+---+-------------+--------------------------------------------------------+
| ! |             | **Healthy People 2010**                                |
| [ |             |                                                        |
| ] |             | **Focus Area Progress Review**                         |
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+---+-------------+--------------------------------------------------------+
|   |             | ### October 20, 2004                                   |
|   |             |                                                        |
|   |             | **1:00 p.m. - 2:30 p.m.**                              |
|   |             |                                                        |
|   |             | ### Hubert H. Humphrey Building, Room 729--G           |
+---+-------------+--------------------------------------------------------+
|   | ##          |                                                        |
+---+-------------+--------------------------------------------------------+

**Hearing Health**

**Goal:** Promote hearing health of the Nation through prevention, early
detection, treatment, and rehabilitation.

#### 

###### Number Objective Short Title

**Newborn Hearing Screening**

28-11 Newborn hearing screening, evaluation, and intervention

**Otitis Media**

28-12 Otitis Media in children

**Hearing Evaluation and Rehabilitation**

28-13 Rehabilitation − hearing aids, cochlear implants, assistive
listening devices

28-14 Regular hearing evaluations

28-15 Referral for audiologic evaluation

**Noise-Induced Hearing Loss**

28-16 Hearing protection

28-17 Noise-induced hearing loss in adolescents

28-18 Noise-induced hearing loss in adults

**Healthy People 2010**

##### Focus Area Progress Review

**Hearing Health Overview**

An estimated 28 million people in the United States have significant
hearing loss.^\[1\]^ Severe to profound hearing impairment or deafness
affects 500,000 to 750,000 Americans.^\[2\]^ No age or ethnic group can
escape the consequences of these life-altering conditions. Every year
numerous deaf or hearing-impaired newborns, children, teenagers, adults,
and older Americans must adjust their lives so they can successfully
live in a world that depends upon hearing.

Causes of deafness or hearing impairment include genetic, noise or
trauma, sensitivity to certain drugs or medications, aging, and viral or
bacterial infections. While hearing impairment can be the first sign of
an underlying life-threatening condition, deafness is typically not
fatal. The impact of hearing loss, however, needlessly reduces the
productivity and quality of life of those affected, as well as all of
society.

Deaf or hearing-impaired individuals can function with their hearing
peers, making untold contributions to the nation's economy and
well-being. However, the key to success for these individuals is early
identification, evaluation, and appropriate intervention and
rehabilitation.

**Newborn Hearing Screening**

Newborns can be easily and cost-effectively screened for hearing
impairment. Many states mandate that hospitals screen all children
before they are discharged from the newborn nursery or within the first
3 months of life. In the past, the average age of diagnosis of hearing
loss in infants and young children ranged from 14 months to around 3
years of age.^\[3\]^ This delay in diagnosis is significant in terms of
time lost during unique opportunities in brain development for language
acquisition, spoken or signed.^\[4\]^ To optimize this critical
intensive period of language development, intervention must start as
close to birth as possible, preferably before 6 months of age.^\[5\]^

The NIH convened a Consensus Development Conference on the Early
Identification of Hearing Impairment in Infants and Young Children in
1993.^\[4\]^ The consensus panel recommended the use of objective,
physiologic measures of hearing for all newborn infants before leaving
the nursery or at least by 1 month of age. The panel also recommended
that those infants who fail this first screening return for a
comprehensive audiologic evaluation before 3 months of age and that
intervention begin before 6 months of age for those with confirmed
hearing impairment. The panel rejected use of routine clinical
procedures (behavioral observation) as unreliable and judged universal
newborn hearing screening to be superior to the practice of screening
only infants identified through a high risk register, which identifies
at best half of the infants with hearing loss. The Joint Committee on
Infant Hearing Screening endorsed the goal of universal detection of
infants with hearing loss and encouraged continuing research and
development to improve methodologies for identification of and
intervention for hearing loss in its 1994 Position Statement.^\[6\]^
Subsequent research has shown that infants with hearing loss who receive
intervention before 6 months of age maintain language development,
commensurate with cognitive ability, through 5 years of age.^\[5\]^

The CDC Early Hearing Detection and Intervention (EHDI) program monitors
universal newborn hearing screening implementation in collaboration with
directors of speech and hearing programs in state health and welfare
agencies. EHDI reports that a total of 49 percent of hospitals and
birthing centers in 22 reporting states/areas screened their newborns
for hearing impairment in 1999.^\[7\]^ The screening program has grown
rapidly since then. The program increased to 52 reporting states/areas
with a total of 73 percent of hospitals or birthing centers performing
universal hearing screening by 2001.^\[7\]^

**Otitis Media**

One of the most common causes of hearing loss in the young child is
otitis media, an infection or inflammation of the middle ear. This
inflammation often begins when infections that cause sore throats,
colds, or other respiratory or breathing problems spread to the middle
ear. Otitis media accounted for 24.5 million visits to doctors' offices
in 1990^\[8\]^ and is the most frequent reason for taking children to
the emergency room.^\[9\]^ Also, it is the most frequent bacterial
infection of childhood and the most common indication for antimicrobial
therapy in children.^\[10\]^ Health care costs for otitis media in the
United States are 3 billion to 5 billion dollars per year.^\[11,12\]^

More than half of US children will have an episode of acute otitis media
before their first birthday, and 90 percent will have an episode by 5
years of age.^\[13,\ 14\]^ Furthermore, up to 7 percent of children less
than 3 years old will have surgical procedures, such as insertion of
tympanostomy ear tubes, for treatment or management of chronic otitis
media.^\[14-16\]^ In addition to the discomfort associated with ear
infections, there is the potential risk of more serious complications
such as mastoiditis and meningitis.^\[17,\ 18\]^ The temporary or
permanent reduction in hearing associated with otitis media can affect
children during the critical time for speech and language development
and may silently impede learning at school.^\[19\]^

The pathogenesis of otitis media is multifactorial, involving the immune
system, Eustachian tube dysfunction, viral and bacterial load, and
genetic and environmental factors. Observation without antibiotic
therapy (watchful waiting) is the first treatment choice for most
children with otitis media, but only if appropriate follow-up can be
assured. Antibiotics may be effective in children younger than 2 years
of age who have an accurate diagnosis of acute otitis media. Surgery may
be performed for frequent, recurrent acute otitis media and for
persistent or chronic otitis media with effusion, especially if
associated with hearing loss. Spontaneous resolution of the effusion
with recovery of hearing may occur. The recommended approach for surgery
is to start with tympanostomy tube placement, to be followed by
adenoidectomy if necessary. The ideal intervention for otitis media,
however, does not yet exist.

**Hearing Evaluation and Rehabilitation**

More and more Americans are experiencing a gradual reduction in hearing
during their adult years. Reports indicate that men are more frequently
affected in the 35- to 60-year-old age group now, as compared to
previous decades.^\[20\]^ Because the change is often gradual, few are
aware of the loss until it becomes difficult to manage.

Only 29 percent of adults 20 to 69 years of age have had their hearing
tested within the last five years.^\[21\]^ Regular hearing testing would
likely improve identification, intervention, productivity, and quality
of life for many Americans. The American Speech, Language and Hearing
Association (ASHA) recommends adult hearing screening at least every
decade until age 50, with more frequent monitoring after 50 years of
age.^\[22\]^

The nation's elderly are especially vulnerable to hearing impairment.
Presbycusis, the loss of hearing associated with aging, affects about 30
percent of adults who are age 65 years or older and about half of those
over age 75.^\[23,\ 24\]^ As the population ages and lives longer, the
number of people with hearing impairment will increase considerably. The
loss of hearing associated with aging usually affects the high frequency
sounds, the sounds necessary for understanding speech. The isolation
created by difficulty conversing with families and friends can be
enormous for individuals with hearing loss. Only 37 percent of Americans
age 70 years or older have had their hearing tested in the past five
years.^\[21\]^

Once hearing impairment is identified, the goal is to provide
appropriate treatment. Strategies for intervention or rehabilitation
depend upon the kind of hearing loss, age of onset, services available,
and family preferences. Treatment often includes mechanical devices,
such as hearing aids, cochlear implants, and augmentative and assistive
devices, designed to enhance residual hearing, allowing the individual
to function better in the hearing world. Unfortunately, only a small
number of adults with hearing impairment use these devices. In 1999 only
211 per 1,000 adults identified with hearing impairment ever used a
hearing aid and approximately 2 per 1,000 deaf or very hard-of-hearing
adults had a cochlear implant.^\[21\]^ It is likely that only about
one-fourth of persons 70 years of age and older who could benefit from a
hearing aid use one. Many who could benefit from assistive listening
devices, instruments that improve hearing in specific situations such as
talking on the telephone, do not know about or use these devices.

**Noise-Induced Hearing Loss**

Ten million Americans have permanent, irreversible hearing loss from
exposure to loud noise or sound.^\[25\]^ In addition, 30 million people
are estimated to be exposed to injurious levels of noise each
day.^\[26\]^ Noise-induced hearing loss (NIHL) is the second most
commonly reported occupational disease and is the most expensive
disability for military and federal workers' compensation.^\[26\]^

Noise-induced hearing loss is hearing loss caused by either a one-time
exposure to very loud sound or by repeated exposure to sounds at various
loudness levels over an extended period of time. Hearing loss may occur
as either temporary threshold shift (when hair cells in the inner ear
are able to recover) or, after a longer or more intense exposure, as
permanent damage from loss of hair cells in the inner ear. Tinnitus, or
ringing in the ears or head with no external source of sound, is a
symptom that frequently accompanies noise-induced damage to the hair
cells. Progression of hearing loss is related to noise level, proximity
of the harmful sound, time of exposure, and individual susceptibility.
Most NIHL can be prevented. Hearing protection devices such as ear plugs
or ear muffs are recommended when individuals are exposed to high noise
levels, whether at work or during leisure or recreational activities.
Prevention of NIHL is necessary for people both on and off the job.

**A. Public Health Application and Outreach: Translating Science into
Practice**

Scientific advancements are providing more knowledge than ever before
about hearing and hearing loss. For example, we understand more about
its genetic basis, ways to prevent its loss, methods to assess the
hearing of individuals of all ages and mental capacities, and we have
new ways to compensate for hearing once it is gone.

While research has produced impressive new understanding and technology,
hearing loss continues to decrease the quality of life for many. Hearing
disorders compromise social, emotional, educational, and vocational
aspects of an individual\'s life. The cost of these disorders in terms
of quality of life and unfulfilled potential is substantial. As
individuals live longer and the survival rate for medically fragile
infants improves, the number of people with hearing disorders will
continue to increase.

The National Institute on Deafness and Other Communication Disorders
(NIDCD) conducts and supports basic and clinical research and research
training in the normal and disordered processes of hearing and other
communication processes. NIDCD's research is motivated by intrinsic
scientific interest, which will translate into advances that allow
individuals to reach their full potential and contribute to the overall
health of the Nation.

  -------------------- --------------------------------------------------
  **Objective 28:11**  **Improve newborn hearing screening, follow-up
                       evaluation, and intervention**

  -------------------- --------------------------------------------------

Congenital hearing loss must be identified as close to birth as
possible, preferably within the first month of life. Early
identification will allow the start of intervention that will help the
child absorb language, whether spoken or signed, during the critical
time period when the brain is most capable of acquiring language.
Appropriate intervention can not begin until the extent and type of
hearing impairment is confirmed by a complete audiologic evaluation.
Because time is of the essence, this complete evaluation should be
accomplished no later than 3 months of age. Language intervention should
begin immediately thereafter, hopefully before the child is 6 months of
age.

In 2001, 46 states reported that 66 percent of their newborns had
hearing screening before 1 month of age.^\[21\]^ Also, 2001 data
gathered from 27 states revealed that 56 percent of infants who failed
their initial hearing screening went on to have a complete audiologic
evaluation before 3 months of age.^\[21\]^ Data from 10 reporting states
showed that 57 percent of infants with confirmed hearing loss in 2001
started an appropriate intervention program before age 6 months.^\[21\]^

**Challenges**

-   The goal of newborn hearing screening is to identify sensorineural
    hearing loss. Most neonates who fail hearing screening, however,
    have a conductive hearing loss resulting in a high false positive
    rate and costly follow-up diagnostic evaluation.

-   The potential impact of false positive results of hearing screening
    on parental anxiety and subsequent parent-child relationships is not
    fully known.

-   Follow-up evaluation of infants who fail initial hearing screening
    is still difficult to track and is lower than original expectations.

-   State budgets are getting tighter and keeping track of those who
    should come for follow-up examinations and, if appropriate, offered
    intervention services is a challenge.

-   The effects of universal genetic testing for hearing loss in
    newborns need to be scientifically assessed before implementation.

-   A well-defined, scientifically-based approach for the selection and
    fitting of hearing aids in infants and young children is needed.

**Strategies and Opportunities**

-   NIDCD-supported scientists continue to develop new tools and
    technologies for evaluating and modifying intervention programs in
    neonates.

-   NIDCD-supported scientists are evaluating new methods to improve
    current techniques for fitting hearing aids to infants and young
    children.

-   The Joint Committee on Infant Hearing Screening is meeting to
    consider developing new practice guidelines to supplement the
    training of pediatric audiologists involved in infant hearing
    screening, evaluation, and intervention programs.

-   The NIDCD Information Clearinghouse disseminates information
    promoting newborn hearing screening and appropriate intervention and
    follow-up.

  ------------------ ----------------------------------------------------
  **Objective        **Reduce the number of physician visits for otitis
  28:12**            media by children and adolescents under 18 years of
                     age**

  ------------------ ----------------------------------------------------

Otitis media, an infection or inflammation of the middle ear, is one of
the most common reasons for visits made by children and adolescents to
physicians, costing the US some 3 to 5 billion dollars annually
(accounting for as many as 30 million visits annually).^\[11,12\]^
Eighty--three percent of children experience at least one episode of
acute otitis media by their third birthday^\[13\]^ and it is the most
frequent reason for taking children to the emergency room.^\[9\]^

Public education can promote hearing health and behavior to reduce
hearing loss from conditions such as otitis media. However, we also need
to learn more about the factors underlying particularly vulnerable
children or populations. A recent scientific study reported a complex
genetic basis for susceptibility to otitis media.^\[27\]^

Otitis media occurs at a disproportionately high rate among Native
American children.^\[28-31\]^ Studies suggest that differences between
Native Americans and other Americans in the anatomy of the Eustachian
tube^\[32\]^ may contribute to the higher incidence of otitis media in
Native Americans. There may also be differences in the rate of otitis
media among various Native American tribes.^\[33\]^ Additionally,
Hispanic or Mexican-American school-age children have been found to
suffer from higher rates of otitis media with effusion compared to
non-Hispanic white and black children.^\[34,\ 35\]^

**Challenges**

-   Babies are at an unusually high risk for ear infections.

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-   Otitis media often occurs in children who have not yet developed
    speech and language making it difficult for parents to know when
    their child is suffering from an ear infection. Parents need to be
    aware of the various signs that may indicate otitis media and they
    should be encouraged to call their physician as soon as they notice
    any of the signs.

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-   Treatment options are varied, ranging from observation to
    antibiotics to surgery.

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-   There are a number of risk factors which may increase or reduce the
    risk of otitis media. We need to know more about predisposing
    factors, whether environmental or genetic.

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-   A severe or untreated ear infection can cause serious complications.

**Strategies and Opportunities**

-   The NIDCD supports research on otitis media to improve scientific
    understanding and to formulate more effective preventive strategies.

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-   The NIDCD published a program announcement in October 2002 calling
    for development of novel diagnostics for the identification of
    specific pathogens causing otitis media.

-   The NIDCD also published a Request for Applications (RFA) calling
    for research on specific pathogenic mechanisms that trigger otitis
    media, genomic approaches to the development of an otitis media
    vaccine and studies of genomic markers in individuals that might
    identify a predisposition to chronic otitis media infections.
    Several grants were funded in response to this RFA.

-   The NIDCD supports research to study the epidemiology of otitis
    media in Native Americans.

-   New clinical practice guidelines on the diagnosis and management of
    uncomplicated, acute otitis media in children from 2 months to 12
    years of age recommend observation (watchful waiting) without use of
    antibacterial agents if other appropriate conditions exist,
    depending upon diagnostic certainty, age, illness severity, and
    assurance of follow-up. The guidelines were written by a
    subcommittee representing the American Academy of Pediatrics and the
    American Academy of Family Physicians in partnership with the Agency
    for Healthcare Research and Quality.^\[36\]^ Implementation of these
    guidelines could significantly slow the evolution of drug-resistant
    strains of OM causing pathogens.

-   Vaccine development for otitis media is a high priority.
    Investigators funded by NIDCD and NIAID participated in a workshop
    in June 2004 to evaluate the status of vaccine development, identify
    obstacles to progress, and propose a plan of action. The summary of
    the workshop's recommendations has been submitted for publication to
    inform the research community with the intention of accelerating
    progress in vaccine development.

-   The recent discovery of bacterial biofilms, which remain in the
    middle ear space long after acute onset of otitis media, is
    providing new insight into the pathogenesis of chronic otitis media
    with persistent middle ear effusion and, eventually, should lead to
    new treatment options.

-   The NIDCD Information Clearinghouse disseminates information to help
    parents and care givers learn about otitis media including risk
    factors and symptoms.

  -------------------- --------------------------------------------------
  **Objective 28:13b** **Increase the number of people who are deaf or
                       very hard-of-hearing who use cochlear implants.**

  -------------------- --------------------------------------------------

Once hearing impairment is identified, the ultimate goal is to provide
the most appropriate treatment. That treatment often includes mechanical
devices designed to enhance or compensate for residual hearing, allowing
the individual to function better in the hearing world. One of those
devices is a cochlear implant, a small, complex electronic device that
can help provide a sense of sound to a person who is profoundly deaf or
severely hard-of-hearing. Part of the implant is surgically placed under
the skin behind the ear; the other part is implanted into the inner ear
or cochlea. Only a small number of adults with hearing impairment use
these devices.

In 1999 approximately 2 per 1,000 deaf or very hard-of-hearing adults
received a cochlear implant.^\[21\]^ The vast majority of deaf adults
with cochlear implants derive substantial benefit when the implant is
used in conjunction with speech reading. As a result of cochlear
implantation, many of these individuals are able to understand some
speech without speech reading, and some are able to communicate by
telephone. Benefits have also been observed in children, including those
who lost their hearing prelingually (before acquiring speech); moreover,
there is evidence that the benefits derived improve with continued use.
New speech-sound processing techniques continue to improve the
effectiveness of cochlear implants, increasing user performance over
time.

**Challenges**

-   It is difficult for parents of deaf infants to decide whether
    cochlear implantation is appropriate for their child.

-   It is difficult to predict which people will benefit greatly from
    cochlear implantation compared to others of the same age and similar
    clinical characteristics who will not fare as well.

-   Medicare for older adults and disabled persons and Medicaid for
    economically disadvantaged patients do not reimburse fully the cost
    of cochlear implants, resulting in disparities in healthcare access
    and utilization.

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-   The benefits of cochlear implantation in adults with lesser degrees
    of hearing loss are not fully known.

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-   Electrophysiological measures to improve fitting of existing and
    high-rate speech processors for young children and adults are still
    developing.

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-   The benefits of binaural (both ears) cochlear implantation are not
    fully known.

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-   The long-term effects of cochlear implantation in children and
    adults need further investigation.

**Strategies and Opportunities**

-   The NIDCD provides support for a number of studies of clinical
    outcomes research studying cochlear implants in children and adults.

-   The NIDCD supports research to improve cochlear implants.

-   Children with hearing loss face challenges learning to speak and
    interact with other people. Early identification of and appropriate
    intervention for children with hearing impairment leads to
    improvements in speech and language development in affected
    children, thereby improving the likelihood of positive social,
    emotional, cognitive, and academic development. With the interface
    of early identification and cochlear implants, children are
    receiving implantation at a much younger age, some as young as 18
    months of age. Generally, earlier implantation yields better
    outcomes.

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-   New short electrode technology promises greater benefit from
    cochlear implants. Scientists have developed a new shorter electrode
    to help an additional population of individuals with hearing loss,
    those who are unsuccessful hearing aid users. These individuals have
    a considerable amount of residual hearing and their primary hearing
    loss is in sounds in the high frequency range. The short electrode
    is inserted into the base of the cochlea to restore hearing at high
    frequencies, while preserving low frequency, or residual hearing, in
    the implanted ear.

-   A new treatment is being developed for deafness caused by
    Neurofibromatosis Type 2 (NF2 is a genetic disorder that causes
    deafness). For many individuals with NF2, surgical intervention is
    required to remove tumors, which involves resection of both acoustic
    nerves so that sound perception cannot be restored with cochlear
    implantation. To help these individuals, NIDCD is supporting
    research to develop a specialized auditory prosthesis for NF2
    patients. Multiple, ultraminiature microelectrodes are implanted
    directly into the cochlear nucleus in the brain to restore auditory
    perception. Evaluation with human subjects of this procedure has
    just begun.

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-   The NIDCD will work with the Healthcare Cost and Utilization Project
    and the National Health Interview Survey of the CDC to gather
    epidemiologic data regarding the use of cochlear implants.

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-   The NIDCD Information Clearinghouse disseminates public information
    about cochlear implants.

B. Reducing Hearing Health Disparities

In this age of information, the ability to hear is central to a
successful life for all Americans, and the labor force of the 21^st^
century will require intense use of communication skills that depend
upon hearing. America's population is diverse, composed of
cross-sections of the entire world. Every person of every age or ethnic
background is vulnerable to the ravages of deafness or impaired hearing.
The NIDCD devotes numerous resources to making Americans of all
backgrounds aware of proper hearing health and of available resources
for those with impaired hearing.

\*\*\*\*\*D. Research Needs and Opportunities for Eye Diseases and
Disorders\*\*\*\*\*\*

###### Challenges

-   Hispanic or Mexican-American school-age children suffer from higher
    rates of otitis media with effusion compared to non-Hispanic white
    and black children.^\[34,\ 35\]^

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-   Hearing health information is not always available to minority
    individuals and families.

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-   Decreased participation of women, disabled, and minority scientists
    exists in human communication research.

**Strategies and Opportunities**

-   The NIDCD is supporting development of a website to help parents,
    healthcare workers, daycare providers, educators, and other
    individuals and institutions as they make decisions about how best
    to help hearing impaired children. The site will address the needs
    of underserved children with hearing loss, including the rural poor,
    rural and inner-city minorities, young households, female-headed
    households, and other groups.

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-   The NIDCD continues to create initiatives for Hispanic/Latino/Latina
    individuals through participation with various Spanish language and
    Hispanic interest-meetings, exhibit opportunities, and collaborative
    efforts with the NIH Hispanic Communications Work Group that
    includes the Radio Unica/WalMart Hispanic Latino/Latina Health Fair
    series.

-   Most NIDCD health information materials are available in Spanish.

-   The NIDCD information for parents about early identification of
    hearing impairment is available in Spanish and Vietnamese.

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-   The NIDCD has implemented a student research trainee program in
    collaboration with the National Center on Minority Health and Health
    Disparities to recruit and retain individuals who are
    under-represented in the human communication sciences. Currently,
    students are selected from minority and majority institutions
    throughout the country to conduct research in cutting-edge NIDCD
    laboratory facilities. Since the program's initial class, 101
    participants have trained under the program.

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-   The NIDCD and Howard University's Graduate School joined an official
    partnership to increase the participation of minority faculty and
    graduate students in human communication research. Since the
    program's beginning, two graduate students have complemented their
    academic training by conducting research in NIDCD intramural
    research laboratories.

**C. Prevention, Early Detection, Treatment, and Rehabilitation of
Hearing Diseases and Disorders**

The NIDCD places high priority on the prevention of hearing loss and
other disorders of human communication. When prevention measures are
unknown, not utilized or fail, the earliest possible detection and
subsequent intervention will lead to the most successful adaptation to
life in the hearing world. The desired goal of all NIDCD basic and
clinical research is to improve the hearing health of the Nation through
identifying and implementing prevention strategies, early detection of
any degree of hearing loss, and improving and promoting treatment and
rehabilitation options.

###### Strategies and Opportunities

-   The NIDCD conducts and supports research and research training in
    normal and disordered processes of hearing and other disorders of
    human communication including genomic and proteomic approaches.
    Knowledge of these processes should aid preservation of hearing
    disorders as well as provide novel treatment approaches.

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-   The NIDCD has developed and distributes the program, "I Love What I
    Hear!" which teaches children in the 3^rd^ through 6^th^ grades
    about noise, the effects of noise on hearing and about hearing
    protection.

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-   The NIDCD Information Clearinghouse distributes information about
    the prevention, early detection, treatment and rehabilitation of
    hearing and hearing disorders.

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-   The NIDCD contributes to the Combined Health Information Database
    (CHID) which catalogues health information for the public.

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-   An education effort, [WISE EARS!]{.underline}^®^, has been launched
    by a coalition of government agencies headed by the NIDCD and the
    National Institute on Occupational Safety and Health (NIOSH) at the
    Centers for Disease Control and Prevention (CDC). They have joined
    with State agencies; some 70 public interest, advocacy, and patient
    organizations; businesses; industries; and unions as well as health
    professional organizations in a national effort to educate the
    public about ear defense. The education effort focuses both on the
    public, with special emphasis on children, and on the workforce and
    has important World Wide Web-based components.

######## Research Needs and Opportunities for Hearing Diseases and Disorders

Since its inception in 1988, NIDCD-supported scientists have made
remarkable progress in research on hearing and its disorders. This
progress was accelerated by related research supported by other
institutes at the NIH. This combined effort has provided the foundation
for current and future research to achieve the Institute's goal of
improving the lives of individuals with hearing loss and other
communication disorders. Despite these advances, more work needs to be
done.

With help from scientists and the public, the NIDCD has identified four
research areas that offer extraordinary research opportunities in the
field of human communication sciences:

I.  Determine the Molecular and Epidemiological Bases of Normal and
    Disordered Communication Processes

II. Study the Development, Deterioration, Regeneration and Plasticity of
    Processes Mediating Communication

III. Study Perceptual and Cognitive Processing in Normal and Disordered
     Communication

IV. Develop and Improve Devices, Pharmacologic Agents and Strategies for
    Habilitation and Rehabilitation of Human Communication Disorders

###### References

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