The first factor is clearly illustrated in the paragraphs on otosclerosis. Each sentence contains both "old" and "new" information. To begin a discourse, a writer must assume a certain common knowledge with his audience, for example that the audience shares the same language, that they can read the language, and that they have at least an elementary knowledge of the subject matter. Because a good writer has a specific audience in mind, he tailors his discourse to their level of understanding, giving background information as needed, using layman's language when possible, and defining technical terms at other times. See what the writer of this passage does.
The paragraphs we are looking at come from a chapter titled "When Hearing Fails." Within this chapter, the previous subtopic heading is "Many Causes, Many Cures" where the author discusses middle-ear infections and conduction deafness. So in the context of the current discussion under the subtopic "When the Stapes Freezes Tight," both middle-ear infectons and conduction deafness constitute old information. But the topic sentence of the first paragraph shown above not only refers to middle ear infections and conduction deafness, but also introduces a new technical word, "otosclerosis."
The author defines this word with a relative clause, calling it "a disease which has rendered some two-million Americans partially or totally deaf" (148). This general defintion constitutes the old information in the sentence. It is "old information" not because it has been mentioned previously, which is the usual case, but because it address the reader's shared common kowledge surrounding the concept of disease, placing the word in a context that eveyone can understand. The two sentences which follow relate still more general information about otosclerosis, effectively establishing it as an "old" concept to provide the starting point for the addition of new information in the next paragraph.
Therefore, the old information in the next topic sentence is the term "otosclerosis." The new information is that it is "a progressive disease." In the next sentence, the pronoun "it" is the shorthand reference to the old information, otosclerosis. The remainder of the sentence presents several new facts about the disease. Embedded in this new information is a second technical term, "stapes." The writer is quick to define this with an appositive, saying it is "the third of the chain of bones in the middle ear" (148). With the defintion given, the word then provides an old concept for the sentences in which it subsequently appears.
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Aside from middle-ear infection, the most common cause of conduction deafness is ostosclerosis, a disease which has rendered some two million Americans partially or totally deaf. It generally has its onset between the ages of 18 and 20, and it afflicts more women than men. Scientists do not yet know its cause, but suspect that it is associated with hereditary factors.
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