Building A New Era of Neuro-Otology: A Brief History Of Hair Cell Regeneration Research And Speculations On The Future

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  • Rubel Edwin W
    Virginia Merrill Bloedel Hearing Research Center Department of Otolaryngology-Head and Neck surgery University of Washington

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Damage and loss of hair cells in the inner ear through aging, exposure to noise, environmental chemical toxins, medications, disease and genetic disorders cause hearing and balance disorders in millions of people each year. In the past, Otolaryngologists seldom envisioned treatments of the inner ear to prevent hearing or balance disorders, or treatments to restore the cells that are damaged or lost. Instead, prevention of hearing loss is mainly limited to peripheral protection (e.g., ear plugs), and treatment is based on either increasing the stimulation of remaining hair cells (amplification) or bypassing the hair cells entirely (cochlear implants). While enormous progress has been made during the past fifty years in those treatment modalities, I believe that during the next five decades biologically-based methods will allow prevention of hearing and balance disorders and replacement of lost receptor elements through regeneration or transplantation. This prediction is based on two important discoveries that occurred over the passed two decades. The first, with overwhelming importance to all of biology and medicine, is the discovery that most cell death is governed by the activation of a well-conserved and relatively small number of pathways that have been grouped together under the name of apoptosis. This important discovery forms the basis for research aimed at developing treatments that will prevent a significant percentage of hearing and balance disorders. The second discovery was of much more limited interest, but may become equally important for the field of Neuro-otology; the discovery that most vertebrates have the capacity to repair and restore function to the damaged inner ear through the regeneration of hair cells.

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