25 to 30 percent of these men have significant hearing losses, which means that the problem of man-hours mounts rapidly when you start paying for the cases who have hearing losses from the therapy standpoint.

Speaking as a physician-and I am a physician in this field-there are two types of hearing losses. One is the type which affects the canal which conducts the sound to the nerve part of the ear, and that is called conductive deafness, and then there is the nerve type deafness which affects the nerve transmission itself.

The conductive type is, in the main, provided it is found soon enough and something is done about it, amenable to treatment, to therapy of some kind or another-surgical, drugs, or medical management.

The nerve type of deafness is irrecoverable in spite of any treatment we know of today, and I can say, frankly, that at the present time there is no treatment available for deafness which is of the nerve type and, believe me, the nerve-type deafness is a considerable problem in the whole, particularly since we are getting to be a noisy civilization and causing considerably more deafness among workers. This problem is summarized by the fact that a company which we have been working with, where men who have worked in excess of 10 to 15 years at certain machines, have a relatively common incidence of certain loss of hearing. One hundred percent of these men that have worked in excess of that many years have a hearing loss. This 100 percent is not compensable, but if they go on continuing in this type of work for more than 20 or 25 years, all of them will be compensable.

Dr. HARDY. You mean if they continued at that noise level?

Dr. GLORIG. Yes, sir. Well, the noise level that I am talking about is not much louder than I am speaking at the moment. My voice, if it were measured at the moment, would probably be at the level of 80 or 85 decibels, and if we measured the noise in industry, it would run over 100 decibels and can go up as high as 135 or 140 decibels. If we get into the jet problem with industry, they go even higher.

Dr. HARDY. May I interrupt once more? There will be some comments from time to time in which this term "decibel" will be used. That is a physical measure of the ratio of sound intensity. It works in a logarithmic fashion. If you take 20 decibels and multiply it 10 times, the difference at a 100-decibel-noise factor in a factory is not a ratio of 10 to 120, but a ratio of 1 to 10, which is why, as these figures go up, the traumatic effect is that much more serious.

Dr. GLORIG. I think, then, our therapy for the type of disease we are talking about lends itself more to prevention of the disease, and we are in hopes, particularly the committee on conservation of hearing of the American Academy of Ophthalmology and Otolaryngology, during the preschool days at our baby clinics, of discovering the hearing losses at an early enough age where something can be done about it or prevent a hearing loss from occurring from the ordinary diseases that we see in preschool children.

In several of the States-and too few at the moment-they are having school surveys where every third or fourth year every child is tested to see whether or not his hearing has changed from the previous test. I suppose a relatively good educated guess would be that 1 out

of 5 children in the country is now receiving such a test, and this is a very poor percentage.

The public in general should have hearing tests. As a matter of fact, at this very moment there is such a testing situation going on in Alexandria, where the public-health people over there have set up a testing program once a year, and individuals come in and get all sorts of tests, and, thank goodness, hearing tests are among them, because I believe among the general public there is a lot of hearing loss which is not discovered until it is too late because they do not have hearing tests done as they would have blood-pressure tests or blood tests or any other kind of tests.

In industry at the present time we are trying to get them to employ preemployment and preplacement tests so that the individual who has normal hearing can be protected by wearing ear protection, and we feel if ear protection is instituted in industry to the degree which it should be, the same as glasses are for eye injuries in industry, we can prevent almost the entire industrial hearing-loss problem. It is just as simple as that, gentlemen. Once, however, this hearing loss has been attained or suffered, there is no cure for it.

As I am here to represent the American Hearing Society, a few figures about the society might be in order.

Our aim is conservation of hearing, and I think there is no better aim for a hearing society to have, because we as physicians are charged with the conservation of hearing.

The American Hearing Society has 115 chapters, and they have spent in 1952, including the national headquarters, about $950,000 on the problem of deafness. I prefer to call it hearing loss. About 60 percent of this is for diagnosis, care, rehabilitation, testing, and so forth. About 20 percent is for public education, and, believe me, I think perhaps if the figures were reversed you would get a better understanding. The public needs a lot of education regarding the hearing-loss problem. Twenty percent is for administrative problems.

To show you what is being done at the present time for the hearing-loss problem, the military, in the form of the Army, Navy, and Air Force, have combined with the National Research Council to form what is called a committee on hearing and bioacoustics. This committee is meeting today and is working primarily with the problem of hearing losses in the Armed Forces, but through its connection with the National Research Council and some of its civilian members we hope they will have a great effect on what is happening to the civilian hearing-loss problem as well.

The Army has done a great deal of research work-that is, the military forces, I should say. In the early years of the war and also the later years of the war this has been done. Most of this has been done on a normal hearing to determine how the hearing problem affects communities, and so forth. However, later during the war the Army led the field in the rehabilitation problem along with the Navy. I stated they rehabilitated some 12,000 men.

The Veterans' Administration at the present time has set up a very fine testing system, and they also have some very fine rehabilitation centers for their eligible individuals. They have set up a much better rating schedule for paying compensation, and this is a terrific problem. As a matter of fact, industry at the present time is wrestling

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 fosses 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 ís 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