++ A new speech processor, developed with NIDCD support, shows great promise in producing important gains in speech understanding for patients fitted with multichannel cochlear implants.

++ Recent studies indicate that congenital cytomegalovirus (CMV), a wellestablished cause of disorders of the auditory, visual and central nervous systems (which once acquired lasts a lifetime), may play a previously unsuspected role in the development of Menier's disease.

BALANCE:

++ Currently, NIDCD is supporting research on the micromechanical properties of inner ear sensory cells that may explain how they detect forces acting upon them during movement of the head, and transform this information into nerve signals.

VOICE:

++ Research is focusing on the development of objective criteria that could be adapted for clinical use which identify, describle and measure the degree of vocal dysfunction.

++ Research indicates that a new therapy (photodynamic therapy with dihematoporphyrin) is effectively treating patients with papillomavirus infection of the larynx and upper respiratory tract, a life-threatening disease that affects both children and adults and can result in respiratory obstruction.

SPEECH:

++ Investigators are studying sex differences in the onset and development of stuttering in children.

LANGUAGE:

++ Recent findings suggest that the loss of ability to use or understand language (aphasia) experienced by stroke patients may be prevented by the immediate administration of Type I gangliosides.

TASTE AND SMELL :

++ As one grows older, the ability to differentiate tastes may decline. However, recent studies indicate that the taste of one substance may be enhanced by another. This finding may help reverse or prevent nutritional deficits that are based upon taste disorders.

++ By comparing patients who developed Parkinson's disease from injecting street drugs with those who developed it from other causes, researchers are closer to understanding the progression of the disease. Patients who used the street drug MPTP do not have smell deficits while patients who contracted Parkinson's disease from other causes suffer smell deficits. Researchers are now studing the possibility that some forms of Parkinson's disease are caused by enviromental agents entering the brain through the olfactory nerve.

While advancements have been made in these fields this year, there is still a great deal of work to be done. Discoveries and solutions do not evolve overnight, but our

researchers are committed and dedicated to the 48 million Americans who suffer from communication disorders and desperately depend on the Institute for answers. The NIDCD has an obligation to them to find the preventions, causes, and cures for all communication disorders. But, we can not do this without a major commitment of resources on the part of the Congress. Through your past generosity you have affirmed the value of the mission of the Institute, and I am urging you to continue to join us in our fight against these debilitating disorders. I am confident that together we will ultimately attain our ambitious goal of relinquishing future generations from the suffering and trauma caused by deafness and other communication disorders. Thank you for allowing me to share this information and my thoughts with you. National Institute on Deafness & Other Communication Disorders Professional Judgement Budget

JUSTIFICATION FOR FY'92 REQUEST OF $201 MILLION FOR NIDCD

At NIDCD, the number of our applications are increasing

No other Institute at NIH is having that kind of explosion.

The FY'92 professional judgement budget (PJB) for NIDCD is $201 million. This has been determined because of the escalation of applications, yet, it would only allow a success rate of 42%.

The vast majority of increased $ in the PJB recommendation is for RESEARCH. There is a $30 million increase over the President's Budget, but it only would allow for a 42% success rate.

This figure will allow support of 399 noncompeting grants and reflects a compliance with eliminating downward negotiations.

+ Will allow 232 new and competing grants at 100% of

recommended cost. Will target studies in molecular biology and molecular genetics of hearing and other communication processes.

+ It provides an additional $11 million for Centers that would allow NIDCD to fund 9 Clinical Centers, 10 RTC's (Research Training Centers), 5 Exploratory Research Awards, and 5 Core Centers. (Core Centers are awarded to an Institution which receives 4 R01 grants to encourage shared services, thereby, reducing expenses.)

++ It would allow an additional $2,300,000 for TRAINING for 59 additional full-time training positions plus a stipend increase.

++ It would enable the NIDCD to provide a major increase in the CONTRACTS line-$3,400,000. We're supporting major work in cochlear implants, which will be expanded to include hearing aid users. The Clearinghouse is proceding on schedule and is included in the contracts.

++

We have an opportunity to initiate a study of the efficacy of
Neo-natal hearing testing in collaboration with the Maternal and
Child Health (part of Public Health Service)

++ Would allow a small INTRAMURAL program to grow and expand ongoing activities-$5 million.

Expanded Funding would allow for the expansion of an Epidemiology Program initiated in FY'91 and a modest expansion of ongoing activities. It would also support a public education campaign to prevent noise-induced hearing loss.

THE NIDCD ADVISORY BOARD RECOMMENDS $201 MILLION FOR FY92 IN ORDER TO TAKE ADVANTAGE OF THE TREMENDOUS RESEARCH OPPORTUNITIES BEING PRESENTED TO US VIA THE DRAMATIC INCREASE IN APPLICATIONS. A SUBSTANTIAL INCREASE WOULD ALLOW NIDCD TO EXPAND ITS QUEST OF FINDING PREVENTIONS, CAUSES, AND CURES OF DEAFNESS AND OTHER COMMUNICATION DISORDERS FOR 48 MILLON AMERICANS.

Caitlin Hala Parton

Every child is different and special. This is certainly true of Caitlin. She contracted H-flu meningitis at the age of 23 months. As a result, Caitlin has a profound hearing loss. This experience turned our lives upside down, and mandated enormous change and challenge. Caitlin had been a verbally precocious child, and it made sense for us to commit all our resources and abilities to keeping her in a hearing and oral world.

Fortunately, we were introduced immediately to The New York League for the Hard of Hearing. At the age of 24 months, Caitlin had powerful hearing aids and had begun the rigorous schedule of attending six to eight hours of intensive hearing and speech therapy

a week.

She continues at the League, currently attending four hours of therapy a week. We are very involved with this wonderful organization and would come to your school with the full support and back-up help of their experience and services.

Due to the extent of Caitlin's hearing loss, she became a candidate for the new 22 channel cochlear implant. At the time of her surgery (January 1988), Caitlin was the 60th child and the youngest in the world to have this device implanted.

Choosing this option has made Caitlin a true pioneer, and it has brought dramatic results. She has surpassed everyone's expectations. She is the only child in the world to use the implant in combination with the FM hearing aid system. Essentially, her brain is synthesizing these two different codes. She likes wearing the devices and likes hearing.

She

Caitlin hears and understands speech, environmental sounds, music, and recently takes delight in talking to her grandparents on the telephone. Caitlin tells stories, and makes up songs. is expressive and wants to communicate. Her auditory perception augments excellent speech reading, age appropriate language skills, and her speech is intelligible.

Her

She is bright, disciplined, curious, and imaginative. concentration, bravery, and humor help her, and she makes continual Improvement. All the advice we've gotten indicates that she, as other hearing impaired children, do best in a nurturing situation of high expectations. She has been in mainstream preschool and camp situations from the onset of her hearing loss.

Caitlin is a happy child with a sense of humor and she loves to learn. Her major passions are books, more books, and art work. She enjoys fantasy play and the improvisational game that we've invented: "Uh-oh!", "Uh-oh what?" At which point, various imaginary heroes are confronted with great odds and we invent solutions.

During the past year, our family has experienced the loss of Caitlin's grandfather, a dear aunt, and her great grandmother. Caitlin had close, individual relationships with each, and saw them an average of once a week. During this difficult and sad period of illness and deaths, Caitlin struggled for her own comprehension of the experience, and she demonstrated unusual compassion and sensitivity to the myriad feelings and family dynamics. She gave comfort, and in her own way helped care for these ailing family members as well as the survivors. We think her art work is fabulous! Of course, we are objective parents. Caitlin's drawings show great detail, are often narrative and humorous. Drawing and painting provide her with another means to express her feelings and experience of life. Her self portraits usually include her hearing aids, which seems to indicate a comfort and acceptance of herself.

We see her artistic ability as one of her greatest strengths, and are eager to have her in a school offering opportunities to explore the visual arts by designating time, talented teachers, and facilities to this discipline.

Caitlin does best in small groups. Large groups or noisy clusters are more difficult and confusing. These situations (such as large playground games) are facilitated by someone explaining the rules or activity first. Caitlin's own creative remedy to these situations is to latch on to one or two children and create a situation easier for her to control i.e. initiate the game.

She is persistent, as well as stubborn.

She has great power

of concentration, and sometimes she is unwilling to move on to the next activity. She is fearless. She loves swimming, her new dance class, as well as climbing, hide-and-seek, and the whole gamut of vaguely terrifying playground activities.

Caitlin can be shy at times. Some visually engaging material usually helps to break the ice (book, crayons and paper, puppet). Since her initial day care experience (15-23 months), Caitlin has "checked out the scene" before entering.

Caitlin is used to hard work. She does not learn language by Osmosis. Listening is a conscious act that requires effort. (We are enclosing some notes from her speech therapist to her current teacher that may be useful for the interview.)