John K. Niparko, MD

George T. Nager, MD, developed a reputation as a meticulous researcher that showed in his research into the value of temporal bone pathology. That research has been utilized in many areas of otolaryngology, including the development of cochlear implants, and it was highlighted in a lecture Tuesday.

During the Paparella Award for Distinguished Contributions in Clinical Otology, John K. Niparko, MD, outlined the impressive research of Dr. Nager, the former chair of Otolaryngology-Head & Neck Surgery at Johns Hopkins University. Dr. Nager, 91, was unable to attend Tuesday's lecture for health reasons, but Dr. Niparko honored him by saying his driving force in research was "separating knowledge from speculation."

Dr. Nager's three main areas of research have been otosclerosis, dehiscence of the labyrinth, and the causes and effects of deafness, which grew out of his "fascination with bone pathology," Dr. Niparko said.

It was in his otosclerosis research that Dr. Nager first made an impact. He was the first researcher to describe the vascular nature of the disease, and a study of identical twins was key to the discovery of the role of genetics in otosclerosis.

"He was struck by the invasive potential of the cochlear capsule," Dr. Niparko said of Dr. Nager's research.
The second area of research was dehiscence of the labyrinth, where he published an article about sound- and pressure-induced vertigo due to bone dehiscence of the superior semicircular canal.

Dr. Nager had been the driving force behind the Johns Hopkins temporal bone collection, and he had sectioned temporal bones in the plane of the superior canal, which showed the range of bone overlying the canal in 1,000 specimens.

The temporal bone collection opened up new areas of thought and "was the final arc of the circle" in Dr. Nager's research into dehiscent bone over the superior canal, Dr. Niparko said.

That research led to the third area of Dr. Nager's research, into the causes and effects of deafness. He investigated the degeneration occurring in the human central auditory system subsequent to profound hearing loss and found that cell size in hearing-impaired subjects ranged from normal to reductions of greater than 50 percent.

It became clear that the cochlear was deformed and that the neural supply can affect cell metabolism and size, Dr. Niparko said of Dr. Nager's research, which led to the study of the dwarf white cat. The auditory fiber endbulbs of the cats showed the stunting of synaptic interfaces and led to the development of cochlear implants to determine if the synapses could be preserved or redeemed, and if synaptic degeneration could be ameliorated.

The use of the implant showed that electrical stimulation could return, and led to cochlear implants in children. Further research showed that the earlier children received implants, the better their verbal language comprehension, Dr. Niparko said.

Dr. Nager's temporal bone pathology research and the temporal bone collection offered important insight into ear disease within the three-dimensional framework of the labyrinth, Dr. Niparko said.

"His curiosity, calm but energetic style, and his uniquely warm way of giving of himself has been a touchstone for hundreds of otolaryngologists who proudly consider themselves to have studied under George T. Nager," Dr. Niparko said.