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comparable to speech understanding performance achieved with multichannel cochlear implants. At least one manufacturer intends to refine the device and begin marketing, pending completion of these studies and FDA approval.

CLEARINGHOUSE

Question. I understand that you awarded the contract for your National Clearinghouse last month and it will come on line next month. Could you update the Committee on the National Clearinghouse operations?

Answer. The National Institute on Deafness and Other Communication Disorders Clearinghouse began start-up operations on March 1, 1991. The scope of the Clearinghouse is a direct reflection of the mandate that established it. The objectives of the Clearinghouse include: provision of effective responses to information requests; coordination of the vast amount of information that already exists in the field of communication sciences and distribution of it to health professionals, patients, industry, and the public; and, establishment of a central resource center that will provide access to current information held by other sources to avoid duplication. The Clearinghouse will maintain databases, develop informational materials including fact sheets, brochures and reprints and will continue, in close cooperation with the Institute staff, to disseminate information in the communication sciences.

INFANT ASSESSMENT

Question. Dr. Snow, your strategic research plan describes an urgent research goal relating to the early identification of hearing disorders in young children, ideally by the age of 9 months. While there are several methods for identifying hearing impairment during the first several months of life, the average age of identification of these problems is two and a half years. What additionally needs to be done to meet this goal of neonatal identification of hearing disorders and what additional research needs to be done in this area?

Answer. At the present time, most authorities would recommend the use of a hospital-based high-risk registry and the use of auditory brainstem response testing of those infants found to be at risk. Unfortunately, 50 percent of the infants with hearing impairment are missed by this approach. One method currently under investigation is otoacoustic emissions testing. Otoacoustic emissions are sounds generated by the normal ear. They are low in intensity, but can be detected in the ear canal using a sensitive microphone and modern methods of signal analysis to extract these low level signals from ambient background noise. The time, equipment and personnel required make it much less expensive than other methods of testing and much more suitable for screening of all infants. Therefore, otoacoustic emissions testing may prove to be an inexpensive, practical method of early detection of hearing loss in infants and may help to reach the goal of reducing the average age of diagnosis from 2.5 years to the first several months of life. The NIDCD is planning a clinical trial to assess the efficacy of this method of testing in the near future.

Question. Also, I understand there are 14 states that have legislative mandates to perform neonatal hearing screening. Will additional state legislation be required in this area to achieve the goal?

Answer. The fact that a state has a législative mandate does not mean that actual screenings are taking place. Program implementation varies widely for each state, ranging from fully implemented programs to only the release of brochures on the subject. Most of the legislation makes no mention of specific funding policies to be followed. The method of testing may or may not be recommended or regulated by the state. Testing processes vary from state to state and may include only one method or several methods. To achieve our goal of early identification of hearing impaired children, a uniform nationwide effort must be undertaken.

Sixteen states now have legislative mandates to perform neonatal hearing screening. These are Hawaii, Kansas, Arizona, California, Connecticut, Florida, Georgia, Kentucky, Maryland, Massachusetts, Mississippi, New Jersey, Ohio, Oklahoma, Rhode Island and Virginia.

MULTI-PURPOSE RESEARCH AND TRAINING CENTERS

Question. There are three of the Multi-purpose Research Training Centers funded and in operation and competition is underway for two more this fiscal year. When will the awards for these new Centers be made?

Answer. The Request for Applications for the new National Multi-purpose Research and Training Centers (RTC) was issued in the NIH Guide to Grants and Contracts on December 22, 1990. As of February 21, 1991, the Institute has received six applications in response to the RFA. The awards for these new Centers will be made by September 1991.

Question. What will the focus area be for each of these new

Centers?

Answer. The program focus for these Centers will be determined by the relative scientific merit of the competitive applications approved for funding by the National Deafness and Other Communication Disorders Advisory Council.

RESEARCH CENTERS

Question. Your budget shows a request for one additional center in 1992. What type of center do you propose for funding in 1992 and will this bring on line all the centers called for by the legislation establishing the Deafness Institute?

Answer. The NIDCD is hoping to initiate a Core grants program

in 1992. Core Grants for the support of Research in the Communication Sciences and Disorders are intended to support the provision of central services and/or resources that enhance or facilitate the studies of a group of investigators currently holding investigator-initiated NIDCD grant support. Core grants may indirectly serve a number of purposes: for example, the establishment and support of appropriate laboratory services may

lead to the expansion of studies of the molecular, cellular, or immunologic bases of the communication sciences and disorders, and the availability of other services and resources may encourage expanded, multidisciplinary and/or collaborative studies in the communication sciences and disorders.

We are funding three RTCs in the areas of voice and speech, hearing and balance, and hearing loss in children.

The Request for Applications for the new National Multipurpose Research and Training Centers (RTC) was issued on December 22, 1990. As of February 21, 1991, the Institute has received six applications in response to the RFA. The awards for these new Centers will be made by September 1991. The focus for these Centers will be

Our

determined by the applications approved for funding by the National Deafness and Other Communication Disorders Advisory Council. goal is to support one RTC in each major program area of the Institute.

INTRAMURAL RESEARCH

Question. Your intramural research program represents only 4.5 percent of your overall budget, well below the average for NIH as a whole. What plans do you have for your laboratory programs?

Answer. In the past year, we have added additional staff to our Intramural Program. We have ongoing programs in speech, voice, and audiology, as well as basic research in molecular biology. We have selected a permanent Scientific Director, and will bring him on board in FY 1991. Once this has occurred, we anticipate a significant expansion of both our clinical and basic science research activities within the Division of Intramural Research. current plans call for the establishment of four clinical branches and five basic laboratories.

Question. Have you been given adequate space?

Our

Answer. NIH has allocated additional space for the intramural research program. This space will permit the Institute to consolidate its current activities as well as expand its program efforts into other areas of communication sciences and disorders. This additional space should be adequate for our current needs.

Question. What difficulties have you experienced in recruiting scientists for areas of your program that you would like to expand?

Answer. The Institute is experiencing the same problems in recruiting and retaining experienced research scientists as other institutes at NIH. NIH's inability to offer competitive salaries and the limited portability of benefits are the main problems.

TEACHING DEAF CHILDREN LANGAUGE

Question. What research do you support that may shed light on the best methods of educating hearing-impaired children and teaching them language?

Answer. A number of currently-supported NIDCD research projects are addressing the most efficacious methods of providing

language input to hearing impaired children. Some studies examine the use of hearing aids vs. cochlear implants vs. tactile devices and document gains in speech and language skills associated with each device. Results will assist professionals in determining which device is most appropriate for hearing impaired children with particular characteristics (for example, degree of hearing loss, age at loss of hearing, family characteristics, etc.). Other research projects examine more advanced language skills and reading and writing abilities to identify factors associated with successful and unsuccessful acquisition of those abilities. Such information will guide educators in assisting deaf students in acquiring higher levels of literacy than has been characteristic of this population in the past.

Question. Are any of the long-standing controversies over sign language, cued speech, and oral-only approaches being clarified by new research results?

Answer. Current initiatives are soliciting research studies to examine language acquisition in deaf children of deaf parents learning a signed language, as well as in deaf children of hearing parents learning oral communication. These investigations are expected to speak to and resolve some of the issues associated with the long-standing controversy over the most appropriate means of teaching language to deaf children.

QUESTIONS SUBMITTTED BY SENATOR ARLEN SPECTER

MENTOR PROGRAM

Question. Dr. Snow, I understand the Institute is planning to implement a "mentor" training program. Would you please describe for the Committee the program and its purpose, and is there an adequate pool of trained researchers in the area of deafness and other communication disorders?

Answer. The purpose of the "Mentor" program is to increase the pool of researchers particularly in molecular biology and molecular genetics who are doing research in communication sciences. The 'mentor award" would permit research project investigators to apply for a supplement that would enable them to support an individual at the postdoctoral level who is interested in enhancing his or her basic research skills. The support would be for no less than two and no more than three years. We believe that molecular biology and molecular genetics represent the most promising area of biomedical research for emphasis and that by developing more of these investigators in the communication sciences, we will hasten the search for answers in this field.

WOMEN'S HEALTH ISSUES

Question: Dr. Snow, concerns over the lack of attention given to women's health issues at the National Institutes of Health have been raised both in the press and in the Congress.

Has your

Institute identified any areas for research focus that have particular relevance to women's health?

Answer: The NIDCD has identified five areas of research for study that are particularly relevant to women's health:

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Meniere's disease is a very difficult disease characterized by periods of dizziness, nausea, vomiting and loss of hearing. Scientists in one NIDCD research program have demonstrated an inner ear response to a particular virus, cytomegalovirus (CMV). CMV is a well-established cause of disorders of the auditory, visual and central nervous systems. Some surveys have established the presence of the virus in 50 percent of upper middle income white females and 83 percent of lower income minority women. "Quiescent" CMV may play a role in the development of Meniere's disease.

Otosclerosis is the most common cause of progressive conductive hearing loss in the adult with a normal eardrum, and it is more common in women than men. An NIDCD-supported physician-scientist has found that a class of drugs, biphosphonates, acts effectively to inhibit bone remodeling. If shown to be effective, these drugs could be used to prevent the onset of otosclerosis in families known to be prone to the disease or to arrest the progression of the disease in persons already affected.

A predominant problem in the elderly is the natural decline in smelling ability that typically occurs after age 60. NIDCD grantees developed a smell identification test that made it possible to test the sense of smell throughout the age span. With this useful clinical tool, when patients complain of a loss of the sense of smell, their sense of smell can be measured and compared to what is normal for their age and gender. Throughout the life span, women have been known to have a more acute sense of smell than men.

Voice tremor affects women primarily and makes speech difficult to understand. For example, because of the high frequency response of the telephone, voice tremor renders use of the telephone a difficult task. This disorder has a dramatic effect in limiting one's ability to communicate in professional and personal situations. In a definitive study, scientists in the NIDCD's Voice and Speech Section have developed a new treatment, injecting botulinum toxin into throat muscles in patients with this disorder. These injections were very successful in eliminating tremor entirely in some and almost completely in others. Grantees are continuing work on diagnostic methods with voice tremor.

While the ear is the organ of hearing and receives sounds from the environment, the ear also produces sounds itself, called otoacoustic emissions. These sounds emanating from the ear may be useful in identifying the type of hearing loss. They represent one of the specific functions of the sensory cells in the inner ear. In most cases, emissions remain extremely stable over time but females evidence measurable changes with monthly hormonal cycles. These findings are revealing new understanding of the biochemistry of the inner ear and its interactions with noise exposure, aging and drugs such as aspirin.

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