earlier onset, were more likely to have sudden onset, and show a stronger tendency for amelioration than boys. NIDCD intramural scientists have demonstrated that botulinum toxin injections are effective in reversing the effects of muscle reinnervation and restoring the voice in the treatment of spasmodic dysphonia. The first three National Multipurpose Research and Training Centers have been established. The Centers will stimulate important areas of basic and clinical research while providing needed research training opportunities. They will increase the numbers and broaden the capabilities of investigators in the communication sciences. Continuing education programs will disseminate research results to physicians, other health professionals and the public. As we approach the new century, the age of communication is coming into maturity. Every aspect of human life is dependent upon skilled communication. Communication processes and technologies have become increasingly critical to success in the workplace. Persons with disabilities have been guaranteed the rights they have always deserved. However, when a child is born with a communication disorder or acquires one later in life, that child faces undeniable challenges throughout his or her lifetime. Often the challenges are economic. The earliest possible diagnosis and intervention are critical to improving the quality of life for individuals with communication disorders. Research in molecular biology and, specifically, molecular genetics holds great promise for the use of gene therapy in hereditary deafness and other disorders of human communication that are clearly hereditary. NIDCD has an ongoing commitment to research that develops strategies and devices to ensure the best possible outcomes for individuals with communication disorders. To the degree that these individuals are able to improve their productivity and independence, research will have contributed to major savings and, more importantly, to the quality of their lives. It is of the greatest importance that the age of communication is truly accessible to all Americans. Mr. Chairman, the FY 1992 budget request is $146,321,000. to try to answer any questions you have. I will be pleased BIOGRAPHICAL SKETCH OF DR. JAMES B. SNOW, JR. Born: March 12, 1932, Oklahoma City, Oklahoma Marital Status: Married, three children Education: B.S., University of Oklahoma, Norman, Oklahoma, 1946-49; M.D., Harvard Medical School, Boston, Massachusetts, 1952-56 Professional History: Intern in Surgery, Johns Hopkins Hospital, Baltimore, Society Affiliations: Alpha Omega Alpha; American Academy of Facial, Plastic Honors and Awards: Regent's Award for Superior Teaching, University of HEARING LOSS Senator HARKIN. Thank you very much, Dr. Snow. Millions of Americans have different-there's different kinds of hearing loss, and some are affected with a hearing loss that if you are tested in the booth, the sound chamber-I don't know what you call that, but the testing room. Dr. SNOW. Yes. Senator HARKIN. Your hearing comes out OK. But if you are in a crowded room or something like that and you are talking to someone, you cannot understand them because of the background noise. I have become aware of this, in fact, having a little bit of a problem with it myself. But I am just wondering what kind of research is being done in this area. What kind of new hearing aids are being developed? I have heard about some, but I don't really have much knowledge about what is being done in that area. Dr. SNOW. Yes, sir; we all have trouble hearing in background noise but, of course, this becomes very severe, particularly in those who develop the loss of hearing due to aging, the condition known as presbycusis. And then when one tries to solve the problem of loss of hearing with a hearing aid, just the thing that you point out, the variation among individuals becomes a very major problem. One of the hopes is that digital hearing aids will help solve this problem, and we are sponsoring research in which hearing aids are being tested both in quiet and in noise, in which there are men's voices in noise, women's voices in noise and each of those in quiet. Our research in hearing aids really is addressing three major approaches: The amplitude compression, the reduction of noise, and the use of binaural hearing aids, each one fitted differently to each ear. DIGITAL HEARING AIDS Part of the problem with the development of digital hearing aids has been that one can work out strategies for different listening circumstances for a given individual, but there is not a great deal of application to other individuals. And that has hampered the production of these for widespread use. What has been worked out in the laboratory for a few subjects is applicable to less than 50 percent of the population that needs a hearing aid, and this makes it a very difficult and complex matter. We are emphasizing the study of the amplified speech signal in a hearing aid and the characteristics of the hearing impairment, trying to match those better than has been done in the past. Senator HARKIN. One last question. I have a number that I will submit to you in writing. I am informed that the Defense Department has been doing a lot of classified funding of research and development in certain kinds of equipment, such as eavesdropping equipment, that if available to those working on improving the quality of hearing aids, could lead to some dramatic breakthroughs in quality and sophistication of hearing aids. In other words, the Federal Government has already done some research in another branch on this. Have you had any discussions with the Department of Defense on this? Are you aware of this? Dr. SNOW. No; we have not. We are developing the interagency coordinating committee that was authorized by the legislation so that we can be aware as much as possible of what other Government agencies are doing in deafness and other communication disorders. I do not know anything about the classified work. Senator HARKIN. I also serve on the Armed Services Appropriations Subcommittee, Defense Appropriations. And I am going to get my staff to look into that and try to coordinate with our staff here and with you, and let's see if we can't get you the appropriate classification, whatever you need, to look at this. OK? Dr. SNOW. Yes, sir. Senator HARKIN. I am not certain that I am totally aware of it. I have been told about it. I don't have a firsthand knowledge of it myself, but I would like to have you take a look at it and see if there is anything there. Dr. SNOW. I would be very pleased to do so. QUESTIONS SUBMITTED BY THE SUBCOMMITTEE Senator HARKIN. Thank you very much. There will be some additional questions which will be submitted for your response in the record. [The following questions were not asked at the hearing, but were submitted to the Institute for response subsequent to the hearing:] QUESTIONS SUBMITTED BY THE SUBCOMMITTEE STATE-OF-THE-ART RESEARCH Question. We've talked in the past about the need to bring the science that supports deafness and communication disorders up to par with the science that supports and investigates other categories of disease. One of the major problems in this field has been the lack of trained molecular biologists and other scientists with state-ofthe-art specialties. I was pleased to see that we were able to increase the number of individuals trained by your Institute from 112 to 149 between 1990 and 1991. Unfortunately, your 1992 request would only maintain the 149 trainees. In your professional judgment, how many training slots should be supported in 1992 to help bring the science of deafness and communication disorders up to par with other fields of science? Answer: In my professional judgment 208 training slots should De supported in 1992. TRAINING Question. If the Congress were able to provide funding to your Institute above the 1992 requested level, what relative priority would you assign to providing more funding for training? Answer. Training is of critical importance. It is the foundation upon which excellence in research is built. Training and career development remain a high priority for the NIDCD. We are very pleased that the National Multipurpose Research and Training Centers are offering continuing education and research training to physicians. Question. Dr. Snow, I understand that you made a proposal to NIH management that would provide a supplement to research project grants to permit additional training to take place in the context of work being done on research project grants. This would be a new mechanism, a new way of attempting to train more individuals. What is the status of this proposal at NIH and how much do you estimate it would cost to add this training component to your research project grants in FY 1992? Answer. We have received tentative approval from the NIH for our "Mentor" program and are now working on the final details of the proposal. I believe this program can offer our investigators an excellent opportunity to move into the forefront of biomedical research by learning research techniques in molecular biology, thereby giving them the tools needed to provide us with answers in such difficult areas as hereditary deafness and the regeneration of hair cells. We estimate that this initiative would cost $4,350,000 in FY 1992 and could be accommodated within our overall request if deemed a priority. In FY 1992 the second year costs of the FY 1991 awards would be supported; and approximately twice as many new awards would be made as in FY 1991. Question. How much would it cost to add this component to your research project grants in FY 1991 and is this something that the Director's Discretionary Fund can be used for? |