Sullivan Veterinary Clinic

This case study will consider the application of hybrid mediation, which is a combination of the civil and family models of mediation, relational mediation, and the wonders of working virtually on Zoom (video). We will look at how these processes operate with a vulnerable separating couple and their solicitors.

Figure: Roy F. SullivanThere is an elemental priority among the basic requirements for a successful hearing aid fitting: The instrument should be comfortable even when worn full-time. It should not feed back except in rare instances—if ever. It should be perceived as beneficial to hearing by both the wearer and significant others. The excellence of DSP programming notwithstanding, if the physical considerations intrinsic to satisfying criteria one and two are not attended to, criterion three will never be realized. Given the critical importance of a good physical fit, I scoured the Internet for a definitive site or sites on taking ear impressions and on making modifications to earmolds and hearing aid shells. Pickings were less fruitful than I had hoped. I could not locate a web site for NAEL (the National Association of Earmold Laboratories). Mik Major's (Microsonic) excellent Custom Earmold Manual is not available in a web-compatible format. With the exception of Westone, the earmold laboratories offered minimal or no professional-level advice on earmold design, earmold or shell modification, or impression-taking techniques. I also drew a blank visiting the non-protected web sites of a representative sample of major manufacturers of custom hearing instruments. A password-protected, professional-level probe of at least one major custom hearing instrument manufacturer also came up light. Paradoxically, that company (Starkey Labs) employs and sponsors the research and publications of the Internet's most prolific researcher on the topic, Chester Pirzanski. SOME USEFUL RESOURCES The Hearing Health Institute International site (www.educationservice.net) is devoted to online continuing education training for hearing professionals. Given the physical venue for on-site courses (Omni) and the ubiquity of the principal presenter (Pirzanski, once again), the not-so-hidden hand of Starkey's continuing education signature is evident. Three of the nine courses present substantial online material relevant to our selected topic. “Ear Impressions” contains extensive information, including sections on getting ready for impression taking, ear impression materials, methods of delivering impression material into the ear, and impression-taking techniques. “Ear Impressions: Does it matter how they are taken?” presents the results of a study by Pirzanski and Brenda Berge. “Earmolds: Are soft materials superior?,” a reprint from The Hearing Journal, discusses, among other topics, earmold materials and considerations for earmold selection. The Westone Laboratories site (www.westone.com/hhc) provides the most comprehensive online information of any of the earmold laboratories on the Internet. Noteworthy illustrated articles include: “Making a good impression,” with sections on non-vented dams, vented dams, impression materials, and impression tools; “Impression tips,” providing information in a Q & A format on earmold material selection. Emsee Canada (www.emsee.ca) provides an illustrated basic-level article, “Making a good impression.” Audiology Online (www.audiologyonline.com) reprints some relevant articles. A variation on the Pirzanski/Berge study, “Ear impressions: Art or science?” can be accessed directly via at: www.audiologyonline.com/audiology/newroot/pagebuilder/userpages/hrghealth/news/newsdisp.asp?newsid=2117. Access to other articles on the Audiology Online web site, requires a simple onsite registration. “Hot summers or thoughts on ear impression technique” by Pirzanski and Pete Russell provides an informal discussion on impression techniques. “Hearing aid physical fit: The next revolution,” by David Fabry discusses computer-assisted shell making. FOR CONSUMERS I discovered two consumer-oriented articles worthy of perusal. “Developments in research and technology: Earmolds” by Mark Ross is a high-level presentation for the layperson. You'll find it at www.hearingloss.org/html/ear_molds.html. “More than meets the ear: Understanding and optimizing your child's earmolds” by Brad Ingrao answers frequently asked questions. It's at www.bradingrao.com/articles.htm. Most custom hearing instrument manufacturers provide equipment-intensive, hands-on, continuing education courses on some of these topics at plant sites and, less frequently, at conventions. Given easy access to online audio and video Internet clients such as Real Audio/Video and Media Player, it would be easy for hearing aid and earmold manufacturers to mount dynamic training presentations as well as static illustrated articles. We could all benefit from refresher courses.

To describe the pool-raft recovery system protocol and to evaluate the clinical outcome in horses that underwent recovery from general anesthesia using this system. Retrospective study. 393 horses that underwent recovery from general anesthesia in the pool-raft system. Anesthetic records were examined from horses recovered from anesthesia in the pool-raft system between January 1984 and December 2000. Complete medical records of horses were examined when available. Information regarding the anesthetic and recovery period was recorded. Horses first recovered from general anesthesia in the pool-raft and, once awake, were transported to a recovery stall and lowered to the floor in a standing position. 351 horses underwent 1 pool-raft recovery, and 42 horses underwent multiple pool-raft recoveries. Most horses were recovered from general anesthesia within the pool-raft system to safeguard repair of a major orthopedic injury. During 471 pool-raft recoveries, 34 (7%) horses had complications within the recovery pool and 62 (13%) had complications within the recovery stall. Deaths resulted from complete failure of internal fixation, pulmonary dysfunction, or a combination of pulmonary dysfunction and fixation failure in 2% (10/471) of horses that underwent pool-raft recoveries. The pool-raft system is a good option for recovery from general anesthesia. Although not a fail-safe system, it appears to decrease the complications of recovering horses in a high-risk category. Potential disadvantages of this system are added expense and manpower necessary in building, maintenance, and usage, as well as size limitations of the raft itself.

The National Institute on Deafness and Other Communication Disorders (NIDCD) was established in 1988 as one of the components of the National Institutes of Health (NIH). Its charge includes the “…conduct and support [of]…research and …training in the normal and disorder processes of hearing, balance…[et al.] …disease prevention and health promotion…” Of particular interest to the hearing health professions are three sections of the NIDCD web site relevant to hearing. Material contained therein is applicable to parents, children, adults, and significant others concerning both the prevention and the treatment of hearing impairment. It also bears application in heightening primary-care physician awareness of the need to refer for hearing evaluation and treatment. Healthy Hearing 2010 is part of a federal public health campaign called Healthy People 2000 (http://web.health.gov/healthypeople/), “…dedicated to helping people improve and protect their hearing health.” Included are objectives, a reprint of the hearing-related sections of the HP2000 report, a limited calendar of events by date and state location, and guidelines and resources for conducting a hearing outreach program. Materials for public distribution include fact sheets on 16 different topics in .pdf format on topics including: hearing aids, hearing loss and older adults, tinnitus, noise, presbycusis, infant and child hearing, auditory processing disorders, cochlear implants, and balance disorders. There is a link to a Harvard web site on the genetics of deafness and an A.G. Bell document on classroom acoustics. The bibliography of 37 peer-reviewed research items is unfocused. Wise Ears! is a national campaign to prevent noise-induced hearing loss. Resources, some dynamic and interactive, are available for “kids and teachers,” parents, public, and media. Of special interest are the Macromedia Flash presentations for children, “Questions and Answers About Hearing,” “Interactive Sound Ruler,” “I Love What I Hear” activities, and “Ask the Scientist Q & A About Hearing.” There are also three QuickTime videos: “What Is Sound,” “How Loud Is Too Loud?,” and “Travel Inside the Ear.” Unfortunately, the video downloading process is somewhat convoluted. There is also a 10-item adult hearing self-check list and a sound meter interactive “thermometer” display. An annotated bibliography lists six NIOSH (National Institute of Occupational Safety and Health) documents. Health Information—Hearing and Balance presents online publications on the following topics: Acoustic Neurinoma and Neurofibromatosis, American Sign Language Quick Facts, Balance Disorders, Captions for Deaf and Hard-of-Hearing Viewers, Cochlear Implants, Cochlear Implants in Adults and Children: Consensus Statement, Communication Options for Children Who Are Deaf or Hard of Hearing, Early Hearing Screening: Consensus Statement, Facts About Telecommunication Relay Services, Has Your Baby's Hearing Been Screened, Hearing Aids, Hearing Loss in Older Adults, How Loud Is Loud? (in English and Spanish), Meniere's Disease (English and Spanish), Noise-Induced Hearing Loss, Noise and Hearing Loss: Consensus Statement, Otitis Media (Ear Infection), Otitis Media: Facts for Parents (English and Spanish), Otosclerosis, Presbycusis, Prevent Noise-Induced Hearing Loss (English and Spanish), Sudden Deafness: Quick Facts, Silence Isn't Always Golden (Hearing Speech and Language Problems in Children) (English, Spanish, and Vietnamese), Ten Ways to Recognize Hearing Loss (English and Spanish), The Noise in Your Ears: Facts about Tinnitus, Update: Tinnitus Research, Usher Syndrome, and Waardenburg Syndrome Quick Facts.FigureInternet-Based Directories lists 97 hearing organizations:18 balance organizations and 79 member organizations of the Wise Ears Coalition. SUMMARY The NIDCD web site (www.nidcd.nih.gov) provides reproducible educational resources for the patient, parent, and physician covering hearing evaluation, impairment, and treatment. Particularly noteworthy are the virtual brochures, “Hearing Aids” and “Hearing loss and Older Adults.” The materials are useful to both private and institutional hearing health practices.

Roy F. Sullivan, PhD, is a dispensing audiologist in private practice with his wife, speech pathologist Carol A. Sullivan, MS, at Sullivan & Sullivan, Inc., Garden City, NY. He is the author of numerous articles in the hearing health field, and ongoing author of Audiology Forum: Video Otoscopy (www.rcsullivan.com). Ear-relevant website URLs may be nominated for future NETSCOPE 2000 review by e-mail to: [email protected].