Howard P. House, MD Memorial Lecture Delivers Hope
Nancy M. Young, MD, takes us on a journey of personal and professional discovery.
On Tuesday, Nancy M. Young, MD, will deliver the Howard P. House, MD Memorial Lecture for Advances in Otology. Her presentation, “Precision Medicine to Improve Outcome: Neurocognitive Machine Learning Enabled Language Prediction for Children with Hearing Loss,” is a journey created by personal and professional experiences.
Dr. Young is the Lillian S. Wells Professor of Pediatric Otolaryngology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. She is head of the section of otology and neurotology in the division of otolaryngology, and medical director of Department of Audiology and Cochlear Implant Program at the Ann and Robert H. Lurie Children’s Hospital of Chicago. Dr. Young’s primary academic focus is pediatric cochlear implantation. She sat down with the Meeting Daily to share more about her work.
Q: Can you give us a sneak peek into your Howard P. House MD, Memorial Lecture for Advances in Otology, “Precision Medicine to Improve Outcome: Neurocognitive Machine Learning Enabled Language Prediction for Children with Hearing Loss?”
Dr. Young: The ability of individuals with normal hearing to understand verbal communication is dependent on the brain. Both top-down and bottom-up processing are needed to encode the auditory information arriving from the ear and apply meaning, based on past experience. This is even more true for individuals who receive a cochlear implant because the information they are receiving is sparse compared to normal hearing.
As otolaryngologists, we tend to focus on the ear and the implant technology alone. It is amazing that implant recipients can do so much with so little, which speaks to the importance of auditory input to our brain from an evolutionary standpoint.
The variability of outcomes after implantation has always fascinated me. I have seen children expected to obtain little benefit from an implant make surprising and unexpected progress. I hope to share that sense of wonder our team experiences working with implanted children, to share our current findings and convey the rational for our neurocognitive research, and why we believe our approach holds great promise to improve children’s language after implantation.
Q: Even though cochlear implantation (CI) has changed lives for individuals with hearing loss, their families, and the scientific understanding of neuroplasticity, why does the language of implanted children, as a whole, fall well below typical hearing children?
Dr. Young: There are many factors that may influence outcome. Two important factors for congenitally deaf implanted children are age of implant and residual hearing. These have repeatedly been demonstrated to be important. However, they do not explain most of the outcome variance. And they are not predictive on the individual child level.
What also needs to be considered is the impact of hearing loss on the brain, what areas of the brain are most important to develop speech perception and language after CI, and how can we use this information to create individualized brain-based therapy that will be optimal, especially for children at risk for language impairment. With more knowledge of brain structure and function of our implant candidates, more effective types and dosing of behavioral therapy may be developed. Our research group calls this a “predict to prescribe” approach for implanted children that takes advantage of children’s neuroplasticity.
Q: Is there more to age at the time of implant and residual hearing that predicts language success?
Dr. Young: Absolutely, these factors only account for, at most, one-third of variance in outcomes.
Q: Artificial intelligence (AI) is quickly becoming a valuable tool in all areas of our lives. Can we set language expectations for language development using predictive analytics with AI?
Dr. Young: Our goal is to use AI to determine how to optimize outcome for children at risk to have persistent language impairment after implantation. They may need more intensive therapy or behavioral therapy more suitable and effective for their brain structure. I think it is important to point out that the prediction models we are currently building are based on implanted children whose brains appear unremarkable on standard high-resolution presurgical MRI.
Analysis of brain density and the folding of the brain are performed on a more detailed mathematical level. Our goal is to use prediction to improve outcomes, not to deny any child an implant and the opportunity to hear. Although our current study focuses on development of speech and language, having hearing improves social engagement and quality of life for children with additional disabilities that impede or prevent language development. I hope in the future that studying more complex children will enable us to improve their communication.
Q: How does your presentation align with Dr. House’s legacy and work?
Dr. Young: I was fortunate to have met Howard P. House, MD, when I spent time at The House Institute after my fellowship in neurotology. Giving his Honorary Guest Lecture is therefore especially meaningful to me. He was a gifted surgeon with tremendous emotional intelligence. He was a visionary with commitment to educating others. He founded The House Institute, which to this day continues to serve the needs of individuals with hearing loss and education of professionals in keeping with his principals.
Q: Beyond Dr. House’s work, what inspired you to pursue this area of science and care?
Dr. Young: This is an interesting question. My family is very much involved in the arts, and therefore storytelling. My great uncle was a lyricist and one of the founders of the American Society of Composers, Authors, and Publishers. His brother, my grandfather, was a film editor in the silent film era who founded a film laboratory. My father, Irwin Young, was an engineer who applied technology to improve film processing in the predigital era. He received two Academy Awards for his technical contributions to the film industry. He also produced of number of films, often directed by his brother, Robert M. Young, an award-winning filmmaker.
I grew up going to film festivals and assumed my interest in language was the result of my family’s gift for storytelling and my exposure to it. However, not long ago, I met a much older second cousin. He barely survived premature birth and was thought to have an intellectual disability. He told me that my grandmother accompanied his mother to the ENT physician when he was finally diagnosed with hearing loss as a teenager. I believe I was told his story as a young child, as it sounded vaguely familiar. I suspect his story inspired my interest.