September 12, 2003
Sheraton Four Points Bethesda
The NIDCD convened the "Human Temporal Bone Research Workshop: Laboratory and Training Support" on September 12, 2003, at the Sheraton Four Points Bethesda at 8:00 A.M.
After welcoming comments, the workshop Chair asked the meeting participants to introduce themselves and reviewed the purposes of the workshop: (1) to identify the funding issues and requirements involved in sustaining human temporal bone research laboratories and the training of qualified researchers in the United States and (2) to develop recommendations for action(s) NIDCD might take to address the identified issues and requirements.
After a presentation reviewing the current status and promise of human temporal bone research, panel discussions took place in which participants made presentations and/or provided written materials for consideration. In addition, written comments from human temporal bone researchers not attending the workshop were considered.
General Comments Arising from the Panel "Funding of Temporal Bone Laboratories--Sources and Needs Assessment"
The capacity to assess human temporal bone histopathology is unique to the temporal bone laboratory and lies outside the domain of the ordinary human pathology laboratory. Despite the tremendous importance and potential of human temporal bone research, particularly in view of the tremendous strides being made in molecular genetics and molecular biology in uncovering the bases of many otologic disorders, the U.S. expertise and infrastructure necessary to conduct human temporal bone histopathologic research are evaporating.
A number of misconceptions dissuade individuals from embarking upon human temporal bone research--otopathology is of historic interest only and has little relevance to modern otology/neurotology, and federal funding agencies have little interest in supporting otopathologic studies.
In actuality, human temporal bone research, although currently of tremendous importance, tends to fare poorly in traditional peer review as it is perceived as "descriptive" rather than "hypothesis-driven" research. It is important to recognize that "descriptive" research is not necessarily non-mechanistic.
Today's active human temporal bone research laboratories survive by cobbling together funds from a variety of sources: private foundations, (otolaryngology) departmental funds, outsourced animal temporal bone processing, federal funding, and personal funds (usually donated by the lead clinician-researcher). A major uncovered cost is that associated with the acquisition, processing, and initial histopathologic assessment of new specimens. On average, it costs $3,000 to remove and process a single human temporal bone; the average human temporal bone research laboratory requires $300,000 per year in support.
To a great extent, specimens are acquired in a non-protocol driven fashion, and laboratories operate independently of one another.
Specific Recommendations Offered by the Participants
The most pressing need for human temporal bone laboratory survival is support for the costs of initial temporal bone acquisition, processing, and assessment of specimen utility. The HIV/CNS Tissue Network is a possible model. Support should extend to the support of a training function.
The review of human temporal bone research proposals should be conducted by specially constituted panels, with reviewers selected on the basis of their expertise in human temporal bone research. There should be funds set aside specifically for human temporal bone research.
Consortia of human temporal bone laboratories should collaborate in protocol-driven specimen acquisition and processing (e.g., DNA acquisition and storage, audiometric and other clinical information). Such collaboration could be informed by, and complement, the data-sharing conducted under the auspices of the NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry. Data should be shared amongst laboratories, facilitated by the use of standard data reporting/recording formats. Moreover, the ideal human temporal bone research laboratory should reflect a multidisciplinary effort comprising clinical otologists/neurotologists, pathologists, molecular biologists, etc., as well as supporting technical and clinical staff. Human temporal bone research must capitalize on modern research methodologies.
There is a need to educate professionals regarding the vital importance of human temporal bone research. The Mid-Winter Meeting of the Association for Research in Otolaryngology is an ideal venue for such an educational endeavor.
There should be an annual meeting of human temporal bone researchers to facilitate information exchange and raise the visibility of otopathologic research.
General Comments Arising from the Panel "Training of Temporal Bone Researchers--Funding and Needs"
Human temporal bone research requires uniquely trained individuals. In addition to otopathologists, there is a need for technicians skilled in the art of temporal bone celloidin embedding and specimen sectioning with a sliding microtome, as well as section mounting and staining--all of which requires a skilled mentor. This technical training is not readily available at most medical centers. Additionally, newer techniques of microsectioning of whole temporal bones is highly specialized and not used for other tissues. Paralleling the dwindling number of active temporal bone labs is a decrease in the number of trainees. Although the NIDCD offers a number of research training opportunities, there is no specific program to recruit and retain aspiring otopathologists.
Despite the vast translational research potential of human temporal bone histopathologic study, new investigators are discouraged from considering a career in this area by the perception that it is of historic interest only and has little relevance to modern otology/neurotology, and that federal funding agencies have little interest in supporting otopathologic studies.
Funding for training has derived from multiple sources, including the World Health Organization; the Fogarty International Center; the Council for International Exchange of Scholars (e.g., Fulbright Scholarships); native country (many recent trainees are foreign nationals); affiliated universities; private foundations; and personal funds. The NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry sponsors a "mini-fellowship" that provides travel funds (up to $1,500) for a young investigator or technician to visit a temporal bone research lab for up to 4 weeks.
Traditionally, the otopathologist has been a clinical otologist/neurotologist motivated by the desire to improve patient care. This traditional model may no longer suffice. The pool of potential candidates could be expanded to individuals holding the Ph.D. in broadly relevant fields, e.g., molecular biology. Once provided sufficient grounding in the basic sciences relevant to human temporal bone histopathology, and if linked to an appropriate clinical link, such individuals could successfully pursue otopathologic research.
Regardless of the candidate pool, the training program must be able to provide an active human temporal bone research laboratory, mentor(s), ongoing clinical linkage, and exposure to different techniques/laboratories. The training program must have adequate funds to allow sufficient time to acquire the skills necessary to conduct human temporal bone research successfully.
Beyond the province of any training program, there must be the perception of a future, i.e., that of funding.
Specific Recommendations Offered by the Participants
The primary requirement for any training program in human otopathology is an active human temporal bone research laboratory. Funding supporting the core functions of such laboratories is critical to their survival and to their ability to train future generations of otopathologists.
The training of aspiring otopathologists should be supported by funds that allow sufficient time (ideally one to two years) to acquire the multidisciplinary skills required. Perhaps supplemental funds to extant mechanisms (e.g., T32, Ks, and Rs) could serve to support otopathology training efforts.
The pool of candidates to consider as potential otopathologists should be expanded to Ph.D. holders from relevant disciplines. Also, medical students could be attracted to a career in human otopathology via a one-year training program.
The meeting was adjourned at approximately 3:00 P.M.
I certify that, to the best of my knowledge, these minutes are complete and accurate.
Richard A. Chole, M.D., Ph.D.