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Ear exam using otoscope

Biodesign and otolaryngology team up for hearing loss and other ear, nose, and throat challenges

A partnership is improving patient care in the field of otolaryngology by pairing Stanford Biodesign fellows with clinicians.

When high-pitched sounds are hard to hear, speech sounds muffled. People feel like they can hear, but they can't understand. The condition is called high frequency hearing loss and when it is severe, not even hearing aids can help. The only other option is a cochlear implant, which requires a surgical procedure, hearing therapy and carries the risk of losing low frequency hearing.

Francis Wong, MBBS, and Jay Dhuldhoya, a biomedical engineer, first learned about the problem while observing patient care at the Stanford Audiology Clinic during their time as Stanford Biodesign Innovation Fellows. The Stanford Byers Center for Biodesign teaches a proven process for identifying and solving problems in health care through technology innovation.

Wong described a patient he met.

"It was obvious that he had real difficulty understanding speech and even communicating with his wife," he said. "He was considering a cochlear implant, but was torn because knew there would be no turning back. It was heartbreaking to see him struggle with even the most basic communication because he couldn't get comfortable with the only treatment option available to him."

Wong and Dhuldhoya decided to try to another approach. Working with Peter Santa Maria, MD, PhD, and others in the Department of Otolaryngology-Head & Neck Surgery, they are developing a device, currently in clinical study, that can improve speech perception with less risk of losing residual hearing.

Peter Santa Maria standing outside
"Our department has a long history of working with engineers and other sciences to solve problems," says Peter Santa Maria, MD, PhD, a Stanford Medicine otolaryngologist.

An innovative partnership

This project is one of several developed through a longstanding collaboration between Stanford Biodesign and the Department of Otolaryngology-Head & Neck Surgery. Also known as ear, nose and throat or ENT, otolaryngology includes the airway and the organs for taste, smell, hearing, and speech.

ENT doctors, who are also surgeons, face challenges ranging from the need to operate through small openings like the ear and the nose to helping patients with life-altering diseases that lack good treatment options.

"As surgeons, we tend to be very needs-oriented. We see a problem and we want to fix it," said Santa Maria.

Robson Capasso at Stanford Health Care
Ear, nose and throat physicians including Robson Capasso partner with Stanford Biodesign to develop innovative solutions to help patients.

"We are always looking for technologies that improve care by making procedures less invasive, risky, or expensive, or move them from the OR to outpatient," said Robson Capasso, MD, chief of sleep surgery and a global advisor at Stanford Biodesign.

As part of this collaboration, the department regularly allows Biodesign trainees to shadow them in the OR and clinic. They also serve as mentors, advisors, and/or clinical support on the projects that result.

ENT doctors interested in health technology innovation also participate in Biodesign's graduate-level Innovation Course and Faculty Fellowship program. To help with faculty-initiated projects, Capasso and Santa Maria launched the Otoinnovation Lab. There, they use Biodesign-developed screening tools to help faculty members decide which ideas to pursue, based on their potential to reach patients and improve care.

"The collaboration with the Byers Center has significantly increased translational research opportunities for the ENT faculty," said Capasso.

Generating solutions

Other important problems being tackled by Biodesign trainees working with ENT faculty include:  

  • Otitis media with effusion, or "glue ear": This pediatric ear disease is one of the primary reasons children get ear tubes, the most common childhood surgery in the U.S. A team of global trainees is working with Santa Maria on a special cup that helps ventilate children's middle ears as they swallow, with the goal of reducing the need for surgery.
  • Chronic nasal and sinus inflammation (rhinosinusitis): This feels like a really bad head cold that never goes away. A 2018-19 fellowship team is developing a device that will improve at-home treatment by delivering medication further up the nasal passageway. 
  • Deviated septum: When the internal wall between the nostrils is crooked, it can be hard to breathe freely. Straightening the septum requires surgery. A team from the 2019-20 Innovation Fellowship is working with Stanford Medicine otolaryngologist Jayakar Nayak, MD, PhD, to develop a less invasive way to correct this in an outpatient setting.

A natural fit

"Our department has a long history of working with engineers and other sciences to solve problems," said Santa Maria. He referenced Rodney Perkins, who pioneered new surgical procedures for the ear before turning to technology innovation.

 "Our primary goal is to keep our patients safe and make sure they receive the best care possible," said Capasso. "But, at the same time, we are always working to improve treatment options through innovation. Our partnership with Stanford Biodesign means we can always find the right person to brainstorm with about an idea."

Top photo by Bangkoker/ Shutterstock; Bottom photos by Andrew Brodhead

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