Department of Otolaryngology (ENT) - Head & Neck Surgery

1. Development of Research in the Department of Otolaryngology – Head and Neck Surgery
Otolaryngology research at MUSC has its roots within the Department of Otolaryngology, and has developed into a collaborative research program involving interdisciplinary researchers with faculty appointments in multiple clinical and basic science departments. The Department of Otolaryngology was formed at the Medical University of South Carolina in 1961. Warren Y. Adkins, M.D. assumed the chair in 1978 and immediately demonstrated his commitment to the development of a strong research program by recruiting John H. Mills, Ph.D., in 1975 to serve as Director of Research. Thus, by 1975 the Department had initiated the development of a solid research program with a focus on basic and clinical studies of hearing and deafness, including auditory psychophysics, neurophysiology, neuroanatomy, and audiology.

The department received its first R01 from NIH in 1975 (J.H. Mills, PI). The research facilities were located in a rented carriage house, and rental was covered by direct costs of the award. During the next three years, Drs. Adkins and Mills recruited two
more researchers into tenure-track faculty positions: Richard A. Schmiedt, Ph.D. (from Washington University, St. Louis; neurophysiology), and Joe C. Adams, Ph.D. (from the NIH; neuroanatomy). Judy R. Dubno, Ph.D. (from the UCLA School of Medicine;
psychophysics and speech recognition) replaced Joe Adams in 1991. Well-equipped laboratories for neurophysiological and neuroanatomical studies of the cochlea and brain, and behavioral studies with human subjects, were established in the Walton
Research Building and in the adjoining Quadrangle Building, most of which remains operational today. By 1981, the Department's research efforts in hearing and deafness were funded by 3 R01s, 1 NSF grant and 1 NIH contract.

2. Initial Focus on Age-Related Hearing Loss
Progressing into the 1980s, in light of the high prevalence and complexity of presbyacusis, a decision was made to expand the research program to include basic science studies with experimental animals and aging human subjects, and integration of basic research with well-designed and executed clinical studies of human patients. This dictated a need for scientific expertise in traditional disciplines, such as anatomy, pathology, neurophysiology, neurochemistry, audiology and otolaryngology, as well as
in rapidly emerging areas of cell and molecular biology. A program of research of this magnitude required financial support from several sources, and funding for multiple, interrelated projects and core support could be provided only through the mechanism
of the program project grant (PPG). Accordingly, a PPG was submitted to NIH/NINCDS in 1986 and funded effective July 1, 1987. Competing renewals submitted to NIH/NIDCD in 1991 and 1996 were successful. In the 2001 renewal, the grant mechanism changed from the P01 to the P50 (Clinical Research Center) to reflect the increasing emphasis on human studies. The current P50 is funded through June 30, 2007. The successful renewal in 2006 for the P50 reflects new emphases and new expertise in neuroimaging, genetics and stem cells. Funding for the P50 is through June 30, 2012.

3. Collaboration with Pathology and Laboratory Medicine
The Hearing Research Program has been strengthened by a close, 20-year collaboration with the Department of Pathology and Laboratory Medicine. Bradley A. Schulte, Ph.D., Director of Research in the Department of Pathology, brings expertise in cell biology, immunocytochemistry, and cochlear fluid and ion transport mediators. A mentor and 25-year colleague of Dr. Schulte is Sam S. Spicer, M.D., who is recognized for his expertise in pathology and immunocytochemistry and for his contributions to the understanding of epithelial cell structure and function. In addition to Drs. Spicer and Schulte, other major collaborators from the Department of Pathology are Hainan Lang, M.D., Ph.D. (molecular biology of the inner ear, and stem cell transplantation), Daynna J. Wolff, Ph.D. and Denise Quigley, Ph.D. (human genetics, gene mutation analyses), Daohong Zhou, M.D. (cellular mechanisms), Gian G. Re, Ph.D. (gene expression in human cochleas), Ling Wei, M.D. (cell death, stem cell transplantation, neural plasticity), and Lisa Cunningham, Ph.D. (apoptosis in hair cells). Collaborations with these investigators significantly enhance the molecular biology and genetic aspects of the program.

4. Recent Enhancements and New Research Foci
An essential ingredient to a successful research program is an administrative structure and incentives provided by the Department and the University. For example, through a competitive process, MUSC Vice President for Academic Affairs and Provost John Raymond, M.D. has designated the Hearing Research Program as a University Center and provided $100,000/year for three years to support recruitment of new faculty. The recruitment of Mark A. Eckert, Ph.D. (from Stanford; neuroimaging) into a tenure-track position was made possible with this support. Another significant example of institutional support is the University’s $1.2 million match to the $1 million Extramural Research Facilities Construction Project (C06) awarded to the Departments of Otolaryngology-Head and Neck Surgery and Pathology and Laboratory Medicine from NIH’s National Center for Research Resources. The renovation project provided centralized research facilities and additional laboratories to support recruitment of new faculty. With this renovation, the personnel and laboratories of the Hearing Research Program are now located on four floors of the Walton Research Building and directly across the street from the clinical facilities of the Departments of Otolaryngology-Head and Neck Surgery and Pathology and Laboratory Medicine. This new proximity further enhances the already strong interactions between investigators from many disciplines.

Dr. Adkins retired in 1998 and in August 1999, Paul R. Lambert, M.D. from the University of Virginia, Charlottesville assumed the position of Chair. Beginning in the late 1990s, departmental faculty grew and new research directions and collaborations were
established. With the recruitment of Terry Day, M.D. as Director of the Head and Neck Tumor Program, Boyd Gillespie, M.D. (oral carcinogenesis and clinical research), Deanne Lathers, Ph.D. (tumor immunology; tumor induced immune suppression), and M. Rita Young, Ph.D. (tumor immunology and immunotherapy; tumor vascularization), a significant research effort was launched in tumor biology and immunology, with a focus on basic, translational, and clinical research in head and neck cancer. This program is significantly enhanced by collaborations with Steve Rosenzweig, Ph.D. from Pharmacology (insulin-like growth factor binding proteins), Stanley Hoffman, Ph.D. from Medicine/Rheumatology and Immunology (extracellular matrix proteins), James Norris,
Ph.D. from Microbiology and Immunology (anti-tumor therapies), Besim Ogretmen, Ph.D. from Biochemistry and Molecular Biology (regulation of tumor growth), and Bryan Toole, Ph.D. (cell-cell and cell-extracellular matrix interactions). Basic science laboratories were established in the Strom Thurmond Building and clinical research facilities were made available at the Hollings Cancer Center. An application for a PPG focused on treatment targets to prevent progression of premalignant oral lesions to cancer is planned for submission to NIH/NCI on June 1, 2006. In addition to the program in tumor biology, Bonnie Martin-Harris, Ph.D. added a research focus in swallowing physiology and founded the MUSC Evelyn Trammell Institute for Voice and Swallowing. Rodney Schlosser, M.D. began a new research initiative in rhinology and sinus, including studies of inflammation in chronic sinusitis, especially in patients with cystic fibrosis, and non-surgical treatment of benign sinus tumors. Among the newest faculty members, David White, M.D. and Ted Meyer, M.D., Ph.D., are developing research programs in pediatric otolaryngology and cochlear implants, respectively.

5. A Balance of Investigators, Research, and Funding
Researchers in the Department include outstanding senior investigators and junior investigators who are at various stages in the development of independent research careers. This balance is reflected in the nature of current NIH support. In addition to the P50 and R01s from three NIH institutes (NIDCD, NIA, NCI) led by senior investigators, there have been several K-awards from NIH (Amy R. Horwitz, Ph.D. and Bonnie-Martin Harris, Ph.D.) and additional applications are in the planning stages (Kelly C. Harris, Ph.D. and Ted A. Meyer, M.D., Ph.D.). This personnel mixture brings economic balance to the program as well as fostering collaborative independence and interdependence among junior and senior investigators. Balance is also achieved through
the expansion of research from the initial focus on hearing and deafness to include current efforts in head and neck oncology, laryngology, otology, and rhinology. The availability of several sources of external support (including the VA) as well as intramural support helps smooth inherent fluctuations in funding from the NIH and the institutional budget, enabling longer-term commitments to personnel and longer-range scientific planning. Support from private foundations has allowed junior investigators to
commence independent research projects. Although all these sources of support are important, the NIH P50 is the foundation of the hearing research program, and an additional PPG will be a significant enhancement to the tumor biology program. This type
of funding allows a level of research, especially, collaborative research, well beyond the means of any other grant mechanism. As evidence of the success of the research program, the department currently ranks 10th in NIH dollars awarded to Departments
of Otolaryngology and 1st in the Southeast (see Table 5). Research awards to department faculty from all sources now exceed $5.0 million per year (see Table 6).

Table 5

NIH Awards to Departments of Otolaryngology (FY 2006)