With its vision--"No Filipino should be deprived of a functioning sense of hearing and balance"--the Institute extends its activities beyond clinical research. Since it is also connected with the Philippine General Hospital, the Institute offers services for the diagnosis and care of patients with hearing and balance problems. It takes pride in being one of the most comprehensive diagnostic centers in the country; it is even recognized internationally, being accredited by Hearing International, International Society of Audiology, and the International Federation of Otolaryngological Societies (HI-ISA-IFOS). Speech evaluation and therapy are also offered to patients who require them, in cooperation with the UP College of Allied Medical Professions.

    The medical staff connected with the Institute also provides quality care, performing such procedures as cochlear implantation, autologous ossicular replacement and tympanoplasty, skull-base surgery for acoustic neuroma and other tumors, and medical and surgical treatment for chronic ear infections.

    Training on various levels is offered at the Institute. Through UP Manila, the Institute offers training for medical students and residents as well as audiology technicians. It also has its master's program in audiology.

    Every year, the Institute conducts lectures and hands-on courses on a number of subjects--basic otology, temporal-bone dissection, vestibular rehabilitation, hearing rehabilitation, temporal-bone imaging, and others. Community-based training is also conducted for front-line health-care professionals and even teachers.

A nationwide screening for hearing

    But above all, the Institute is known for high-quality research, which has received various awards and is published in local and international journals (such as the Philippine Journal of Otorhinolaryngology-Head and Neck Surgery, Acta Otolaryngologica-Stockholm, and ORL: Journal for Oto-Rhino-Laryngology and Its Related Specialties).

    One of the immediate concerns of the Institute is to come up with studies that will make public officials in the country realize the importance of mandatory hearing screening. Abes said that in many developed countries, hearing screening is mandatory. "It's a program that should be done in all students," he said. However, there is no such program in the Philippines. "Probably you have gone through school and you have not gone through a hearing-screening procedure," he said.

    But there are challenges. For instance, the screening tools used in such countries as the United States are not available here, and are expensive. "To be able to advocate hearing screening for all grade-one students, at least, all over the country, we have to solve this problem," he pointed out.

    One of the solutions they came up with is to compare the use of a 512-hertz tuning fork with the screening and diagnostic audiometer in air-conduction tests. In the test spearheaded by Abes, the tuning fork was used thus: "[It was struck] against the ball of the opposite palm and placed six inches away from the external auditory meatus, [then] the qualitative responses of the subjects on the sounds (30- and 40-decibel sound pressure levels) heard on both ears were recorded."

    While the accuracy of the tuning fork in detecting hearing loss is high, whether at 40 decibels (97 percent v. 98 percent with the audiometer) or at 30 decibels (80 percent with the tuning fork v. 81 percent with the audiometer), "we found out that the sensitivity of the tuning fork is not that high," explained Abes. Therefore they decided to supplement the use of the tuning fork with ear examination.

    Obviously, specialists can't take up the task of conducting hearing screening by themselves. And so Abes and his colleagues are interested in teaching school nurses and teachers how to perform tests using the tuning fork and basic ear examinations. With the Department of Education, they have started training public-school nurses in a number of regions in the country.

    "They were very enthusiastic," said Abes. "For the first time they have found out that just by using the penlight, you could examine the ear, with correct technique." Now that the series of workshops is underway, a program to measure how effectively the nurses are conducting the tests is in the works.

    They also conducted a validation study for the use of a low-cost, collapsible, portable, sound-treated booth in hearing screening, which they developed in cooperation with the UP College of Engineering. Abes recalled: "One of the problems we envisioned in the schools, when we do hearing tests for children, is the lack of available and adequate environment to conduct…tests."

    The booth proved to serve its purpose, and the study won first prize at the NIH research-paper contest. The patent for the booth is pending, said Abes. They are willing to share the design with public schools that wish to construct their own booths, for free.

National data needed

    At present there are no definitive data on the extent of the problem of hearing loss in different population groups. Dr. Rina Reyes-Quintos, research fellow at the Institute, said some sources estimate the number of Filipinos "with significant hearing loss" at four million.

    What the Institute is working on is hold discussions with the National Statistics Office to provide questions specific to hearing in the national statistics surveys. Through the survey, they will be able to give more focus on their intervention efforts.

    Said Abes: "We need to come up, really, with relevant solutions to our hearing and balance problems. We do not want to be hampered by technological handicaps just to be able to pursue our [projects]." And given the amount of work the Institute is putting in and the kind of response that it is getting, its endeavors are definitely not falling on deaf ears.