T 



THE PREVENTION OF DEAFNESS 



HE WHITE HOUSE CONFERENCE Called by President Hoover in 1931, and 

 composed of public health officials, social workers, psychiatrists, those in- 

 terested in child labor, and members of other agencies dealing with the welfare 

 of children, estimated that three million school children in the United States 

 are handicapped by impaired hearing. This figure probably represents only 

 the more advanced cases. Our impression after seventeen years of study of the 

 causes and prevention of impaired hearing is that deafness is incipient in a 

 much greater number, and in many it will slowly progress and become a handi- 

 cap later in life unless something is done to correct the cause in the early stages 

 of the disease. Almost every variety of deafness in adults is also found in 

 children. Many types, such as otosclerosis, hereditary nerve deafness, Meniere's 

 disease, acoustic tumors, and developmental anomalies, cannot be helped by 

 operation or treatment, but in the large group caused by infections and me- 

 chanical interference with the function of the Eustachian tubes the progress 

 of the disease can be stopped and often the hearing can be restored, provided 

 the condition is recognized early and treatment instituted before the middle- 

 and inner-ear structures are damaged. After years of trial of the method used 

 in general pathology, namely, the correlation of clinical examinations and 

 functional tests with the gross and histologic appearance of the middle and 

 inner ear after death, my associates and I have become convinced that most of 

 the remedial kinds of deafness begin in childhood, and that to learn more 

 about causes, treatment, and prevention we must concentrate our studies on 

 living, grooving children. Deafness in adults is rarely cured, but it is truly 

 astounding hoAV often hearing can be restored in children under fourteen with 

 a middle-ear type of deafness severe enough to place them in a lip-reading class. 

 With the cooperation of the Baltimore Department of Health and Board of 

 Education we have examined for three successive years the hearing and upper 

 air passages of an unselected group of 1,365 school children between the ages 

 of eight and fourteen years. The hearing of each child has now been tested 

 from eight to ten times in sound-proof rooms, for all octaves from' 32 to 

 16,384 d.v. We were fortunate to have for this purpose audiometers built by 

 the Western Electric Company for research. Commercial audiometers are not 

 designed to test the frequencies above 8,000 d.v. and for this reason the fact 

 had not been previously observed that almost every variety of middle- as well 

 as inner-ear deafness begins with impaired hearing for the higher tones, and 

 progressi\'ely involves the lower tones and the speech range (250 to 3,500 d.v.). 

 In addition to the hearing tests, the tympanic membranes, nasal passages, 

 nasopharynx, and particularly the pharyngeal orifice of the Eustachian tubes 

 were examined with a nasopharyngoscope, which provides as clear a vicAV 

 of these regions as a cystoscope does of the interior of the bladder. All but a 

 small percentage of these 1.365 children were thought by their teachers and 



