Jessica Morrison: This is The Future Of,
where experts share their vision of the future and how their work is helping shape it for the better.
I'm Jessica Morrison. One in six people worldwide
suffer from hearing loss, yet it's one of the most preventable impairments.
Current treatment for hearing loss is managed with hearing aids, cochlear implants,
or surgery. In this episode, I spoke with Dr Hani Al-Salami, an associate professor in the
Curtin Medical School and Curtin Health Innovation Research Institute. He is also the Head of Hearing
Therapeutics Department at Ear Science Institute Australia. Dr Al-Salami and I talked about his
novel treatment of hearing loss with medication, some of the causes of our collective deafness,
and what we can do to protect our hearing. If you'd like to find out more about this research,
visit the links provided in the show notes. This episode was recorded remotely due to COVID.
So Hani, we'll just dive right into the first question. How do we hear and why are more of us
experiencing hearing loss? Dr Hani Al-Salami:
To encapsulate the full picture of the hearing organ, we have three parts. There's the outer ear,
there's the middle ear, and there is the inner ear. The outer ear collects noise and passes it
through the middle ear – where we have parts of the ear that vibrates in a certain way,
that resonates with the sound and the intensity of it and the type of it, and it translates all
that into the middle ear and into the inner ear. Inside the inner ear, we have cells. These cells
vibrate and they send the signal through nerves inside the inner ear all the way to the brain.
The inner ear is the part of the ear that transfers sound into the brain.
Jessica: And why are more of us experiencing hearing loss?
Hani: Okay, so this is a multifactorial question.
There's different reasons for that: First of all, age-related hearing loss is one of the main ones;
and the second one, which is quite rapidly increasing in the prevalence of hearing loss,
is all the gadgets and music that we put in our ears that magnifies
noise. The long-term use of them is anticipated to exacerbate hearing loss dramatically.
Jessica: What are the current treatments for hearing
loss and what are some of their limitations? Hani:
There's no current drug for treating hearing loss or interventions in the clinic.
There are things that some people try, but the main two interventions for hearing loss
are cochlear implants and hearing devices or aids – they're the only two things that we have
at the moment. They do help and they're better than not having anything, but they've got great
limitations. Not everyone can have them, in fact, one in five only in Australia use hearing devices.
In terms of the implants, it's a very invasive surgery. It is helpful, but it is invasive and
we also see long-term complications when these implanted devices don't function well long-term,
because the body can react to them. Those whose bodies react to these devices or implants can
reduce the ability of these devices to function, and taking them out and
putting it another one in is not something we do. We don't have a drug that can treat or cure
hearing loss. That's what got me into this area in the first place, it's a very complex area where
you need, not just a pharmacist or a doctor, like myself for example; you also need the cochlear
physiologist – I've got Dan Brown, who I work very closely with – we've got surgeons, we've got
chemists. We have a very good group of people that I work with to overcome such obstacles, hoping to
develop something that would make a difference. Jessica:
Talking about developing something that's making a difference or hopes to make a difference.
As part of your Curtin research, you co-created a new formula of an existing drug that can be
delivered directly into the inner ear to counter hearing loss. Can you tell me a bit more about
this medication? Hani:
One of the things that I've been pretty much working on all my life,
is the applications of some of the hormones that we produce in the body, in the gut,
and repurposing these hormones to enable better and more optimum and safe drug delivery.
For example, one of the areas that I worked on is adding these kind of digestive hormones or enzymes
into a capsule that you can swallow and take the drug more into the brain – and it worked. And I've
taken this idea of an enzyme that bile has in it, that digests food, mixing it with a special gel
using our technology – and that worked. By doing it this way, the gel glues into the inner ear and
it facilitates the permeation of this drug – which is one of the most powerful antioxidants – all the
way into the cochlea, the inner ear. Jessica:
So this is the first time anything like this has been developed or got
to the point of development where it could potentially be a treatment for hearing loss?
Hani: That's correct. I just
have to say that this is just not my work, it's a great group of people that I work with, that I've
been very lucky to have. Jessica:
Who are some of the other people, or what are some of the roles that they're playing
as part of the team? Hani:
I am a pharmacist, by trade, so I come from a pharmaceutical science background.
We have another pharmacist who I work very closely with, Armin Mooranian. I've got also Daniel Brown,
who is the physiologist, who understands the physiology of inside the inner ear. And we also
have surgeons, Jeffrey and Marcus. We also have chemists that have got a very good understanding
of the chemistry of the gel itself. So we all come from a different background, but it's really nice
mix of expertise that made that happen. Jessica:
Absolutely. What are some of the simple things we can do to prevent hearing loss? You mentioned that
it can be age factors, but also things that we're doing in our lifestyle as well.
Hani: So overall healthy living is a good thing.
Of course you cannot help ageing, but noise is a major contributor – more than 30%. And not only
that, as you would imagine, a younger person now, going for a run or having these gadgets in their
ears and blasting noise every day, a couple of hours a day – it will complicate things
when they get older. So you're not going to just have someone who's ageing nicely by just losing
a bit of hearing; you're going to have someone who's already got significant damage before they
even start properly ageing, if you know what I mean. And the one problem with that is that
you can't reverse it back, and this is one of the greatest challenges. So, for example, birds can –
they don't lose their hearing. But in humans, the cells, once they die they don't grow back.
The work that we are doing at the moment at the institute, which is gene-therapy-based research,
and that gene therapy aims at regenerating the cells that die because of as a result we lose
hearing. So noise is a major factor in my opinion. Jessica:
Does it look a little bleak in terms of suspected cases of hearing loss? Have we seen
what will happen when we've had obviously lots more devices, earphones, AirPods, the like,
grown in popularity in the last couple of decades. So have we really seen what the actual true
effects of that is going to be? You mentioned obviously these people that their hearing has
already been sort of impacted before they've even hit older age. Do we expect the future of hearing
loss to really be quite significant? Hani:
I think we're going to have a massive surge of hearing loss, because we are growing older
and we are also using more and more technology. And these two are main drivers
of what's known as hearing loss. In terms of medications, we're not matching it
with new drugs and new development. We don't have anything at the moment – there's no intervention
… in terms of recovering hearing loss or even preventing it the first place.
So it doesn't look ideal, the situation … some expectations in WA for example,
one in two, in 2050, will have hearing loss problems. So it is growing rapidly, but
ideally if something, if a new drug comes to the market, then that should change things a fair bit.
Jessica: That's good to know,
considering that cases are expected to rise. Hani, you touched on this a little earlier,
what inspired you to become a researcher in the area of pharmaceutical science and why
hearing loss specifically? Hani:
So pharmaceutical science is an area to me that I cannot get enough of. It excites me,
it's intriguing. It combines biology, physics, chemistry – so it's a multifactorial type of
research or studies that you can learn a lot from. You also can deal with patients directly, which
I like, to be a clinician, at the same time you can develop new things that can help millions of
people. All these combinations made me go for it. Jessica:
You're Head of Hearing Therapeutics Department at the Ear Science Institute Australia.
Can you tell me a little bit about some of the work you're doing in this role?
Hani: It is a bit of a management role, leading
the department. We do have senior researchers that have got specific line of research inquiries.
My role is to grow their profile, to support the Institute. We growing the research capacity
and driving engagement with Curtin to come up with something novel, robust, new and unique.
Jessica: Well, definitely sounds like you're on the right
path with what we've talked about a little earlier in this episode. What challenges have you faced
in this area of research? Hani:
No-one in the world so far has come up with the drug to treat hearing loss, which is an indication
of how challenging this area is in terms of development. I mean, we normally have drugs
treating a lot of things, cancer, diabetes, all these things we will have something – it
may not cure it, but it's still significantly reducing the symptoms or side-effects of other
medication and things like that. With hearing loss, there's nothing, besides the implants and
the hearing aids, that's about it. There are other medications that people are trialling,
but so far nothing is being clinically indicated. The challenges, I would say, if you say one thing,
is delivery … to design something that will take your drug or your intervention, or your gene,
all the way deep into the cochlea inner ear, which is a very tiny piece of bone stuck inside more
bones … and that remains a major challenge. Jessica Morrison:
How can people or industry get involved in your research?
Hani: We have people
involved in terms of either patients interested in supporting us, engaging with us, definitely
the Telethon grant that I've received this year, funding this project is part of a milestone, is
engagement with consumers. So that's one approach. We get emails from people interested in giving us
their ideas and opinions and what journey have they gone through. It's very beneficial for us
to understand it from a patient's point of view. Industry partners, if they're interested in
investing and exploring options and opportunities with Curtin, that would be also great. So just
direct engagement is always very useful for us. Jessica:
We'll make sure we put all of your contact details in the podcast episode show notes as well. Just
lastly, Hani, I don't know if you're prepared to say it, but if you could put a number on it,
how many years off, hopefully, are we to having a targeted medication to treat hearing loss?
Hani: It's one question I get asked about
very often, and it's one of these tricky ones. I always like to think about it as COVID vaccine: So
normally medications from discovery, from zero to a hundred, it will take about 15 years on average;
with COVID, it took few months. So the question is really … how many people are interested to invest
in curing hearing? And for that reason, it's quite hard for me to know, because I don't know
what kind of funding available in the coming five years. There's a lot of unknowns, so it remains
still a tricky question to answer, sorry. Jessica:
No, no need to apologise. I think, really insightful answer there that you've given us.
Thank you so much, Hani, for coming and discussing this topic today. It sounds like
you've got some really exciting work that you're undertaking, and we look forward to hearing how
it progresses. Hani:
Thank you so much. Appreciate it. Jessica:
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