The recently appointed director of NIDCD brings an extensive research background in hearing loss, ear disease, and cochlear implantation—and an enthusiasm for addressing barriers to hearing health care.
Interview by Jillian Kornak
The National Institutes of Health (NIH) recently named Debara L. Tucci the next director of the National Institute on Deafness and Other Communication Disorders (NIDCD), replacing acting director Judith Cooper. Tucci will leave her position as professor of surgery in the Division of Head and Neck Surgery & Communication Sciences at Duke University Medical Center, where she has served on the faculty since 1993.
The Leader spoke with Tucci about her career and research passions as she prepares to begin her new role in September.
You began your career as an audiologist. What was it about this field that first attracted you?
I initially was interested in speech-language pathology. I went to the University of Virginia and enrolled in its undergraduate speech-language pathology program and was required to take audiology courses as well. I developed a strong interest in audiology and switched to that major. It was fascinating to me to learn about hearing, the anatomy of the inner ear, and the physics of sound.
What drew you to study cochlear implantation and how has this technology evolved since your career began?
It came out of a normal outgrowth of my interest in hearing. I graduated from medical school in 1985, and at that point we were just starting to do cochlear implants. Prior to that time, the people we saw in clinic who had profound hearing loss didn’t have any options other than hearing aids, and hearing aids often didn’t help that much. It was a very sad and distressing situation for patients and providers.
When cochlear implants became available, we were very anxious to provide that technology for patients. We started to do cochlear implants when I was a resident. Back then, patients had to be almost deaf in order to qualify for a cochlear implant, and we don’t have those same stringent criteria now because CIs work so well for patients with more residual hearing.
We’re now implanting children before age 12 months, and adults into their 90s. It’s a technology that is transformative for many patients.
What does “patient-centered care” mean to you?
Patient-centered care first involves having respect for each patient, and listening carefully to their symptoms and how the symptoms affect their life. After a diagnosis, there are often treatment options. My job is to explain the disease process to the patient and recommend treatment options. We then work together to decide on the treatment course that best suits the patient’s needs and preferences. Sometimes insurers will not support the course of treatment that I feel is best for the patient, and I try my best to advocate in the patient’s best interests.
What are some of the key barriers to adults accessing hearing health?
Even though the United States is such an advanced country, it’s not always the best in making hearing health care accessible to patients. A lot of the recent public health work to address hearing loss was prompted by the National Academies Report on accessibility and affordability of hearing health care in adults, which was funded in part by the NIDCD. This and the President’s Council of Advisors on Science and Technology (PCAST) report made significant recommendations to address this problem of how we can deliver better hearing health care to the population in the United States.
The first part of the equation is identifying the hearing loss. It’s not commonplace to screen adults for hearing loss, or even ask about potential hearing loss in the primary care clinic. It’s very important that this be a part of primary care, especially for older adults. Once an audiogram is done and a hearing loss diagnosis is made, how do you provide the best and most affordable technology?
Even in Europe, where hearing aids are free of charge, the uptake is less than 50%. This statistic reflects the reality that issues other than cost limit use of hearing aids for people who could benefit from them; other issues may include stigma, and the perception that hearing aids aren’t effective. Issues of cost and accessibility have been very much in the news recently with the legislation acted on by the FDA to allow the sale of over-the-counter hearing aids for people with mild to moderate hearing loss. We hope that’s a way of bringing people into the hearing health care system.
What would be the benefit of approaching hearing loss as a public health concern?
We are now beginning to think about large-scale public health consequences of hearing loss. We know that adults with untreated hearing loss are more likely to be hospitalized, to experience falls, and to struggle with anxiety, depression, and cognitive decline. Exact causal relationships have not been established, but the data support the advisability of attention to identification and treatment of hearing loss to avoid costly long-range consequences. Hearing health care is cost-effective because it improves the overall health of the population.
You’ve been at Duke since 1993. Which of your career and research achievements would you consider highlights?
I am proud of the early basic science work that was funded by the NIDCD. I think that it helped us to understand why children with otitis media and associated fluctuating hearing loss sometimes do struggle academically in their early years of school. After that, I did more clinical research, and working with colleagues here at Duke we developed a national practice-based research network. There is a need for more clinical trials in our field. The research network is made up of academic and private practice otolaryngology practices that study a variety of questions related to our patients with hearing and balance disorders. Most recently, we partnered with the primary care research consortium at Duke to study methods of implementing hearing screenings in primary care clinics.
I have also been passionate about our work in global hearing health care. I worked with colleagues in Nairobi to develop a newborn hearing screening program at the largest hospital in Kenya, and that was very rewarding. Blake Wilson, I, and other colleagues have been invited by the journal The Lancet to chair a commission on global hearing loss that will address the significant global problems related to unaddressed hearing loss and develop innovative solutions and policies to reduce this burden. This effort will include commissioners from developed and developing countries in a variety of fields, in addition to ours, including childhood education, child and maternal health, economics, and policy. The commission will implement a multifaceted and multidisciplinary approach to address the prevention and treatment of hearing loss worldwide.
I look forward to working with the NIH, NIDCD, and all of our partner organizations and our patients to advance the care of all people with hearing and communication disorders. It’s a pivotal time in our field in which many promising therapies and interventions are becoming available to help patients, and I’m very excited for the opportunity.