Transforming Hearing Healthcare Through Translational Science with Sumit Dhar

[00:00:00] Erin Spain, MS: Welcome to Science in Translation, a podcast from NUCATS, Northwestern University Clinical and Translational Sciences Institute. I'm your host, Erin Spain. Today we're talking about the promise of translational science through cross campus cross school collaboration between NUCATS and a professor of communication at Northwestern that could help the 48 million Americans with hearing loss. We welcome to the show today, professor Sumit Dar. Hugh Knowles, professor of Hearing Science in the School of Communication and Associate Provost or Faculty at Northwestern University. His research bridges basic auditory science with public health from understanding the tiny sounds produced by the inner ear to building systems that can make hearing care more affordable and accessible for millions of people. His work is an important example of how translational science can move discoveries from the lab to real world solutions that improve human health and quality of life. Welcome to the show.

[00:01:09] Sumitrajit (Sumit) Dhar, PhD: Thank you so much for having me. This is quite the pleasure.

[00:01:12] Erin Spain, MS: Well, we are thrilled to have you here, especially featuring a faculty member from outside of the medical school. You are in the School of Communication. Tell me a little bit about your background and what led you to studying, hearing and hearing loss.

[00:01:26] Sumitrajit (Sumit) Dhar, PhD: I started life in India where I went to college and I studied audiology and the goal was. At that point, not very clear, but after my bachelor's degree, I sort of fell in love with the science and the physics of what happens in the ear that allows us to hear. And that led me to graduate school here in the US and that studied in a lab that had two pIs to professors. One was a theoretical physicist and the other an experimental psychologist. So it was really a a really awesome mix of theory and experimentation. Once I started studying the ear I fell in love with the physiology and the mechanics of the ear. Like it was just so neat that all these different parts essentially mechanically have to move to make the brain hear the sound that is coming in. So that's what got me to graduate school, and that's what keeps me going.

[00:02:19] Erin Spain, MS:  Since coming to Northwestern in 2004, your research has uncovered some very interesting things about sounds created in the inner ear. Tell me about that.

[00:02:28] Sumitrajit (Sumit) Dhar, PhD: Turns out these sounds known as auto acoustic emissions are one of the first things to go when there is mechanical damage to the ear. Even before you, you have actual difficulty hearing. And again, that's sort of easy to understand once you think that we also have brains attached to our ears, so as a little bit of deficit in the actual acoustics is made up for by the brain, by our knowledge, by knowing the language, by knowing the context, by knowing who you're talking to, et cetera. but these auto acoustic emissions are not language are not based on cognition, they're just pure mechanical response. So the first signs of damage show up in them as well. So, our work there you know, quickly shifted to not only can we tell when something's going bad, but also can we tell what is going bad? So today, if you have run of the mill age related or noise exposure related hearing loss, at some point you can't take it anymore and you go get hearing aids. Or if you have a lot of hearing loss, you could get implanted using a cochlear implant. We imagine a future, not so distant future where we can start working on preserving hearing and we can actually work on repairing hearing through pharmacological means or stem cells or genetic therapies, et cetera. There are other groups all over the world working very hard on those solutions. And what our role is is to figure out what is broken in the ear. So that could be one of five things. And you wanna know which drug to administer, how much to administer, or what kind of therapy is the right therapy. So we don't wanna, or. Off chance that we end up with the treatment but not know how and when to treat. So our role is in that front end to figure out exactly what is wrong and how much of it is wrong. So you can decide on what kind of treatment, what kind of dosage et cetera.

[00:04:18] Erin Spain, MS: But you've also pivoted some of your focus and your research focus into hearing healthcare delivery and understanding why so few people seek hearing healthcare. Tell me about this part of your work.

[00:04:30] Sumitrajit (Sumit) Dhar, PhD: What I came to realize probably around 2010, 2012, is that, this is all future looking. And today there are a ton of people who don't do anything about their hearing loss or wait too long before they do anything about it. So there has to be something done to make it easier today to make hearing healthcare more accessible today. And I was so lucky that right around that time, the NIH was putting together a working group on what was a very novel concept at that time called affordable and accessible hearing healthcare for adults, and I got to be on that, working group, and it kind of was fell in right in time when I was starting to imagine some contribution to that area. So I've been involved in this second line of work, which is almost at the other end of the spectrum where how can we. Get more people to use the treatments that are available today and not wait and wish for some other form of treatment that comes, you know, tomorrow or five years or 50 years down the road. We've been doing projects where we kind of first understood that there's Not just one barrier that we need to dismantle that there, you know, I call a door with a thousand locks and every one of these locks have to be unlocked. And so we've been pardon the pun, picking one lock at a time and trying to find solutions going forward so that's where we are today.

[00:05:55] Erin Spain, MS: People wait between five and seven years on average before seeking treatment. And as you said, there's all these, there's like stigma and access, can you gimme a little more details about this problem and what you've discovered?

[00:06:07] Sumitrajit (Sumit) Dhar, PhD: The US is really interesting in that hearing healthcare is not incorporated into sort of like your annual checkup or treatment for hearing loss as it stands today, for example, is not covered by Medicare. And like draw contrast with. England or Western Europe where you have this system where you get all your healthcare, including hearing healthcare, right? So hearing aids are free or very subsidized, et cetera. But that's not the case here. Most till very recently, hearing aids were dispensed at a private practitioner or at your physician's office. You had to pay out of pocket for them, and they were, they are continuing to be expensive. And all of that did contribute, however a lot of people thought and still believe that, oh, if it was just cheap, everybody would do it. I don't think that's the full solution. And, a few years ago we wrote an opinion paper where we said the problem is deeper than the cost. You can take the example of say, Western Europe, where hearing aids are a hundred percent covered, there about 40 to 45% of the people, maybe 50% of the people who could use hearing aids, use them. So clearly, if you made them free today, we would not cover a hundred percent of the people who need it. So then there are, there's stigma, there's all these other factors. And so, you know, the way I think about it broadly is we as humans have learned to control our environment. So as our hearing or other facilities start to deteriorate, we put up with it as long as we can by turning the TV up, or not going out as much or doing this or doing that, and only when it's just not possible to manipulate everything else, do we think, oh, now I should do something about it. I mean, that is a little bit of exaggeration, but that sort of gives us a framework of everything that we need to be able to solve. And we are getting there because there's this increasing recognition that hearing loss itself is not very good, but then there are all these other things that happen when you don't treat hearing loss, you fall more. You know, there's these connections with cognitive decline that are coming out now. Depression, health costs go up, you know, there's quite a bit of evidence now showing how more expensive health utilization, general health utilization gets when you have untreated hearing loss. And some of it is pretty common sense. Like you, if you have a significant hearing loss, every interaction you have with the healthcare world is compromised. Right. So it makes sense when you start thinking about it that way. With vision, that's the primary mode of taking in the world. Right. And if it's impaired or if it's only half functional, that has to. Have an impact on many other things, so the US starting with that workshop that I told you I was part of has taken several big steps. And one of them was the regularization by the FDA of what we call over the counter hearing aids that have brought down prices quite a bit of marginal increase in uptake since they've been around since 2022. But. Hopefully this is just the beginning and we just need to continue to sort of take these other locks off the door to open it fully.

[00:09:12] Erin Spain, MS: Well, you actually came to NUCATS to explore the idea of creating a clinical trial network for affordable hearing healthcare. Because you've said there aren't a lot of these high quality clinical trials for hearing health research. Tell me about this problem and how you came to NUCATS for solutions.

[00:09:30] Sumitrajit (Sumit) Dhar, PhD: So there's this thing called the joint commission of something or the other of the many things it decides is what is included in your annual physical. That your insurance would cover as preventive medicine or whatnot. And many years now, people have been saying, after a certain age, a hearing checkup should be part of it. And time and again, the joint Commission says no, because we don't have enough quality data to tell us that it's gonna make a difference or this or the other. What these kinds of groups mean by quality data is large scale, high quality, high impact clinical trials that are randomized, that may have placebo in it, et cetera, et the gold standard. And truly there aren't as many as there are in other fields. When I started working in this area, I was now in our group. We've done pretty large clinical trials and one was to ask the question whether people can fit their own hearing aids or not. For example about a thousand people, so not a cardiology size, uh, clinical trial, but pretty decent size. And it also occurred to me. while doing this is like, I am not a trialist and I had to learn all of this on my own So this was an idea to sort of see if we can build a platform for not only me, but others to be able to jump in and actually do the science rather than have to build the airplane while they're flying it. And yeahNUCATS rich and Anju Peters and Nick Vic have been just. You know, God sent and uh, they've been guides. They've been, you know, counselors and mentors and we hope we could put that together. In the meantime on my other proposals. I'm working with several people inNUCATS for implementation science , so it has opened a door. for experts that are my colleagues, and I should have been working with them for the last 10 years now, now I have a connection.

[00:11:17] Erin Spain, MS: Well, tell me about that, the sort of cross campus interdisciplinary science. This is a hallmark of Northwestern University and you're really seeing this in action firsthand. What's it like working with these colleagues that you mentioned throughNUCATS? What's this like?

[00:11:33] Sumitrajit (Sumit) Dhar, PhD: faculty, who are starting out don't think of looking for a structural connection. They're looking for collaborators initially. Like that's sort of how we are trained is like, oh, you work with a person versus this is a, someone in industry would say, let's find a group that can take a subcontract. And, you know, do this for us. They have a more structural approach to it. Right? AndNUCATS, once you come to know them, are a neat blend of the two. Like there are people who do the science within there, but they also have the organizational structure. That allows the work to get done in a systematic way. So like 10 years ago, I did not have that recognition, right? So I, I kind of was looking for people to work with and every once in a while I'd find somebody, and you can scale that stuff to some extent, but also that me recognize that there's no one at Northwestern who's just sitting around waiting for someone to call and say, Hey, do I have time to, yeah. So it has to be of interest to them. They have to see the importance of it. They have to kind of recognize, oh, I could learn something, or it would be an interesting project for me to jump into. Contrast that with something likeNUCATS whose mission it is to launch other people's work, right? So the equation changes when you approach a faculty member versus the organization through the proper channels, right? So that's a learning that I'd love to share with others and say, think of this as utilizing infrastructure versus forming a collaboration. The other answer is one that I see in my role as associate Provost. So a lot of times other faculty will ask me, do this and I'm looking for this, that, or the other, and I'm gonna collaborate with someone at the University of Honolulu. I'm like, wait a minute. You know what? Have you looked at this or have you looked at that? And that is really fascinating to me because, you know, they may have read a paper by them and whatnot and what a lot of folks don't. Realize what NUCATS has built is actually an infrastructure, general infrastructure project. It doesn't matter whether you work in hearing or vision or all faction or limb control. It doesn't make a difference to them. Underneath there is the proper structure that can help anybody doing translational science. So that's it. What I'd love to share with the community is that, you know, if you think you need support in design, in recruitment, and dissemination, whatever it might be, these phases of research, don't worry about what is the science or what is the exact question you're gonna ask. Ask if they have the capacity to help or the knowledge base to help you.

[00:14:08] Erin Spain, MS: wanna hear more about this workshop that you recently led, and this had a lot of different leading voices like scientists, clinicians, engineers, advocates, and this was a and you're now producing a white paper from this. Tell me about this workshop and what was the impetus of this and what do you hope happens?

[00:14:26] Sumitrajit (Sumit) Dhar, PhD: I conceived of this when I had this idea of a trials network and I had imagined that we'd bring these people together and these are folks who are interested in or are working in the area. And would love to participate in a trials network or would have use for a trials network, right? So I sort of handpicked folks in large places like Stanford and Duke and other big clinical centers. One of my collaborators from Hopkins helped me organize this workshop. So Carrie Neiman's her name. It turns out Northwestern alum is now an ENT surgeon at Hopkins. And we had a good 40 people come and the day was initially, in my mind was okay, we'd have a goal of proposing a trial network and we'd spend the day refining what that grant proposal should look like, what should go in it. But in the buildup, in conversations with NUCATS and with Carrie and conversations with NIH and other funding agencies, we realized that a clinical trials network is one very viable, very needed solution. But that's not the only thing that is needed for this field. There may be other things, some, you know, easier problems, some easy things that time-limited solutions that could be put together. So we converted the day. Two more of a brainstorming come, planning a day to arrive at a few things to do, one of which could be the trials network, for example, right? So people were there for the full day. And we had given them homework to read, barriers to this kind of work, and they came in with some ideas of what kinds of barriers they had faced. Because all of them had tried to do this work. And in groups they decided what are some solutions that we need to think about? Then the whole group came together and finalized a short list of things to work on as a group. So, Rich was there for the whole day. I'm so grateful for that. And he guided us through the discussion and you know, we'll write this white paper and, but also this group is now galvanized to stay connected and take on a few of these projects um, for the next three, six months or a year or so, and then see where we are.

[00:16:41] Erin Spain, MS: So looking to the future, from some of the ideas that you were able to refine that day, can you share some of the things that we might. Be seen soon?

[00:16:50] Sumitrajit (Sumit) Dhar, PhD: sure. So, a good example is, there are many places where guidelines for things are published. So guidelines, for example when should you seek hearing healthcare guidelines for what are some communication strategies when you have hearing loss? They are very static. And we know policies are evolving, insurance is evolving. Coverage for hearing aids are evolving. So one of the consensus, well, we need a set of living documents and there needs to be a place to house it, right? So, we at Northwestern are in discussions. Internally to say, can we be the place where this group helps us create these set living guidelines, but this is where it lives. So that's one thing that I'm pretty sure we'll see come through. Second, there was already a group within this group that was doing a thorough review of the last 15 years of literature in this area. And it's quite close to being done, but one of the realizations in this day was it should not just be a paper. It should also be something that people can update and imagine a table with different cells. It says in this kind of population, this kind of science is only. Done 10% and there's 90% room. And if there was a mechanism to keep that updated for the field, early career scientists would come in and have a roadmap right away. So we'll probably see that we will build and host and, you know, others can use it. So that's another thing and then, third thing is probably gonna be a proposal that involves not all of these 40 people, but you know, the folks who are at the right places have the same sort of interests and could be put together three or four institutions and propose something that is long lasting, that is impactful and can be built on by the others.

[00:18:34] Erin Spain, MS: Well, and what's really cool about this is once this infrastructure's in place, other folks can use this outside of audiology and hearing.

 [00:18:41] Sumitrajit (Sumit) Dhar, PhD: Yeah, that's absolutely right. So, you know, I think it would, the stretch is very easy to other behavioral sciences, sensory health and so on, so forth. Because a lot of these things impact lifestyle in the same way. So, hearing, vision, cognition then you, some kinds of social conditions that impact your lifestyle, et cetera. They fall very close in this bucket of things. And then as you keep going farther, you get farther from behavioral health and now you need assays, blood draws this, that, or the other, and then it becomes a little more difficult to stretch. But till that point, this is all very accessible for other kinds of signs.

[00:19:19] Erin Spain, MS: . So looking to the future, you have all of these things that are kind of bubbling up right now and different papers that you're working on and possibilities. What excites you the most about these developments and what's possible?

[00:19:31] Sumitrajit (Sumit) Dhar, PhD: Truly what excites me the most is to see. Early career hearing scientists, health scientists who are choosing to work primarily on access to hearing healthcare. Now my generation of scientists like me came upon it accidentally, almost, you know, trained to do something else and decided this needs to be worked on as well. But even in this group of 40, there were a good 10 people who are in the first five years of their career. They've seen the path that has been open now and, and they wanna make an impact. It's bringing in population health scientists, it's bringing in biostatisticians, it's bringing in health economics is another area where people have, you know, start paying attention to hearing as well. So that is what excites me. It's truly becoming like a community problem, a community of scientists problem, not just, you know, five people working on it in their spare time kind of.

[00:20:21] Erin Spain, MS: This is such a cool example of translational science that you like you said, this is something you started working on, something in the lab, had this idea, and now there's so many possibilities ahead. Can you talk about this promise of translational science? And you know, at this point in your career too, what's it like to see something like this happening?

[00:20:39] Sumitrajit (Sumit) Dhar, PhD: It's not for the sake of doing science anymore, it's for public health. And it's the recognition that all of these things contribute to the health of the nation, contribute to the longevity and an active life in that longer lifespan that we are seeing Is central to many of our thinking today. Even those of us who came from basic sciences and now are trying to do something that is more translational or implementation end of line kind of work. And the link is not just obvious, but it is. It's just one thing, like, yes, you might work in this part of the train or this part of the train or that part of, but it is one train and if you wanna go in the right direction, all of these little elements have to be coordinated in a way where nothing's sitting. After discovery for so long that it, you know, that people don't get the benefit out of it. And at the same time the implementation science has enough fundamental science to, build upon, every one of these stages have to grow together. It's not like you do this first and then you do that as the supply chain has to be continuous for us to make progress as a civilization, as a community.

[00:21:51] Erin Spain, MS: I mean, in the future is your hope that everybody's getting those hearing tests and try out a hearing aid

[00:21:56] Sumitrajit (Sumit) Dhar, PhD: my ideal future is that there are many kinds of treatment. There is preventive treatment and Right, which is now a lifestyle. Like put your earplugs in, whatnot. . But my hope is that there are pharmacological retardants or protective agents as well, along with the social awareness of protecting hearing. My hope also is that we understand genetics well enough to know who is predisposed to hearing loss and who is less predisposed to hearing loss. And then we have, you know, biological treatments of tissue preservation or tissue restoration. But then when that is not enough or that doesn't work, we have ready access to amplification, be it hearing aids or cochlear implants and whatnot. And all of this can only be as successful as the. financial support for these treatments are right. How inexpensive are they? How accessible are they? So all of it, in my dream world, all of it happens maybe sooner, some rather than later. Some, but at some point in time, we have to have all of these solutions on the table.

[00:22:56] Erin Spain, MS: What message would you like to leave maybe with your colleagues at other schools at Northwestern that haven't interacted as much withNUCATS, but they're interested in doing something like you've done, what advice would you give to them?

[00:23:08] Sumitrajit (Sumit) Dhar, PhD: I would say if you have an experiment or have an idea that is. Just even a bit outside your own lab. It's worth sending a note toNUCATS to see if they have structures that can be of help. There are so many shops withNUCATS. They have this service mindset that is remarkable, and they will help. And other than that, get your hearing tested.

[00:23:32] Erin Spain, MS: Love it. Well, thank you so much for joining me today talking about this project and the way thatNUCATS has been able to help you as you're really just getting started here.

[00:23:41] Sumitrajit (Sumit) Dhar, PhD: Yeah, that's absolutely right. And thank you.

[00:23:44] Erin Spain, MS: Subscribe to Science in Translation wherever you listen to your podcasts. To find out more about NUCATS, check out our website, NUCATS.northwestern.edu.