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Published: April 15, 2008

A device, called the Lyric, is being used in only 500 patients, it appears to have overcome many of the problems associated with traditional hearing aids — without the expense and uncertainty of surgery and anesthesia.

The Lyric, made by InSound Medical of Newark, Calif., is hidden deep inside the ear canal, just four millimeters (about one-sixth of an inch) from the ear drum. While doctors for years have been implanting hearing devices in the middle ear, the Lyric is not an implant: it can be removed with a small magnet. It is worn 24 hours a day, and its batteries last one to four months.

Typically, anything that clogs the ear canal would trap moisture and pose an infection risk, but the Lyric is surrounded by a spongy material that allows moisture to escape. Because it sits so close to the ear drum, doctors say that it works more efficiently and that sounds are more natural because they don’t have to be amplified as much.

When the Lyric’s battery dies, the entire device is replaced. Patients do not pay for a new device every time; instead, they pay an annual subscription fee of $2,900 to $3,600 for both ears (less if the hearing loss is in only one ear). Insurance plans typically do not cover the cost of the Lyric, or any other hearing device.

A magnet is used to control the volume, turn it on and off and remove it when the battery runs out. It takes only a few minutes for a doctor to insert a replacement device.

The Lyric does not work for everyone. In particular, some ear canals are too narrow to accommodate it, and the company estimates that it is not suitable for up to half of potential patients. A planned newer version should work for about 85 percent of patients, it says.

Still, it is already getting an enthusiastic reception from patients and from hearing specialists not connected with the company. “There are a certain number of patients who just can’t get over having something in their ear, just as there are a certain number of patients who can’t wear contact lenses,” said Dr. Chester F. Griffiths, chairman of the department of surgery at the Santa Monica U.C.L.A. Medical Center. “But that’s the minority. The patients that have them love them.”

Dr. Griffiths says he has no financial ties to the Lyric, nor does he receive a commission for referring patients.

One patient who swears by the device is Mike Waufle, the 53-year-old him. Using a traditional hearing aid, he found it difficult to control his own voice.

“I teach a lot in a classroom as a coach, but when I would wear a hearing aid my voice pattern wasn’t very good,” he said. “It was all over the place. I just took it out most of the time. I missed an awful lot.”

As it happened, a team doctor was one of a handful of physicians test-marketing the Lyric, which has been available for about 16 months. Mr. Waufle tried it, and he says it has changed his life.

“My voice pattern is so natural, and I hear so much better,” he said. “Obviously, it’s easier to carry on normal conversations without having to always say, ‘Huh? What did you say?’ And it helps just enjoying life over all and being able to hear the simple things like birds and other sounds you take for granted.”

Mr. Waufle says he has no financial ties to the company and receives no benefit for talking about his experience with the device. (The company says none of the people featured in testimonials on its Web site, www.lyrichearing.com, receive any form of compensation for their endorsements.)

Right now, the Lyric is offered only through a dozen clinics in California, Florida and New Jersey, but it should be available at about 100 sites by the end of the year. Some patients who don’t live near a clinic simply fly or drive to a site four or five times a year. InSound is a privately held firm, although the pharmaceutical giant Johnson & Johnson is a major investor.

Dr. Robert A. Schindler, a co-founder of InSound and chairman emeritus of the department of otolaryngology at the University of California, San Francisco, says he has had hearing loss most of his life and has worn a Lyric since 2005. He says he remembers listening to an orchestra and hearing the light ping of the triangle.

“I realized I hadn’t heard it before,” he said. “That was a very exciting moment for me.”

“I’ve had a hearing problem for several years,” reports retired grocery executive Ken Fletcher. “I used to go into staff meetings and not be able to hear clearly, and it was very frustrating. “I wasn’t able to hear a lot of particular sounds,” he adds. “Sometimes it sounded like people were speaking a foreign language, where I could hear the sounds but couldn’t distinguish the words.” Ken searched for an answer, but without results. “I’ve been in and out of different hearing clinics and doctors’ offices in Texas, Virginia, and Florida,” he recalls. “I have a nerve type hearing loss, and there was nothing any of them could do. I never had any kind of hearing aids, because I was always told that hearing aids wouldn’t help me. It was very disheartening.”

The right solution

Ken finally found help when he consulted Jeffrey Clark, a certified clinical audiologist and founder of Physician’s Choice Hearing & Dizziness Center. “Hearing aids are so easy to use now and so much better than they have ever been before,” says Dr. Clark. “At Physician’s Choice we pride ourselves on offering the highest quality of care, professionalism, and products, and on ensuring patient satisfaction. ”Oticon hearing instruments proved the best choice for Ken. “Oticon provides revolutionary hearing devices specifically designed for people who find noisy situations challenging at work or when socializing,” explains Dr. Clark. “Never before has a device looked so good and had so much power to improve patients’ understanding in challenging noise environments. “The Oticon Delta fits about eighty percent of people, which is just phenomenal,” notes Dr. Clark. “I’ve been fitting hearing instruments for twelve years now and have never worked with a product that is so successful for so many patients.” “I’m finding that the Delta is what hearing aid wearers always hoped hearing aids would be,” adds certified clinical audiologist Scott Sims. “They put them on, other people don’t notice them, and they hear naturally.” The Delta is a tiny device that fits partly in the ear and partly on top of the ear, basically hidden by the ear. The high-tech triangular design propels hearing devices into the 21st century and sets a new standard for aesthetics, says Dr. Clark. “Speech comes through more clearly, whether someone is in a quiet or noisy environment. Artificial Intelligence inside Delta makes thousands of subtle digital adjustments every second to keep any listening experience clear and effortless.” “This device offers the most sophisticated sound processing technologies available today,” says Dr. Sims. “From advanced noise management to voice detection systems, Delta has all that’s necessary to help someone hear better in noise.”

“Absolutely wonderful”

Ken says his experience at Physician’s Choice was first rate from the first day. “The entire staff is exceptionally friendly,” he assures, “and they just bend over backwards to help you. I’ve never witnessed anything like it in any other hearing center I’ve visited. The place is just phenomenal.” And the results of his Oticon instruments surpassed his expectations. “It’s been three weeks since I got them, and I’m still euphoric,” marvels Ken. “I’m hearing sounds I haven’t heard in years. It’s wonderful.” Unexpected benefits for Ken. “I’ve had tinnitus [ringing in the ears] for over twenty years, and that can drive you crazy. I was also having dizzy spells. Since I’ve gotten my hearing aids, all that has stopped! “I just can’t say enough about how absolutely wonderful these hearing aids are.” FHCN–Michael J. Sahno

Tinnitus Desensitization Treatment Shows Promising Clinical Data

An FDA-cleared, noninvasive treatment approach that utilizes neural stimulation to desensitize patients to the disturbing impact of tinnitus has achieved consistently positive results in a controlled clinical study in Australia. "In setting up this study we sought to set a much higher hurdle for a clinical success than others have done in the past," said Peter J. Hanley, PhD, CEO of the Australian entity Neuromonics.

Two prior clinical trials for this approach have been conducted in the last decade. "What was pleasing in the third trial was to see an even quicker benefit and even more significant outcomes," said Dr. Hanley. "We set our benchmark for success at an improvement of at least 40 percent in tinnitus disturbance, and over 90 percent of the patients met or exceeded that hurdle after 6 months."1

The device and treatment, called the Neuromonics Tinnitus Treatment, combines the novel use of acoustic stimulation with a structured program of counseling. The distinctive acoustic component provides stimulation to auditory pathways deprived by hearing loss, engages positively with the limbic system, and allows intermittent, momentary tinnitus perception within a pleasant and relaxing listening experience, thereby facilitating desensitization to the tinnitus signal. By gradually breaking down the patient’s ability to detect the tinnitus, the amount of sound needed to cover up the tinnitus lessens over time. Patients become progressively less aware of and less disturbed by their tinnitus.

In the clinical trial, 35 subjects with predominantly moderate-to-severe tinnitus related distress were randomly assigned to one of two treatment groups, corresponding to two stage-based variations of the treatment. In the first group, subjects were exposed to intermittent tinnitus perception throughout the six-month treatment program; in the second group, subjects’ tinnitus perception was completely covered up for the first two months and then only intermittently covered for the remaining four months of treatment.

After initial assessment and instructions, participants were given a personal sound player with earphones and an acoustic stimulus that was customized for their individual audiometric profile. Patients were instructed to use the instrument for at least two hours per day. At two, four, six, and 12 months after beginning treatment, both groups displayed clinically and statistically significant improvements in tinnitus disturbance, awareness, and minimum masking levels, as well as loudness discomfort levels. The Tinnitus Reaction Questionnaire (TRQ), comprised of 26 questions regarding the impact of tinnitus on the subject’s quality of life, was the primary measurement tool used in the trial (Figure 1).

"In our study there was a quite a significant early benefit from the treatment, which happened in the first couple of months," said Dr. Hanley. "Other treatment modalities that have been available for some time, which are heavily counseling-intensive, set the expectation of a year and a half to two years before the patient experiences significant benefit."

There were good rates of acceptability, convenience, and ease of use for the patients. "More than 95 percent rated those questions positively in our treatment review survey," Dr. Hanley said. "That has a major bearing on the relationship between the clinician and the patient." He added that this is also a time-efficient treatment that can be viably integrated into a physician’s practice (Figure 2).

Clinical outcomes were found to be related to the level of usage of the acoustic stimulus. "One of the most striking results in the third trial was the dosage effect that we found," said Dr. Hanley. "There was a strong relationship between the hours of usage per day—that is, the amount of the therapeutic agent that the patients receive— and the speed and consistency with which the benefits were reported."

Furthermore, in the version of the technology that is being employed since the time of the third trial, a dosage meter can now be used to record patients’ usage."We are seeing highly compliant usage, and that’s another big point of distinction compared with [other] treatment options," he said.

Neuromonics in Practice
Jack A. Shohet, MD, otologist-neurotologist in the solo practice of Shohet Ear Associates in Newport Beach, CA, has been using the treatment with a number of his patients for the last year. His patients have had a variety of responses but they are mostly favorable. "There are some patients who feel an instant relief the minute they put the device on their ears," he said, "but that’s certainly the exception rather than the rule. Others experience that their tinnitus awareness and disturbance are slowly improving. And some patients don’t realize the improvement until we point out how they were at the very beginning of the treatment plan."

Dr. Shohet appreciates the approach’s well-defined treatment protocol that gives the patient control. "We have a limited armamentarium for the treatment for tinnitus," he said. "Many of these patients are looking for something they can do, and for a lot of them, having the feeling that they are doing something for their disease process, in and of itself is a benefit." Dr. Shohet emphasizes that the first step in treating tinnitus is identifying the origin of the tinnitus and treating any medically or surgically treatable cause. After that, patients need to address lifestyle issues that affect their tinnitus. "I call them the avoidance factors: avoid stress, fatigue, caffeine, and other loud noises," he said. "And for anyone who has a hearing loss, we get them into a hearing instrument. If all those things fail,we typically will go to our Neuromonics [approach], and in our practice that is a pretty significant proportion [of patients]." Because of the fluctuating nature and intensity of their tinnitus, patients with Ménière’s disease and cochlear hydrops are not ordinarily good candidates for this treatment, although some inpatients in a nonacute phase of their symptomology have experienced some success. Other patients who would be considered poor candidates for the treatment are those who would have trouble self-administering it.

"Any new treatment for tinnitus deserves some healthy skepticism," said Dr. Shohet. "There have been a lot of things that have come up in the past that have been touted as the next greatest thing for tinnitus and in the end it hasn’t turned out to be much better than a placebo," he said. "It is possible that with further studies we may find this instrument’s place in our armamentarium, but so far our early experience has been favorable."

Jack J. Wazen,MD, Director of Research at the Silverstein Institute in Sarasota,FL, helped lead the planning phase for the US trial, which is slated to enroll approximately 100 patients. Dr. Wazen, the first research fellow at the Silverstein Institute and now a partner in that practice, left Sarasota in 1983 and worked as a researcher, professor, and practitioner with Columbia University Presbyterian Medical Center in New York. "Because of my academic background and interest in research, Neuromonics approached me and asked if I wanted to participate in coordinating a national research protocol," he said. Approval of that protocol is imminent.

Because tinnitus is not one disorder, different people may react differently to various treatments. "One of the fallacies is that there is going to be a cure for tinnitus," said Dr. Wazen. "There may be a cure for a certain type of tinnitus that may not work for others. The advantage of the Neuromonics device is that it works on what all types of tinnitus have in common: the brain."

Because the treatment works to dissociate the sound the patient hears from the rest of emotional consciousness, he said, "although the patient may still hear the sound, it is not depressing, it is not aggravating, it is not causing anxiety."

To Dr. Wazen, the principle of the Neuromonics treatment is attractive because dissociating the tinnitus from the rest of the patient’s brain activity would mean that patients can continue thinking, working, and enjoying their lives while their tinnitus is in their subconscious. "That’s a big step in the right direction," he said (Figure 3). Being cautious about what to tell patients is important to symptom management. "What I tell my colleagues and particularly my patients is, ‘Although you may have heard and read that there is no cure for tinnitus, you should not assume every tinnitus is from the same reason.’" Dr. Wazen said. "I want to make sure this tinnitus is not due to a tumor, like an acoustic neuroma, or other treatable conditions," he continued. Until a more definitive procedure or treatment is discovered, he added, "we can now still tell our patients, ‘We have different treatment protocols you can consider—medications and instruments—which could reduce the impact of tinnitus and have you live with it in a better state of mind.’ "Although so-called answers for treating tinnitus have come and gone, this is something that does make sense," said Dr. Wazen. He is hopeful that his investigative team will be able to duplicate the good results of the Australian studies. "Then patients become advocates for this technology," he said, "and the patient would be the best example to other patients."

Reference
1. Davis PB, Paki B, Hanley PJ. Neuromonics Tinnitus Treatment: third clinical trial. Ear Hear 2007; 28 (2):242–59.

Comment by Dr. Sims:

"The theories behind the Neuromonics treatment approach make sense. In practice, we have had positive results with this treatment. I am excited to have the Neuromonics treatment approach available as an option to treat tinnitus."

What the ADA does

• The ADA prohibits discrimination against people with disabilities in all employment practices including job application procedures, hiring, firing, advancement, compensation, and training. In addition, the ADA protects other terms, conditions, and privileges of employment such as recruitment, advertising, tenure, layoff, leave, and fringe benefits.
• The ADA requires that employers make reasonable accommodation . A reasonable accommodation can be any modification or adjustment to a job or work environment that will enable an employee with a disability to perform essential job functions. Essential job functions involve those duties and assignments that an employee is actually required to perform, where its omission would fundamentally change the job and where no other employee can provide this function. Reasonable accommodations may include use of a text telephone (TTY), amplified telephone, notetaker, augmentative or alternative communication device, or the services of a sign language interpreter. Restructuring a job (redistributing marginal functions of jobs), modifying work schedules, providing flexible leave policies, and adapting training materials are other means of reasonable accommodation. Accommodations also may be necessary for the employee to enjoy other employee activities and benefits, for example, holding office parties in an accessible location. The employer must also make reasonable accommodation for job applicants during the interview process.
• ADA protects the employee/applicant from expenses associated with providing a reasonable accommodation. For example, the use of the services of a sign language interpreter cannot be billed to the employee. Nor can the employee’s salary be reduced to cover these costs.
• The ADA prohibits employers from asking questions about the nature or severity of the person’s disability on the application form or during the interview. The employer can ask applicants how they would perform certain tasks (with or without an accommodation). A medical evaluation may also be required as part of a conditional job offer but only if all job applicants are asked to do so. Questions regarding how attendance might be affected by a disability may not be asked. However, an employer may provide information on regular work hours, leave policies, and special attendance needs, and ask if the applicant can meet these requirements.

What the ADA does not do

• The ADA does not obligate an employer to provide a reasonable accommodation that will result in undue hardship (requiring significant difficulty; disruption to work schedules, environment, etc; and/or expense) or will fundamentally alter the business. *
• The ADA does not require the employer to provide a personally prescribed device such as a hearing aid or eyeglasses. However, providing such a device may be the most cost-effective accommodation in some cases. *
• The ADA does not obligate the employer to hire a job applicant whose communication disability poses a direct threat to the health or safety of that person or others. For example, if an individual with a hearing loss is unable to hear an essential alarm/alert device and no accommodation is appropriate, the employer is not obligated to hire this job applicant.

If you think that you have been discriminated against in employment on the basis of your communication disability or if you want further information about ADA requirements affecting employment, contact:

Equal Employment Opportunity Commission
1801 L Street, NW Washington, DC 20507
(800) 669-3362 (voice) (800) 800-3302 (TT)

Source: This important information was obtained from Medline Plus (a service of the U.S. NATIONAL LIBRARY OF MEDICINE and the NATIONAL INSTITUTES OF HEALTH) through the following link to the AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION’S

web site: http://www.asha.org/public/outreach/take-action/Employment+Rights.htm

Further information can be obtained from the ADA Homepage: http://www.ada.gov/

Negley C., Katbamna B., Crumpton T., Lawson G., (2007). Effects of cigarette smoking on distortion product Otoacoustic emissions. J Am Acad Audiol 18: 665-674.

The U.S. Food and Drug Administration has approved labeling changes for erectile dysfunction (ED) drugs in the class that includes Cialis, Levitra, and Viagra, to display more prominently the potential risk of sudden hearing loss, and to guide consumers on what to do if they experience sudden problems with their hearing.

In addition, the FDA plans to require the same changes in labeling for the drug Revatio, also a member of this drug class known as phosphodiesterase type 5 (PDE5) inhibitors. Revatio is used to treat pulmonary arterial hypertension (PAH). PAH is a serious medical condition in which continuous high blood pressure in arteries of the lungs weakens the heart muscle and often leads to right heart failure and death.

The FDA asked manufacturers of these drugs to revise product labeling after a very small number of patients taking the PDE5 inhibitors reported sudden hearing loss, sometimes accompanied by ringing in the ears and dizziness. “

Because some level of hearing loss is usually associated with the aging process, patients on these drugs may not think to talk to their doctor about it,” said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer, and acting director of its Center for Drug Evaluation and Research.

Patients taking Cialis, Levitra, or Viagra who experience sudden hearing loss should immediately stop taking the drug and seek prompt medical attention. Those using Revatio should continue taking their medication but should contact their health care provider for further evaluation. Because Revatio is used to treat a potentially life-threatening condition, the FDA does not recommend patients abruptly stop taking this medication but should consult their physician if they experience sudden problems with their hearing.

A case report in the April 2007 issue of the Journal of Laryngology & Otology involving sudden hearing loss in a man taking Viagra prompted the FDA to search the FDA’s Adverse Events Reporting System for instances of hearing loss and PDE5 inhibitors. The FDA found a total of 29 postmarketing reports of sudden hearing loss, both with and without accompanying ringing in the ears, vertigo, or dizziness. In most of the cases, the hearing loss involved one ear. The hearing loss was either a partial or complete loss of usual hearing. In approximately one third of cases, the event was temporary. In the remainder, the hearing loss was ongoing at the time of the report or the final outcome was not described.

Although no causal relationship has been demonstrated, the strong relationship between the use of these drugs and sudden hearing loss in these cases warrants revisions to the product labeling for this drug class.

Product Web sites, marketing and educational materials, and advertisements for PDE5 inhibitors will reflect the revised product labeling. The label revisions can be viewed at: www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm.

For more information:

http://www.fda.gov/cder/drug/infopage/ed_drugs/QA.htm

Brain scientists at Johns Hopkins have discovered how cells in the developing ear make their own noise, long before the ear is able to detect sound around them. The finding, reported in this week’s Nature, helps to explain how the developing auditory system generates brain activity in the absence of sound. It also may explain why people sometimes experience tinnitus and hear sounds that seem to come from nowhere.

The research team made their discovery while studying the properties of non-nerve cells in the ears of young rats. These so-called support cells were thought to be silent bystanders not directly involved in nerve communication. However, to the researchers’ surprise, these cells showed robust electrical activity, similar to nerve cells. Further, this activity occurred spontaneously, without sound or any external stimulus.

“It’s long been thought that nerve cells that connect auditory organs to the brain need to experience sound or other nerve activity to find their way to the part of the brain responsible for processing sound,” says the study’s lead author, Dwight Bergles, Ph.D., an associate professor of neuroscience at Hopkins. “So when we saw that these supporting cells could generate their own electrical activity, we suspected they might somehow be involved in triggering the activity required for proper nerve wiring.”

To figure out how these cells were generating electrical pulses, Bergles’ team suspected that a chemical might be involved; so they applied a number of different candidate drugs and chemicals to the developing cochlea — the small, hollow and liquid-filled chamber in the inner ear that converts sound waves to electrical signals — hoping to block the mystery trigger. The few drugs that altered the electrical output all disabled ATP (adenosine triphosphate), a chemical most often used as a cell’s energy currency but also, as in this case, as a signal to communicate with other cells.

According to Bergles, a breakthrough came when it was discovered that ATP also caused the supporting cells to change their shape. By simply videotaping the developing cochlea, the team was able to monitor where and when ATP was released. After studying these movies, they found that ATP was being released near hair cells, the cells that are responsible for transferring sound information to auditory nerves. It was known that hair cells have receptors for ATP, so they might also be affected by the ATP released from the supporting cells. Indeed, the team found that hair cells also showed spontaneous electrical activity, which occurred at the same time as the responses in neighboring support cells and was blocked by drugs that block ATP receptors.

In a domino-like effect, ATP then signals the hair cells to release another chemical, glutamate, which then activates the nerve cells that project into the brain. “It is as if ATP substitutes for sound when the ear is still immature and physically incapable of detecting sound,” says Bergles, adding that “the cells we have been studying seem to be warming up the machinery that will later be used to transmit sound signals to the brain.”

“We think that only a few cells release ATP at one time,” says Bergles. “And that small amount of free-floating ATP then activates only a few nearby hair cells.” This may help associated nerve cells, far away in the depths of the brain, figure out who and where their neighbors are.
Bergles acknowledges that his experiments beg the question of why a human or any animal would need to “hear” before birth. He speculates that the ability to hear subtle differences, like the inflection in one’s voice, “requires a lot of fine-tuning based on where in the brain the nerves connect. It could be that brief bursts of electrical activity in just a few nerve cells at a time help do that fine-tuning so the system works well.”

While this activity likely is essential for the auditory system’s proper development, it could be bad in the adult, mature nervous system as it would trigger electrical signals in the absence of sound. However, as the ear matures during the first two weeks of a rat’s life, most of the cells that release ATP disappear so that by the time the rat can hear sound, all the spontaneous electrical activity in its ears has stopped.

Although there is no ATP floating around at that point, the hair cells continue to be able to respond to it, and injury to the cochlea can trigger the release of ATP. Bergles suspects that “if ATP were released by the remaining support cells, it may cause the sensation of sound when there is none,” a condition known as tinnitus or ringing in the ears. Alternatively, he notes that bursts of activity might trigger changes in the connectivity of neurons in the brain, just like it does during development, eventually leading to abnormal activity that is perceived as sound.

The research was funded by the National Institutes of Health.

Source: http://www.hopkinsmedicine.org/Press_releases/2007/10_31_07.html

Comment by Dr. Sims :

Dr. Bergles and his team appear to have discovered an important tinnitus clue. Further research is needed to determine if hair cell injuries like excessive noise exposure and ototoxic medications can cause the release of ATP, triggering the neurological changes that lead to tinnitus.

Waltham, MA–A new Brandeis University study of twins shows that genes play a significant role in the level of hearing loss that often appears in late middle age. The research, in the Journal of Gerontology: Medical Sciences, examined genetic and environmental factors affecting hearing loss in the frequency range of speech recognition.

“This research confirms the importance of genetic factors in age-associated hearing loss, and the need for vulnerable individuals and their families to take extra care to prevent further hearing damage,” said lead author Brandeis neuroscientist Arthur Wingfield.

The research suggests that middle-aged and older people with a genetic vulnerability to hearing loss should be particularly careful about environmental risk factors such as harmful noise and medications whose side-effects could be detrimental to hearing.

The study examined 179 identical and 150 fraternal male twin pairs, ranging in age from 52 to 60 years, as part of the Viet Nam Era Twin Study of Aging (VETSA). About two-thirds of the hearing loss in the individual subjects’ better ears could be accounted for by genetic factors. In the subjects’ poorer ears, about one-half of the hearing loss was due to genes, the study concluded.

Wingfield, an expert on the relationship between memory performance and hearing loss in older adults, said that even mild hearing loss can indirectly lead to declines in cognitive performance because intellectual energy normally reserved for higher-level comprehension must be directed toward perceptual effort for accurately hearing speech.

Hearing loss is the third most common chronic disability among older adults after arthritis and hypertension.

Taken from: http://my.brandeis.edu/news/item?news%5fitem%5fid=11976&show%5frelease%5fdate=1