Over the past 33 years, the Melbourne-based Passe & Williams Foundation has funded more than 400 research projects in Australia and New Zealand, donating $85 million and significantly impacting ENT research and clinical practice. Thousands of people have benefitted.
Within days of birth, every newborn in Australia is offered free hearing screening, usually in hospital. The research which led to this critical test becoming universal was kick-started by the Passe & Williams Foundation.
The foundation’s CEO Dr Jeanette Pritchard says paediatric otolaryngologist Professor Harvey Coates AO and Dr Veronica Smyth each received initial funding to improve neonatal hearing screening, leading to a national framework for early detection.
Likewise, Video Head Impulse Test (v-HIT) technology, which is now the gold standard for assessing balance disorders, was also initially funded by the foundation, she adds. It granted funds to University of Sydney Professor Ian Curthoys, Professor Michael Halmagyi and Associate Professor Hamish MacDougall to develop the technology.
“These projects demonstrate the foundation’s impact on clinical practice and patient outcomes,” Dr Pritchard says. “The main goal of the research we fund is to benefit clinical practice and many projects have resulted in changes to the way practitioners do their work.
“It has improved outcomes for patients and may have saved lives. Our grants have also helped researchers pursue projects that might not have been funded otherwise.
“We look at what the potential impact might be for patients. About 35% of our funding or more than $30 million has been allocated to projects relating to otology, audiology or hearing-related research, something that an ENT practitioner would be treating and that could be surgical, allied health, biomedical, paramedical, anything in the ENT remit.”
Professor Coates from The University of WA and Dr Smyth from the University of Queensland’s Department of Audiology and Speech Pathology each received grants of $30,000 to investigate ways of improving detection of hearing impairment in newborns and infants, Dr Pritchard says.
“After that, state-based programs were implemented around neonatal hearing screening and then the national framework was established ensuring all neonates were screened,” she adds. “Our grants were small, but they were the trigger and Harvey often mentions that when he’s talking about the foundation.
“We granted $7 million to the University of Sydney team of Curthoys, Halmagyi and MacDougall who developed a methodology for neurologists and ENT surgeons to measure semicircular ear canal dysfunction in patients with balance disorders.
“These tests are now the gold standard for neurology clinics around the world, enabling patients to be quickly and easily assessed, diagnosed and then treated.”
Dr Pritchard, who has a background as a scientific researcher in medical diagnostics, says these are just two examples of the important research funded by the foundation’s grants, scholarships and fellowships.
Its board comprises ENT specialists, other medical specialists, academics and scientists. Grants also focus on involving clinical practitioners at an early stage which helps drive translatable research.
She says its unique focus on ENT sets it apart from other charitable organisations. It also supports career pathways for researchers, granting scholarships and fellowships and funding them from junior positions through to professorships.
“We’re told by people in our specialty and from other specialties that this is a game-changer,” she adds.
The foundation has funded more than 40 scholarships for ENT trainees training to become surgeons, enabling them to also study for their PhD during training.
“Graduating with a PhD, a surgical fellowship and surgical experience then building academic departments around clinical research has such a big impact over the longer term,” Dr Pritchard adds.
The foundation is also looking at strategically addressing the otitis media crisis with a focus on rural outreach and equitable service provision. It has funded projects in NSW and is co-funding a national ENT outreach audit to understand service gaps and needs.
“Over the past few years we’ve co-funded an audiometrist’s position in a small but really important project in Dubbo, Hear Our Heart Ear Bus, which runs off the smell of an oily rag,” Dr Pritchard says.
The bus provides free ear health education, targeted hearing testing and free access to ear specialists for children in Dubbo and districts. Audiology staff screen children’s hearing at school if a teacher or parent believe they may have hearing problems.
EarGenie to help babies with auditory neuropathy
Another innovation being brought to life partly due to Passe & Williams Foundation grants and fellowships is the EarGenie system, developed by Professor Colette McKay, the Bionics Institute’s principal scientist and leader of its translational hearing program in Melbourne.
She is developing better paediatric hearing tests and innovative ways to fast-track early intervention for youngsters with hearing loss.
The technology is a non-invasive, harmless brain imaging system for detecting auditory responses in babies, infants and young children. It uses light via functional near-infrared spectroscopy (fNIRS) to measure the brain’s response to sounds.
The tool, which started using a research ‘bonnet’ system with lots of cables, has developed into a prototype with a headband containing light sources and detectors that wrap around the child’s head. The headband connects to a laptop via Bluetooth. When the brain responds to a sound, there is a change in oxygen level in the brain detected by EarGenie.
These changes indicate whether the child has heard the sound and if they can differentiate between different sounds, known as discrimination.
“It’s similar to the blood pulse oximeter clipped on your finger in hospital to measure oxygen levels but this is like a pulse oximeter for the head,” Prof McKay says. “When a child hears a sound or distinguishes between two sounds, the oxygen level changes, and we can detect that in the signal.”
When screening babies with auditory neuropathy, it may appear they’re profoundly deaf, she says, but their hearing can range between normal and severely deaf because screening technology measures electrical responses of hearing nerves, which rely on synchrony in those nerves.
“With auditory neuropathy, synchrony is not there, so it looks like the nerves aren’t firing when they may be OK,” Prof McKay explains.
“When parents are told ‘your baby has this condition but you’ll have to wait until they’re older to know what they can hear, or whether a hearing aid will help’, the baby misses out on critical early intervention because nobody knows what their functional hearing is.”
In some cases, these babies might wait years before appropriate intervention yet every week of delay in intervention means babies fall further behind in language development.
“Sometimes they’re two years old before a decision is made to do a cochlear implant if that’s the most appropriate action, or they’re 12 months of age before we can fit a hearing aid or know whether the aids are helping them develop language,” she says.
About 10% of babies with permanent hearing loss have auditory neuropathy.
“While other kids with other forms of deafness are getting cochlear implants and hearing aids early, this group is missing out. In just one EarGenie test, we play a series of sounds at different levels and can see which sounds the baby can hear.”
An elastic cap, similar to a swimming cap, was used to develop the technology, but a prototype headband has now been developed for ease of use in clinics. “It’s easier for clinicians to put on as the cap was quite difficult to manage with lots of cables.
“The protoype is a headband that closes with Velcro fasteners. The lights and detectors in the headband talk to a computer using Bluetooth. The whole system currently consists of a laptop computer and the headband with embedded electronics.”
Initial trials showed fNIRS was 95% accurate at determining when babies heard sounds.
First clinical test of speech sound discrimination
“The other important thing that EarGenie can do,” Prof McKay says, “is to tell whether a baby, infant or child can discriminate between sounds.
“To develop language, you need to do more than just hear speech. You need to tell the difference between all the different speech sounds.
“We’ve developed the first clinical test of speech sound discrimination and that’s important for hearing-impaired babies, infants and young children because results will tell us, if they’ve got a hearing aid, whether it’s giving them the information they need to develop language.”
It also enables practitioners to see if the hearing aid has been programmed correctly, whether it’s sufficient for the child or they need a cochlear implant.
“If the child’s profoundly deaf, then it’s a no brainer, they are referred for a cochlear implant. However, most children are not profoundly deaf – they have at least some hearing so always a hearing aid is trialled first,” she adds.
Currently the baby’s language development with their hearing aid is monitored and only when it’s clear they are falling behind are they referred for cochlear implantation.
“This is the wrong way around because you’re already waiting for the child to be delayed in language before you do something about it,” she explains. “If hearing aids are not providing them with discrimination between sounds they’re not going to develop language with the device, and they’re better off with a cochlear implant.”
Prof McKay says EarGenie could revolutionise hearing assessments for babies. She hopes it will be in audiology practices soon, after getting FDA approval, and says it may eventually allow audiologists to tune hearing aids and cochlear implants accurately from the start, allowing babies, infants and young children to hear vital sounds and give them the best start in life.
Her research team is recruiting paediatric audiologists and hearing-impaired infants from newborn to age two to evaluate the clinical value of EarGenie for the care of infants with hearing loss. Paediatric audiologists can be located anywhere nationwide for the trial, because their part is conducted online, but infants must be local to Melbourne to attend testing.
“We’ll provide results to two panels of audiologists, one that has standard audiological measurements the child has gone through and the other will have standard results plus the fNIRS results,” she says.
“We’re establishing how confident those audiologists are in deciding the next intervention steps for the baby. If the baby has a hearing aid, we might ask the audiologist if the child’s hearing aid is adequately programmed, for example.
“The prototype is clinician-friendly and operates automatically. It analyses the signal and automatically tells clinicians the confidence of whether the baby responded to the sound or distinguished sounds.”
In 2025, researchers will provide the EarGenie prototype to external clinics seeking feedback for the final design. The Bionics Institute and The University of Melbourne invested pre-seed funding to start a spin-off company (NIRGenie) to develop EarGenie but additional investment is being sought to advance commercialisation.
Audiologists and parents of hearing-impaired infants wanting to take part in the trial can email HearingStudy@bionicsinstitute.org.
New vaccines to prevent ear infections
Other intriguing research currently being funded by the foundation is focussing on otitis media.
Passe & Williams Research Fellow at The University of Adelaide, scientist Dr Erin Brazel, is developing two new vaccines aimed at preventing otitis media infections, one of which is already in clinical trials.
Her Junior Fellowship of $239,729 to progress the work includes investigating if the vaccines can be combined to provide more coverage and reduce the number of injections needed for immunisations.
“Bacterial ear infections are commonly caused by Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis bacteria,” she explains.
“The Gamma-PN and Gamma-HI vaccines co-developed with biotechnology company GPN Vaccines, target Streptococcus pneumoniae and Haemophilus influenzae, respectively. These are common bacterial causes of otitis media in children.
“My fellowship project is investigating a combined vaccine with Gamma-PN and Gamma-HI, called ‘Gamma-OM’.”
There have been more than 100 different pneumococcal serotypes identified but current pneumococcal conjugate vaccines don’t protect against all types responsible for infection, she adds. Gamma-PN however targets Streptococcus pneumoniae independently of serotype.
Dr Brazel is also director of microbiology at GPN Vaccines and has been working for several years in partnership with the company to develop Gamma-PN.
“We have engineered this vaccine candidate targeting Streptococcus pneumoniae (Gamma-PN), taken it through preclinical development and manufacturing, and the vaccine is currently being evaluated in clinical trials.”
As this vaccine targets only one species of bacteria responsible for otitis media, they sought to develop vaccines to help target a broader range of bacteria that cause ear infections.
“Last year at The University of Adelaide, with funding from the National Industry PhD Program and GPN Vaccines, my team began a similar approach to create and test a range of other vaccines to expand this development pipeline, including for non-typeable Haemophilus influenzae (Gamma-HI),” she says.
“Gamma-HI which targets non-typeable Haemophilus influenzae is at earlier stages of development but looks promising in early preclinical studies.”
The Gamma-OM vaccine comprising Gamma-PN and Gamma-HI is also in the early preclinical stage of development. In her Fellowship, Dr Brazel is investigating preclinical immune responses of the combined Gamma-OM and comparing how it performs to Gamma-PN and Gamma-HI.
“We are exploring how these two vaccines activate different components of the immune system. The next step will be to expand our preclinical studies of Gamma-OM to determine protection against infection. If we demonstrate it’s safe and effective in preclinical studies, we hope to progress this combined vaccine to clinical trials,” she says.
Ear infections remain undiagnosed
Dr Brazel says ear infections remain under-diagnosed and their complications are not fully appreciated. “We are also seeing a rise in antimicrobial resistance, partly due to extensive use of antibiotics around the world that are prescribed for these common infections,” she adds.
“These infections in some instances can be incredibly difficult to treat and we urgently need new ways of dealing with them. Vaccines are one strategy that could help reduce incidence or severity of acute ear infections and hopefully also the need for antibiotics.
“The Passe & Williams Foundation has been incredibly important for advancing this research and I am very grateful. Since the award I have established and led the Molecular and Translational Microbiology Research Group, which is part of the Research Centre for Infectious Diseases at the University of Adelaide.
“This has allowed me to build my research team including supervising students focused on developing new approaches to treat and prevent bacterial infections. This fellowship allows me to focus my efforts on these new vaccines to give them the best chance to progress to the clinic where they can have a real impact.”
Origins of the Passe & Williams Foundation
Edward Garnett Passe. Images: Passe & Williams Foundation.
In 1908 in Kenya a baby girl was born, Ms Barbara Slatter. Her legacy 126 years later is that thousands of people around Australia and the world have benefitted from research funded by the foundation she established to honour the memory of her two husbands.
The first of those men, South African-born Mr Edward Roland Garnett Passe (pronounced ‘pass’), moved with his Australian parents to Victoria in 1907. He graduated in dentistry from The University of Melbourne in 1926 and moved to England to study medicine at London Hospital, later becoming fascinated with otolaryngology.
Slatter, who had studied art in the UK, provided illustrations for his otolaryngology book The Singing Voice. Six years later they married and Passe joined the Royal Naval Volunteer Reserve, attaining rank of Surgeon Commander. The pair moved to Plymouth, where he served at the Royal Naval Hospital during WW2, and she was an air raid warden.
Post-war Passe was a pioneer of the fenestration operation to treat otosclerosis deafness and was one of the first British surgeons to advocate sympathectomy to treat nerve deafness, tinnitus and Ménière’s disease. He died from haemoptysis aged 48.
Across the world, Mr Rodney Wellington Williams was born in New York in 1892 and after serving in the US Navy as a seaman during WW1, returned to a stockbroking firm where he rose to become floor partner in charge of trading at the New York Stock Exchange.
He met his second wife, Slatter, in Scotland and they married in 1968. When he died in 1984, at age 91, Williams left her a substantial bequest.
During her marriage to Passe, she had learnt how difficult it was for a young surgeon to obtain specialist medical training in otolaryngology head and neck surgery (OHNS) so she decided to provide support to young ENT surgical trainees.
This was realised when Williams’ bequest enabled her to establish a trust in 1986 to support OHNS research and practice in Australia. The trust funds the foundation, which became operational in 1991 after her death. Thanks to wise investment and management, the estimated $38 million she left to the trust now sits at $108 million, and that is after $85 million has been donated.
*The historical information for the Origins of the Passe & Williams Foundation section was provided by medical writer and historian Tina K. Allen.
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