ATRR 2018 Interview with Tanisha Hammill FINAL V2

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ANNUAL

TINNITUS

RESEARCH

REVIEW

2018

“HOLD OUT HOPE”

Dr Tanisha Hammill talks to Prof Deb Hall

Annual Tinnitus Research Review 2018


Annual Tinnitus Research Review 2018.

Copyright © British Tinnitus Association 2018.

Editors: Deborah Hall & Nic Wray

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DR TANISHA

HAMMILL

“HOLD OUT HOPE”

Dr Tanisha Hammill talks to Prof Deb Hall

Chief, Research Coordination Branch

DoD Hearing Center of Excellence

Dr. Hammill currently serves as the Research

Coordination Branch Lead for the Department of

Defense Hearing Center of Excellence (HCE). In

this position, she oversees a global research effort

to support the military’s Hearing Health Program,

which includes the coordination of a regional

team of administrators, portfolio coordinator

and targeted project teams; various work stream

group coordination efforts including the HCE’s

Collaborative Auditory/Vestibular Research

Network (CAVRN) and Pharmaceutical Interventions

for Hearing Loss (PIHL) Working Groups, among

others, comprised of hundreds of subject matter

experts from around the world; research experience

spanning bench to bedside to community to

policy; and scientific steering and road mapping

contributions to the scientific community.

She completed a Master of Arts degree in Religious

Studies and Ethics from the Point Loma Nazarene

University in San Diego, and a Master of Arts

in Public Health with a focus in Administration

from the San Diego State University. Dr. Hammill

completed her PhD programme in Translational

Science at the University of Texas at Austin, with

affiliation at the UT Health Science Center San

Antonio, UT School of Public Health and UT San

Antonio, and maintains professional certifications

as a Clinical Research Administrator and Project

Management Professional.

Tanisha, thanks so much for agreeing to talk to

us about the work that you do in the US for the

Department of Defense. Could you tell us a little

bit more about the organisation and the sort of

research that it supports?

Absolutely. It’s a good place to start! There was

a Congressional Mandate in 2009 to stand up

the Hearing Center of Excellence (HCE). Within a

few years, there were similar mandates to stand

up a Center of Excellence for Traumatic Brain

Injury (TBI) and Psychological Health and Vision

and Extremities and Amputees, and so we’re

the fourth of the four Congressional Centers of

Excellence stood up. And our mandate covers the

full spectrum of auditory and vestibular disorders,

from prevention and mitigation, treatment,

rehabilitation. And so our mission is quite broad:

we’re not a research facility, nor is it a clinical

facility; it’s quite a broad scope.

And across all of that, research coordination

is one of the branches in the Hearing Center of

Excellence which really serves as a means to

improve prevention strategies for our service

members and veterans, and clinical best

practices and improved outcomes for service

members and veterans. Our Congressional

Mandate is through the Department of Defense

(DoD), yet the language says that we’ll coordinate

as much as is practicable with the Veterans’

Affairs department, and so our deputy chief,

she’s a VA employee, so we do have a lot of focus

not just on the war fighter, but the continual life

cycle of the service member through their veteran

status. So that also broadens our scope quite a

bit, obviously.

There’s a lot of different ways that we approach

research coordination in the HCE. Some of

our primary focuses are just facilitating and

coordinating. There’s so much going on across

Annual Tinnitus Research Review 2018


“Hold out hope”

Figure 1:

Serving soldier

the DoD alone, from the bench laboratories, who

are doing wonderful work in acoustic sciences

and have been for many decades, all the way

through clinical treatment facilities with toptier

clinicians in trauma care in really unique

scenarios, and they weren’t very well connected;

there was no existing platform for that sort of

interaction and communication, so we serve as

kind of a translational platform and guide for

those collaborations and conversations to take

place.

We started the Collaborative Auditory and

Vestibular Research Network – CAVRN –to bring

all of the research stakeholders together, from

bench to bedside researchers to the funding

portfolio managers, those who are actually

driving the science forward, and prioritising the

research lines for the future, and future combat

concerns.

So part of the research coordination within

the Hearing Center of Excellence is to have an

overview of that pipeline and help facilitate

those researchers.

Annual Tinnitus Research Review 2018

Absolutely. That’s a big part of what we do,

is work from the top down: we work with the

portfolio coordination, the leadership in DoD,

other Centers of Excellence that have maybe

a polytrauma or some sort of polymorbitiy,

comorbidities with us, your blast and TBI patients

are prime examples of that. And then from the

bottom up, the really sort of grassroots approach

of reaching out into our communities. We have

Sarah Murphy, who is stationed as a contractor

at the Navy Medical Center, San Diego, and we

have many counterparts like her throughout the

system, who are integrated with the investigators,

integrated with operational and public health

commands and other DoD boots on the ground

to siphon that information back up. So it’s really

on-going bi-directional.

It seems like a really great infrastructure. So

your role is research coordinator within the

organisation. Can you just tell us a little bit

about the kind of research that you’re currently

involved in; what one project really excites you

at the moment?


“Hold out hope”

Sure: I can name a few, actually. Of interest,

I think, to the British Tinnitus Association

readership: we are engaged with the National

Center for Rehabilitative Auditory Research in

Portland, Oregon, the NCRAR, and a study that’s

run by Dr James Henry, he’s leading a study into

noise exposure in service members and following

out where there’s noise and other sonic exposures

common in the military environment in the act of

duty, and recently separating veteran populations

and how those affect and impact their lives, their

quality of life, their hearing loss, their tinnitus

specifically; that’s a big interest. So we’re excited

to be part of that. It’s a longitudinal study, so

we shall be collecting data for many years to

come, funding pending, and we’re already getting

really valuable and meaningful outcomes on the

impacts of hearing loss and tinnitus on service

member populations.

We’re also doing a study with Dr. Fatima Hussain

from the Beckman Institute at the University

of Illinois, who’s looking to create objective

diagnostics for tinnitus through functional

MRI, so we’re a participating site on her grant.

Speaking to the UK, we are partnering with the

Ministry of Defence (MoD) in the UK to look at

standardising data collection for our Allied forces

for starters, and we’re doing that not just for the

UK but with many NATO partners. We’re trying to

come up with some common data elements so

that there are some ways to compare outcomes

down the road and similarly, the HCE has a large

driving mandate to develop a registry of all

auditory injury in the DoD, and share that data

bi-directionally with the VA, and that registry has

already been discussed in the NATO context and

has really driven some inspiration for similar

registry builds in our partner nations.

But with the MoD in particular, we have started

to advise on studies that they’re doing, to collect

super-threshold measures so that we can be a

bit more sensitive in our monitoring of these new

noise hazard weapons, shoulder-fire weapons like

the Carl Gustaf, which there have been very highrisk

assessments of. So we’re doing that with the

UK.

So those three studies I think are good examples

of areas that we’re working on in tinnitus with the

UK.

It’s really great to hear that there’s that

connection and collaboration between the US

and the UK on those projects. I know that as part

of your role, you also coordinate a working group

that’s focusing on pharmaceutical interventions

for hearing loss, the PIHL group. Can you just tell

us briefly what that’s all about?

Yes, right when the Hearing Center first stood up,

we recognised that as a gap, it’s an important

area of enquiry, and growing every year in the

number of publications and presentations on

that topic, and yet, over the decades, there has

been a stagnation where it had not reached,

back in 2011, the point of any clinical trials

or FDA clearance. So it was a recognised gap

where there were some areas where the HCE

felt we could intervene and create a platform

for communication and collaboration that

could help expedite this research forward.

And so we chartered the PIHL working group

(Pharmaceutical Interventions for Hearing Loss).

We wanted to focus on reviewing the data for

science, and we wanted to try to develop some

guidance for researchers, such as best research

practices. We wanted not only to develop these

but make sure that we disseminate and get

them implemented in research practice, so we

do that through a few different approaches.

One, obviously, is the PIHL working group itself,

a large stakeholder roster of people from all

walks of the issue, and bringing them together

on one common platform has been largely

successful in getting kind of a consensus

guidance out in a number of areas, including

clinical trial development. We had a workshop

at the ARO meeting in 2016 on that topic and we

have worked with the journal editors to ensure

that we’re spreading these PIHL disseminations

out across different journals that have

different readerships, so we’re broadening our

dissemination and including a broader range of

interest every year.

Annual Tinnitus Research Review 2018


“Hold out hope”

We’re up to about 175 people: we range between

150 and 200 as they come and go, as they should

in a group like that.

Do you know how many countries are

represented in the PIHL group?

Right now, I think we’re at about six: the UK,

France, Germany, Israel, Canada and the US.

We’ve been growing internationally in the last

two years, quite rapidly, and things like this ARO

meeting I think really help with that, providing

a nice platform to reach out globally. The

stakeholder range in that group has been, I think,

the biggest strength of the group: not just having

bench or clinician scientists, but folks from public

health and folks that will be further down that

translational pipeline in the research have been

engaged from the beginning in pharmacology

and other things. So it’s really nice to put

something together that has the potential to

actually see its implementation in place and have

clinical efficacy and clinical relevance in the end.

Oftentimes, we’re left out of the early stages of

scientific development, I think, and I think this

group has poised the field very well to move

forward a lot smarter.

Just focusing down a bit more on some of the

concepts in research. We know that military

personnel are exposed to high levels of noise

during active service; could you just try and

explain in simple terms, what is the link between

hearing loss and tinnitus in this population?

I wish that I could in clear terms! I can tell you

that it’s something that we’re very interested in

in HCE and the DoD at large; it’s something that

Congress is interested in, and they mandated

a study that was published by the Institute of

Medicine in 2005 [1]. It’s on noise in the military,

and they clearly made the link between hearing

loss and noise and hearing loss and tinnitus,

and they outlined several gaps in research that

ought to be pursued. So those bullet points from

that report are found throughout the portfolios

of the DoD’s joint programme committees now,

including Jim Henry’s study, which is largely

Annual Tinnitus Research Review 2018

following those recommendations as well.

There’s been a lot of work here at ARO, as well,

from those DoD-funded programmes that I just

saw this week, so that’s exciting, and some of

those answers are starting to surface, but I think

that’s a complicated question!

You’ve recently completed a really extensive

review, a brilliant piece of work: you’ve pulled

together all of the current evidence for the

effect of pharmaceutical interventions for

noise-induced hearing loss in animal models

and in humans. Could you try to summarise for

our readers what would the main insights or

findings from that body of work be?

If I had the graphs to show you, you’d see that

the outcomes were sort of flat across the board,

meaning that there was so much disparity that

nothing really stood out, and that’s what stood

out. The disparity was not just prevalent but very

ubiquitous, in such a way that outcomes were

disparate and incomparable.

Was that in terms of methods or actual findings?

The different domains were the animal models

and the use of animal model strains. Each

gets disparate noise exposures, so whether it’s

impulse, steady state, blast, what frequencies

were used, what durations, these were all

disparate. There were some studies that also

added an ototoxic agent but that was not the

focus of my review, so those were excluded. But

nevertheless, there was a range.

The statistical analyses used were also, I would

say, under-reported or not reported to standards,

so quality was also really a problem. That’s

definitely a big takeaway, that the quality of

reporting was not up to standards, and is not

something that clearly is being employed in this

field throughout even some of the top journals.

There was no correlation between higher-scoring

journals and the quality of the papers. So that

was disappointing to see, too. And there’s a lot

of work our field can do to up their game in that

respect.


“Hold out hope”

Can you just explain to our readers in simple

terms, what’s the impact of that variability? Why

should we care?

One of the most important parts of scientific

process is repeatability, and being able to verify

results, and if you are in a scientific lab, trying to

reproduce a study that you’ve read about online

to see if it indeed has the same results, or can

have similar results with your compound instead

of the compound that was used in the published

study. It’s very challenging to do that when the

reporting does not include of all the relevant

information that you need to repeat the study.

That’s a big problem.

It’s also a very big problem when it comes to

trust in the science that you’re reading, and if

you cannot verify what was done, if you can’t

even quite understand what was done, it’s hard

to trust that the results are as robust as they may

claim —or otherwise. There are so many more

problems, that’s a whole different interview, but

you could go into how many negative results

are never published at all; there are all kinds of

problems with that.

“One of the most

important parts of

scientific process is

repeatability, and being

able to verify results”

- Tanisha Hammill

It’s an issue that’s well-recognised in the UK as

well. And in fact, our government funding bodies

are very focused at the moment on replicability.

They’re very much in favour of pre-registering or

publishing protocols to actually describe what

your methodology is going to be, particularly in

terms of how you’re going to analyse the data to

address your question.

I did register my review. I had good mentors to

tell me. I think that’s part of the problem: a lot of

people aren’t told that that’s even a thing, and so

they’re not aware that there is a new registry for a

basic science protocol.

It sounds like there’s lots of really interesting

work going on at the moment. What exciting

scientific break-throughs do you think that we

might see in the next ten to fifteen years, if you

had a glass ball to look into the future?

Ten to fifteen years? There’s so much exciting

Annual Tinnitus Research Review 2018


“Hold out hope”

research going on and looking at not only my own

graphs and the PIHL systematic review, but what

I’ve seen here at ARO this week is that numbers of

publications are just exponentially sky-rocketing.

So progress is being made across a number of

fields: things like hidden hearing loss coming

out of the woodwork in the last several years

point to a lot of promising work to be done in the

next ten or fifteen years about earlier detection

and intervention points that could really prevent

permanent thresholds shift (PTS) out of what are

common temporary threshold shifts (TTS).

When it comes to new developments in

pharmacological therapies, I’m very hopeful.

There are clinical trials now going on into

prophylactic and early rescue interventions in

the metabolic pathways of TTS to PTS, but there’s

also really exciting regeneration work going on

that’s entering clinical trials, and so seeing where

those lead in the next ten years, even, should be

very exciting again.

Certainly five years ago, we never thought that

we’d be at a stage of looking at regeneration

No, even in the middle of October, I didn’t think

that regeneration would make as fast strides,

but some of that speaks to the motivations of

the research, I think, when you look at things

like prophylactic or acute rescue, you have a

very finite window of when you can intervene,

and the market. When you talk about the World

Health Organization and 50 million people, all

these large numbers that get the attention of Big

Pharma, those dwindle away when you narrow

it down to that acute period that for something

like presbycusis, which obviously has huge

implications for our veteran community, and

certainly Big Pharma has interest in those large

numbers, and money gets science done!

Thinking about the challenges of working in

this translational space, what do you think the

biggest challenges are for tinnitus research at

the moment?

Awareness is, I think, a very key issue. And it sort

of leads to another issue-

Annual Tinnitus Research Review 2018

Do you mean awareness in the general public or

the clinical community?

I think awareness in the general public leads to

sustaining funding for tinnitus research; there

are public drivers of science, usually, so having

more of an awareness of tinnitus across the

public domain I think is really important, for a

couple of reasons, not just sustaining funding.

If the patients are not really aware of what

they have and don’t know how to qualify or

categorise it, they may not even think to discuss

it with providers. I know many people are in that

category: so they’re not having discussions with

their providers, they’re just not being collected in

data for incidence and prevalence, so we don’t

have the epidemiological data to support further

research as well. It’s all sort of a cascading

effect.

I think hyperacusis is in that same bundle, where

there are disagreements about nomenclature and

how you categorise different kinds of tinnitus,

different kinds of hyperacusis as well, and all of

those disparities in knowledge and awareness

of the condition itself really do a disservice all

the way down the line of research. So it’s hard to

know how to develop models for certain causes

that you really don’t understand the mechanisms

underlying, and if you don’t know that there’s

different kinds, you may not be looking for

additional mechanisms.

I know tinnitus is a little further along in that than

hyperacusis.

I guess the awareness gap is something that the

British Tinnitus Association – and the American

Tinnitus Association – are trying to plug through

their outreach work and general promotional

work.

Agreed, as is the HCE. We’re very dedicated

to increasing awareness across our service

members, our providers. We have more than the

PIHL working group: we utilise that platform in

multiple domains, including tinnitus, so we have

a tinnitus working group that’s trying to develop


“Hold out hope”

and disseminate best practices, and some of

that will probably include some educational

components for the patients.

Quite a lot of our readers would like to know

whether there’s ever going to be a cure for

tinnitus. What would you say to somebody who

asked you that question?

Well, I would say hold out hope. I mean, there’s

progress being made, and in the midst of the

on-going research and progress being made

toward a cure, there are still a number of new

developing and fairly evidence-based approaches

for therapies. You can look into cognitive

behavioural therapies like Progressive Tinnitus

Management, or sound therapies that are gaining

in evidence base to back their claims of providing

coping mechanisms for tinnitus patients that

have certainly come a long way just in the last

few years. While coping is not cure, it’s certainly

helpful and can improve function and quality

of life, so I would say hold out hope. The further

that basic research gets in understanding those

underlying mechanisms and teasing out ways

to understand and diagnose what is causing

individual A versus individual B’s actual tinnitus,

the closer we’ll get to targeting interventions for

each of those different pathways.

Thank you, that’s a very positive message And

finally, is there any other message that you

wanted to share?

I would say get involved and there are numbers

of growing ways that patients and providers

can get more involved. I know in the UK, the

Action on Hearing Loss group provides a sort

of platform like that; the HCE strives to be that

platform for service members and veterans to

have a single place to come to get information

to be aware of on-going research and there are

a number of ways to look into that. And I think

the difficulties in science are usually overcome

with collaboration, and sharing lessons learned is

the fastest way to increase efficacy of research

and ‘work smarter not harder’ is a saying we

have here. Collaboration is not always easy, and

of course there are some barriers to that, but

ultimately, communication, if not collaboration,

is a good start. So even things like limited tinnitus

research funding I think can certainly be helped

and not hindered by a unified voice, and so when

patients get involved and providers get involved

and work with research organisations, it adds

a lot of credibility and spotlights those issues.

Tinnitus certainly has more room to grow in those

areas, so get involved!

Thank you: that echoes very much my approach

to tinnitus research. It’s been really interesting

hearing what you’ve got to say, thank you very

much.

References

[1] Institute of Medicine. Noise and Military Service:

Implications for Hearing Loss and Tinnitus. 2006.

The National Academies Press.

“hold out hope ... there’s

progress being made”

- Tanisha Hammill

Annual Tinnitus Research Review 2018

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