feed on humans over animals, thus spreading human bloodborne diseases such as encephalitis, malaria, dengue, West Nile, and Zika. NIDCD-supported investigators are working to determine how the insects preferentially target humans.²⁴

They studied odor signaling in the clusters of nerve cell synapses within the mosquito brain, called glomeruli, that receive input from olfactory receptors. The team identified a specific glomerulus that is strongly activated by human odor but not by animal odor. Their experiments determined that human odor is enriched in long-chain aldehydes, most likely derived from sebum, an oily skin protectant secreted into hair follicles. The long-chain aldehydes specifically activate the human-responsive mosquito glomerulus, helping the mosquito brain distinguish a human scent from an animal scent, and stimulate female mosquitos to target the human odor source for their blood meal. Scientists now hope to use this information to develop new ways to prevent mosquitos from biting humans and spreading serious diseases.

Budget Policy: The FY 2025 President’s Budget request for the Taste and Smell Program is $58.0 million, an increase of $0.2 million or 0.3 percent compared with the FY 2023 Final level.

Voice, Speech, and Language Program
Disorders involving voice, speech, or language can have an overwhelming effect on an individual’s health and quality of life. These disorders affect people of all ages with or without hearing impairment, including children with autism, those who stutter, and adults with acquired communication disorders. Voice, speech, and language disorders also come at a significant cost.²⁵ The cost to society of laryngeal disorders alone is estimated at $11 billion annually due to work-related disability, lost productivity, and direct health care cost. By the first grade, roughly five percent of children have noticeable speech disorders.²⁶ In children, delayed speech and language acquisition or impairment are often significant predictors of future academic, social, vocational, and adaptive outcomes.

Autism spectrum disorder (ASD) is a complex developmental disorder that affects behavior, communication, and social interaction. About 1 in 36 children are identified with ASD in the United States²⁷, and approximately 25 percent of children with ASD are minimally verbal or non-speaking. Early identification and intervention can improve overall social and emotional outcomes. In 2023, NIDCD sponsored a webinar to foster the development of critical research studies addressing the varying communication needs and abilities of this population. The discussants represented a wide range of backgrounds and perspectives and included scientists, advocates, and individuals with autism. From this workshop, NIDCD published a Notice of Special Interest to promote language and communication research in minimally verbal or non-speaking individuals with autism.²⁸ The Notice encourages research to evaluate and tailor existing interventions, develop novel interventions, develop and apply new research designs and methods to intervention efforts, and identify meaningful outcome measures.

Essential tremor (previously also called benign essential tremor or familial tremor) is one of the most common movement disorders. The key feature is a tremor in both hands and arms, but a person’s voice is also affected. Although the tremor can start at any age, it most often first appears during adolescence or in middle age (between ages 40 and 50). It can be mild and stay mild, or slowly get worse over time. The exact cause of essential tremor is unknown, and finding treatments is a challenge. NIDCD-funded voice researchers tested the use of an FDA-approved drug, sodium oxybate, which is used for excessive daytime sleepiness in children and adults with narcolepsy (a disorder where there is an extreme tendency to fall asleep).²⁹ The researchers found that sodium oxybate targets the same areas in the brain that are suspected to cause the tremors. This open-label study is the first to show that patients with a particular type of essential tremor have an average of 41 percent reduction in their symptoms after a single-dose of sodium oxybate. These findings are an important first step in providing some relief to those with essential tremor of voice.

Budget Policy: The FY 2025 President’s Budget request for the Voice, Speech and Language Program is $151.1 million, an increase of $0.4 million or 0.3 percent compared with the FY 2023 Final level.

Intramural Research Program
The NIDCD Intramural Research Program (IRP) conducts basic and clinical research in human communication. In the past few years, the IRP program has made important changes including the addition of new programs.

NIDCD recently hired a new Clinical Director. The Clinical Director oversees NIDCD’s clinical and translational research program conducted in the NIH Clinical Center, a world-class research hospital located on the NIH campus in Bethesda, Maryland. NIDCD’s clinical program fosters interaction to support pre-clinical, translational, and clinical studies aimed at developing novel diagnostic and therapeutic strategies for disorders affecting hearing, balance, taste, smell, voice, speech, and language. Under this new leadership, the program will provide clinical training opportunities for future clinician-scientists, including physicians who are engaged in cutting-edge, translational research through NIDCD’s Otolaryngology Surgeon-Scientist Program.³⁰ The Clinical Director will also head NIDCD’s new Sinonasal and Olfaction Program where a multidisciplinary team will explore basic science discoveries that have the potential to advance taste and smell treatments for patients.³¹

In 2023, NIDCD established a new Neurotology Branch. The branch will oversee clinical trials to identify promising new pharmacologic, biologic, gene therapy, and surgical procedures to advance treatments for hearing impairment, tinnitus, and balance disorders. Focus areas include the molecular pathways that direct hair cell (sensory cells in the inner ear) development and survival, sex differences in hearing and acquired hearing loss, and innovative tools for sharing, visualization, and analyzing data. Bringing this expertise to the NIDCD intramural program affords the opportunity for high-risk, high-reward research and acceleration of translating emerging basic science discoveries into impactful advances for hearing and balance disorders.

NIDCD intramural scientists are also working to identify therapeutic targets and novel treatments for sudden hearing loss and hearing instability disorders, including Ménière’s disease. Corticosteroids are the current standard of care for these types of inner ear diseases. However, complete recovery is rare, and results vary from person to person. To address this clinical need, an NIDCD intramural research team used a data-science approach to cross-reference steroid-responsive gene targets with FDA approved medications.³² The researchers identified 42 medications that have been shown to interact with these gene targets. The findings provide the basis for future clinical trials utilizing repurposed drugs that have demonstrated safety and tolerability in humans. Repurposing drugs provides an opportunity to speed development and testing of therapies available to individuals with few effective treatment options to restore hearing.

Budget Policy: The FY 2025 President’s Budget request for the Intramural Research Program is $56.7 million, an increase of $0.3 million or 0.6 percent compared with the FY 2023 Final level.

Research Management and Support (RMS) Program
NIDCD RMS activities provide administrative, budgetary, logistical, and scientific support in the review, award, and monitoring of research grants, training awards, and research and development contracts. RMS functions also include strategic planning, coordination, and evaluation of the Institute’s programs, regulatory compliance, and international coordination. NIDCD administrative and program staff liaise with other Federal agencies, Congress, and the public to provide program, policy, health information, and scientific advances. The Institute currently supports approximately 1,400 research grants, training awards, and Research & Development contracts.

Enhancing diversity, equity, inclusion, and accessibility within NIDCD’s workforce is a major priority. With leadership from NIDCD’s first Chief Diversity Officer, the Institute is cultivating a growth mindset that seeks and values diverse perspectives. NIDCD has developed a comprehensive plan to advance racial and ethnic equity for NIDCD employees. With the participation and collaboration with all levels of the NIDCD workforce, this plan includes expanding the awareness of cultural issues that impact the employee experience in the workplace through training and education on a wide range of topics, such as inclusive pronoun uses, ableism, biases against certain dialects, and structural racism. To expand on practices to support fair and consistent hiring practices, NIDCD has created step-by-step guidance on reducing bias in recruitment and a policy utilizing search committees for specific leadership positions. These efforts will focus on ensuring that hiring managers and selecting officials receive resources to support their ability to recognize the merits of all candidates.

Budget Policy: The FY 2025 President’s Budget request for RMS is $26.8 million, an increase of $0.1 million or 0.2 percent compared with the FY 2023 Final level.

Authorizing Legislation

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