A Silent and Imminent Threat
Richard A. Chole, MD, PhD and Michael J. McKenna, MD, Task Force Co-chairs On September 12, 2012, during this year’s AAO-HNSF Annual Meeting & OTO EXPO in Washington, DC, an Otopathology Task Force was convened to address a serious and imminent threat to our specialty. This Task Force was organized because of an initiative by Michael M. Paparella, MD. It was chaired by Richard A. Chole, MD, PhD, and sanctioned by the American Academy of Otolaryngology—Head and Neck Surgery. Present were some of the preeminent leaders in our field. There was no debate regarding the gravity or seriousness of the problem at hand. The specialty of otolaryngology is on the verge of losing its ability to examine the pathology of the human ear. If this were to occur, we would no longer be able to characterize the pathology of a host of problems that we see and treat on a daily basis. It will stifle our ability to develop new and effective treatments and to evaluate the results of our clinical interventions. Without this fundamental discipline, our specialty will justifiably lose all credibility with our medical and surgical colleagues and our patients. To better understand the scope of the problem, it is essential to review how we got here in the first place. The study of human otopathology is unlike all other pathologic endeavors. It requires a specialized laboratory and unique and intricate processing techniques that take years to master. These techniques cannot be learned from a book or instructional video, but rather take years of mentorship and practice. Similarly, the expertise required to examine and evaluate pathologic specimens takes years of dedicated study and is not a component of the formal educational process in either pathology or otolaryngology training programs. Historically, the great majority of otopathologists have been otolaryngologists. In 1980, there were 32 active temporal bone laboratories throughout the world with 25 located in the United States. The field was thriving with a critical mass of investigators. The work performed within these facilities is largely responsible for the pathologic characterization of many of the diseases we treat on a frequent basis, including otosclerosis, Meniere’s disease, chronic otitis media and many others. Today, there are three remaining labs in the world, all located within the United States. Insufficient operating funds threaten two of these labs, which are on the verge of closing. This abrupt decline resulted from a significant reduction in research funding for human otopathology and departmental discretionary funds used to support these labs. Most alarming is the near extinction of the technical and pathological expertise. Despite this, there remains a multitude of otologic disorders for which the pathology has not been well characterized with poor treatment options for our patients. Several years ago, a group of concerned leaders in the field approached the National Institute on Deafness and Other Communication Disorders (NIDCD) with their concerns. These discussions led to the formation of a human temporal bone registry and a research network, resulting in the acquisition of pathologic specimens and for funding of a limited number of labs. This funding is specifically for hypothesis driven research and does not support the ongoing processing and evaluations of new pathologic specimens that only become available when a patient with a well documented otologic problem dies. It has been this slow and steady process of investigation that has led to the greatest advancements in our understanding of human otopathology and without which our field will almost certainly begin to stagnate. The solution to this impending problem is not entirely clear. It will likely require both financial and institutional support. To this end, Michael Paparella, MD, has personally pledged more than $500,000 during the next 14 years and established an annual lectureship in human otopathology to be given at the AAO-HNSF meeting. Joseph Nadol, Jr., MD, gave the inaugural lecture at this year’s annual meeting where he eloquently highlighted the importance of human otopathology to the clinical practice of otology and reviewed the dilemma outlined above. The purpose of this communication is to educate the AAO-HNS membership. The task force will continue to actively explore all options to circumvent this potential disaster. There will come a time in the near future when we will call upon the AAO-HNS membership for support. This is a problem that will certainly affect the future of our specialty and will require a unified response.
Richard A. Chole, MD, PhD and Michael J. McKenna, MD, Task Force Co-chairs
On September 12, 2012, during this year’s AAO-HNSF Annual Meeting & OTO EXPO in Washington, DC, an Otopathology Task Force was convened to address a serious and imminent threat to our specialty. This Task Force was organized because of an initiative by Michael M. Paparella, MD. It was chaired by Richard A. Chole, MD, PhD, and sanctioned by the American Academy of Otolaryngology—Head and Neck Surgery. Present were some of the preeminent leaders in our field. There was no debate regarding the gravity or seriousness of the problem at hand. The specialty of otolaryngology is on the verge of losing its ability to examine the pathology of the human ear. If this were to occur, we would no longer be able to characterize the pathology of a host of problems that we see and treat on a daily basis. It will stifle our ability to develop new and effective treatments and to evaluate the results of our clinical interventions. Without this fundamental discipline, our specialty will justifiably lose all credibility with our medical and surgical colleagues and our patients. To better understand the scope of the problem, it is essential to review how we got here in the first place.
The study of human otopathology is unlike all other pathologic endeavors. It requires a specialized laboratory and unique and intricate processing techniques that take years to master. These techniques cannot be learned from a book or instructional video, but rather take years of mentorship and practice. Similarly, the expertise required to examine and evaluate pathologic specimens takes years of dedicated study and is not a component of the formal educational process in either pathology or otolaryngology training programs. Historically, the great majority of otopathologists have been otolaryngologists.
In 1980, there were 32 active temporal bone laboratories throughout the world with 25 located in the United States. The field was thriving with a critical mass of investigators. The work performed within these facilities is largely responsible for the pathologic characterization of many of the diseases we treat on a frequent basis, including otosclerosis, Meniere’s disease, chronic otitis media and many others. Today, there are three remaining labs in the world, all located within the United States. Insufficient operating funds threaten two of these labs, which are on the verge of closing. This abrupt decline resulted from a significant reduction in research funding for human otopathology and departmental discretionary funds used to support these labs. Most alarming is the near extinction of the technical and pathological expertise. Despite this, there remains a multitude of otologic disorders for which the pathology has not been well characterized with poor treatment options for our patients.
Several years ago, a group of concerned leaders in the field approached the National Institute on Deafness and Other Communication Disorders (NIDCD) with their concerns. These discussions led to the formation of a human temporal bone registry and a research network, resulting in the acquisition of pathologic specimens and for funding of a limited number of labs. This funding is specifically for hypothesis driven research and does not support the ongoing processing and evaluations of new pathologic specimens that only become available when a patient with a well documented otologic problem dies. It has been this slow and steady process of investigation that has led to the greatest advancements in our understanding of human otopathology and without which our field will almost certainly begin to stagnate.
The solution to this impending problem is not entirely clear. It will likely require both financial and institutional support. To this end, Michael Paparella, MD, has personally pledged more than $500,000 during the next 14 years and established an annual lectureship in human otopathology to be given at the AAO-HNSF meeting. Joseph Nadol, Jr., MD, gave the inaugural lecture at this year’s annual meeting where he eloquently highlighted the importance of human otopathology to the clinical practice of otology and reviewed the dilemma outlined above. The purpose of this communication is to educate the AAO-HNS membership. The task force will continue to actively explore all options to circumvent this potential disaster. There will come a time in the near future when we will call upon the AAO-HNS membership for support. This is a problem that will certainly affect the future of our specialty and will require a unified response.