with it very severely, because there is no recognized way to develop a disability for an individual. That is, if he has so much hearing loss, how much in disability does he actually have from the standpoint of his work.

We have several committees working on it and also a combined committee of the American Medical Association and a subcommittee from the Ear, Nose, and Throat Society. Also we have a so-called Z24X2 committee, which is a committee formed by the American Standards Association, to explore the problem of standards in industry. In other words, just how much noise can an ear stand before hearing loss occurs, and how long does it take to produce such a hearing loss. This committee has been in existence 2 years, and it will come out with a report, which in no way will be a standard, because we feel we need 5 to 10 years of research before we can come up with a definite answer as to how much noice and what kind of noise and how long a period of exposure will produce hearing loss.

At the present time, we are sending out a report which will give a relation between the number of years of exposure to certain kinds of noise and the hearing loss produced. We do know that noises produce hearing losses.

Dr. HARDY. I wonder if I could interrupt again. From what you say in your general description, it would seem true that certain institutionally centered programs in the armed services and Veterans' Administration have contributed a very high level of help to people with hearing disorders and one which is greater than any similar situation applicable to general groups of citizens. Is that true?

Dr. GLORIG. I feel that this is very true, and that is why I am mentioning the Army and the VA program, because they have a program which individuals have access to which the civilian population does not have access to accept in the form of a few universities like JohnsHopkins, which is one of them, and it should be made available to the civilian population, but I am afraid it will take a lot more research and public education and such things than a committee of this sort can do in the way of public education.

Dr. HARDY. Can you estimate even in rough terms the expenditure of funds from the armed services and other Federal agencies like the Veterans' Administration in research in regard to the casual picture? Dr. GLORIG. The ONR has expended to my knowledge somewhere up close to $400,000 in the problem of hearing. However, most of this research, as I stated in the beginning, has not had directly to do with hearing losses but more with normal hearing and its relationship to the general physical needs of the man in the Armed Forces. However, from the standpoint of hearing losses, I think there is a pretty poor sum that is actually being spent to study the problem of hearing losses by either the Armed Forces or civilian agencies.

Dr. HARDY. That is what I meant.

Dr. GLORIG. As a matter of fact, it is negligible. There is no amount to it that I could mention that would be worth mentioning. Dr. HARDY. As I understand, it is dissipated throughout a variety of private institutions and agencies. I do not mean the money is dissipated but the effort is dissipated.

Dr. GLORIG. Yes, sir. But if you centered it all in one group, it is not enough by any means to care for this problem. That is all I have to say.

Mr. CARLYLE. What percent of disability is assigned to a veteran when he is found to be totally deaf?

Dr. GLORIG. Well, if he is totally deaf-and total deafness in the Veterans' Administration means a loss of 85 percent of his hearing faculties, which is relatively, in percent terms, probably 80 to 83 percent on the basis of 100 percent of deafness-he gets total disability, and I think that amounts to around $165 a month.

Mr. CARLYLE. They do assign total disability for total deafness? Dr. GLORIG. Yes, sir.

Mr. CARLYLE. Doctor, where deafness is caused by obstructions, of course, that can be removed. Is that correct?

Dr. GLORIG. By what?

Mr. CARLYLE. Obstructions.

Dr. GLORIG. Yes, sir. Obstructions by disease or foreign bodies or whatever it is. Is that what you mean?

Mr. CARLYLE. Yes.

Dr. HARDY. There is one qualification, and that is if it is done early enough. The facts are clear that there are long continuing factors in the chronic condition, but the defects accrue accordingly.

Dr. GLORIG. All I heard was the word "obstruction." What was the rest of your question?

Mr. CARLYLE. Can it be cured?

Dr. GLORIG. I did not hear that part of your question. I suppose, even in the conductive hearing losses a relatively good guess would be less than 50 percent of them can be. I would not go so far as to say cured, but can be either stopped so far as progression is concerned or helped. It is very difficult to cure an obstruction type of deafness. If a baby is brought in to you and he has a pin in his ear and you take the pin out, of course, the chances are he is going to be all right. However, if some older person comes in and you remove this, this is a complete cure, but you never can cure a damage that is done to the conductive part of the mechanism, because if this disease has gone on long enough, the way they are before they get attention, you have damage which cannot be repaired surgically or otherwise.

Dr. HARDY. That is why I believe Dr. Glorig would agree that so much emphasis is currently being placed on getting at the problem early.

Mr. CARLYLE. Is it normal for a man as he grows older to lose some of his capacity to hear?

Dr. GLORIG. Yes, sir. This is a problem at the present time in making up any sort of a rating scale for compensation. For example, you can take the case of industry. Now, industry wants to know if they have got to pay a man for a hearing loss and how much. Is it normal progression due to age? Several agencies have been working on the problem, and one is the Public Health Service, and there is another one in San Diego, and a man by the name of Dr. Bunch did a survey, and on the basis of these figures which they arrived at, I would say a man who had-of course, you have to separate this also into frequencies, which is a little technical, but let us divide them into low and high frequencies. At the high frequency, after 50 years of age, a man begins to lose considerable of his high frequency hearing. This does not affect his job. After 60 years of age, he will lose very little on the upper end of his frequency. However, he will not suffer much

of a disability from the actual normal progression until he is past the age of 70. Even then, if he is in good condition mentally and alert, he does not notice it too much. However, there is a natural progression just as there is with vision.

Mr. CARLYLE. Is it normal for a person who has been able to hear and then loses his capacity to hear to become extremely nervous?

Dr. GLORIG. Well, this is something I should have mentioned before, and I had it down here, but insofar as the effect on the individual is concerned, as Dr. Hardy has stated, it does not have, as he called it, a "killing" complication, but it does have a severe psychological effect on the individual, and this psychological effect is in proportion, of course, to the amount of hearing loss. But a hearing loss which needs help is not very much of a hearing loss actually when you put it down in figures.

To go back to percentages, which I think everyone understands, a 30 or 35 percent hearing loss will give quite severe psychological implications in the form of paranoia and this type of thing. I do not mean it causes this type of disease, but if there is any tendency in the individual toward this type of psychological problem, deafness brings it out definitely. So therefore we are now doing some psychological surveys in the clinic, and we are finding this out, that there is a definite tendency toward hysteria in the individual with a hearing loss.

Mr. HESELTON. Are there any further questions, gentlemen?

Mr. THORNBERRY. Doctor, you referred a while ago to the examination of people as to their hearing. Is it generally true that there is no examination until after the child goes to school?

Dr. GLORIG. This is unfortunately true, and that is why I mentioned hoping that we would be able to get into the preschool problem. Believe me, the preschool problem is not as simple as the school problem. This testing method needs suggestive response, and if the child is younger than school age, it is difficult to determine the exact extent of his loss. So preschool testing is another problem which we hope we can answer later.

Mr. THORNBERRY. The reason I asked that question was because of what you said in regard to the cure or prevention of progressive loss of hearing and that it was necessary to get to children at an early

age.

Dr. GLORIG. That is the secret of the whole problem, and at the present time preschool children are not being tested in any situation. Dr. HARDY. There is another point that comes in there. In a broad course of events, a variety of problems presented, the major problem presented in the preschool testing is that, if preschool children who are in serious trouble because of hearing disorders have a nerve tissue impairment which is the result of disease infection or whatever other prenatal injuries may have been suffered, at the time of school age it is rather difficult to handle. However, for reasons that are pretty well understood to anyone who has spent much time around this part of the country where the climate is damp, the incidence of respiratory infection rises very fast, and probably that is due to a lot of children being together and exposing each other. In other words, somewhere in the age range of about 6 to 8, by all manner of means, the higher proportion of hearing disorders is of the conductive type and relates to

upper respiratory infections, and, as Dr. Glorig pointed out, that can be healed. We cannot reverse it, but if gotten early enough, it can be helped.

The other point is that, with generally wide health techniques of examining large numbers of children, there naturally comes into being problems in terms of administrative care at the level where children are insufficient to be able to respond to a good or designed test.

Mr. THORNBERRY. I understand that, but what worries me is that from what I understood you to say, even after you are able to examine children at that stage, it may be a little late.

Dr. HARDY. It certainly is too late to begin an operation or begin thinking about the problem of a certain child who has a serious impairment, because he has, before school age, already gone too far without attention. His developmental point for these aspects of language and speech and so forth are centered in the 4 years before school

age.

Dr. GLORIG. I think the point here is not so much that we are able to reverse this process, but we are able to get the child in an educational setup whereby he will make the best of what he has if we get him early enough. However, we usually wait too late, and then it is a much more difficult problem.

Mr. THORNBERRY. Let me ask you this question. Is a large part of the loss of hearing hereditary?

Dr. GLORIG. A large part of it? You mean the whole problem? Mr. THORNBERRY. Yes. I mean the cause of it.

Dr. HARDY. Speaking in clinical terms, no, sir. A significant amount is, but I do not believe that there is any evidence that a large proportion of it is.

Mr. THORNBERRY. A significant amount is? Do you have any idea about how much that is?

Dr. HARDY. I can only deduct that from direct clinical experience, and our statistics are no good. We see children who are in trouble, and we have no way at all to relate that to an incidence. Of the last 850 cases of preschool children whose problems we studied carefully 17 were assignable clearly to a direct family strain.

Dr. GLORIG. Otosclerosis, which is hereditary, is of the entire deaf problem less than 5 percent.

Mr. THORNBERRY. Has there been any attempt to trace the family background as to whether or not some time ago they may have had it in the family?

Dr. ELSTAD. Our records would show that this 30 percent holds up pretty well, which we mentioned before. Of course, we have no way to check it.

Mr. THORNBERRY. That is what I understood awhile ago. So many say it is hereditary, but I am not so sure that is true.

Dr. HARDY. I think you are quite correct. The medical field is beginning to demonstrate beyond any doubt that, although these problems exist on a prenatal basis, it is not hereditary in a large propor

tion.

Mr. THORNBERRY. May I ask this question? It may sound ridiculous, but to the lay person it is not. Have you ever examined or found a person who was deaf, who, along with that, lost his speech! I know they do not talk, but so often they are referred to as deaf and

dumb people. They really do not speak, as I observe them, because they cannot hear. You have never run into anyone who was deaf and did not have speech organs?

Dr. GLORIG. No, sir. Well, you might have cases relating to a congenital condition, as it relates to a finger or thumb and so forth, but I have never seen one in my experience who did not have speech

organs.

Mr. THORNBERRY. You often have people referred to who are deaf as being deaf and dumb, and they do not appreciate that very much when the term "dumb" is used.

Dr. HARDY. As a matter of fact, that is one of the reasons why this field has been so very slow in developing in terms of general education and in professional education. It has been assumed for years that this problem lay so far beyond comprehension and that nobody could do anything about it that they referred to them as "deaf and dumb" and felt that they belonged to some other level of society.

Mr. THORNBERRY. I think this is a field which has received less attention than any other one, and needs it very much.

Dr. Bailey, are any Federal funds set aside in the National Institute for this problem?

Dr. BAILEY. We have a responsibility for hearing losses in the National Institute of Neurological Diseases and Blindness, and we have an intramural program in which the amount set aside right now is very small. We are the youngest Institute of the National Institutes of Health, and we were born at a rather unpropitious time from the standpoint of economy. Although we have definite plans for research at the Clinical Center at Bethesda and we do have one or two people working on the physiological side of deafness and on the problem of hearing loss, it is very small. Besides this intramural program, we do have an extramural program which awards research grants to nonfederal institutions and universities for research in the problem of hearing loss as well as neurological diseases and blindness. I believe Dr. Stone has the latest figures on that.

Dr. STONE. In the fiscal year 1953, we supported 5 projects in the total sum of $60,987-roughly $61,000; in fiscal year 1954 we are supporting now 8 projects in the amount of $72,573, and I would like to say at this point that we were forced to turn down, for lack of funds, approximately $50,000 in applications that we got in the hearing field that we could not support.

Mr. THORNBERRY. How much do you allow for blindness?

Dr. STONE. The amount for blindness in the last fiscal year, that is, the fiscal year 1954, is $392,000.

Mr. THORNBERRY. I believe those are all of the questions I have right now, Mr. Chairman.

Mr. HESELTON. Mr. Williams.

Mr. WILLIAMS. Quite a belief prevails among the lay public that the intermariage of relatives quite often causes deafness in offspring. Is there any evidence to support that?

Dr. HARDY. That statement, to my knowledge, sir, is a little bit too broad.

That there is some hereditary strain which is genetic, which involves the lack of development of the hearing mechanism, yes, there is a good deal of evidence that, but my goodness, I think we would be going pretty far to say that intermarriage is a cause for hearing dis