A Common Childhood Ailment Remedied
Professor Shlomo Silman combines modern science with old-fashioned ingenuity to find treatments for auditory impairment.

According to one dictionary, an audiologist is “a specialist in the evaluation and rehabilitation of those whose communication disorders center in whole or in part in the hearing function.” But anyone who has met Shlomo Silman knows that this definition does not even begin to encompass his understanding of the term. A Presidential Professor in Brooklyn College’s Department of Speech Communication Arts and Sciences, and a Professor in the Audiology Program and the Speech–Language–Hearing Sciences Program at the Graduate Center, Silman is an audiologist by training. Nonetheless, he sees himself as one-part scientist, one-part health care professional, and one-part hands-on American inventor.

As a child growing up in southern Iraq, Silman’s original dream was to become a doctor. However, the loss of both his parents at a young age, emigration to Israel, and other exigencies of life altered his course and made him “mobile.” His travels took him to various countries in Africa, including Tanzania, where he worked as a teacher. Eventually, he arrived in the United States where, already in his thirties, he focused on audiology. After studies at Columbia and NYU, he edited a book on middle-ear muscle reflexes that has inspired successive generations of audiologists, achieved renown for his theory on brain plasticity related to hearing in adults, and received the first Research Achievement Award from the American Academy of Audiology. But this was not enough for Silman. He was, and still is, a problem solver.

One auditory problem that captured his attention was OME (otitis media with effusion), a build-up of excess fluid in the middle ear. People of all ages suffer from the ailment, which causes a feeling of pressure or pain similar to what many experience during the descent of an airplane. For most, it is a rare, temporary sensation that occurs under highly specific circumstances. For others, it is a chronic, debilitating experience. In children, the resulting hearing deficit can inhibit the acquisition of speech and language, and cause serious learning difficulties. “I care about children and their health and their psychological development,” says Silman.

OME occurs in youngsters because the Eustachian tube, which connects the back of the nose to the middle ear, has not developed fully and cannot carry a steady stream of air between the two points. A vacuum is created in the middle ear and fluid rushes in to fill that vacuum. Even though the fluid is sterile, OME is often diagnosed as an infection and treated with antibiotics. Another common approach is to insert a draining tube into the ear, a costly surgery that is sometimes performed repeatedly since its effectiveness can be temporary.

Though Silman can recite the statistics – 700,000 surgeries, $10 million in antibiotic prescriptions, and $4 billion in medical costs each year – it’s the plight of the children and their parents that moves him most. He recalls one mother who came to him in a state of near despair, her child having endured eight surgeries. He turned to his research partner at the time, Dr. Daniel Arick, an otolaryngologist, and said, “What’s going on here, and what can we do?”

They tackled the problem and, while sitting at the kitchen table, had what Silman calls “a ‘Eureka!’ moment.” They remembered a treatment common in the nineteenth century, the Politzer maneuver, which used a pear-shaped rubber air-bag to blow air up the nose during the act of swallowing. But there was no way to determine the correct pressure to exert on the bag, and there was no guarantee that the patient would swallow at precisely the right moment. It was, to say the least, a tricky procedure. “You could blow the child’s head off!” says Silman. So they decided to explore the possibility of creating a device that would do essentially the same thing while taking advantage of modern technology to control pressure, air flow, and timing. Their ideas were judged worthy of a million dollar grant from the National Institutes of Health (NIH), which supported the development of their invention, the EarPopper.

The EarPopper (manufactured by Micromedics, Inc.) is a hand-held, battery-operated device that is prescribed by a doctor, but operated by a parent or, if mature enough, the child. The individual inserts the device into one nostril, blocks the other nostril, presses a button to release a stream of air, and swallows while the device is running. During the swallow, air is diverted up the Eustachian tube, relieving negative air pressure and allowing accumulated fluids to drain. This brief, simple treatment is done twice a day, once in the morning and once in the evening. Settings on the EarPopper can be adjusted based upon the child’s age, fluid build-up, and degree of hearing loss. “We worked for a long time on these adjustments,” says Silman.

Clinical trials at Brooklyn College’s Center for Auditory Research produced astonishing results. 74% of children in the experimental group were restored to normal hearing after seven weeks. With extended treatment, the recovery rate jumped to 85%. Most important, says Silman, “Every one of these children was a candidate for surgery and, so far, no surgeries!” (The follow-up study, tracking children two to three years after the initial treatment, was still in progress at the time of this writing.)

The device can be used to treat a number of middle ear pressure and hearing problems caused by Eustachian tube dysfunction, colds, allergies, or sinusitis. It has been approved for use by adults, and many who experience discomfort during airplane landings have made it a permanent part of their travel kits. Silman believes that the principles of the EarPopper’s design can work across the entire lifespan. Along with his colleague, Dr. Michele Emmer, he has received a patent for a new device to relieve OME in infants – a real challenge since babies lack the coordination skills required to operate any health-related instrument. “We’re going for everybody!” he says.

Arisil, Inc., the company created by Silman and Arick to develop the EarPopper, received the prestigious Tibbetts Award, which recognizes significant achievements involving technological innovation that change the lives of Americans for the better. It is presented by the Small Business Technology Council, with support from organizations such as the NIH, the National Science Foundation, and NASA.

Silman is thrilled with the Graduate Center’s new Audiology Program, which was established in the Fall of 2005. Conducted in cooperation with Brooklyn College and Hunter College, its four-year comprehensive curriculum leads to the Au.D. degree, the clinical equivalent of a doctorate. He believes that this program will train audiologists who share his vision of the profession – a vision that includes mastery of a body of scientific knowledge, first-rate clinical skills, the ability to work in close collaboration with physicians, and creativity. The program is already attracting an incredibly diverse group of students. Among them, of course, are students of audiology and hearing science, but there are also individuals from disciplines such as psychology and electrical engineering. “The field is becoming so rich,” says Silman. “I hope other institutions will look to this program as a model.”

Though he has not lived out his childhood dream of being a doctor, Silman believes that audiology is the right field for him. “I am satisfied,” he says. “I work with hospitals, physicians, hearing scientists, and physiologists. I am involved in scientific, medical, psychological, and educational issues.” Referring to his work with students, he says, “There are many like me across the country who have trained a generation of audiologists to be proud of what they know so that a physician can respect them and see them as a partner.”

At Brooklyn College, Professor Silman has also been named Broeklundian Professor and Claire and Leonard Tow Professor.

—Gail Goldberg