Otometrics Madsen A450 audiometer Reference Manual

Otometrics Madsen A450

Reference Manual

Doc. No.7-50-1840-EN/01

Part No.7-50-18400-EN

Copyright notice

The manufacturer authorizes GN Otometrics A/S to publish manuals approved and released by the manufacturer.

© 2017, 2017 GN Otometrics A/S. All rights reserved. ® Otometrics, the Otometrics Icon, AURICAL, MADSEN, ICS and HORTMANN are registered trademarks of GN Otometrics A/S in the U.S.A. and/or other countries.

Version release date

2017-03-20 (153952)

Technical support

Please contact your supplier.

2

Otometrics - Otometrics Madsen A450

Table of Contents

1

Introduction to Otometrics Madsen A450

1.1

The OTOsuite Audiometry Module

1.1.1 NOAH

1.2

Intended use

1.3

About this manual

1.4

Typographical conventions

1.4.1 Navigation

2

Navigating in the OTOsuite Audiometry module

2.1

The Audiometry module main window

2.2

Toolbar icons and menus

2.2.1 File menu

2.2.2 Edit menu

2.2.3 View menu

2.2.4 Measurement menu

2.2.5 Tools menu

2.3

The Patient Responder indicator

2.4

The Masking Assistant

2.5

The control panel

2.6

The stimulus bar

2.6.1 Test controls

2.6.2 The Tone stimulus bar

2.6.3 The Speech stimulus bar

2.7

The Tone test screen

2.7.1 The work area in the Tone screen

2.7.2 The audiogram

2.7.3 Curves and symbols selection

2.7.3.1 Selecting a symbol or curve

2.7.3.2 Creating new symbols

2.7.4 Compare audiograms

2.7.5 Tone feature boxes

2.7.6 Tone editing options

2.8

Work-flow related features

2.8.1 Selecting orientation

2.8.2 Automatic frequency/level shift when storing

2.8.3 Stimulus duration

2.8.4 Ear shift frequency and level setting

2.8.5 Saving non-stimulus channel as masking

2.9

The Speech test screen

2.9.1 Creating and editing the speech test table

2.9.2 Selecting word or phoneme scoring

2.9.3 Selecting speech stimulus

2.9.4 Scoring words using integrated OTOsuite speech material

2.9.5 Scoring words using external sound source

2.9.6 Scoring phonemes using integrated OTOsuite speech material

2.9.7 Scoring phonemes using external sound source

2.9.8 Saving source levels for speech material

2.9.9 Speech editing options - tabular view

2.9.10 Storing SNR for Speech testing


31

31

32

32

28

28

30

31

24

26

26

27

23

23

24

24

14

16

21

22

12

13

14

14

10

10

11

11

12

38

40

42

43

32

33

34

34

44

45

46

47

8

8

9

6

6

7

8

3

4

2.9.11 Speech feature boxes

2.9.12 Terms and abbreviations used in Speech testing

2.10 Special tests

2.10.1 Available special tests

2.10.2 SISI (Short Increment Sensitivity Index)

2.10.2.1 Navigating in SISI

2.10.2.2 The test process - SISI

2.10.3 ABLB (Alternate Binaural Loudness Balance)

2.10.3.1 Navigating in ABLB

2.10.3.2 The test process

2.11 Test controls (keyboard, mouse)

2.11.1 PC keyboard controls

3

Preparing for testing

3.1

Preparing the test environment

3.2

Preparing the test equipment

3.3

Listening check

4

Preparing the client

4.1

Hygienic precautions

4.2

Inspecting the client’s ear(s)

4.3

Proper transducer placement

5

Examples of audiometric testing

5.1

Testing the older child or adult patient

5.1.1 Assessing pure tone threshold using the Hughson/Westlake procedure

5.1.2 Assessing pure tone or speech most comfortable loudness level (MCL)

5.1.3 Assessing pure tone or speech uncomfortable loudness level (UCL)

5.1.4 Assessing speech reception threshold (SRT) using the Hughson/Westlake procedure

5.1.5 Assessing word recognition score

5.2

Special Tests

5.2.1 Performing Tone Decay using the Modified Carhart Method

5.2.2 Performing a pure tone Stenger

5.2.3 Performing speech Stenger

5.2.4 Performing Weber

5.2.5 Performing Rinne

5.2.6 Performing Alternate Binaural Loudness Balancing (ABLB) test

5.2.7 Performing Short Increment Sensitivity Index (SISI) test

5.3

Testing with sound files

5.3.1 Playing sound files without word lists

5.3.2 Playing sound files with word lists

6

Unpacking and installing

6.1

Requirements to the location

6.1.1 Requirements to noise in the test environment

6.2

Unpacking

6.3

Storing

6.4

Views of Otometrics Madsen A450

6.5

Otometrics Madsen A450 connection panel

6.6

Assembling Otometrics Madsen A450

6.7

Desktop or wall-mount installation

6.8

Connecting accessories and PC to Otometrics Madsen A450

6.9

Powering Otometrics Madsen A450

58

58

58

58

56

56

56

57

49

49

51

52

47

48

48

48

52

55

55

55

65

66

66

67

63

64

64

65

67

67

61

62

62

63

60

60

60

61

70

73

73

74

74

69

69

69

70

70

70


7

Configuring the Audiometry Module

8

Communicating with the device

8.1

Reconnecting to the device

8.2

Updating device firmware

9

Maintenance and calibration

9.1

Service and repair

9.1.1 Fuses

9.2

Maintenance

9.3

Cleaning

9.4

Calibration

10 Troubleshooting

10.1 Powering

10.2 Software/device communication

11 Standards and Safety

11.1 Otometrics Madsen A450

11.2 Warning notes

11.2.1 Connector warning notes

11.2.2 General warning notes

11.3 The OTOsuite Audiometry Module

12 Technical specifications

12.1 Accessories

12.2 Notes on EMC (Electromagnetic Compatibility)

13 Manufacturer

13.1 Responsibility of the manufacturer

Index

79

79

79

79

79

80

81

81

81

76

78

78

78

98

98

99

82

83

85

82

82

82

86

94

94

Otometrics - Otometrics Madsen A450 5

6

1 Introduction to Otometrics Madsen A450



Otometrics Madsen A450 is a PC-controlled audiometer for testing a person's hearing.The audiometer is operated from the OTOsuite Audiometry

Module PC software.

With Otometrics Madsen A450 you can perform all standard audiometric tests, tone and speech audiometry and special tests.

1.1

Otometrics Madsen A450 can be placed on the desk top or mounted on the wall.

Operating Otometrics Madsen A450

• You operate Otometrics Madsen A450 from the PC’s keyboard/mouse with the OTOsuite Audiometry Software Module acting as the display showing the intensity, frequency as well as current settings and other information on the PC monitor.

• From the OTOsuite Audiometry Software Module, which is NOAH compatible, you can monitor test results, create

User Tests, store and export data, and print reports.

Test intensities and frequencies as well as the current test settings and other information are shown on the PC monitor.

• Speech input signals can be taken from audio files on the PC hard drive, CD-ROM, external line-in devices such as a CD player, or live-voice from a microphone.

Outputs

Otometrics Madsen A450 supports the following types of output:

• One set of headphones. The supported headphone types are:

– TDH39 headphones

• Insert phones

• Bone oscillator

• 2 sound field loudspeakers. The speakers can use either the power amplifier built into Otometrics Madsen A450 or an external power amplifier.

The OTOsuite Audiometry Module

OTOsuite

OTOsuite is a software tool that integrates a suite of hearing tests and hearing instrument fitting functionality with result review and reporting capabilities into a single powerful PC application.

OTOsuite integrates closely with the latest generation of Otometrics test devices by offering real time presentation of test results and full test control directly from a PC with a comprehensive user interface and NOAH compatibility.

The OTOsuite Audiometry Module is designed to operate with Otometrics Madsen A450 as the test device.



1.1.1


The OTOsuite Audiometry Module provides you with comprehensive control and overview of the current stimulus and masking choices both numerically and graphically in the displayed audiogram when you test with a connected Otometrics audiometer.

As the module is part of OTOsuite, audiograms can be used directly in other OTOsuite modules such as the PMM and

Immittance modules for an optimized workflow independent of NOAH, and for combined reporting.

The Audiometry Module provides you with a wide range of features:

Testing

• Testing, using the Audiometry Module as a handy control panel while you follow stimulus settings and test progress on your PC display

• Tone testing

• Speech testing

• Special tests

• Controlling play-back of speech test material

• Creating complete User Tests for specific audiometric tasks, including selecting specific speech lists, viewing preferences, activating operator monitoring peripherals, etc.

• Entering tester details and test date entry for manually entered audiograms

• Entering special test and tuning fork test results

Viewing and printing

• Viewing and printing test results

• Viewing the progression of a range of tests online

• Viewing historic audiometry results from NOAH or XML

• Viewing online audiometry results during testing

• Viewing masking level indicator in audiogram

• Viewing audiogram overlays

NOAH

OTOsuite integrates with:

• NOAH systems

• NOAH for ENT

• NOAH-compatible Office Management systems.

The NOAH System is a HIMSA product for managing clients, launching hearing test applications and fitting software, and storing audiological test results. OTOsuite stores test results using NOAH.

Note

•

Whenever reference in this manual is made to NOAH, this reference should also apply to NOAH-compatible systems.



1.2

1.3

1.4

Intended use

Otometrics Madsen A450 with the Audiometry module

Users: audiologists, ENTs, hearing instrument dispensers and other health care professionals in testing the hearing of their patients.

Use: diagnostic and clinical audiometric testing.

About this manual

This is your guide to installing, calibrating and using Otometrics Madsen A450 and to using the OTOsuite Audiometry Module. It also introduces you to the key features of the device and the software, as well as to working scenarios for performing tests and viewing and printing test results.

We strongly recommend that you read this manual carefully before using Otometrics Madsen A450 and the Audiometry

Module for the first time.

Note

•

If you are using the Audiometry Module with NOAH, we recommend that you are familiar with the screens and functions provided in NOAH.

Installation and assembly

Unpacking ► 70

and

Assembling Otometrics Madsen A450 ► 73

contain a full description of unpacking instructions and how to assemble the device. For instructions on installing the software, see the OTOsuite Installation Guide.

Safety

This manual contains information and warnings which must be followed to ensure the safe performance of Otometrics Madsen A450.

Warning

•

Local government rules and regulations, if applicable, should be followed at all times.

Safety information is stated where it is relevant, and general safety aspects are described in

Standards and Safety ► 82

.

Training

It is recommended that you read this manual and try out test scenarios before you start operating Otometrics Madsen

A450 so that you are familiar with both the device and the software program before testing a patient.

Typographical conventions

The use of Warning, Caution and Note

To draw your attention to information regarding safe and appropriate use of the device or software, the manual uses precautionary statements as follows:

Warning

•

Indicates that there is a risk of death or serious injury to the user or patient.

8 Otometrics - Otometrics Madsen A450


Caution

•

Indicates that there is a risk of injury to the user or patient or risk of damage to data or the device.

Note

•

Indicates that you should take special notice.

1.4.1

Navigation

Menus, icons and functions to select are shown in bold type, as for instance in:

• Click the

Set Options

icon on the toolbar or select

Tools

>

Options

...


2 Navigating in the OTOsuite Audiometry module

2

2.1

Navigating in the OTOsuite Audiometry module

The general functions for navigating in the main window are described in the OTOsuite manual.

You will find descriptions of the Audiometry test screens in:

•

•

The Tone test screen ► 24

The Speech test screen ► 33

Special tests are described in:

•

Special tests ► 48

The Audiometry module main window

The basic OTOsuite functions are described in the OTOsuite User Guide.

Audiometry elements

10

D.

E.

F.

G.

A.

B.

C.

Menu bar

See the OTOsuite User Guide.

Audiometry toolbar

Toolbar icons and menus ► 11

Stimulus bar

The stimulus bar ► 21

Control panel

The control panel ► 16

Work area

The Tone test screen ► 24

,


Feature boxes

Tone feature boxes ► 28 ,

Speech feature boxes ► 47

Masking level indicator, stimulus marker

The audiogram ► 24



2.2

Toolbar icons and menus

General icons - see the OTOsuite manual

Audiometry icons and menu selections

The icons and menu selections that are unique to Audiometry functionality depend on the test functions included in OTOsuite and/or whether a test device is connected.

Audiometry icons

Tone audiometry Speech audiometry

Toolbar selections

Menu item

View

>

Combined

Audiogram

Scoring and Playing

Icon Description

Click to toggle between viewing both ears in a single audiogram (combined audiogram) or both a left and a right audiogram on your screen.

Combined View

• Click to view both ears in a single audiogram.

Split View

• Click to view separate audiograms for each ear.

Click to open the


dialog.

2.2.1

Menu selections

Menu item

View

>

Select Orientation

View

>

Manual entry

File menu

Menu item

New Audiogram


Click to select the perspective of the patient's ears as presented on the screen for graph and table views.

You can also select the location of the stimulus control.

Click to create an audiogram manually.


Select new audiogram. You will be prompted to save or cancel current data.



2.2.2

Edit menu

Menu item

Audiometric properties

...

Icon Shortcut Description

Ctrl+U

Click to enter Tester name, Test Date, and air conduction transducer for a manually entered audiogram.

Note

•

The air conduction transducer is stored when you have selected it in the transducer section of the Control

Panel (or with device controls, if applicable) and data points are entered on the audiogram.

2.2.3

View menu

Menu item (Tone)


Masking Assistant

Overlays

Combined Audiogram


Click to select the perspective of the patient's ears as presented on the screen for graph and table views.

Enable or disable the Masking Assistant.

The Masking Assistant causes an unmasked threshold to flash repeatedly if masking is recommended.

• See

The Masking Assistant ► 14

.

Enables or disables the overlays. Overlays display

• pictures

• severity

• speech banana,

• speech letters,

• unusable area on the audiogram.

Overlays can also be displayed by selecting them from the overlays box below or next to the audiogram.

To view/hide the overlays box, select

Tools

>

Options

>

General

.

See

Tone feature boxes ► 28

.

Combined View

• Click to view both ears in a single audiogram.

Split View

• Click to view separate audiograms for each ear.

Click to toggle between viewing both ears in a single audiogram (combined audiogram) or both a left and a right audiogram on your screen.



2.2.4

Menu item (Tone)

Audiogram Legend

Standard / All / High frequencies


Click to enable or disable the display of the audiogram legend. The legend contains the most commonly used symbols for the audiogram.

It is not configurable.

The graph shows up to 20,000 Hz. Otometrics Madsen A450 presents stimulus up to 12,500 Hz.

• Click to choose between viewing:

Standard Frequencies

Displays the audiogram from 125 to 8000 Hz.

All Frequencies

Displays the audiogram from 125 to 20,000 Hz.

High Frequencies

Displays the audiogram from 8000 to 20,000 Hz.

Measurement menu

Menu item

Monitoring

Talk Forward


Enables or disables the monitor speaker for monitoring stimuli presented to the patient from the

Stimulus

or

Masking

channel.

Enables communicating with the patient in the sound booth. This will display the

Talk Forward

dialog box, where you can control the talk forward microphone sensitivity and the output level (in dB HL) to the patient.



When enabled, the monitor speaker will be disabled.

When the

Allow stimulation

checkbox is checked, you can present stimuli while leaving

Talk Forward

on. This is useful when you wish to present stimuli and verbally reinforce the patient quickly, as for instance during pediatric testing.

Note

•

Be aware that background noise must not be present if

Allow stimulation is checked.

See

Selecting word or phoneme scoring ► 34

.

13


2.2.5

2.3

Tools menu

Menu item

Curves and Symbols

Severity Overlay

Description

Click to select the


dialog box.

This dialog box and its related function are specific to configuring the curves and symbols to be displayed on the audiogram or speech graph during testing.

See

Curves and symbols selection ► 26

.

Click to select the

Severity Overlay

dialog box.

Double click to change the headline or the boundaries for a severity band. The severity bands share boundaries so it is only possible to enter the lower boundary for each band except for the upper band.

The Patient Responder indicator

When the patient presses the Patient Responder this is shown on the Stimulus bar, and a sound signal from the PC is heard through the Monitor Speaker or Operator Headset. The sound signal is optional (

Tools

>

Options

>

Audiometry

>

General

>

Measurement, Misc

>

Audible patient response

).

Single Responder setup

•

Green

Indicates that the patient is pressing the Patient

Responder.

2.4

The Masking Assistant

If the Masking Assistant is enabled, it will at all times check for frequencies that may require testing with masking. This also applies to old audiograms imported from NOAH or XML as long as a supported transducer was stored with the data.

The Masking Assistant is a tool provided to help you with an indication that there may be frequencies where testing with masking

1

is recommended.

• The audiogram symbol will flash at the specific frequencies where contralateral masking may be recommended

2

.

14

1(Katz, J., Lezynski, J. (2002). Clinical Masking. In J. Katz, ed.,

Handbook of Clinical Audiology

, Williams and Wilkins, Baltimore.)

2Based on criteria described in

Clinical Masking, Essentials of Audiology, Stanley A. Gelfand, Thieme 1997

, and

Measurement of Pure Tone Hearing Thresholds, Audiologists’ Desk Reference - Vol 1, James W. Hall III, H. Gustav Mueller

III, Singular Publishing Group 1997

. and

Munro K.J., Agnew N. A comparison of inter-aural attenuation with the Etymotic ER-3A insert earphone and the Telephonics TDH-39 supra-aural earphone. Br J Audiol 1999; 33: 259-262

.



• The masking criteria are configurable so that you can set them up to match your local recommendations for masking. You can for instance choose either frequency specific criteria, which increases the efficacy of your work, or the traditional "one-level-fits-all" criteria.

Select the

Tools

>

Configuration Wizard

>

Audiometry

-

Configure

... >


to set up the masking criteria.

All masking signals are calibrated in effective masking.

How does the Masking Assistant work?

Terminology

AC

ACc

BC

BCc

Min IA

AC test ear

AC contra

BC

BC contra

Minimum inter-aural attenuation.

When is masking required?

Masking is recommended when the following conditions are met:

AC AC > ACc + Min IA

BC or AC > BCc + Min IA

BC < AC - x* dB

Only stored thresholds measured without masking are checked. Levels which did not evoke a response are excluded from the check. This means that as soon as a masked threshold has been stored, the flashing stops for that frequency.

* denotes configurable Air/Bone gap criterion (

Tools

>


>

Audiometry

-

Configure

... >

Masking

Assistant

).

Min IA is frequency specific

These are the Min IA tables for TDH-39 and Otometrics Inserts used in the Masking Assistant

1

.

1Katz, J., Lezynski, J. (2002). Clinical Masking. In J. Katz, ed.,

Handbook of Clinical Audiology

, Williams and Wilkins, Baltimore. Munro, K.J., Agnew,

N. A comparison of inter-aural attenuation with the Etymotic ER-3A insert earphone and the Telephonics TDH-39 supra-aural earphone

. Br J Audiol 1999; 33: 259-262. Hall, JW., MUELLER, HG. (1997).

The audiologists’ desk reference

, Volume I., Singular Publishing Group, San Diego.



2.5

Min IA (supraaural phone: TDH-39), frequency specific

125

250

Hz

500

750

1000

1500

2000

3000

4000

6000

8000

44

56

50

44

44

40

48

40

42

dB

35

48

Katz & Lezynski, (2002)

Munro & Agnew, BJA (1999)


N/A - fulfill traditional approach


N/A - fulfill traditional approach


Hall J.W. III & Mueller G.H. III / Munro & Agnew, BJA (1999)

Katz J / Munro & Agnew, BJA (1999)

Hall J.W. III & Mueller G.H. III / Munro & Agnew, BJA (1999)

Katz J / Munro & Agnew, BJA (1999)

Min IA insert phone

1000

1500

2000

3000

4000

6000

8000

Hz

125

250

500

750

72

54

62

58

60

56

58

dB

60

72

64

60

N/A - traditional value











The control panel

Click the

Control Panel

icon in the toolbar to activate the Control Panel.



Control panels

Tone testing Speech testing

In the control panel you can quickly select test ear, transducer, masking, and test type.

Click on the buttons to toggle the selection or right-click on a button to select a combination of functions.

Your selections are shown in the

Stimulus

bar and as symbols in the audiogram.

You can control the monitor level, activate the

Talk Forward

dialog, and use the user test.

Test Selector

to quick select the relevant

• Right-click on the buttons in the control panel to view the right-click menu. Click to enable or disable selections of your choice.

• Right-click on the blue masking link area in the control panel to view the

Masking Options

right-click menu.

Click to enable or disable selections of your choice.

Tone testing

Test ear selection

•

Right

•

Both

•

Left

Transducer selection

• Air conduction

Phones

(standard headphones), optional

• Air conduction

Insert

(earphones), optional

• Bone conduction

Bone

(oscillator)




•

SF Unaided

(Sound Field speaker, unaided), optional

•

SF Aided 1

and

SF Aided 2

(Sound field speaker - Aided 1 and 2), optional

Stimulus type selection

•

Tone

•

Warble

•

FRESH

noise

•

Pulsed

Test type selection

•

AUD

(audiogram threshold curve)

•

SRT

(Speech Recognition Threshold)

•

WRS

(Word Recognition Score)

•

MCL

(Most Comfortable Loudness level)

•

UCL

(Uncomfortable Loudness level)

Speech testing

Test ear selection

•

Right

•

Both

•

Left




• Air conduction

Phones

(standard headphones), optional

• Air conduction

Insert

(earphones), optional

• Bone conduction

Bone

(oscillator)

•

SF Unaided

(Sound Field speaker, unaided), optional

•

SF Aided 1

and

SF Aided 2

(Sound field speaker - Aided 1 and 2), optional

Stimulus type selection

• Microphone for presenting live speech stimulus

• Recorded stimulus

Talk Forward

Click to open the

Talk Forward

dialog. See the Otometrics Madsen A450 Reference Manual.

Enables communicating with the patient in the sound booth. This will display the

Talk Forward

dialog box, where you can control the talk forward microphone sensitivity and the output level (in dB HL) to the patient.

Monitor and Level

Click to open the



Test Selector

Click to open the

Test Selector


The Control Panel right-click menu

Right-click on the buttons in the control panel to view the right-click menu. Click to enable or disable selections of your choice.



Stimulus Ear Selection

Left

,

Right

,

Both

Transducer Selection Insert

,

Phones

,

Bone

,

SF Unaided

,

SF Aided 1

,

SF Aided 2

Stimulus Selection

Curve Selection

Masking Transducer

Selection

•

•

•

•

•

•

•

•

•

•

•

•

•

Tone

•

Tone

Warble

FRESH

• Pulsed stimulus

•

•

Stim. Lock

Tracking

• 1 dB step

•

•

•

•

•

•

•

•

• 5 dB step

Speech

•

Mic

•

Recorded (Source A)

Recorded (Source B)

Int. CD

(internal CD ROM built into the PC) (Speech)

File

(stored on hard drive) (Speech)

Line In

(external medium connected to the PC) (Speech)

Stim. Lock

(presents stimulus and masker simultaneously)

Tracking

1 dB Step

(increases stimulus and masker intensity by the same number of dB)

5 dB Step

AUD

MCL

UCL

SDT

SRT

WRS

SNR

(audiogram threshold curve) (Tone)

(Speech Detection Threshold) (Speech)

(Speech Recognition Threshold) (Speech)

(Word Recognition Score) (Speech)

(Signal to Noise Ratio) (Speech)

Insert

Phone

Bone

(Speech)

SF


2.6

Masking Options

•

•

•

•

•

•

•

•

•

Contralateral

Ipsilateral

NBN

(Tone)

WN

(Tone)

Stimulus 2 (Stenger)

SWN

(Speech)

Mic

(Speech)

Recorded (Source A)

(Speech)

Recorded (Source B)

(Speech)

The stimulus bar


A.

B.

C.

D.

Intensity

Stimulus indicator

Transducer indicator

Stimulus being presented

E.

F.

G.

H.

Frequency

Stimulus bar color

Routing indicator

Masking on

Intensity

Indicated by the dB level above the channel status bars.

• Masking is denoted by square brackets around the level (calibrated in effective masking level).

• The green triple wave symbol above the level indicates that the stimulus is currently being presented.

Stimulus bar color

Indicates the routing for each channel:

• Blue = left ear

• Red = right ear

• Blue/Red = binaural

• Gray = unspecified



2.6.1

Stimulus, transducer and routing indicators

The stimulus/masking type, the transducer and the routing for each channel.

Test controls

Test controls provide a means of operating the audiometer if you use the mouse and on-screen options to perform tests.

• To enable test controls, select

Tools

>

Options

>

Audiometry

>

General

>

On-screen controls

>

Show

>

On

.

Up and down arrows

Tone and Speech. Stimulus and Masking

• The Arrow Up and the Arrow Down buttons change the stimulus level depending on the setting in

Tools

>

Options

>

Audiometry

>

Tone

>

Misc.

>

Level Direction of Arrow Keys

.

Left and right arrows

Tone. Stimulus and Masking

• Arrow left decreases the stimulus frequency.

• Arrow right increases the stimulus frequency.

Stimulate button

Present Tone

• Presents stimulus.

• If

Continuous On

is enabled, activating the button interrupts the stimulus.

Store button

Store Tone and Speech

• Stores the data point on the audiogram(s) or in the Speech screen.

Silence Mode

Silence Mode allows you to control tone levels and presentation by hovering the mouse cursor over the respective onscreen controls. This is particularly useful when the operator of the audiometer and the person being tested are in the same room.

• To enable silence mode, select

Tools

>

Options

>

Audiometry

>

General

>


>

Silence Mode

>

On

.

• To change the level and frequency by more than one click at a time, use the mouse scroll wheel.



2.6.2

The Tone stimulus bar

2.6.3

A.

Symbol

B.

Frequency

During online testing, the stimulus bar shows:

Symbol

• Indicates the symbol that will be displayed on the audiogram(s) when a data point is stored. The symbol shown reflects the current audiometer measurement settings.

See also

Curves and symbols selection ► 26

.

Frequency

• Indicated by the Hz value in the center of the stimulus bar.

The Speech stimulus bar

A.

B.

C.

VU meter

Speech score

Word count

During online testing, the stimulus bar shows:

Speech Score/Word Count

• Displays the percentage correct/incorrect and the amount of words correct/incorrect out of a given number of words. You can display speech score and word count either as “% Correct” or as “% Incorrect”. To set your preference, select

Tools

>

Options

>

Speech

>

Misc.

>

Score Presentation

.

% Correct

is the default setting.



2.7

VU Meter

• Displays the level (in volume units) of the test microphone or speech material from Source A or Source B. Speech should always be delivered at 0 dB on the VU meter so that the dB level on the stimulus intensity bar represents the level actually being delivered to the patient.

The Tone test screen

During online testing, the screen reflects the test done by the audiometer as it progresses.

A.

B.

C.

D.

E.

F.

Menu bar

Audiometry toolbar

Stimulus bar

Control panel

Work area

Feature boxes

2.7.1

2.7.2

The work area in the Tone screen

The Tone test work area consists of a range of elements for viewing and selecting various features:

•

•

The audiogram ► 24

With a description of audiogram elements, how to view single or dual graphs, and how to view the intensity levels used for masking.

Tone feature boxes ► 28

With a description of result boxes for special tests, utilities such as a timer and an overlays selector, and instructions for how to view/hide the feature boxes.

The audiogram

Audiogram elements

Cross hatch

Indicates your current stimulus level and frequency. The color indicates the routing:

• Blue = left

• Red = right

• Black = binaural


Mouse cursor

Audiogram


Indicates where you place the mouse. The color indicates the routing:

• Blue = left

• Red = right

• Black = binaural

• Intensity is shown to the left of the audiogram in dB HL.

• Octave frequencies are shown below the audiogram in Hz.

• Interoctave frequencies are shown above the audiogram in Hz.

Viewing the audiogram

You can choose between:

Single graph view

A.

B.

C.

Stimulus marker (ear color)

Masking level indicator

Mouse cursor (ear color)



Dual graph view

When you use the dual graph viewing option, the graph that corresponds with the stimulus ear will have a gray outline to denote the active audiogram.

You can switch the position of the right and left graphs to correspond to your viewing preference.

1. Select

Tools

>

Options

>

Tone

>

Misc.

>

Dual Graph View

or in the menu bar under

View

.

A.

B.

Stimulus marker (ear color)

Masking level indicator

Viewing masking levels

Masking levels

Below the audiogram, the intensity levels used for masking can be displayed. It is an option to display the masking levels. Select

Tools

>

Options

>

Tone

>

View

>

Misc.

>

Masking Levels

.

• In combined view, the non-test ear masking levels are shown below the graph.

• In

Dual Graph View

, the masking level used for masking the non-test ear is by default displayed under the graph for the test ear. The masking level can be set to be displayed either under the test ear or under the non-test ear: select

Tools

>

Options

>

Tone

>

View

>

Misc

>

Masking Table Placement

.

2.7.3

2.7.3.1

Curves and symbols selection

You can select a symbol and/or a curve style for a specific measurement and you can create new symbols.

Selecting a symbol or curve

You can select a symbol and/or a curve style for a specific measurement.

1. Select

Tools

>


...

2. Click on the selections that apply to your measurement under

Test

,

Transducer

, and

Aided Condition

. The current symbols and line style are shown.

3. Double-click on the symbol you wish to change. The

Symbols

selection dialog box is shown.



4. Double-click on the symbol you wish to use.

5. To change the line style of the curve, select from the

Line Style

drop-down list.

6. To change the color, double-click on the current

Color

square. Select a new color or click on

Define custom colors>>

to select a color not shown. Click

OK

.

7. To optimize viewing of the audiogram, you can offset the symbols in relation to the audiogram grid in the fields

Horizontal Offset

and

Vertical Offset

.

You can superimpose symbols on the audiogram where two different points share the same value (i.e. air and bone threshold). In order to see both superimposed symbols, you can define an offset direction for each individual symbol.

2.7.3.2

Creating new symbols

1. Use Microsoft Powerpoint to create graphics that can be saved in Enhanced Meta Files (*.emf) format.

2. The outer size of the EMF file must be less than or equal to 1 x 1 inches (2.5 x 2.5 cm).

Note

•

If the symbols are created larger, this may severely compromise the performance of OTOsuite.

The standard symbols are drawn within a centered inner frame of 1.5 x 1.5 cm (0.6 x 0.6 inches).

The area between the inner and outer frames is used for additions to the main symbol, such as arrows for

No

Response

or

Response at Limit

, and designators for

Aided Left

or

Aided Right

.

3. Before you store the new graphic, make sure that the outer and inner frames are invisible: Select the frame, and set the line color to

No Line

. Repeat this for each frame.

4. To save as an *.emf graphics file, select all elements in the drawing (including the invisible outer frame as well as the symbol itself centered within the frame). Right-click and select

Save as picture

...

5. Name the file and select the file type *.emf.

6. Save it in

C:\Program Files\GN Otometrics\OTOsuite\AudSymbols

.

7. Launch the OTOsuite Audiometry Module and select

Tools

>


.

The new symbol should appear on the list of symbol options.

In this dialog box, you also have options for setting the color, line type, and horizontal and vertical offsets that will apply when you use the new symbol.



2.7.4

Compare audiograms

Make sure the feature box for

Compare Audiograms

is visible in the OTOsuite main view area (if not, set

Tools

>

Options

>

Tone

>

View

>

Show


to

On

).

OTOsuite under NOAH

All sessions relating to the selected client, and containing audiometry data are automatically loaded into the

Compare

Audiograms

feature box.

Compare current and historical audiograms

1. In the


feature box, single-click to select the audiograms you wish to view from the list of historical audiograms. Any selected historical audiogram will appear with grey curves in the audiogram graph.

2. All curves of the selected audiograms are viewed and compared simultaneously unless you explicitly select a curve type from the feature box drop-down lists. The lists let you define the test type and aided condition that you wish to view and compare.

3. You can enhance the compare view by enabling the

Difference

view. This is done by checking the

Difference

option in the feature box. The

Difference

view highlights any difference between the most recent and any older audiogram curves selected in the list.

2.7.5

4. If you decide to make a new audiogram, then a new

Current

audiogram is generated in the


feature box list, and what was previously the current audiogram consequently becomes a historical one, displayed with measurement date.

5. If you deselect the viewing of a

Current

audiogram so that it is no longer shown, then it will instantly be reselected if you try to edit a curve.

6. You can keep any previously collected audiogram visible in the graph while collecting the current audiogram simply by keeping it selected in the


feature box while measuring.

Tone feature boxes

You can access a number of Tone view options directly from the

Tone

main screen.

The view options can be turned on/off. To do so, select

Tools

>

Options

>

Tone

.



Feature boxes

Weber

Stenger

Rinne

Reliability

Timer

Pure Tone Data

Tone Decay

Overlays

Displays the results of a Weber test.

• Scoring options are left (arrow left), right (arrow right) or center (arrow up).

Displays the results of a pure tone Stenger test.

• Scoring options are positive (+) or negative (-).

Displays the results of a Rinne tuning fork test.


Displays the reliability of the patient's responses (good, fair, poor).

Allows you to time the length of a tone presentation (e.g. during

Tone Decay

testing).

• The arrow starts the timer.

• The square stops the timer.

• The

Reset

button resets the timer to 00:00.

Displays the pure tone average (PTA) for air conduction and bone conduction as well as the articulation index (AI).

• The AI is calculated according to the “Count-the-dot” method.

• To configure PTA calculation, select

Tools

>

Options

>

General

>

Misc

>

PTA Frequency Multipliers AC/BC

.

Displays the results of the tone decay test.

Scoring options are:

• Rosenberg Method (Normal, Mild, Moderate, Marked) or

• Jerger STAT Method (Negative, Positive).

Select the overlay to be displayed on the audiogram.

These overlays assist in the counseling process.

• Select

Tools

>

Options

>

Audiometry

>

Tone

>

Overlay Selection Box.

The overlay options are:

Pictures

Displays pictures representing common environmental sounds at their approximate dB level (e.g. bird, plane).



Severity

Displays the audiometric severity levels (normal, mild, moderate, moderate-to-severe, severe, profound).

Speech Banana

Displays the speech banana of a listener with normal hearing.

Speech Letters

Displays speech sounds at their approximate dB level.

Unusable area

Shades the area which is outside the patient's dynamic range of hearing.

2.7.6

Tone editing options

When you right-click on the main screen in

Tone

mode, the following options appear:


Selected Point (e.g. Left AC threshold, 1kHz)

If more than one symbol is at the same intensity/frequency, select the data point of interest from the drop-down list.

Delete Point

Delete Curve

Insert “No Response”

• Deletes a selected data point.

• Deletes a selected data curve.

• Inserts a “no response” symbol (default: symbol with arrow downward) on the audiogram. You can also access the “no response” symbol by holding down the "S" key on the keyboard.



2.8

2.8.1


Insert “Response at Limit”

Insert "Did Not Test"

Insert "Could Not Test"

• Inserts a "response at limit" symbol (default: symbol with arrow upward) on the audiogram.

• Inserts a "Did Not Test" symbol (default: symbol with

DNT

) on the audiogram.

• Inserts a "Could Not Test" symbol (default: symbol with

CNT

) on the audiogram.

Work-flow related features

Selecting orientation

Select graph, table and control layout

Select

View

>


to see the following dialog:

Graphs and Tables

Click to select the way you view the patient in relation to your monitor.

Control

Click to select the position of the stimulus channel on the screen.

2.8.2

Automatic frequency/level shift when storing

When you use the

Wrap

or

Butterfly

method for testing, this feature enables you to speed up the test process by automatically shifting frequency (and level) when you store a point in the audiogram. To do so, select

Tools

>

Options

>

Tone

>

Measurement

>

Auto Freq./Level Shift

.

Note

•

Masking is always switched off when the frequency is changed automatically.

You can set up the definitions for each of the test types THR/MCL and UCL individually:



2.8.3

2.8.4

2.8.5

Options

Included AC/BC/SF

Frequencies

Defines which frequencies to exclude from the automatic frequency shift. The actual available frequency range is defined by the selected transducer.

Level Shift when

Storing

Note

•

You can always select any frequency manually.

You can choose whether the new level should be referenced to the previous data point or be set to a fixed level. If a data point already exists at the new frequency, this will be used as a reference point.

Note

•

The automatically selected level never exceeds 80 dB HL for reasons of safety.

Frequency Shift when Storing

(None, Wrap, Butterfly)

•

•

Wrap

:

Automatically selects the next, higher frequency. When it reaches the highest available frequency, it wraps around to the lowest frequency.

Butterfly

:

Automatically selects the next, higher frequency. When it reaches the highest available frequency, it goes to 1000 Hz and automatically selects the next, lower frequency. When it reaches the lowest frequency, it automatically goes to 1000 Hz.

The direction depends on whether the previous data point was stored at a higher or lower frequency.

Stimulus duration

You can set a fixed duration of the presentation of the tone stimulus. To do so, select

Tools

>

Options

>

Tone

>

Measurement

>

Stimulus Duration

.

Ear shift frequency and level setting

When you change test ear, you can define that the frequency and level should be set to 1000 Hz at 20 dB HL. To do so, select

Tools

>

Options

>

Tone

>

Measurement

>

Ear Shift Frequency and Level

. Check

Ear Shift Frequency and Level

.

Saving non-stimulus channel as masking

If you use an external masking signal (non-audiometer masking noise) for speech masking, you can choose to store the presentation level of the non-stimulus channel as a masking level.

To do so, set

Tools

>

Options

>

Speech

>

Measurement

>

Use Non-Stimulus Channel as Masking

to

Yes

.


2.9

The Speech test screen

Otometrics Madsen A450 is intended for use with predefined speech protocols that are loaded automatically when you select a user test.

You can have a full overview and instantly select measurement type, ear, transducer, stimulus type, routing, and speech material.

• If you wish to make manual changes on the fly, use the control panel to select.


The predefined tests are incorporated as rows in the speech table.

• To select a predefined test, simply click the button in the

Test

colum. This will load all the speech settings and speech material.

If you perform a test which is not available in a predefined Speech table, a speech row is created automatically. This temporary row will exist as long as there is stored test data for that measurement setup.

Storing speech data

You can store the current data as the result either by clicking with the mouse on the highlighted field, or by pressing the

Store

shortcut key on the keyboard (S).



2.9.1

2.9.2

• If a predefined test is not available, or if you wish to change settings on the fly, see

Creating and editing the speech test table ► 34

.

Creating and editing the speech test table

You can create the speech test table if a predefined test is not available, or if you wish to change settings on the fly.

1. Select ear, transducer, stimulus type, routing, test type, and speech material.

2. To permanently add the test row to the table, you must

– pin it to the table,

– save it to a user test.

Pinning the test

You can pin one or several rows to the table,one by one. To do so, right-click the active row in the speech table, select

Configure > Pin Test

.

When you have pinned the test row to the table, you can change the order of the pinned tests. To do so, right-click the active row in the speech table, select

Configure > Move Up/Move Down

.

You can also assign a different speech material or stimulus source. To do so, make your stimulus selection, right-click the active row in the speech table, and select

Configure > Assign selected stimulus

.

Saving the table to a user test

When you have pinned the new test rows to the speech table, you must save it to a user test or to your start-up settings.

Open the

Tools > Options

dialog and click to save as a user test or as start-up settings.

Saving different speech tables to specific user tests has several benefits:

• You can have identical test setups, but use different speech materials for different patient groups (e.g. different languages, pediatric materials)

• You can use different test setups depending on the task (e.g. diagnosis/hearing aid verification)

You can load and include several different speech tables when you test a patient. Rows with no data will be discarded

(right-click in the row to select

Did not test

or

Could not test

if you wish to retain blank rows before you load additional user tests).

If you do not use any predefined tests, you must select all settings and speech material manually. Rows will then automatically be added and you retain them in the table by storing the result.

Selecting word or phoneme scoring


is a control where you can configure how to play back recordings and score the results. The control contains four different columns as listed and described below. These columns present various controls, which you can combine to define how to run the test.

To set up word or phoneme scoring,

• click or

• select

Tools

>

Options

>

Speech

>


and click the pop-up button.



The


dialog is shown.

The Scoring and Playing dialog

Word scoring

In word scoring you score either correct or incorrect responses using + or - in the Speech Player Panel.

Numerical phoneme/sentence scoring

In numerical scoring you click the numbered buttons in the Speech Player Panel to score the number of correct phonemes in phoneme scoring or words in sentence scoring. The maximum score in a single presentation is either determined as a fixed value (1 to 9 in the


dialog) or automatically as determined by the integrated word list.

Specific phoneme/sentence scoring

Some speech materials support specific scoring. This means that you can click the scorable items directly in the speech list.

Scorable items can be either individual phonemes in phoneme scoring or individual words in sentence scoring.

You can use the

All Correct

button when the patient responds correctly to a presentation.

When you use specific phoneme scoring, you can keep your focus on the speech list by using the

Play

button next to the item in the speech list.

Scoring

Scoring

Word scoring

Enable

Word Scoring

.

Number of phonemes or words in sentence

Calculate 'All Correct'

Score

Phoneme/Sentence scoring

Enable

Phoneme/Sentence Scoring

.

Word scoring

Does not apply to word scoring.


Defines the total number of phonemes in the word. The default is 3 phonemes intended for monosyllabic words. The corresponding number of buttons is enabled in the

Speech Player

Panel

, and on the Numerical pad of the PC keyboard.

Word scoring



Calculates all correctly scored phonemes or items based on



Scoring

Always use Numerical scoring method

Word scoring



Select this if you use lists using specific phoneme/sentence scoring, but prefer to score the test items numerically.

Counting

Defines how you want to score words (

Both

,

Corrects only

and

Incorrects only

).

•

Both

Word scoring

You manually score correct and incorrect words. The word counter is updated accordingly.


Does not apply to phoneme scoring.

•

Corrects only

Word scoring

Software assumes the word is incorrect unless you manually score it as correct.

External speech material:

The percentage is calculated based on the total number of words you have defined in advance -

Tools

>

Options

>

Audiometry

>

Speech

>


>

Number of items to play back

.


Score the number of correct phonemes using the corresponding numbers in the

Counter

.


Always enter a score for each word. This will update the counter accordingly.

•

Incorrects only

Word scoring

Software assumes word is correct unless you manually score it as incorrect.


The percentage is calculated based on the total number of words you have defined in advance -

Tools

>

Options

>

Audiometry

>

Speech

>


>


.





Playing

Playing

Note

•

This feature applies to the playback of integrated word lists from the OTOsuite Speech Material. It contains the following options:

•

Time-out (Play on

Count)

•

Continuous Playback

•

Play on Count

Word scoring

Next word is presented every x seconds based on the value set in the

Autoscore in sec

box.

If the word is scored, the next word will be presented without pausing. If the current word times out, the

Autoscore

is applied.


Does not apply to external sound source speech material.



Word scoring

The word list is presented exactly as the original recording without pausing.




The word list is presented exactly as the original recording without pausing. If a word is presented without any phonemes being counted, the

Autoscore

is applied.



Word scoring

Next word plays after previous word is scored. To enable this option, select the value

Both

under

Counting

.




When the number of correct phonemes has been scored for a word, the next word is presented.





2.9.3

Playing

•


Word scoring

Defines the number of words to be presented from the integrated/external word list.

Integrated speech material:

The player pauses after presenting the defined number of words. Press

Play

to continue playing the rest of the list.


This is the total number on which the percentage should be based when counting

Corrects only

or

Incorrects only

.


Defines the number of words to be presented from the integrated word list. The player pauses after presenting the defined number of words. Press

Play

to continue playing the rest of the list.



Autoscore

Autoscore

Word scoring

When you score words,

Autoscore

is defined by the combinations of the settings in the columns

Counting

and

Playing

.

If a word is not manually scored before

Time-out

or before the next word is presented by


, the scoring is set automatically.




When you score phonemes, you can define

Autoscore

manually to either ignore the entire word, or count it as fully correct or incorrect.

If phonemes are not manually scored before

Time-out

or before the next word is presented by


, the scoring is set automatically.



Selecting speech stimulus

Caution

•

Only speech material supplied on the OTOsuite Speech material CD is precalibrated according to the description supplied with the original speech material.

If you use any other speech material, make sure that it is calibrated correctly.



1. To select speech input from pre-recorded input sources for

Source A

or

Source B

, right-click on the Speech control panel and select from the


section of the right-click menu.

–

Int. CD

(CD material in CD/DVD drive)

–

–

File

(integrated OTOsuite Speech Material or regular sound files)

Line In

(analog input from external sound players, eg. CD, MD, MP3 or cassette recorders connected to the audiometer via the

Line In

input).

2. To select speech input signals from either microphone input or prerecorded input sources, right-click on the Speech control panel and select from the


section of the right-click menu.

Combining Recorded (

Source A

and Recorded (

Source B

) as

Input

ources in the control panel right-click menu will replace the audiometer speech masking with a recorded input.

Binaural speech or masking

You can use the second audiometer channel to either present masking, or to present the stimulus at a different level to the second ear.

Click the blue link in the control panel to access the

Masking/Stim 2

settings.

– For masking, select SWN (Speech Weighted Noise) or a recorded source which contains a masking signal.

– For binaural speech, select the same stimulus as in the primary stimulus channel (Mic, or recorded source).

3. You can find the speech material files in the

File/track/list selection

drop-down list.

Speech list files (provided by Otometrics)

When you use integrated OTOsuite Speech Material, you can choose between speech lists in the


drop-down list.

• Select

Int. File

in the

Control Panel

, and browse to the folder where your speech material is installed (default location:

c:\ Program Files\GN Otometrics\OTOsuite\Wordlists\

...).

Regular sound files (files not supplied on the OTOsuite Speech Material CD)

You can use any sound file stored on your PC hard drive:

• Select

Int. File

in the

Control Panel

, and browse to the folder where your recordings are stored.



2.9.4

CD material

You can use any type of CD sound recordings of your choice.

• Select

Int. CD

in the

Control Panel

, and browse to the drive you wish to use.

These files are shown as CD track numbers in the


drop-down list.

Line In

When

Line In

is selected, only the

Counter

of the

Player Panel

is activated.

Scoring words using integrated OTOsuite speech material

The Speech Player Panel

B.

C.

D.

E.

F.

A.

Word score counter buttons:

Correct (+)

Incorrect (-)

Play/Pause

Stop

Reset word score

Previous/next list

File/track/list selection

Setting up for Scoring and Playing

To set up for scoring and playing, see

Selecting word or phoneme scoring ► 34 .

The Stimulus bar - word score

Scoring Panel

The score percentage and the

Correct

or

Incorrect

scores relating to the number of words played are shown at the top of the screen.

When you use integrated word lists, the Scoring Panel is either initialized to "0% 0/0" or to “100% 0/0”, depending on the setting in

Tools

>

Options

>

Audiometry

>

Speech

>

View

>


.

• Click on the relevant Word score counter button to record the response of the client.



The Word List box

The Word List box consists of a tab showing the list

Selected for Play

, and

Tested Lists

.


The

Word List

is shown automatically in the


tab, when you select an integrated word list.

You can view the selected OTOsuite Speech Material in the

Word List

, and use it to review and edit scoring during the test.

Scoring

You can always click on any word to change the score.

The word that has just been played is also shown above the list so that you can easily score it.

•

Specific scoring:

Click on the word to toggle between

Correct

,

Incorrect

. or

Not Scored,

or

•

Numerical scoring:

Use the traditional score controls (+/- for word scoring, or 0, 1, 2, 3... for phoneme and sentence scoring) in the Player Panel.

Tested Lists

After you have scored the integrated word lists they will appear in the

Tested Lists

tab.

The

Tested Lists

tab will show the list belonging to the test currently selected in the

Speech Results table (tabular) or Speech legend (graphical). The tested lists are also available for printing.

When you mouse over an item in the speech list, a Play button appears to the left of the item. Click the

Play

button to present the item to the patient.

The word currently playing is indicated by a musical note and highlighted in blue in the list.

A word that was correctly repeated is highlighted in green in the list.

A word that was incorrectly repeated is highlighted in gray in the list.

• You can right-click on a word to change the score or control the play-back of the word list.

• You can either play back a single item or select a place in the list where you want to start the play-back.



2.9.5

Using word lists with monitored live voice testing

When you have loaded an integrated OTOsuite Speech Material, you can use the word list to read from using

Mic.

stimulus, for live voice testing.

Store the word scores

See

Storing speech data ► 33

.

Scoring words using external sound source

Note

•

Using an external sound source includes the use of all types of sound sources such as CDs, MP3 players, cassette recorders, and sound files on the PC hard drive except for the integrated OTOsuite Speech Material.


B.

C.

D.

E.

F.

A.

Word score counter buttons:

Correct (+)

Incorrect (-)

Play/Pause

Stop

Reset word score

Previous/next list


(disabled when Line In is selected)



Selecting word or phoneme scoring ► 34

.

The Stimulus bar - word score

Scoring Panel

The score percentage and the

Correct

or

Incorrect

scores relating to the number of words played are shown at the top of the screen.

When you use external word lists, the Scoring Panel is either initialized to "0% 0/n" or to “100% n/n”, depending on the setting in

Tools

>

Options

>

Audiometry

>

Speech

>

View

>


.

• Click on the relevant Word score counter button to record the response of the client.

Store the word scores

See

Storing speech data ► 33

.



2.9.6

Scoring phonemes using integrated OTOsuite speech material


B.

C.

D.

E.

F.

A.

Phoneme score counter buttons:

No correct phonemes (0)

1 phoneme correct (1)

2 phonemes correct (2)

All 3 phonemes correct (3)

Play/Pause

Stop

Reset Counter scoring and Player

Previous/next list


In the Speech Player Panel example shown above, the

Number of phonemes

setting in the


dialog box is set to

3

.

Configurable number of phonemes

The integrated speech materials dictate the number of phonemes and provide the appropriate number of scoring buttons automatically. This can be configured specifically for each item in the integrated Speech material. Please contact your supplier for further information.




The Stimulus bar - phoneme score

Scoring Panel

The score percentage and the number of words played are shown at the top of the screen.

The Scoring Panel is either initialized to "0% 0 words" or to “100% 0 words”, depending on the setting in

Tools

>

Options

>

Audiometry

>

Speech

>

View

>


.

• Click on the relevant phoneme score counter button to record the response of the client.



The Word List

The Word List is shown automatically when you select an integrated word list.

You can view the currently selected integrated OTOsuite Speech Material in the

Word

List

, and use it to review and edit scoring during the test. You can also see the word currently being played back for monitoring purposes.

The number of correct phonemes repeated is marked with the corresponding number to the left of the word in the list.

The word currently playing is indicated by a musical note and highlighted in blue in the list.

• You can right-click on a word to change the score or control the play-back of the word list.

• You can either play back a single item or select a place in the list where you want to start the play-back.

2.9.7

Using word lists with monitored live voice testing

When you have loaded an integrated OTOsuite Speech Material, you can use the word list to read from using

Mic.

stimulus, for live voice testing.

Store the phoneme score results

See


.

Scoring phonemes using external sound source

Note

•

Using an external sound source includes the use of all types of sound sources such as CDs, MP3 players, cassette recorders, and sound files on the PC hard drive except for the integrated OTOsuite Speech Material.




B.

C.

D.

E.

F.

A.

Phoneme score counter buttons:

No correct phonemes (0)

1 phoneme correct (1)

2 phonemes correct (2)

All 3 phonemes correct (3)

Play/Pause

Stop

Reset Counter scoring and Player

Previous/next list


(disabled when Line In is selected)

In the Speech Player Panel example shown above, the

Number of phonemes

setting in the


dialog box is set to

3

.




The Stimulus bar - phoneme score

2.9.8

Scoring Panel

The score percentage and the number of words played are shown at the top of the screen.

The Scoring Panel is either initialized to "0% 0 words" or to “100% 0 words”, depending on the setting in

Tools

>

Options

>

Audiometry

>

Speech

>

View

>


.

• Click on the relevant phoneme score counter button to record the response of the client.

Store the phoneme score results

See

The Speech test screen ► 33 .

Saving source levels for speech material

Note

•

This feature applies to sound files on the PC hard drive except for the integrated OTOsuite Speech Material.

If you have a folder on the PC containing WAVE (.wav) files, eg. from a CD, you can calibrate these files by adjusting the

Source A

and

Source B

levels in the


section of the control panel. The next time you browse to this folder (or create a user test) the

Source A

and

Source B

level settings will automatically be set to the saved level.



2.9.9

Procedure

1. Browse to the folder containing the WAVE (.wav) file or files you wish to adjust to a specific level.

2. Play the calibration file from the Speech player.

3. Use the dials in the


section of the control panel to adjust the levels to zero, as seen on the VU meter.

4. Open the Play list in the Speech player and click

Save Source A & B level in this folder.

5. A file called "0.speechlevel" is created in this folder.

The next time you play any file from this folder, it will be calibrated to the level set in the "0.speechlevel" file.

Speech editing options - tabular view

When you right-click any of the rows in tabular view, the following options appear:

46

Options

Store

Insert No Response

Stores the dB level(s) currently displayed to the field that is highlighted.

NR will replace the stimulus level for the selected speech test.

Insert Did Not Test

DNT will replace the stimulus level for the selected speech test.

Insert Could Not Test

CNT will replace the stimulus level for the selected speech test.

Delete Measurement

Deletes an existing measurement.



Options

Entry fields

Configure

Enables you to enter results in the selected field.

• When you have typed in the desired data, confirm by pressing

Enter

or cancel by pressing

Esc

.

See

Creating and editing the speech test table ► 34

.

Editing a row

Click on the data you wish to edit and use the right-click menu to change the value.

Deleting a row

Right-click on the field you wish to delete and select

Delete Measurement

.

Sorting the tabular speech data

You can sort your data either by ear or by its sequential number depending on your needs. Usually, the sequential sorting is preferred during data collection when you perform one test type at a time. Sorting by ear is sometimes preferred when you compare the ears when analyzing the complete results.

• To sort data by their sequential number, click the number field in the table header (marked with the #symbol).

• To sort data by ear, click the ear field in the table header.

The Info field

The

Info

field provides additional information such as a stimulus source (e.g. CD, Live, File, or specific speech material), as well as noise condition, and your own comments if desired. To add your own comments, right-click the

Info

field.

Pure Tone Data

These fields contain the tone test results. They display the pure tone average (PTA) for air conduction (AC), bone conduction (BC), and the calculated Articulation Index (AI) for that ear.

The PTA and AI are automatically calculated from the tone audiogram.

• To configure pure tone average (PTA) calculation, select

Tools

>

Options

>

Audiometry

>

General

>

Misc.

>

PTA

Frequency AC/BC

.

2.9.10

2.9.11

Storing SNR for Speech testing

Word and Sentence Recognition tests can be performed in noise. The Signal to Noise Ratio can be stored with the data regardless of whether the noise comes from the recording or is generated in the audiometer.

You can enter an SNR manually or set it to be calculated automatically based on the difference between the Stimulus and the noise channel levels.

•

•

Manual:

is useful when signal and noise are mixed together in the speech recording.

Automatic:

is useful when you mix speech and noise from the two audiometer channels.

Speech feature boxes

You can access a number of speech display options directly from the

Speech

main screen.



Feature boxes

Pure Tone Data

Stenger

Displays the pure tone average for air conduction and bone conduction as well as the articulation index.

• To configure pure tone average (PTA) calculation, select

Tools

>

Options

>

Audiometry

>

General

>

Misc.

>

PTA Frequency AC/BC

.

• The AI is calculated according to the “Count-the-dot” method.

Displays the results of a speech Stenger test (optional).


2.9.12

Terms and abbreviations used in Speech testing

SDT

Speech Detection Threshold

Speech Recognition Threshold

SRT

MCL

UCL

WRS/SRS

Most Comfortable Loudness Level

UnComfortable Loudness Level

Word Recognition Score/Sentence Recognition Score

•

Score

Percentage of correct/incorrect words.

PTA

AI

•

•

Level

dB level at which the words were presented.

[Msk]

Effective masking level (dB EML) used for contralateral masking.

•

SNR

Signal-to-Noise Ratio.

Pure Tone Average

•

PTA - AC

Pure Tone Average for Air Conduction thresholds.

•

PTA - BC

Pure Tone Average for Bone Conduction thresholds.

Articulation Index (%), based on the Count-the-dot method.

2.10

Special tests

2.10.1

Available special tests

Some special tests may be specific to language or local test protocols and are not included in OTOsuite but are available for adding to the OTOsuite Audiometry module. Contact your local supplier for further information.



2.10.2

SISI (Short Increment Sensitivity Index)

The SISI Test was developed by Jerger and co-workers (Jerger, Shedd, and Harford, 1959) and was introduced as a procedure that was reliable and reasonably objective.

The test consists of superimposing brief bursts of 1 dB intensity increments on a sustained tone presented monaurally through earphones at a sensation level of 20 dB at each tested frequency.

The patient is instructed to report any jumps in loudness detected while listening to the sustained tone for a period of about two minutes.

2.10.2.1

Navigating in SISI

The Control Panel

Channel

Continuous On

When checked, the stimulus will be continuously on and will turn off when you press the stimulus button.

Transducer

Insert

Phone

High Frequency

Presents the stimulus through the insert earphones.

Presents the stimulus through the headphones.

Presents the stimulus through the high frequency headphones.

Routing

Left

Right

Test Options - SISI

Transducer dB Step

SISI dB Step

This determines the dB step size for the intensity of the stimulus when presenting the tone manually. Options are 1, 2, and 5.

This determines the dB step size for the intensity of the stimulus when presenting the tone automatically using the play button. Options are 1 (should be used for testing), 2, and 5.

SISI Stimulus Bar

Stimulus is routed to the left transducer.

Stimulus is routed to the right transducer.

A.

B.

C.

D.

E.

F.

Intensity

Stimulus indicator


Routing indicator

Stimulus bar color

Frequency



Intensity


• The green wave symbol above the level indicates with two waves that the stimulus carrier tone is currently being presented, and with three waves that the increment is applied.


Indicates the routing for the channel:

• Blue = left ear

• Red = right ear


Indicates the stimulus type, the transducer and the routing for each channel.

Test controls



Tools

>

Options

>

Audiometry

>

General

>


.

Controlling intensity and frequency, and storing data

Store

• The

Arrow up

button increases the intensity.

• The

Arrow down

button decreases the intensity.

• The

Arrow left

button decreases the stimulus frequency.

• The

Arrow right

button increases the stimulus frequency.

• Stores the data point.

Scoring Level Intensity Change Recognition

• Click the

+

button each time the patient acknowledges that a change in intensity was heard

Reset

•

Play

button

Starts the test.

•

Stop

button

Stops the test.

•

Reset

button

Resets the score to 0% and 0/0.



Scoring Level Intensity Change Recognition

The score box tracks the number of 1 dB intensity changes presented and the number of 1 dB intensity changes the patient heard.

The percentage is a ratio of the number of intensity changes heard compared to the number of intensity changes presented.

SISI data

Data display in SISI screen

Frequency dB

%

Audiogram

Threshold

• The frequency which was presented.

• The intensity.

• The score.

• Displays pure tone audiogram.

• Displays pure tone average.

SISI editing options

Editing options

Delete

Delete all

• Deletes the data for a particular frequency for a particular ear.

• Deletes the data for all the frequencies for a particular ear.

2.10.2.2

The test process - SISI

The audiometer produces an intensity increment every 5 seconds. Each increment has a rise time of 50 msec, a duration at full strength of 200 msec, and a decay time of 50 msec. The size of the increment can be varied from 0 to 5 dB in 1 dB



2.10.3

steps (selected on-screen from the Increment box), although the test is scored only on the percentage of 1 dB increments correctly identified by the patient. Twenty 1 dB increments are presented during the test. If the subject responds 10 times out of the 20 1 dB increments, the sensitivity index is 50%.

Before starting the test

Before starting the test, present five 5 dB increments to give the patient a noticeably intense increment to respond to.

ABLB (Alternate Binaural Loudness Balance)

This test was first described by Fowler (1928).

Hearing levels at which a pure tone sounds equally loud to both ears of a subject are compared.

The test is applicable when there is a difference in hearing loss of at least 20 dB between the two ears at the pure-tone test frequency.

2.10.3.1

Navigating in ABLB

The Control Panel

Channel

Continuous On

When checked, the stimulus will be continuously on and will turn off when you press the stimulus button.

Transducer

Insert

Phone

Presents the stimulus through the insert earphones.

Presents the stimulus through the headphones.

High Frequency

Presents the stimulus through the high frequency headphones.

Routing

Left

Right

Left transducer is considered the ABLB test ear.

Right transducer is considered the ABLB test ear.

Test Options - ABLB

Transducer dB Step

This determines the dB step size for the intensity of the reference stimulus tone. Options are 1, 2, and 5.

ABLB dB Step

This determines the dB step size for the intensity of the ABLB test stimulus. Options are 1 (should be used for testing), 2, and 5.



ABLB Stimulus Bar

A.

B.

C.

D.

E.

F.

Intensity

Stimulus indicator


Routing indicator

Stimulus bar color

Frequency

Intensity


• The green triple wave symbol above the level indicates that the stimulus is currently being presented.


Indicates the routing for the channel:

• Blue = left ear

• Red = right ear


Indicates the stimulus type, the transducer and the routing for each channel.

Test controls



Tools

>

Options

>

Audiometry

>

General

>


.

Controlling intensity and frequency, and storing data

Store

•

•

•

•

Arrow up

increases the intensity.

Arrow down

decreases the intensity.

Arrow left

decreases the stimulus frequency.

Arrow right

increases the stimulus frequency.

• Stores the data point.



ABLB data

54

Data display in ABLB screen

Frequency column

Ref

Test

• Each frequency displays low to high intensity from top to bottom.

• The ear that is considered to be the reference ear. A steady tone at a particular intensity is presented to this ear.

• The ear that is considered the test ear. A steady tone with adjustable intensity is presented to this ear until equal loudness with the reference ear is determined.

ABLB editing options

Editing options

Selected point

Delete selected measurement

Delete all at x (e.g. 1000) Hz

• e.g. 1000 Hz (90/75) dB

• Deletes the data for the frequency that is currently displayed.

• Deletes the data for that particular column when the frequency is currently set differently from that column.



2.10.3.2

The test process

Tones are presented alternately to both ears, and the patient is asked to make an equal loudness judgment.

2.11

Test controls (keyboard, mouse)

2.11.1

PC keyboard controls

You can open an overview of PC keyboard shortcuts from the

OTOsuite Manuals

file.


was installed on your PC when you installed OTOsuite. You can open


from the Windows

Start

menu.


3 Preparing for testing

3

3.1

3.2

Preparing for testing

It is important to prepare properly before making measurements with Otometrics Madsen A450 and the OTOsuite software. It is time-saving for both you and the client if the environment, the client, the test device, and the software are ready for the test.

Preparing the test environment

Before you start testing, make sure that the test environment is conducive to testing.

• The test environment should be quiet, preferably in a sound proof booth, for accurate threshold results.

• The test room or sound booth should have a minimum of furniture and hard surfaced articles (i.e. filing cabinets, tables etc), as these can cause reverberation during sound field testing.Live voice examinations are best carried out when using a sound booth, so that the client/patient cannot hear the tester's voice directly. With tester and client/patient in the same room, especially of clients with normal or almost normal hearing, false results could be obtained.

Furniture

The test environment should include

• a comfortable chair for the client,

• a child-sized chair if testing pediatrics,

• a comfortable chair for the assistant.

The examiner should be able to see the client/patient. The client/patient should be seated so that it is not possible to see what the examiner is doing or how the equipment is being operated. This reduces the likelihood that the client/patient can anticipate when the stimulus will be presented.

For pediatric testing consider using a highchair, which is a familiar environment for most children and will place them closer to eye level with the visual reinforcement toys. Make sure if performing visual reinforcement audiometry that the reinforcing toys can be seen by the child. A child cannot look over and up at a toy until approximately 9 months of age.

Lighting

The lighting in the booth should be bright enough for the examiner to adequately see the client.

Toys

If testing pediatrics, several interesting toys are needed to center the child (obtain the child's attention toward the assistant or tester) prior to stimulus presentation. It is best if these toys do not produce sounds.

The child should be conditioned to respond to the sound of the stimulus only. Competing sounds from toys can confuse the child and reduce the reliability of the test.

Soft toys are needed to keep a young child's attention during behavioral observation or visual reinforcement audiometry.

Younger children like to tap the toy on the highchair tray and therefore a toy that does not create much sound would be more appropriate during testing.

Blocks, buckets, puzzles are needed to keep a child's attention during play audiometry.

Preparing the test equipment

Accessories

Make sure that you have connected the required accessories to the audiometer:

• headphones

• insert phone(s)


3 Preparing for testing

3.3

• bone oscillator

• patient responder.

Otometrics Madsen A450 and the Audiometry module

• Make sure the cables of the test equipment are connected correctly.

• Launch OTOsuite and the Audiometry module on the PC (see the OTOsuite User Guide).

• Make sure Otometrics Madsen A450 is switched on.

• Make sure the connection between the Audiometry module and Otometrics Madsen A450 is enabled.

See

Configuring the Audiometry Module ► 76

.

Listening check

Perform listening checks routinely to make sure that the equipment is functioning properly.

• Use a person who has auditory thresholds below 10 dB and make sure that he or she can hear a very faint sound for each stimulus type, frequency and for each transducer at 0 to 5 dB.

• If the person cannot hear the stimulus, contact the manufacturer or local representative to troubleshoot the system.

• It is recommended that the system be calibrated annually or according to the local requirements.


4 Preparing the client

4

4.1

Preparing the client

Hygienic precautions

It is important that hygienic precautions are taken to protect the client from cross-infection. Be sure to follow any established infection control procedures for the setting in which you are working.

•

Headphones

•

Clean the headphones between patients, e.g. with a non-alcohol based antibacterial wipe, such as Audiowipes.

Insert earphones

Warning

•

To prevent cross-infection, use new eartips when you test the next client.

4.2

4.3

Inspecting the client’s ear(s)

1. Position the client so that you can easily access the client’s ear(s).

2. Grasp the pinna and gently pull it back and slightly up and away from the client's head.

3. Inspect the ear canal and make sure that you can see the ear drum.

If you can see apparent narrowing of the ear canal, it may be blocked by vernix or debris, or it may not be straight.

4. If the ear canal is blocked, for instance by vernix or debris, the outcome of the procedures may be affected.

Clean the ear canal if required.

Proper transducer placement

Headphones

1. Loosen the headband and place both the left and right side of the headphones simultaneously.

2. Make sure that the blue indicator is on the left ear and the red indicator is on the right ear. The center of the headphone diaphragm should be directly opposite the opening of the ear canal for the left and right side.

Note

•

If the headphones are not placed properly, there is risk of causing the ear canal to collapse which will result in elevated thresholds.

3. Ask the patient if the headphones are comfortable.

4. Tighten the headband while holding the headphones in place with your thumbs.

5. Examine the placement of the headphones to make sure they are level, and properly positioned.

Insert Earphones

Young children tolerate insert earphones better than headphones.

The insert earphones are color-coded:

• the blue indicator for the left ear,

• the red indicator for the right ear.


4 Preparing the client

1. Select the largest foam eartip that will fit into the patient's ear.

If the eartip is too small the sound will leak out and the dB level will not be accurate at the eardrum.

Insert earphones have greater attenuation between ears especially at the low frequencies; this reduces the need for masking.

2. It is best to clip the insert earphone transducers behind the child or on the back of their clothing and then fit the foam eartip into the child's ears.

If the foam eartip is a little too large, consider cutting it down to make it a little smaller.

Bone Oscillator

Note

•

For unmasked bone thresholds, you can store binaural data:

- Select Both in the Ear Selection part of the control panel.

Note

•

If there is a difference of 10 dB or greater between the bone conduction threshold and the air conduction threshold of the same ear, masking is needed. The Masking Assistant can assist you in determining which thresholds need to be masked.

Note

•

If the SRT of the test ear and the SRT or PTA of the nontest ear differ by 45 dB or more, masking is needed.

If the SRT of the test ear and the bone conduction PTA of the nontest ear differ by 45 dB or more, masking is needed.

Mastoid placement

1. Move any hair covering the mastoid out of the way and place the flat round part of the bone oscillator securely on the boniest portion of the mastoid without any part of the transducer touching the external ear.

2. Make sure the bone oscillator is tight on the mastoid but still comfortable.

3. If you are going to perform masking with earphones, position the other end of the bone oscillator headband over the patient's temple on the opposite side of the head so that the headband of the earphones and bone oscillator fit on the patient's head.


5 Examples of audiometric testing

5

5.1

5.1.1

Examples of audiometric testing

Testing the older child or adult patient

Assessing pure tone threshold using the Hughson/Westlake procedure

Threshold

This is the lowest level at which the patient responds to the stimulus at least 50% of the time.

1. Talk to the patient while you walk him/her to the booth. This will give you some idea of how well he/she is hearing.

– Ask him/her which ear is his/her better hearing ear.

2. Perform otoscopic inspection of the ear canals to make sure that the ears are free from occluding cerumen (earwax) or debris.

3. Optional: Perform tympanometry and reflexes prior to audiometric test.

4. Properly place the earphones. Begin the test with the air conduction transducer.

– If you are planning to test high frequencies, use the HDA 300 earphones for all frequencies (if they have been calibrated for all frequencies).

5. Give the patient the responder(s).

6. Instruct the patient so that he/she knows what to expect: "You will hear various sounds from low pitches to high pitches. Push the button when you hear a sound, even if it is very soft."

7. If the patient reports having tinnitus, consider using a pulsed tone for testing.

8. Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing, sound level, and frequency. Make sure that threshold test (THR) is selected.

9. Begin the test in the ear reported as the better hearing ear.

– Tell the patient in which ear the test will begin.

10. Start the testing at 1000 Hz.

11. Start presenting the tone at a sound level that should be clearly audible to the patient to confirm that instructions for responding were understood.

– Present the tone for 1 to 2 seconds.

12. If the patient responds to the initial sound level presented, proceed with the test by decreasing the level in 10 dB steps until no response is obtained.

– Increase the level in 5 dB steps until a response is obtained again.

– Continue decreasing in 10 dB steps and increasing in 5 dB steps until you determine the lowest level at which the patient responds correctly to two of three trials. This is the threshold.

– Once threshold is obtained, store the response.

13. Continue testing with this up/down procedure in the following frequency order: 2000, 4000, 8000, 500, 250, 125, and reconfirm the threshold at 1000 Hz.

– If there is a 20 dB difference or greater between octaves, test the interoctave frequencies.

– Talk to the patient occasionally. Encourage the patient to concentrate on the task. This will keep your patient from getting bored or becoming an unreliable responder.

14. Switch to the other ear and tell the patient to listen for the sounds in that ear.

15. Repeat steps

11

to

13

.



5.1.2

5.1.3

16. If there is a difference of 40 dB or more between the test ear threshold and nontest ear threshold, the better ear must be masked to test the poorer ear. The Masking Assistant can assist you in determining which thresholds need to be masked.

17. To use masking noise in combination with the pure tone, either check

Stim. Lock

to coordinate the presentation of two channels or check

Continuous On

to keep the masking channel presenting continuously.

18. After the air conduction thresholds are determined, bone conduction audiometry can be performed.

19. Properly place the bone oscillator.

20. Instruct the patient again to push the button in response to the tone even if the stimulus is very soft.

21. Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing, sound level, and frequency.

22. Repeat steps

9

to

13

.

– If there is a difference of 10 dB or greater between the bone conduction threshold and the air conduction threshold of the same ear, masking is needed. The Masking Assistant can assist you in determining which thresholds need to be masked.

23. When all air and bone conduction thresholds are determined, the pure tone average (PTA) for each will appear in the

PTA/AI

box. The Articulation Index (AI) and the overlay options can be used for counseling the patient.

24. Click in the

Reliability

box to report the reliability of the patient's responses during testing -

Good

,

Fair

, or

Poor

.

Assessing pure tone or speech most comfortable loudness level (MCL)

1. Properly place the earphones.

– Begin the test with the air conduction transducer.

2. Instruct the patient that you are trying to find the level at which he/she is most comfortable listening to the sounds.

3. Make sure that the control panel of the OTOsuite software is set to the correct transducer, desired routing and sound level.

– Make sure that most comfortable level test (MCL) is selected.

4. Start at a moderate level. Present the stimulus and ask the patient if the current level is comfortable or if he/she would prefer it louder or softer.

– Increase and decrease the sound level until the patient's preferred level is determined. This is the MCL.

– Once MCL is obtained, store the response.

5. Repeat steps

3

and

4

for each frequency if performing MCL testing for pure tones.


7. Repeat steps

3

and

4

for the opposite ear.

Assessing pure tone or speech uncomfortable loudness level (UCL)



2. Instruct the patient that you are trying to find the level at which the sound is uncomfortably loud. It should be tolerable and not painful.

3. Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing and sound level.

– Make sure that uncomfortable loudness testing (UCL) is selected.



5.1.4

5.1.5

4. Start at a moderate level. Present the stimulus and then ask the patient if the current level is okay or uncomfortable.

Increase the presentation level in 5 to 10 dB steps until the patient's uncomfortable loudness level is determined.

5. Repeat steps

3

and

4

for each frequency if performing UCL testing for pure tones.


7. Repeat steps

3

and

4

for the opposite ear.

Assessing speech reception threshold (SRT) using the Hughson/Westlake procedure



2. Instruct the patient so that he/she will know what to expect: "You will hear various words, like hotdog, ice cream, ect.

When you hear a word, repeat it back to me even if the word is very soft. It is okay to guess if you are unsure of the word."


– Make sure that speech reception threshold (SRT) is selected.

4. Begin the test in the ear that has the lower PTA.

– Inform the patient in which ear the test will begin.

5. Start presenting words at a level that should be clearly audible to the patient to confirm that the instructions for responding were understood.

6. It is best to use recorded speech to reduce variability.

– If the automated presentation speed of the recorded speech is too fast for the patient, you can deliver the recorded words one at a time by double-clicking on the word in the word list.

– You can also present the speech material using monitored live-voice.

7. If the patient responds to the initial sound level presented, proceed with the test by decreasing the level in 10 dB steps until no response is obtained.

– Increase the level in 5 dB steps until a response is obtained again.

– Continue decreasing in 10-dB steps and increasing in 5-dB steps until you determine the lowest level at which the patient responds correctly to two of three trials. This is the SRT.

– Once the SRT is obtained, store the response.

8. If the SRT of the test ear and the SRT or PTA of the nontest ear differ by 45 dB or more, masking is needed.

If the SRT of the test ear and the bone conduction PTA of the nontest ear differ by 45 dB or more, masking is needed.

9. Switch to the other ear and tell the patient to listen for the words in that ear.

10. Repeat steps

3

to

7

.

11. The SRT will be ± 8 dB of the PTA for each ear if the data are reliable.

Assessing word recognition score



2. Instruct the patient so that he/she will know what to expect: "You will hear various words, like bird, dog, etc. When you hear a word, repeat it back to me. This time the words will all be loud enough to hear. It is okay to guess if you are unsure of the word."



5.2

5.2.1


– Make sure that word recognition score (WRS/SRS) is selected.

4. Begin the test in the ear with the lower PTA and/or SRT.

– Tell the patient in which ear the test will begin.

5. It is best to use recorded speech to reduce variability.

– If the automated presentation speed of the recorded speech is too fast for the patient, you can deliver the recorded words one at a time by double-clicking on the word in the word list.

– You can also present the speech material using monitored live-voice.

6. Present the words at a sound level that is 30 to 40 dB higher than the SRT score.

– Some examiners prefer to give the patient a couple of words to make sure that the response instructions are understood. These words should not be part of the test word list as familiarity can bias the test.

7. Score the responses using the +/- buttons. Typically, 25 or 50 words are presented in a list. Once all the words on the list have been presented, you have a percentage correct. This is the WRS.

– Once the WRS is obtained, store the response.

8. Switch to the other ear and tell the patient to listen for the words in that ear.

9. Repeat steps

6

to

7

.

10. Type any desired notes regarding the test (for example, "NU-6, word list 3A") in the box to the left of the scores (tabular view) or symbols (graphical view).

Special Tests

Performing Tone Decay using the Modified Carhart Method



2. Give the patient a responder.

3. Instruct the patient so that he/she knows what to expect: "You will hear a continuous tone. Press the button on the responder as long as the tone stays the same. If the pitch changes or you can no longer hear the tone, release the responder button."

4. Select tone decay in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer, and desired routing, sound level and frequency. Any frequency can be used.

5. Make sure that the tone decay box and the timer box have appeared in the display.

6. Start the test at 5 dB above the patient's threshold for that frequency in that ear.

7. As soon as the subject responds, start the timer. You will be presenting a tone for at least one minute.

8. If the patient indicates that the tone was audible at the same pitch for one minute, then the test is complete.

– Store the test result in the

Tone Decay Box

.

9. If the patient indicates that the tone is no longer audible or changes pitch before one minute passes, increase the level of the tone by 5 dB.

– Reset the timer when you increase the level and begin timing again.



5.2.2

5.2.3

10. Continue increasing the tone by 5 dB until a level is reached at which the patient indicates that the tone is audible at the same pitch for one minute.

11. If desired, test additional frequencies or the opposite ear.

12. Store the test result in the

Tone Decay

box.

Performing a pure tone Stenger

1. To perform this test, the pure tone thresholds for the chosen stimulus frequency should be at least 20 dB different in each ear.

– You must suspect that the patient is malingering.



3. Instruct the patient to push the button in response to the tone even if the sound is very soft.

4. Select Puretone Stenger in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing, frequency, and sound level.

– Choose any frequency.

– Set the level for the better ear at 10 dB above recorded threshold and set the level in the poorer ear at 10 dB below recorded threshold.

5. Make sure that the

Stenger

box has appeared in the display.

6. Make sure that

Stim. Lock

is enabled and present the tone to both ears simultaneously.

7. If the patient truly has a hearing loss in the poorer ear, he/she will only hear the presented tone in the better ear and will respond that the tone is present.

– This is a negative Stenger response.

8. If the patient does not truly have a hearing loss in the poorer ear, he/she will only hear the presented tone in the reportedly poorer ear. As the patient is trying to appear as if he/she has a hearing loss in that ear, the patient will not respond to the tone.

– This is a positive Stenger response.


Stenger

box.

Performing speech Stenger

1. To perform this test, the SRT should be at least 20 dB different in each ear.

– You must suspect that the patient is malingering.

2. Properly place the earphones. Begin the test with the air conduction transducer.

3. Instruct the patient to repeat the word back to the examiner even if the word is very soft.

4. Select Speech Stenger in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer, and desired routing and sound level.

– Set the level for the better ear at 10 dB above recorded SRT and set the level in the poorer ear at 10 dB below recorded SRT.


Stenger


6. Make sure that

Stim. Lock

is enabled and present the word to both ears simultaneously.



5.2.4

5.2.5

7. If the patient truly has a hearing loss in the poorer ear, he/she will only hear the presented word in the better ear and will respond by repeating the word.

– This is a negative Stenger response.

8. If the patient does not truly have a hearing loss in the poorer ear, he/she will only hear the presented word in the reportedly poorer ear. As the patient is trying to appear as if he/she has a hearing loss in that ear, the patient will not repeat the word.

– This is a positive Stenger response.


Stenger

box.

Performing Weber

1. Properly place the bone oscillator on the forehead.

2. Instruct the patient so that he/she knows what to expect: "You will hear a tone. Tell me whether you hear the tone in the left, right or both ears."

3. Select

Weber

in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing, sound level and frequency.


Weber


5. Present a pure tone at a frequency below 1000 Hz and a sound level above the patient's bone conduction threshold.

6. If the patient reports hearing the tone equally in both ears, this is indicative of normal hearing.

7. If the patient reports hearing the tone in the poorer ear, this is indicative of a conductive hearing loss.

8. If the patient reports hearing the tone in the better ear, this is indicative of a sensorineural hearing loss.


Weber

box.

Performing Rinne

1. This test is performed using a 256 or 512 Hz tuning fork and compares that patient's hearing to air and bone conduction.

– This test is used to confirm a conductive hearing loss.

2. Instruct the patient that two tones will be presented to him/her. Ask the patient to tell you when the tone can no longer be heard.


Rinne

box is present.

4. Strike the tuning fork against the knee or the elbow, not the table, otherwise the vibrations will be excessive and cause the patient discomfort.

5. Hold the fork for 2-3 seconds and then place it on the patient's mastoid.

Note

•

The time interval from initial stimulus perception to inability to hear the tone.

6. Strike the fork again.

7. Hold the fork for 2-3 seconds and then place it in front of the patient's ear.

Note

•

The time interval from initial stimulus perception to inability to hear the tone.



5.2.6

5.2.7

8. If air conduction perception is better than bone conduction, this is a positive Rinne and agrees with normal hearing

9. If bone conduction perception is better than air conduction, this is a negative Rinne and indicative of a conductive hearing loss.

10. If air conduction and bone conduction are equal, this is a positive Rinne and indicative of a sensorineural hearing loss.


Rinne

Box.

Performing Alternate Binaural Loudness Balancing (ABLB) test

If you have measured thresholds prior to performing ABLB, then these will appear already plotted in the ABLB graph.



3. Instruct the patient so that he/she knows what to expect: "You will hear a continuous tone. The level of this tone will be changed periodically. Press the button on the responder immediately each time you hear a change. I will ask you if the test tone is softer than, louder than or equal to the reference tone in the opposite ear."

4. Choose the ABLB tab or select ABLB in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing.

– If left ear is selected as the test ear in the Control Panel Routing section, then the right ear will be the reference ear.

5. Set the reference level (

Ch 1

).

6. Set the test level (

Ch 2

) to 10 dB above the patient's threshold for that ear.

7. Adjust the level of the test signal (

Ch 2

) until the patient reports that the two signals sound equally loud.

8. Store the data points.

9. Repeat steps

5

to

8

for additional frequencies.

10. If desired, switch routing to test the opposite ear and repeat steps

5

to

8

.

Performing Short Increment Sensitivity Index (SISI) test



3. Instruct the patient so that he/she knows what to expect: "You will hear a continuous tone. The level of this tone will be changed periodically. Press the button on the responder immediately each time you hear a change."

4. Choose the

SISI

tab or select

SISI

in the Test Selector.

– Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing.

– Make sure that the frequency is correct.

5. Begin the test in the ear with the lower PTA or SRT.

6. Start with 5 dB SISI dB step and set the level 20 dB above the patient's threshold for that frequency in that ear.

7. The test begins with 1000 Hz.

8. Make sure that the patient understands the response task.

9. Change the SISI dB step to 1 dB. Set the level 20 dB above the patient's threshold for that frequency in that ear and press the

Play

button.

10. Store the data points.

11. Repeat steps

6

to

10

for additional frequencies.



5.3

5.3.1

5.3.2

Testing with sound files

Playing sound files without word lists

Prepare playback

1. Use either

Int. CD

or

Int. File

as

Sound Source

.

2. If

Int. CD

is chosen, select

CD Drive Selection

and/or

CD Track Selection

in the

Options

dialog or directly in the

Player Panel

. This will list CD tracks in the

Player Panel

combo box.

3. If

Int. File

is chosen, select

Sound File Selection

in the

Options

dialog or browse for a folder containing sound files in the

Player Panel

. This will list all sound files contained in the same folder as the


file in the

Player Panel

combo box.

How to play back / stop playback

1. Use either the

Play

or

Pause

button.

2. A click on the

Pause

button (actually a stop icon) will pause playing (this is different when using word lists).

3. A click on

Reset

stops the playback and resets the score.

How to score

• Use the score buttons or shortcut keys (+, -).

When to reset score

Notice the field

Reset Score Counter

in the

Options

dialog.

•


=

True

The

Scoring panel

is reset if you change

Channel Settings

(except

Continuous On

), the

Intensity

or if the

Reset

button is clicked.

•


=

False

Does not change the score even if

Reset

is clicked.

Playing sound files with word lists

Prepare playing

1. Use either

Int. CD

or

Int. File

as

Sound Source

.

2. If

Int. CD

is chosen, select a CD drive in

CD Drive Selection

in the

Options

dialog or in the

Player Panel

. It is important that an XML file (extension *.wordlistdefinition) describing the word lists exist on your PC (in the installation folder). If not the tracks on the CD will be listed and not the actual words.

3. If

Int. File

is chosen, select a .wav file in the


which is located in the same folder as a wordlistdefinition file. You can also browse for a folder in the

Player Panel

that contains a wordlistdefinition.

How to play/stop files

1. Use either the

Play

or

Pause

button.

2. A double click on a word in the

Word list control

plays the selected word.

3. A

Play

button click will start to play back the word list from the current index to the end.

4. If you like to change index during playback, just change index in the


and it will keep on playing from that position.



How to score

• Use the score buttons or shortcut keys (

+

,

-

), or make a right click on a given word already played in the


.

When to reset score

Notice the field


in the

Options

dialog.

•


=

True

The

Scoring panel

as well as the


images (

+

,

-

) is reset if changes are made to the

Channel Settings

(except

Continuous On

), the

Intensity

or when the

Reset

button is clicked.


=

False

•

We actually reset the score in some cases even if


=

False

. This is in situations where we go from using a word list to e.g.

Stimulus CH1

=

Stimulus CH2

=

Mic.


6 Unpacking and installing

6

6.1

Unpacking and installing

This section applies to Otometrics Madsen A450 as well as to the various accessories available. If the accessories are not part of your configuration, disregard the instructions relating to the accessories.

To install and get started with Otometrics Madsen A450 and the OTOsuite Audiometry module, follow the sequence below:

• Install OTOsuite on the PC before you connect to Otometrics Madsen A450 from the PC.

• Unpack Otometrics Madsen A450. See

Unpacking ► 70

.

• Assemble Otometrics Madsen A450 See

Assembling Otometrics Madsen A450 ► 73

.

• Connect the cables of the test equipment. See

Connecting accessories and PC to Otometrics Madsen A450 ► 74

• Run the OTOsuite Configuration Wizard to connect to and set up communication with Otometrics Madsen A450. See


.

Requirements to the location

A sound cabin or sound treated room is not necessary, but it is recommended that you use a room where reverberation time is not too long.

To ensure safe performance, Otometrics Madsen A450 must be correctly installed and the requirements listed in

Standards and Safety ► 82

and

Technical specifications ► 86

must be complied with.

Warning

•

The charger unit should be kept away from the client area.

Warning

•

Keep Otometrics Madsen A450 away from all liquids and sources of heat (for detailed specifications, see Operating environment in

Technical specifications ► 86 ).

Warning

•

It is recommended to install the unit in an environment that minimizes the amount of static electricity.

For example, anti-static carpeting is recommended.

6.1.1

Requirements to noise in the test environment

Audiometry testing does not require a quieter testing environment than do other traditional Real Ear Measurement systems.

Although Audiometry testing is designed for use in a regular dispensing office environment, the test environment should in some cases be adapted to suit the specific test types.

• Make sure that the test environment is as quiet as possible. The quieter the room is, the more accurate your testing will be.

It is very important that the measurements are not influenced by sounds or noise relating to anything else than the presented test signals. Measurements of peak levels will be influenced by any sounds louder than the presented test signals. Even extremely brief sounds may impact the measurements.

It is therefore important that the environment is well controlled to prevent any unforeseen influence.

• Check that testing is not being done under an air conditioner or in front of a fan or ventilator.



6.2

6.3

6.4

Unpacking

1. Unpack the device carefully.

When you unpack the device and accessories, it is a good idea to keep the packing material in which they were delivered. If you need to send the device in for service, the original packing material will protect against damage during transport, etc.

2. Visually inspect the equipment for possible damage.

If damage has occurred, do not put the device into operation. Contact your local distributor for assistance.

3. Check with the packing list to make sure that you have received all necessary parts and accessories. If your package is incomplete, contact your local distributor.

4. Check the Test Report (Calibration Certificate), make sure that the transducers (headphones and bone oscillator) are the correct ones, and that they comply with the ordered calibration standards.

Storing

If you need to store Otometrics Madsen A450 before you put it into operation, follow the guidelines below:

• Store Otometrics Madsen A450 and accessories in the boxes provided to protect the equipment from damage.

• Store Otometrics Madsen A450 and accessories in a dry environment.

See also Transport and storage in


.

Views of Otometrics Madsen A450

Otometrics Madsen A450 Connection panel

6.5

Otometrics Madsen A450 connection panel

Install OTOsuite on the PC before you connect to Otometrics Madsen A450 from the PC.

The installation must be carried out in accordance with IEC 60601-1-1 plus addendum in the form of Part 1:

General provisions -1 and UL 60601-1, CAN/CSA-C22.2 NO 601.1-90. The supplementary provisions on the reliability of electro-medical systems.



It is a general rule for all electrical equipment used in the proximity of the client that:

• The connected equipment must comply with IEC 60601-1 and/or IEC 60601-1-1 except for the PC, and equipment connected to the line in and the line out sockets of Otometrics Madsen

A450.

See also

Warning notes ► 82

.

When you have connected the accessories, configure your system setup. To do so, see


.

D.

E.

F.

G.

A.

B.

C.

A. PC/USB connection ► 71

B. External power supply ► 72

C. Sound field speakers (built-in amplifier output)

► 72

D. Insert earphones ► 72

E. Headphones - air conduction ► 72

F. Patient Responder ► 72

G. Bone oscillator ► 72

H.

I.

J.

K.

L.

M.

H. Speaker, Analog (line output) ► 72

I. Line-in ► 72

J. Operator monitor headset - headphones ► 72

K. Operator monitor headset - boom microphone

► 73

L. Counseling and Simulations headphones ► 73

M. Talk-back microphone ► 73

Note

•

Blue corresponds to Left and red corresponds to Right.

A. PC/USB connection

Caution

•

Install OTOsuite on the PC before you connect to Otometrics Madsen A450 from the PC.

To connect Otometrics Madsen A450 to a PC, use the supplied USB cable.

1. Plug one end of the USB cable into the PC/USB socket in the connection panel and the other into a USB socket on the

PC.

2. Switch on Otometrics Madsen A450. The driver installation will be initiated.

3. If the

Found New Hardware Wizard

appears on the screen, click the radio button

No, not this time

and click

Next

.

4. Follow the on-screen instructions.



72

B. External power supply

Warning

•

Use only the power supply provided by Otometrics.

Warning

•

Otometrics Madsen A450 is not provided with a mains switch.

To connect Otometrics Madsen A450 to the mains supply, plug the mains plug into the wall mains outlet.

To disconnect Otometrics Madsen A450 from the mains supply, pull the mains plug out of the wall mains outlet.

Do not position the unit so that it is difficult to pull the mains plug out of the wall mains.

See


for details.

1. Plug the external power supply into the Power socket in the connection panel.

2. Plug the mains plug of the external power supply into an AC mains outlet with a three-wire protective ground.

C. Sound field speakers (built-in amplifier output)

Connections for sound field speakers using the built-in amplifiers (2 sound field speakers are supported in the software).

• Plug the cable of the left speaker into socket no. 1, and the cable of the right speaker into socket no. 2.

D. Insert earphones

• Plug the insert earphones into the Right and Left

Insert

sockets.

• If you are using a mono insert earphone, plug it into the

Left Insert

socket (the lower socket).

E. Headphones - air conduction

• Plug standard headphone cables (red and blue jacks) into the Right and Left

Headphone

sockets.

F. Patient Responder

• If you are using a Patient Responder, plug it into this socket.

G. Bone oscillator

• Connection for a standard Bone Oscillator for Mastoid or Forehead placement.

H. Speaker, Analog (line output)

• Connection for a sound field speaker with external amplifier. (Not active on some models.)

I. Line-in

• Connection for a line-in device (e.g. CD player).

Caution

•

When you connect other electrical equipment to Otometrics Madsen A450, remember that equipment that does not comply with the same safety standards as Otometrics Madsen A450 can lead to a general reduction in the system's safety level.

J. Operator monitor headset - headphones

• If you are using headphones with the operator monitor headset, plug the headphones into this socket.



The jack is marked with this symbol.

K. Operator monitor headset - boom microphone

• If you are using a boom microphone with the operator monitor headset, plug the boom microphone on the monitor headset into this socket.


L. Counseling and Simulations headphones

• Connection for Counseling and Simulations headphones.

M. Talk-back microphone

• Connection for an operator desktop microphone.


6.6

6.7

Assembling Otometrics Madsen A450

• Read the OTOsuite user documentation before you connect or use Otometrics Madsen A450 for the first time.

Otometrics Madsen A450 is fully assembled on delivery, and you simply have to connect cables.

Wall-mount installation

If you wish to mount Otometrics Madsen A450 on the wall, see

Desktop or wall-mount installation ► 73 .

Desktop or wall-mount installation

Install OTOsuite on the PC before you connect to Otometrics Madsen A450 from the PC.

For instructions on installing OTOsuite, see the OTOsuite Installation Manual, which you can find on the OTOsuite installation medium (disk or memory stick).

Otometrics Madsen A450 is fully assembled on delivery, and you simply have to connect cables.

Caution

•

To connect Otometrics Madsen A450 to the PC, use the supplied USB cable. The cable length must not exceed 3 m (approx. 10 feet).

Desktop or wall-mount installation

You can place Otometrics Madsen A450 on the desktop or mount it on the wall.

• Connect the accessories and external power supply to the device. Follow the instructions in

Connecting accessories and PC to Otometrics Madsen A450 ► 74

.

Desktop installation

1. Place Otometrics Madsen A450 on the desktop.



A.

B.

External power supply cable

USB cable between Otometrics Madsen A450 and the PC

6.8

Note

•

Connection cables for accessories connected to Otometrics Madsen A450 are not shown. See

Otometrics

Madsen A450 connection panel ► 70 .

Wall-mount installation

It is recommended that you connect the external power supply and the accessories before you mount Otometrics Madsen

A450 on the wall.

2. Select two suitably sized screws that will pass through the wall-mount holes on the back of the device:

Max. screw diameter 4.3 mm (0.15 in).

Max. screw head diameter: 9 mm (0.35 in).

3. The distance between the two wall-mount holes on the back of the device is 24 cm (9.4 inches), measured from the center of each hole.

4. Mark up the two holes on the wall and make sure that the device will be placed horizontally.

5. Fix the two screws in the wall.

6. Hang Otometrics Madsen A450 on the screws.

Connecting accessories and PC to Otometrics Madsen A450

1. Connect the accessories to Otometrics Madsen A450. See

Otometrics Madsen A450 connection panel ► 70

for a description of the connection panel.

2. Connect Otometrics Madsen A450 to the PC with the supplied USB cable.

Caution

•

To connect Otometrics Madsen A450 to the PC, use the supplied USB cable. The cable length must not exceed 3 m (approx. 10 feet).

6.9

Powering Otometrics Madsen A450

Otometrics Madsen A450 is powered through an external power supply connected directly to the mains outlet.



Warning

•

Otometrics Madsen A450 is not provided with a mains switch.

To connect Otometrics Madsen A450 to the mains supply, plug the mains plug into the wall mains outlet.

To disconnect Otometrics Madsen A450 from the mains supply, pull the mains plug out of the wall mains outlet.

Do not position the unit so that it is difficult to pull the mains plug out of the wall mains.

1. Plug the external power supply into the Power socket in the connection panel.

2. Plug the mains plug of the external power supply into an AC mains outlet with a three-wire protective ground.

Switching on Otometrics Madsen A450

Use only the power supply specified in Technical Specifications in the Otometrics Madsen A450 Reference

Manual.

1. Connect the mains plug of the external power supply directly to an AC mains outlet with a threewire protective ground.

2. Switch on the mains supply.

3. The On/Off indicator on Otometrics Madsen A450 lights green.

Switching off Otometrics Madsen A450

1. To completely switch off Otometrics Madsen A450, disconnect the power supply from the mains outlet.


7 Configuring the Audiometry Module


You must run the


before you can use the Audiometry Module and the audiometer for the first time.

You can also use the wizard later to change specific settings or, for example, to repair the connection between the Audiometry Module and the audiometer.

1. Select

Tools

>


...

2. Click on

Configure

... next to

Audiometry

.

3. Enter your selections and click on

Next

to continue the configuration or

Finish

to return to the

Applications

page of the configuration wizard.

Audiometers

Connect to the device you wish to use for testing.

• Click on the device you wish to use.

– If the device is not listed, check the check box

My device is turned on and ready to be found

, and click on

Search

.

License Keys

Enter your License Keys to unlock OTOsuite functions

• If you have purchased additional OTOsuite functions, you will be prompted to enter the relevant license keys.

Test Type

Show

"test type" • Click to enable viewing any of these test types as a test tab selection on the Audiometry test screens.

If a User Test is set up to include either of these tests, and they have been disabled in this screen, you will be prompted to enable them here.

Bone Oscillator Level Limitation

Mastoid/Forehead Placement Max. Level

Define the output level limitations for Bone Conduction testing in order to avoid vibrotactile stimulation.


Masking Criteria

Air-Bone Gap Criterion

Define the masking criteria for insert phone(s), earphones, and high frequency earphones (if applicable).

Set the dB level for the Air-Bone gap criterion.

Preferences

Enable BSA (United Kingdom only)

Use Masking Threshold

• Click to enable storing Tone audiometry according to the recommendations of the

British Society of Audiology.

• If the BSA masking threshold is needed, click to enable.



Preferences

SRT Designation

• You can define how SRT data is stored in NOAH by selecting the appropriate type of speech material designation. This enables proper viewing in NOAH AUD.


8 Communicating with the device

8

8.1

8.2

Communicating with the device

Connecting to the device

OTOsuite is designed to communicate with and display test data generated by Otometrics test devices.

• When you start up OTOsuite, click on the

Control Panel

icon. OTOsuite will automatically connect to the test device.

• See also the section "Activating the Control Panel" in the OTOsuite User Guide.

Firmware update

If a Firmware Update message appears, see:

•

Updating device firmware ► 78

.

Information about the test device

To see information relating to the test device, select

Help

>

About Device

.

Reconnecting to the device

If the control panel for a test type is shown, and communication with the selected test device is interrupted, a message appears stating that there is no longer connection to the device.

• Click the

Connect

button on the

Control Panel

to reconnect to the selected test device.

Updating device firmware

If the OTOsuite software version contains a more recent firmware for the device, a message will appear when next you switch on the device.

It is recommended that you update the device firmware to make sure that the device and OTOsuite perform correctly.

• Follow the on-screen instructions.


9 Maintenance and calibration


Warning

•

Under no circumstances disassemble Otometrics Madsen A450. Contact your supplier. Parts inside Otometrics Madsen A450 must only be checked or serviced by authorized personnel.

9.1

Service and repair

It is recommended that you keep the packing material in which Otometrics Madsen A450 was delivered. If you need to send it in for service, the original packing material will ensure protection against damage during transport, etc.

Warning

•

For the sake of safety and in order not to void the warranty, service and repair of electro-medical equipment should be carried out only by the equipment manufacturer or by service personnel at authorized workshops. In case of any defects, make a detailed description of the defect(s) and contact your supplier. Do not use a defective device.

Note

•

There are no user-serviceable parts inside the Otometrics Madsen A450 cabinet.

9.1.1

9.2

9.3

Fuses

Otometrics Madsen A450 has no user-accessible fuses.

Maintenance

Otometrics Madsen A450 requires no preventive maintenance except for regular calibration of the transducers.

See

Calibration ► 80

.

Cleaning

There are no specific requirements to sterilization or disinfection of the test device.

Cleaning the device

The device

• Remove dust using a soft brush.

• Use a soft, slightly damp cloth with a small amount of mild detergent or approved non-caustic medical grade disinfectant wipes to clean the unit according to local infection control regulations.

Caution

•

Keep the unit away from liquids. Do not allow moisture inside the unit. Moisture inside the unit can damage the instrument and it may result in a risk of electrical shock to the user or patient.



9.4

Cleaning accessories

Accessories

These parts are in constant contact with your patients and should therefore be kept clean.

• Headphones

Use a non-alcohol based wipe (e.g. Audiowipe) to clean the headphones between patients.

• Eartips for Insert Earphones

The eartips are disposable and therefore should not be cleaned or re-used.

Warning

•

To prevent cross-infection, use new eartips when you test the next client.

• Bone oscillator

Clean the bone oscillator between patients, e.g. with a non-alcohol based antibacterial wipe, such as Audiowipes.

Disposal

There are no special requirements for the disposal of eartips, i.e. they can be discarded according to local regulations.

Calibration

Annual calibration

The audiometer, headphones, bone oscillators, and sound field speakers must be calibrated once a year by your authorized service department.

The audiometer is dispatched from the factory together with a Test Report (Calibration Certificate). The Test Report specifies the transducers that have been calibrated (i.e., those which have been supplied together with the instrument), according to which standards, and the equipment used for calibration. Results are listed for each transducer at all standard frequencies.

In general, the instrument is calibrated in dB HL and dB masking level using the stated reference equivalent thresholds; dB

HL is related to sound pressure levels, dB SPL = dB re 20

µ

Pa, and force levels (dB re 1

µ

N).

Caution

•

Note that calibration has been performed only on the transducers supplied! If you wish to use any other transducer for testing with the device, please contact your local distributor first.




10.1

Powering

Problem

The On/Off light indicator is not lit

Cause

• There is no power supply to the device.

Solution

• Check that the cables of the power supply are firmly connected to the device and the mains outlet socket.

• Check that the mains supply is switched on.

10.2

Software/device communication

Problem

During installation, the installation process may be interrupted. Various error messages may occur.

When OTOsuite is launched, one or more error messages may appear regarding XML errors.

There is no connection to the device.

Cause Solution

• The PC’s virus scan is active and prevents the installation process from progressing.

• Deactivate the PC virus scan until the installation process is completed.

• An earlier version of OTOsuite was installed. An extended version of data sets has been installed with the new version of

OTOsuite.

• The USB cable connecting the device to the PC was connected prior to installing OTOsuite. This results in a Windows default driver being allocated.

• Accept the error message. This message only appears the first time the new version of OTOsuite is launched.

1. Select the Windows Device Manager followed by Universal Serial Bus controllers.

The faulty connection will be marked by a yellow question mark in the list.

2. Uninstall the driver.

3. Make sure OTOsuite is installed and relaunch

OTOsuite.




This manual contains information and warnings, which must be followed to ensure the safe performance of the devices and software covered by this manual. Local government rules and regulations, if applicable, should also be followed at all times.

See

Otometrics Madsen A450 ► 82

and

Warning notes ► 82

.

11.1


Electronic equipment covered by the Directive 2002/96/EC on waste electrical and electronic equipment

(WEEE).

All electrical and electronic products, batteries, and accumulators must be taken to separate collection at the end of their working life. This requirement applies in the European Union. Do not dispose of these products as unsorted municipal waste.

You can return your device and accessories to Otometrics, or to any Otometrics supplier. You can also contact your local authorities for advice on disposal.

Consult user manual for warnings and cautions.

Consult instructions for use.

Complies with Type B requirements of IEC60601-1.

Complies with Medical Devices Directive 93/42/EEC and RoHS Directive (2011/65/EC).

MEDICAL - General Medical Equipment as to electrical shock, fire and mechanical hazards only in accordance with UL 60601-1, first edition, 2003 CAN/CSA-22.2 No. 601.1-M90.

Indicates the medical device manufacturer, as defined in EU Directives 90/385/EEC, 93/42/EEC and

98/79/EC.

Suitable for direct current only.

11.2

Warning notes

11.2.1

Connector warning notes

Warning

•

Never mix connections between the two types of connectors shown below:

Direct connectors

• All connectors within the red frame are connected directly to patient transducers.



Fig. 1

Sockets with direct connections to patient transducers - Otometrics Madsen A450 connection panel

Isolated connectors

• All connectors within the red frame are isolated from patient transducers.

Note

•

The safety standards listed in

Standards and Safety ► 82

do not apply to the isolated connectors used in the audiometer.

Fig. 2

Connectors isolated from patient transducers - Otometrics Madsen A450 connection panel

11.2.2

General warning notes

1. This class of equipment is allowed in domestic establishments when used under the jurisdiction of a health care professional.

2. Otometrics Madsen A450 is intended for diagnostic and clinical use by audiologists and other trained health care professionals in testing the hearing of their patients.

3. To prevent cross-infection, use new eartips when you test the next client.

4. Accidental damage and incorrect handling can have a negative effect on the functionality of the device. Contact your supplier for advice.

5. For the sake of safety and in order not to void the warranty, service and repair of electro-medical equipment should be carried out only by the equipment manufacturer or by service personnel at authorized workshops. In case of any defects, make a detailed description of the defect(s) and contact your supplier. Do not use a defective device.

6. It is recommended to install the unit in an environment that minimizes the amount of static electricity. For example, anti-static carpeting is recommended.

7. Do not store or operate the device at temperatures and humidity exceeding those stated in the Technical Specifications, Transport and storage.

8. Keep the unit away from liquids. Do not allow moisture inside the unit. Moisture inside the unit can damage the instrument and it may result in a risk of electrical shock to the user or patient.

9. Do not use the instrument in the presence of flammable agents (gases) or in an oxygen-rich environment.



10. No parts may be eaten, burnt, or in any way used for purposes other than the applications defined in the Intended Use section of this manual.

11. To avoid the risk of electric shock, this equipment must only be connected to a mains supply with protective ground.

12. The device and any device to be connected which has its own power supply should be turned off before any connections are established.

To disconnect the device from the mains supply, pull the mains plug out of the wall mains outlet. Do not position the unit so that it is difficult to pull the mains plug out of the wall mains.

13. For safety reasons and due to effects on EMC, accessories connected to the equipment's outlet fittings must be identical to the type supplied with the system.

14. It is recommended that an annual calibration be performed on accessories containing transducers. Furthermore, it is recommended that calibration be performed if the equipment has suffered any potential damage (e.g. headphones dropped on the floor).

Note that calibration has been performed only on the transducers supplied! If you wish to use any other transducer for testing with the device, please contact your local distributor first.

15. Disposable accessories, such as eartips, should not be reused and must be replaced between patients to prevent crossinfection.

16. We recommend that the device should not be stacked with other equipment or placed in a poorly ventilated space as this may affect the performance of the device. If it is stacked or placed adjacent to other equipment, make sure that the operation of the device is not affected.

17. Unwanted noise may occur if the device is exposed to a strong radio field. Such noise may interfere with the performance of the device. Many types of electrical devices, e.g. mobile telephones, may generate radio fields. We recommend that the use of such devices in the vicinity of Otometrics Madsen A450 be restricted.

Likewise, we recommend that the instrument is not used in the vicinity of devices sensitive to electromagnetic fields.

18. Changes or modifications not expressly approved by the manufacturer could void the user's authority to operate the equipment.

19. The device can be disposed of as normal electronic waste, according to local regulations.

20. Use only the specified power supply.

See the Technical Specifications, Power Supply.

When assembling an electro-medical system, the person carrying out the assembly must take into account that other connected equipment which does not comply with the same safety and EMC requirements as this product (e.g., cables, PC and/or printer) may lead to a reduction in the overall safety level or EMC compliance level of the system. The equipment must comply with IEC 60950.

When selecting accessories connected to the device, the following points must be considered:

• Use of connected equipment in a patient environment

• Proof that connected equipment has been tested in accordance with IEC60601-1 and/or IEC60601-1-1 and UL60601-1 and CAN/CSA-C22.2 NO 601.1-90.

21. To comply with EN 60601-1-1 computer and printer must be placed out of reach of the client, i.e. not closer than approx. 1.5 meters/5 ft.



11.3


Complies with Medical Devices Directive 93/42/EEC and RoHS Directive (2011/65/EC).

Used in error message dialogs if software program fails. See the detailed information in the dialog box.




Type identification

Otometrics Madsen A450 is type 1081 from GN Otometrics A/S.

Channels

Two separate and identical channels.

Frequency range

Insert earphones:

TDH39 earphones:

BC:

SF:

Accuracy:

FRESH noise stimulus:

Standard frequencies: 125 - 8000 Hz




< 0.03%.

Available in entire frequency range within the transducer specified range (for

SF 125 - 8000 Hz). Accuracy 0.3%

Available for each stimulus frequency.

125 to 8000 Hz at standard frequencies

Narrow Band Noise masking:

Frequency resolution:

Stimulus types

• Tone

• Warble

• Pulsed tone

• Pulsed warble

• FRESH Noise Frequency-specific hearing assessment noise.

Consists of noise bands, with frequency-specific filter width.

The FRESH noise is filtered to obtain very steep slopes outside the passband.

Masking types

• Narrow Band Noise

– AC and BC

– SF

• Speech Weighted Noise

– AC and BC

– SF

• White Noise (Wide band noise)

– AC and BC

– SF

Correlated

Correlated

Correlated

Correlated

Correlated

Correlated



White noise for Pure Tone masking

Conversion between displayed “effective masking level” and sound pressure level

The level of white noise used for masking of pure tones is indicated in dB of “effective masking level” in OTOsuite. This means that the sound pressure level of the power contained in a third-octave band around the presented pure tone frequency will equal the attenuator setting, plus the RETSPL at the pure tone frequency, plus the noise correction factor from ISO 389-4:1994, Table 1.

The following tables can be used to calculate the actual sound pressure level of the white noise signal for a given attenuator setting (Table 1), or to select the attenuator setting required to obtain a specific level in dB SPL (Table 2).

Note: As the sound pressure level of the white noise signal will be quite high even for moderate attenuator settings, a warning sign will be displayed in OTOsuite when appropriate (for levels above 100 dB HL).

Table 1 - Offset from Effective Masking Level to Sound Pressure Level

Frequency (Hz)

125 250 500 750 1000 1500 2000 3000 4000 6000 8000 9000 10000 11200 12500

Offset (dB)

N/A* 53 37 32 31 29 30 29 27 31 27 26 26 25 25

This table indicates the number (“Offset”) to be added to the displayed masking level in order to calculate the sound pressure level in dB SPL.

* White masking noise is not available at 125 Hz

Table 2 - Attenuator settings required to obtain a white noise level of 80 dB SPL

Frequency (Hz)

125 250 500 750 1000 1500 2000 3000 4000 6000 8000 9000 10000 11200 12500

Attenuator setting to obtain 80 dB SPL

N/A* 27 43 48 49 51 50 51 53 49 53 54 54 55 55

This table indicates the attenuator settings required to obtain a sound pressure level of 80 dB SPL at indicated frequencies.

Stimulus modulation

FM (Warble):

SISI:

Adjustable modulation rate and depth

• Modulation rate: 1-20 Hz (default: 5 Hz).

• Modulation depth: 1-25% of center frequency (default: 5%).

5, 2, 1 dB increments

Accuracy of sound level

Entire level range (AC):

Entire level range (BC):

125 to 5000 Hz: ±3 dB, 5000 to 8000 Hz: ±5 dB

250 to 4000 Hz: ±4 dB

The reference conditions for the specification of frequency response and sound pressure level depend on the type of audiometer. Otometrics Madsen A450 can be calibrated as either a “corrected” (Type AE) or “uncorrected” (Type A) speech audiometer:



Type AE calibration:

• The output sound pressure level and frequency response are specified in terms of free-field equivalent sound pressure level.

• The loudspeaker output is specified as measured under free-field conditions, at 1 m distance, and on the axis of the loudspeaker.

• Bone vibrator output is not corrected to obtain a free-field equivalent sound force level; uncorrected output is produced (please see below under “Type A”).

• Calibration of speech signals is performed using either a 1 kHz pure tone (earphones) or 1 kHz warble tone (loudspeakers).

Type A calibration:

• The output sound pressure level and frequency response are specified in terms of coupler level. See table below for coupler/ear simulator used.

• The loudspeaker output is specified as measured under free-field conditions, at 1 m distance, and on the axis of the loudspeaker.

• Bone vibrator output is not corrected to obtain a free-field equivalent sound force level; uncorrected output measured by an artificial mastoid (IEC 60318-6) is produced.

• Calibration of speech signals is performed using either a 1 kHz pure tone (earphones) or 1 kHz warble tone (loudspeakers).

Transducer type

Supra-aural earphone

Coupler/ear simulator

IEC 60318-3

Insert phone IEC 60318-5

Attenuator

1 or 5 dB step resolution over the entire range.

HL Range

The maximum output levels from Otometrics Madsen A450 depend on the actual sensitivity of the individual transducers, and they will be slightly different for each unit. However, the minimum requirements from IEC and ANSI standards are fulfilled for all units.

They are specified in the following.

Frequencies and minimum output levels (dB HL)

Frequency

125

250

500

1000

Supra-aural

60

80

110

110

Circum-aural

60

80

110

110

Insert phone

60

80

110

110

Bone oscillator

N/A

45

60

70



Frequency

1500

2000

3000

4000

6000

8000

Supra-aural

110

110

110

110

100

90

Circum-aural

110

110

110

110

100

90

Insert phone

110

110

110

110

100

90

Bone oscillator

70

70

70

60

N/A

N/A

Distortion of signals occurs for higher stimulus levels. Otometrics Madsen A450 complies with IEC and ANSI standards with respect to maximum distortion. The following specification from IEC 60645-1:2001 applies:

Specification of allowable distortion levels for airborne sound (test level and distortion)

Frequency (Hz)

125-250

315-400

500-5000

Test level for

Supra-aural earphone

(dBHL)

75

90

110

Test level for Circum-aural and Insert earphone

(dBHL)

65

80

100

Allowed THD

(%)

2.5

2.5

2.5

Specification of allowable distortion levels for bone conducted sound (test level and distortion)

Frequency (Hz) Test level for bone vibration

(dBHL)

Allowed THD

(%)

250-400

500-800

1000-4000

20

50

60

5.5

5.5

5.5

For higher output levels than those specified in the tables above, transducers will produce higher distortion levels. The distortion is generated almost exclusively by the transducers, as the audiometer itself produces negligible distortion. Based on the extensive knowledge which exists regarding the standard transducers, audiologists should determine if levels higher than those specified above can be used for a particular test.

Total harmonic distortion

Air < 2.5%

Bone < 5%



(Hz)

63

315

400

500

630

125

160

200

250

750

800

1000

1250

1500

Selectable transducers

1

AC: TDH 39

2 headphones, and Insert Earphones

BC:

SF:

Bone oscillator (Mastoid)

• Passive sound field speaker using the built-in amplifier, or

• External amplifier using the line output.

Transducer options depend on how Otometrics Madsen A450 is ordered and calibrated.

1. All headbands supplied with transducers comply with the ISO 389 series for that model of transducer unless otherwise specified.

2. Headphone TDH-39 can be supplied with two different headbands, HB7 and HB8:

- For adult skulls or above normal skull size, HB8 shall be applied (HB8 is in compliance with ISO 389).

- For children and below normal skull size HB7 shall be applied (HB7 provides a greater force required to accommodate smaller skull size)

For audiometric testing outside of noise attenuating test rooms, Otometrics recommends using earphones which feature passive noise reduction. For the applicable earphone models, the attenuation is specified in the following table.

Sound attenuation values for earphones

Frequency Attenuation

TDH39 with

MX41/AR cushion

(dB)

EAR 3A

(dB)

7

9

5

6

5

5

3

4

-

11

15

18

-

37

37

38

37

33

34

35

36

37

37

35



Sound attenuation values for earphones

3150

4000

5000

6000

1600

2000

2500

3000

6300

8000

31

32

29

-

21

26

28

-

26

24

37

40

41

34

33

35

42

43

ISO 4869-1:1994

Data obtained from manufacturer’s data sheet.

Outputs

AC:

BC:

Speaker for SF power output and Counseling and Simulations:

SF line output:

2 x 2 mono jacks, 6.3 mm (1/4 inch)

1 x mono jack, 6.3 mm (1/4 inch)

3 x terminals,

3 x 40 W peak, 8

Ω load

2 x 1.6 Vrms,

External inputs

CD/Analog line in:

Talk Back microphone:

0.2 to 2.0 Vrms, 10 k

Ω

, 1 stereo 3.5 mm (1/8 inch) jack

• Electret microphone

• Input voltage: 0.002 to 0.02 Vrms

• Input resistance: 2.21 k

Ω

.

• 3.5 mm (1/8 inch) jack

• DC power, 2.5 mm 24V DC power supply:

Stimulus presentation

Normal:

Continuous ON:

Pulse:

Pulse duration:

The signal is presented when the Stimulus Presentation button is activated.

The signal is interrupted when the Stimulus Presentation button is activated.

The signal is pulsed.

200 ms on and 200 ms off configurable



Bone oscillator

Bone oscillator output

The maximum speech output level from the bone oscillator depends on the actual sensitivity of the vibrator. The actual maximum output is therefore determined at the time of calibration. The actual maximum output level may be determined by the operator by simply increasing the output level until the attenuator setting no longer increases.

Additionally, Otometrics Madsen A450 includes a feature which allows the operator to select the maximum output level from a bone oscillator . Using this feature, the maximum output may be set lower than the physically available output level

(installation option).

As the maximum available output level will result in significant distortion from the bone oscillator , the specification below limits the speech output level to 60 dBHL. Typical distortion levels (median values of a sample of bone oscillator ) are indicated in the following table.

Total harmonic distortion (THD), %

Speech hearing level (dBHL) ->

Frequency below (Hz)

250

500

1000

60

34,7

3,7

2,6

50

13,7

1

0,9

40

4,4

0,3

0,3

30

2,2

0,2

0,3

Frequency response

Frequency

(Hz)

250

500

750

1000

1500

2000

3000

4000

Nominal response level

(dB re. 1kHz level)

-1.5

6.5

1.0

0.0

1.5

-6.5

-15.5

-11.0

Tolerance

(dB)

±4

±4

±4

0

1

±4

±4

±4

±6

Operator accessories

Operator monitor headphones:

• 40 mW 16

Ω

• 3.5 mm (1/8 inch) stereo jack



Operator microphone: • Electret microphone

• Input voltage: 0.002 to 0.02 Vrms,

• Input resistance: 2.21 k

Ω

.

• 3.5 mm (1/8 inch) jack

USB port connector

Type:

Compliant:

Speed:

USB device port

USB 2.0

High speed

Transport and storage

Temperature:

Air humidity:

Air pressure:

-20°C to +60°C (-22°F to 140°F)

10% to 90%, non-condensing

500 hPa to 1060 hPa

Operating environment

Mode of operation:

Temperature:

Air humidity:

Continuous

+15°C to +35°C (59°F to 95°F)

30% to 90%, non-condensing

Air pressure: 700 hPa to 1060 hPa.

(Operation in temperatures exceeding -20°C (-4°F) or +60°C (140°F) may cause permanent damage.)

Warm-up time

< 5 min.

Note

•

Should be extended if Otometrics Madsen A450 has been stored in a cold environment.

Disposal

Otometrics Madsen A450 can be disposed of as normal electronic waste, according to WEEE and local regulations.

Dimensions

Otometrics Madsen A450: Approx. 279 x 196 x 54 mm, (10.0 x 7.7 x 2.1 inches)

Weight

Otometrics Madsen A450: Approx. 0.7 kg, (1.5 lb)



Power supply

External power supply, type:

MeanWell MES50A-6P1J, 50W

Power consumption

Mains cables

8-71-86400

7-08-017

Standards

Audiometer:

Patient Safety:

EMC:

Output: 24 V, 2.08 A; Input: 100-240 V AC, 50/60 Hz, 1.5 - 0.8 A

< 60 VA

POWER CABLE CHINA

POWER CABLE, SJ, US HOSP. PLUG

IEC 60645-1, Type 2, 2010; IEC 60645-2, Type A, 1993;ANSI S3.6

Complies with IEC 60601-1, Class 1, Type B; UL 60601-1; CAN/CSA-C22.2 NO

601.1-90.

IEC 60601-1-2

12.1

Accessories

Standard accessories and optional accessories may vary from country to country - please consult your local distributor.

• TDH 39 headphones (Headband: HB-7, HB-8)

• Bone oscillators: BC-1, B-71

• Otometrics insert phones

• Sound field loudspeakers

• Monitor headphones with boom microphone

• Talkback microphone

• Patient Responder

• Power supply and mains cable

• Otometrics Madsen A450 Reference Manual

• Otometrics Madsen A450 User Guide

• Otometrics Madsen A450 Quick Guide

12.2

Notes on EMC (Electromagnetic Compatibility)

• Otometrics Madsen A450 is part of a medical electrical system and is thus subject to special safety precautions. For this reason, the installation and operating instructions provided in this document should be followed closely.

• Portable and mobile high-frequency communication devices, such as mobile phones, may interfere with the functioning of Otometrics Madsen A450.



Guidance and manufacturer's declaration - electromagnetic emissions for all equipment and systems

Otometrics Madsen A450 is intended for use in the electromagnetic environment specified below. The user of Otometrics Madsen A450 should ensure that it is used in such an environment.

Emissions test

RF emissions

CISPR 11

RF emissions

CISPR 11

Compliance

Group 1

Class B

Electromagnetic environment - guidance

Otometrics Madsen A450 uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.

Otometrics Madsen A450 is suitable for use in all environments, including domestic environments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.

Guidance and manufacturer's declaration - electromagnetic immunity for all equipment and systems


Immunity test IEC 60601 test level

Compliance level Electromagnetic environment - guidance

Electrostatic discharge (ESD)

IEC 61000-4-2

+/- 6 kV contact

+/- 8 kV air

+/- 6 kV contact

+/- 8 kV air

Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30 %.

Electrical fast transient/burst

IEC 61000-4-4

+/- 2 kV for power supply lines

+/- 1 kV for input/output lines

+/- 2 kV for power supply lines

+/- 1 kV for input/output lines

Mains power quality should be that of a typical commercial or hospital environment.

Surge IEC 61000-4-5 +/- 1 kV line(s) to line(s)

+/- 2 kV line(s) to earth

+/- 1 kV line(s) to line(s)

+/- 2 kV line(s) to earth

Mains power quality should be that of a typical commercial or hospital environment.

Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11

<5 % U

T

(>95 % dip in U

T

) for

0.5 cycle

40 % UT (60 % dip in U

T

) for 5 cycles

70 % U

T

(30 % dip in U

T

) for 25 cycles

<5 % U

T

(>95 % dip in U

T

) for 5 s

<5 % U

T

(>95 % dip in U

T

) for

0.5 cycle

40 % UT (60 % dip in U

T

) for 5 cycles

70 % U

T

(30 % dip in U

T

) for 25 cycles

<5 % U

T

(>95 % dip in U

T

) for 5 s

Mains power quality should be that of a typical commercial or hospital environment. If the user of the Otometrics Madsen

A450 requires continued operation during power mains interruptions, it is recommended that the Otometrics Madsen A450 be powered from an uninterruptible power supply or a battery.

Power frequency

(50/60 Hz) magnetic field

IEC 61000-4-8

3 A/m

U

T is the AC mains voltage prior to application of the test level.

3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.

Guidance and manufacturer's declaration - electromagnetic immunity - for equipment and systems that are NOT life-supporting




Immunity test

Radiated RF

IEC 61000-4-3

IEC 60601 test level

3 V/m

150 kHz to 80 MHz

3 V/m

80 MHz to 2.5 GHz

Compliance level

3 V/m

Electromagnetic environment - guidance

Portable and mobile RF communications equipment should be used no closer to any part of Otometrics Madsen A450, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter.

Recommended separation distance: d = 1.2

d = 1.2

d = 2.3

for 80 MHz to 800 MHz for 80 MHz to 2.5 GHz, where

P

is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m).

Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, a should be less than the compliance level in each frequency range.

b

Interference may occur in the vicinity of equipment marked with this symbol:

Note 1

: At 80 MHz and 800 MHz the separation distance for the higher frequency range applies.

Note 2

: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.

a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which Otometrics Madsen A450 is used exceeds the applicable RF compliance level above, the Otometrics Madsen A450 should be observed to verify normal operation. If abnormal performance is observed, additional measures might be necessary, such as reorienting or relocating Otometrics Madsen A450.

b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.



Recommended separation distances between portable and mobile RF communications equipment and Otometrics Madsen A450

The Otometrics Madsen A450 is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the Otometrics Madsen A450 can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the Otometrics Madsen A450as recommended below, according to the maximum output power of the communications equipment.

Rated maximum output power of transmitter

W

Separation distance according to frequency of transmitter m

150 kHz to 80 MHz d = 1.2

80 MHz to 800 MHz d = 1.2

800 MHz to 2.5 GHz d = 2.3

1

10

0.01

0.1

1.2

3.8

0.12

0.38

1.2

3.8

0.12

0.38

2.3

7.3

0.23

0.73

100 12 12 23

For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where

P

is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.

Note 1

: At 80 MHz and 800 MHz the separation distance for the higher frequency range applies.

Note 2

: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.


13 Manufacturer

13 Manufacturer

GN Otometrics A/S

Hoerskaetten 9, 2630 Taastrup

Denmark

( +45 45 75 55 55

7 +45 45 75 55 59 www.otometrics.com

13.1

Responsibility of the manufacturer

The manufacturer is to be considered responsible for effects on safety, reliability, and performance of the equipment only if:

• All assembly operations, extensions, re-adjustments, modifications or repairs are carried out by the equipment manufacturer or personnel authorized by the manufacturer.

• The electrical installation to which the equipment is connected complies with EN/IEC requirements.

• The equipment is used in accordance with the instructions for use.

The manufacturer reserves the right to disclaim all responsibility for the operating safety, reliability and performance of equipment serviced or repaired by other parties.


Index

A

ABLB 66

About this manual 8

Accessories

specifications 94

AI 48

Assembly 73

Attenuator

specifications 88

Audiogram combined,

enabling/disabling 11-

12

show combined view, Audiogram

Module 11-12

show split view, Audiogram Mod-

ule 11-12

viewing frequency range 13 viewing legend box 13

work area in screen, Audiogram

Module 24

Audiometry

functional description 6

user interface 60

B

Bone oscillator

connection 72

C

Calibration 80 certificate 80

CD/tape connections 72

Cleaning 79

accessories 80

device 79

Client

inspecting the ear 58 preparing for testing 58

Combined audiogram

enabling/disabling 11-12

Configuration Wizard 76


Connections

bone oscillator 72

CD/tape 72

Counseling and Simulations head-

phones 73

external power supply 72 headphones 72 insert earphone 72

operator boom microphone 73

operator headphone 72 patient responder 72

PC/USB connection 71

speaker 72 speaker power output 72

talk-back microphone 73

Control Panel

OTOsuite description 16

Controls 55

Counseling and Simulations head-

phones connection 73

Curves and symbols 26

selecting 14

F

Firmware update, test devices

(Aud.) 78

Frequency

specifications 86

Frequency range, audiogram

viewing 13

H

Headphones

connections 72

operator headphone

connection 72

Headsets

Counseling and Simulations con-

nection 73

HL

range specifications 88

Hygienic precautions 58

Index

99

Index

100

I

Icons combined view, Audiogram Mod-

ule 11-12

split view, Audiogram

Module 11-12

Insert earphone

connections 72

Installation 73

Intended use 8

Interrupter

specifications 91

L

Legend box, audiogram

viewing 13

Line in

connections 72

Line output

connections 72

M

Main window

OTOsuite 10

Maintenance 79

Manufacturer 98

Masking assistant

enabling/disabling 12

Masking Assistant 14

enabling/disabling 12

Masking types

specifications 86

Measurement menu

Monitoring 13 talk forward 13

Measurement menu (Aud)

Monitoring 13

talk forward 13, 19

Menu bar

OTOsuite 11

Microphones operator boom microphone con-

nection 73

talk-back microphone con-

nection 73

Monitoring 13

N

Navigating in Audiometry 60

O

On-screen controls 22

Operator boom microphone con-

nection 73

Operator headphone connection 72

OTOsuite

main window 10

menu bar 11

the user interface 10

Overlays feature box;Feature box

overlays 29

viewing 12

P

Patient responder 14

connection 72


Power supply

connection 72

Powering

problems 81

Preparing for testing 56

inspecting the client’s ear 58 preparing the client 58

Pure tone data feature box;Feature box

pure tone data 29

R

Reliability feature box;Feature box

Reliability 29

Rinne 65

feature box;Feature box

Rinne 29


S

Safety 82

Warning notes 82

Screens

OTOsuite main window 10

Speech 33

Tone, Audiogram Module 24

Select orientation

toolbar 12

Silence Mode 22

SISI 66

Speaker

connections 72

Speaker connections 72

Special tests

how to 63

Specifications

accessories 94

Specifications, technical 86

Speech test

external sound source 42, 44

scoring words 40

speech material 38

tabular view 34

terms and abbreviations 48

the counter/player 40, 42-43,

45

the Speech screen 33

viewing speech list 41, 44

Stenger feature box;Feature box

Stenger 29

navigation, speech 48

speech 64 tone 64

Stimulus modulation

specifications 87

Stimulus types

specifications 86

Storing the device 70

Symbols and curves

selecting 14


Index

T

Talk-back microphone

connection 73

Talk forward

selecting 13, 19

Technical specifications 86

Test devices

connecting 78 information about 78

views 70

Test devices (Audiometry)

firmware update 78

Test report 80

Tests

Speech screen 33

Tone screen, Audiogram Mod-

ule 24

Timer feature box;Feature box

Timer 29

Tone decay feature box;Feature box

tone decay 29

Tone test the Tone screen, Audiogram

Module 24

Toolbar

select orientation 12

Tools menu


Tools menu (Aud)


Transducers

calibration 80

headphone connections 72 insert earphone connections 72

specifications 90

Troubleshooting 81

U

Unpacking and installing 69

Unpacking the device 70

USB


101

Index

User interface 60

V

View menu

audiogram legend 13

combined audiogram 12

frequency range 13

Masking Assistant 12

Overlays 12

View menu (Aud)

audiogram legend 13

combined audiogram 11-12

frequency range 13

masking assistant 12

Overlays 12

Views of the device 70

W

Warning notes 82

Weber 65

feature box;Feature box

Weber 29


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