Otometrics MADSEN Astera 2 audiometer Reference Manual

MADSEN Astera²

Reference Manual

Doc. No. 7-50-0780-EN/17

Part No. 7-50-07800-EN

Copyrightnotice

No part of this documentation orprogram may be reproduced, stored in a retrieval system, ortransmitted, in any form orby any means, electronic, mechanical, photocopying, recording,or otherwise,without the prior written consent of GN Otometrics A/S.

Copyright© 2015, GN Otometrics A/S

Published in Denmark byGN Otometrics A/S, Denmark

All information, illustrations, and specifications in this manual are based on the latest productinformation available at the time of publication. GN Otometrics A/Sreserves the right to make changes at any time without notice.

Registered trademarks and Trademarks

MADSEN Itera II,MADSEN OTOflex 100, OTOsuite,AURICAL FreeFit, AURICAL Visible Speech, MADSEN Astera², MADSEN Xeta, ICS

Chartr 200 VNG/ENG, ICS Chartr EP, OTOcam 300, MADSEN AccuScreen, MADSEN AccuLink,ICS AirCal, AURICAL Aud, AURICAL HIT,

ICS Impulse, OTObase and MADSEN Capella² are either registered trademarks ortrademarks of GN Otometrics A/S.

Versionrelease date

2015-02-04

Technicalsupport

Please contact your supplier.

2 Otometrics - MADSEN Astera²

Table of Contents

1

Introduction to MADSEN Astera²

1.1

MADSEN Astera²

1.2

The MADSEN Astera² Audiometer Control Panel (ACP)

1.3

The OTOsuite Audiometry Module

1.3.1 NOAH

1.4

Intended use

1.5

About this manual

1.5.1 Safety

1.6

Typographical conventions

1.6.1 Navigation

2

Getting started

3

Navigating in the OTOsuite Audiometry Module

3.1

The Audiometry Module main window

3.2

Menus and toolbar icons

3.2.1 File menu

3.2.2 Edit menu

3.2.3 View menu

3.2.4 Measurement menu

3.2.5 Tools menu

3.3

The Patient Responder indicator

3.4

The Masking Assistant

3.5

The Control Panels

3.5.1 The Sunshine Panel

3.5.2 The Classic Control Panel

3.5.2.1 Channel Settings

3.5.2.2 Test Options

3.5.2.3 Monitor and Level

3.6

The stimulus bar

3.6.1 Test controls

3.6.2 The Tone stimulus bar

3.6.3 The Speech stimulus bar

3.7

The Tone test screen

3.7.1 The work area in the Tone screen

3.7.2 The audiogram

3.7.3 Curves and symbols selection

3.7.3.1 Selecting a symbol or curve

3.7.3.2 Creating new symbols

3.7.4 Compare audiograms

3.7.5 Tone feature boxes

3.7.6 Tone editing options

3.8

Work-flow related features

3.8.1 Selecting orientation

3.8.2 Channel-specific Storing

3.8.3 Automatic frequency/level shift when storing

3.8.4 Stimulus duration

3.8.5 Ear shift frequency and level setting

3.8.6 Saving non-stimulus channel as masking

Otometrics - MADSEN Astera²

13

38

38

39

41

35

35

37

37

32

33

34

34

27

29

31

31

43

43

43

42

42

42

42

20

23

23

26

17

18

20

20

15

15

15

16

16

9

10

10

10

10

11

7

7

8

8

3

4

3.9

The Speech test screen

3.9.1 Selecting word or phoneme scoring

3.9.2 Selecting speech material

3.9.3 Scoring words using integrated OTOsuite Speech Material

3.9.4 Scoring words using external sound source

3.9.5 Scoring phonemes using integrated OTOsuite speech material

3.9.6 Scoring phonemes using external sound source

3.9.7 Saving source levels for speech material

3.10 Speech testing - tabular view

3.10.1 Speech editing options - tabular view

3.10.2 Storing SNR for Speech testing

3.11 Speech testing - graph view

3.11.1 Speech editing options - graph view

3.12 Speech feature boxes

3.13 Terms and abbreviations used in Speech testing

3.14 Special tests

3.14.1 Locally available special tests

3.14.2 Pediatric testing

3.14.2.1 Navigating in the Pediatric test

3.14.2.2 The Control and Test Panels

3.14.2.3 The audiogram area

3.14.2.4 Controlling and using VRA

3.14.2.5 The Curve Selection box

3.14.3 SISI (Short Increment Sensitivity Index)

3.14.3.1 Navigating in SISI

3.14.3.2 The test process

3.14.4 ABLB (Alternate Binaural Loudness Balance)

3.14.4.1 Navigating in ABLB


3.14.5 MLD (Masking Level Difference)

3.14.5.1 Navigating in MLD


3.14.6 DLI (Difference Limen Intensity)

3.14.6.1 Navigating in DLI


3.14.7 Békésy (OTOsuite Bekesy audiometry)


3.14.7.2 The test result

3.14.8 LIPread

3.14.8.1 Navigating in LIPread

3.14.8.2 The LIPread Scoring Counter

3.14.8.3 The LIPread Player Panel

3.14.8.4 The LIPread List View

3.14.8.5 The LIPread Results Table

3.14.8.6 Preparing for LIPread testing


3.14.9 Tinnitus

3.14.9.1 Navigating in Tinnitus

3.14.9.2 Tinnitus questionnaires

3.14.10 TEN (Threshold-Equalizing Noise)

3.14.11 Loudness Scaling

3.14.11.1 Navigating in Loudness Scaling


76

76

76

78

70

73

73

73

68

68

69

70

65

65

65

66

62

63

63

65

56

59

59

60

52

53

54

55

43

44

48

50

87

88

89

89

85

85

86

87

92

94

94

95

97

82

83

84

85

78

79

82

82


3.14.11.3 The test result

3.14.12 Oldenburg

3.14.12.1 Using the Oldenburg module

3.14.13 Ambient Noise Assessor

3.14.13.1 Selecting the FreeFit device in OTOsuite

3.14.13.2 Measuring Ambient Noise with FreeFit

3.14.13.3 Noise level indicators in the audiogram

3.14.13.4 Activating the Ambient Noise Assessor automatically

3.14.13.5 Minimum HTL per transducer type

3.15 Test controls (ACP, keyboard, mouse)

3.15.1 ACP front panel layout

3.15.2 ACP front panel controls

3.15.2.1 Test controls

3.15.2.2 Test related controls

3.15.2.3 Monitoring controls

3.15.2.4 CH1 and CH2 controls

3.15.2.5 Test type controls

3.15.2.6 Speech test controls

3.15.3 PC keyboard controls

4

Preparing for testing

4.1

Preparing the test environment

4.2

Preparing the test equipment

4.3

Listening check

4.4

Preparing the client

4.4.1 Hygienic precautions

4.4.2 Inspecting the client’s ear(s)

4.5

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

Testing the pediatric patient

5.2.1 Assessing speech detection threshold (SDT) using the Hughson/Westlake procedure

5.2.2 Assessing pure tone threshold using the Hughson/Westlake procedure

5.3

Special Tests

5.3.1 Performing Tone Decay using the Modified Carhart Method

5.3.2 Performing a pure tone Stenger

5.3.3 Performing speech Stenger

5.3.4 Performing Weber

5.3.5 Performing Rinne

5.3.6 Performing Alternate Binaural Loudness Balancing (ABLB) test

5.3.7 Performing Short Increment Sensitivity Index (SISI) test

5.4

Testing with sound files

5.4.1 Playing sound files without word lists

5.4.2 Playing sound files with word lists

6

Unpacking and installing

6.1

Unpacking

106

106

106

106

107

109

109

110

98

99

100

100

101

101

104

105

112

113

114

115

115

115

116

116

116

116

117

121

121

122

122

123

125

125

125

119

119

119

120

120

126

126

127

127

128

128

128

129

131

131

Otometrics - MADSEN Astera² 5

6

6.2

Storing

6.3

Views of MADSEN Astera²

6.3.1 MADSEN Astera²

6.3.2 ACP

6.3.3 Total system view

6.4

Installing MADSEN Astera² and the ACP

6.4.1 Assembling MADSEN Astera²

6.4.2 Wall-mounting MADSEN Astera²

6.4.3 Assembling the ACP

6.4.4 Connecting the ACP to MADSEN Astera²

6.4.5 Connecting the ACP to the PC

6.4.6 Connecting accessories to the ACP

6.5

MADSEN Astera² connection panel

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

Cleaning

9.3

Calibration

10 Troubleshooting

10.1 Powering

10.2 Software/device communication

11 Standards and safety

11.1 Symbols used

11.2 Connector warning notes

11.3 General warning notes

11.4 The OTOsuite Audiometry Module

11.5 Manufacturer

11.5.1 Responsibility of the manufacturer

12 Technical specifications

12.1 MADSEN Astera²

12.2 ACP

12.3 Accessories

12.4 Notes on EMC (Electromagnetic Compatibility)

Index

153

153

153

153

154

155

155

155

157

157

157

158

160

160

160

161

161

165

167

167

171

147

151

151

151

131

132

132

132

134

134

135

136

137

138

139

141

142


1 Introduction to MADSEN Astera²

1.1

The two-channel MADSEN Astera² features two separate and fully independent channels ("true" two-channel circuitry).

This permits different stimuli to be freely routed in any combination of ears (including binaural). "True" two-channel circuitry can be used to perform dichotic listening tests or to present two different stimuli to the same ear simultaneously.

With MADSEN Astera² you can perform all standard audiometric tests, tone and speech audiometry and special tests.

• You can operate MADSEN Astera² from the PC’s keyboard/mouse, or from the MADSEN Astera² Audiometer Control

Panel (ACP) with the OTOsuite Audiometry Software Module acting as the display.

• 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.

MADSEN Astera²

MADSEN Astera² is a Type-1, 2-channel, PC-based audiometer for testing patient hearing.

MADSEN Astera² can be used only in connection with the OTOsuite Audiometry Module for online operation, monitoring of test results, data export and storage, printing and NOAH compatibility. When used with the OTOsuite Audiometry Module, MADSEN Astera² is capable of performing all standard audiometric tests, tone and speech audiometry and special tests.

MADSEN Astera² can be desktop or wall-mounted.

Operation

MADSEN Astera² is operated from the PC’s keyboard/mouse, or from the the MADSEN Astera² Audiometer Control Panel

(ACP), with the OTOsuite Audiometry Module acting as the display showing the intensity, frequency as well as current settings and other information 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 CD player or tape recorder, or live-voice from a microphone.

Outputs

MADSEN Astera² supports

• 3 sets of air conduction transducers

– TDH39 headphones

– HDA 200 headphones for high-frequency audiometry (calibration can be stored to test 125 to 20,000 Hz)

– Insert Phones.

• Bone oscillator (calibration can be stored for mastoid and forehead placement),



1.2

1.3

• 1 set of sound field speakers (2 to 5, more than 2 is optional). The speakers can use either the power amplifier built into MADSEN Astera² or external power amplifiers through the balanced line outputs.

The MADSEN Astera² Audiometer Control Panel (ACP)

The MADSEN Astera² ACP is used as a supplementary user interface connected to

MADSEN Astera², and via a USB connection to a PC with theOTOsuite Audiometry Module.

When connected to MADSEN Astera² and the PC with the OTOsuite Audiometry Module started, the ACP can be used for performing all standard audiometric tests, tone and speech audiometry and special tests.

Operation

The ACP provides the controls for operating MADSEN Astera² with the OTOsuite Audiometry Module acting as the display showing the current settings, as well as intensity, frequency and other information on the PC monitor.

Input and output options

The ACP connects both to MADSEN Astera² and the PC.

From MADSEN Astera² to the ACP

• Desktop microphone socket

• Operator headset socket

• Operator boom microphone socket

• Built-in monitor speaker

From the ACP to accessories

• Desktop microphone socket

• Headset socket

• Boom microphone socket

From the PC to the ACP

• USB socket (if needed, through externally powered USB hub)

The OTOsuite Audiometry Module

OTOsuite

OTOsuite is a software tool that integrates a suite of audiological tests 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 MADSEN Astera² as the test device.



1.3.1


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

• A wide range of special tests

• Controlling play-back of speech test material

• Using the Masking Assistant to prompt when masking is recommended

• 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.



1.4

1.5

Intended use

MADSEN Astera² and the Audiometry module

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

Use: diagnostic and clinical audiometric testing.

The MADSEN Astera² Audiometer Control Panel (ACP)

The ACP is intended as a supplementary user interface connected to MADSEN Astera².

About this manual

This is your guide to installing, calibrating and using MADSEN Astera² and the MADSEN Astera² ACP, 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 MADSEN Astera² and the OTOsuite 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.

1.5.1

1.6

Safety

This manual contains information and warnings which must be followed to ensure the safe performance of MADSEN

Astera², the ACP, and the OTOsuite Audiometry Module.

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 ► 157 .

•

Standards and safety ► 157

gives you an overview of device labeling and standards.

•

•

General warning notes ► 158

contains relevant warning notes.

Connector warning notes ► 157

contains connector warning notes.

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.



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.

1.6.1

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 Getting started

Training

We recommend that you read this manual and make yourself familiar with the MADSEN Astera², and if needed the Audiometer Control Panel (ACP), and how they operate with the OTOsuite Audiometry Module.

Safety

For safety information, see

•


Installation

• To install the new system, see

Unpacking and installing ► 131 .

Connecting to MADSEN Astera²

• See

Communicating with the device ► 151

Configuring the OTOsuite Audiometry Module

• See see

Configuring the Audiometry Module ► 147

.


Before you receive the client and start the session of testing and explaining test results, your time is well spent preparing for the session.

• Test preparations are described in

Preparing for testing ► 115 .

Descriptions and testing

In order for you to feel well prepared and confident before you receive clients for testing using the Audiometry Module, see the test screen descriptions. They provide you with examples on how to view the test results.

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

• The test screens are described in

Navigating in the OTOsuite Audiometry Module ► 15 .

• Useful information on how to test may be found in

Examples of audiometric testing ► 119

.

Printing

• See the OTOsuite User Guide.


2 Getting started


3

3.1

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 ► 34

The Speech test screen ► 43

Special tests are described in:

•

Special tests ► 65

The Audiometry Module main window

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

Audiometry elements

3.2

A.

B.

C.

Audiometry toolbar

Control Panel

Work area

Menus and toolbar icons

General icons

See the OTOsuite User Guide.


D.

E.

F.

Stimulus bar

Masking level indicator

Stimulus marker

15

3 Navigating in the OTOsuite Audiometry Module

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.

Tone audiometry

Speech audiometry

3.2.1

File menu

Menu item

New Audiogram

Icon Description

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

3.2.2

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.



3.2.3

View menu

Menu item

Masking Assistant

Overlays

Combined Audiogram

Left - Right

Right - Left

Audiogram Legend


Enable or disable the Masking Assistant.

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

• See

The Masking Assistant ► 20 .

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 ► 39 .

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 display the left ear audiogram on the left side of the window and the right ear audiogram on the right side of the window (when

Dual Graph View

is enabled in

Options > Audiometry > Tone >

Misc

).

Click to display the right ear audiogram on the left side of the window and the left ear audiogram on the right side of the window

(when

Dual Graph View

is enabled in

Options > Audiometry > Tone

> Misc

).

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.



Menu item

Standard / All / High frequencies

Frequency resolution


The graph shows up to 20,000 Hz. MADSEN Astera² 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.

The options for frequency resolutions are 1/6, 1/12, 1/24 and 1/48 octave as well as 1 Hz. Select the different tone stimulus resolutions from the toolbar or from

Tools

>

Options

>

Audiometry

>

General

.

You can store up to 24 points for each audiometry curve. You will be prompted if you try to store more than the maximum number of points.

3.2.4

Measurement menu

Menu item

Monitoring

Icon

Desktop/Headset

Microphone

Talk to Assistant

Description

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

Stimulus

or

Masking

channel.

I.e. Channel 1 or Channel 2.

Toggle microphone types

Click to toggle between the operator headset boom microphones and desktop microphone used to communicate with the patient and/or the assistant. The one displayed is the one currently active.

Click to enable or disable talking to another party (usually a second tester) in the booth.


Menu item

Talk Forward



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.

Select Orientation

Sunshine Panel

Scoring and Playing

Ambient Noise

Assessor

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.

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

Click to select the Sunshine Panel in

Tone

or

Speech

testing, or in some of the special tests. See

The Sunshine Panel

.

See

Selecting word or phoneme scoring ► 44 .

See

Ambient Noise Assessor ► 100 .



3.2.5

3.3

Tools menu

Menu item

Curves and Symbols


Click to select the

Curves and Symbols

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 ► 37

.

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

> Monitoring and Levels > Audible patient response

).

Use the Configuration Wizard to select Single Responder or Dual Responder setup. See


.

Single Responder setup

•

Green

Indicates that the patient is pressing the Patient

Responder.

Dual Responder setup

•

Red

Indicates that the patient is pressing the right response button.

•

Blue

Indicates that the patient is pressing the left response button.

•

Red and blue

Indicates that the patient is pressing both response buttons.

3.4

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

.

• 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 > Configure... Audiometry > Masking Assistant

to set up the masking criteria.

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.

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

.



* denotes configurable Air/Bone gap criterion (

Tools > Configuration Wizard > Configure... Audiometry > 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

.

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

Hz dB

1000

1500

2000

3000

125

250

500

750

4000

6000

8000

48

40

44

56

35

48

44

40

50

44

42

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

Hz

125

250

500

750

1000

1500

2000

dB

58

60

56

60

72

64

60

N/A - traditional value







22

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.



3.5

Hz

3000

4000

6000

8000

dB

58

72

54

62





The Control Panels

Click the

Control Panel

icon in the toolbar to activate the Control Panel.

3.5.1

Note

•

If you are using the MADSEN Astera² ACP, you may choose not to display the Control Panel. Select Tools >

Configuration Wizard... > and click Next until the Preferences screen is displayed. The checkbox Activate control

panel must be disabled.

Click the Sunshine icon to select or deselect the Sunshine Panel in either

Tone

or

Speech

testing. The Sunshine Panel is also available in a range of special tests.

The Sunshine Panel

Use the Sunshine Panel to quickly select the main settings for testing.

See

The Sunshine Panel ► 23

.

The Classic Control Panel

Use the Classic Control Panel to select more advanced settings for testing.

See

The Classic Control Panel ► 26

.

The Sunshine Panel


Click the

Control Panel


Click the

Sunshine

icon in the toolbar to select the Sunshine Panel in

Tone

or

Speech

testing, or in some of the special tests.



Tone Speech

In the Sunshine Panel you can quickly select test ear, transducer, masking, and test type.

You can control the monitor level, activate the

Talk Forward

dialog, and select the

Test Selector

for quickly selecting the relevant user test.

Your selections are shown in the

Stimulus

bar and as symbols in the audiogram.

Customizing the Sunshine Panel

You can customize the Sunshine Panel to display one or several buttons for some of the functions. For instance, you can display one or more of the

Curve Selection

buttons on the panel.

When the right-click menu for a button includes the selection

Add / Remove Buttons

you can customize the setup.

1. Enable/disable the button(s) you wish to display.

2. Click to disable the selection

Use Single Button

. The enabled buttons are displayed immediately in the panel.

Unusual settings

Non-default settings that you can select only in the right-click menus are shown as shortcut links in the Sunshine Panel.

Click the link to deselect or change the setting.

Panel description

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

Function

Test ear selection


•

•

Click to select test ear:

•

Right

Left

Binaural



Function

Transducer selection for test ear

Transducer selection for masked ear

Icon

Masking on/off

Stimulus selection

Mask

Description

•

•

•

•

•

•

Click to select the transducer used for the test ear:

Phones

(standard headphones)

Bone

(oscillator)

Insert

(earphones)

High Frequency

(headphones)

SF Unaided

(Sound Field speaker, unaided)

SF Aided 1

and

SF Aided 2

(Sound field speaker - Aided 1 and 2)

•

•

•

•

•

•

Click to select the transducer used for the masked ear:

Phones

(standard headphones)

Bone

(oscillator)

Insert

(earphones)

High Frequency

(headphones)

SF

(Sound Field speaker)

SF Aided 1

and

SF Aided 2

(Sound field speaker - Aided 1 and 2)

Click to enable or disable masking.

Click to select stimulus type.

• Tone (Tone testing)

• Warble (Tone testing)

• FRESH noise (Tone testing)

• Pre-recorded stimulus (Speech)

• Microphone to present live speech stimulus (Speech)

From the right-click menu of the

Stimulus selection

button you can also select

• 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)

• Pulsed stimulus (Tone)

• Stim Lock (presents stimulus and masker simultaneously)

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

• 1, 2 or 5 dB step



Function

Curve selection

Opens the Monitor and Level dialog

Opens the Talk Forward dialog

Opens the Test

Selector dialog


•

•

•

•

•

•

Click to select the curve type:

THR

(Threshold level) (Tone)

MCL

(Most Comfortable Loudness level)

UCL

(Uncomfortable Loudness level)

SDT

(Speech Detection Threshold) (Speech)

SRT

(Speech Recognition Threshold) (Speech)

WRS/SRS

(Speech)

(Word Recognition Score/Sentence Recognition Score)

For a description of the

Monitor and Level

dialog, see

Monitor and Level ►

31 .

For a description of the

Talk Forward

dialog, see

Measurement menu ► 18

.

The

Test Selector

dialog is described in the OTOsuite User Guide.

3.5.2

The Classic Control Panel

Click the

Control Panel


Note

•

If you are using the MADSEN Astera² ACP, you may choose not to display the Control Panel. Select Tools >

Configuration Wizard... > and click Next until the Preferences screen is displayed. The checkbox Activate control

panel must be disabled.

The Classic Control Panel is divided into the following main sections, where you can view and change various settings depending on the selected test type.



A.

B.

C.

Channel Settings ► 27

Test Options ► 29

Monitor and Level ► 31

3.5.2.1

Channel Settings

Channel

Continuous ON

Stimulus (Tone)

Tone

Warble

FRESH Noise

The stimulus is continuously on and turns off when you present the stimulus.

Presents a pure tone as the stimulus type.

• 125 Hz to 12,500 Hz is standard,

• 12,500 to 20,000 Hz is optional.

Presents a warbled pure tone as the stimulus type. This stimulus type should be used for sound field testing to avoid any standing waves.

Presents the customized FRESH noise as the stimulus type.

ab

FRESH stands for FREquency Specific Hearing assessment noise.

Stimulus (Speech)

Mic.

Source A

Source B

The microphone (operator headset boom microphone or desktop microphone) delivers the speech stimulus using live voice.

Delivers recorded speech material from source A.

Delivers recorded speech material from source B.

aThe FRESH noise is implemented according to specifications of "Stimuli for Sound Field Audiometry: A Response to

Lippmann and Adams", G. Walker and H. Dillon, 1984 in Journal of Speech and Hearing Disorders, p 219, and H. Dillon

(2008), personal communication.

bFor more information read: "Narrow Band Noise Audiometry: The Effect of Filter Slope", Daneil J. Orchik and Nancy L.

Mosher, 1975 in The Journal of American Audiology Society, Vol. 1, No. 2, p. 50-53.



Stimulus (Speech)

Speech material source

(drop down list)

Determines the input to Source A and Source B.

The options are:

• Int. File (stored on hard drive),

• Int. CD (internal CD ROM built into the PC),

• Line In (external medium connected to the PC).

Masking

In

Tools > Options > Audiometry > Tone > Measurement > Switch off Masking on Store

, you can set up whether the masking signal should automatically switch off when you store a data point or whether it should be manually controlled.

NBN

Tone

Presents a Narrow Band Noise as the masking type. If selected under the masking parameters it should only be used as a masker (not a stimulus) because it is calibrated in effective masking level.

NBN is the default.

WN

Tone and Speech

Presents a White Noise as the masking type.

SWN

Note

•

Select WN in Tools > Options > Tone or Tools > Options > Speech.

Speech

Presents a Speech Weighted Noise as the masking type. SWN is the default.

Transducer

Insert

Phone

High Frequency

Bone

Speaker

Presents the stimulus or masker through the insert earphones.

Presents the stimulus or masker through the supra-aural headphones.

Presents the stimulus or masker through the high frequency headphones.

Presents the stimulus or masker through the bone oscillator.

Presents the stimulus or masker through the soundfield speakers.

• If you are using only 2 speakers, the routing is determined by the routing controls

Left

,

Right

,

Binaural

.

• If you are using only 2 speakers, you can set up a channel to provide stimulus/masking via a different transducer (i.e. when providing masking to one ear and stimulating the other ear using the soundfield speakers).



Transducer

Multiple

Enables multiple speaker routing options. This routing setup is only available if you have purchased the multiple speaker package.

– If 4 speakers are used you can determine which stimulus will be presented from an individual speaker or from a combination of speakers.

– You can determine which speaker(s) will be used for talk forward.

– When 2 speakers and a masking noise are selected in a channel, the noise can be non-correlated between the speakers if non-correlated noise is enabled in

Tools > Options > General

.

– Alternate transducers cannot be used in combination with a multiple speaker setup.

Save As

Left

Right

Binaural

Stores the left symbol on the left audiogram.

Stores the right symbol on the right audiogram.

Stores the binaural symbol on both audiograms (or once on the combined audiogram).

Routing

Left

Right

Binaural

Stimulus is routed to the left transducer.

Stimulus is routed to the right transducer.

Stimulus is routed to both the left and right transducer.

3.5.2.2

Test Options

Test options dB Step

Stim Lock

Tracking

Threshold

Defines the intensity of the stimulus and masker used to record the audiogram.

The stimulus/masker from both channels will be presented simultaneously if this option is enabled.

When the intensity of the stimulus/masker for a channel is increased/decreased by x dB the intensity of the stimulus/masker for the other channel will also increase/decrease by the same x dB if this option is enabled.

Tone

:

The audiometric symbols for air conduction or bone conduction thresholds (masked or unmasked) will display on the graph when data points are stored.



Test options

SDT

SRT

MCL

UCL

Unaided/Aided 1/

Aided 2

Pulsed

WRS/SRS

SNR

SNR in dB

Speech

:

The data will be stored as a Speech Detection Threshold. This is the lowest level at which the patient responds to speech at least 50% of the time (also known as SAT - Speech Awareness Threshold).

Speech

:

The data will be stored as a Speech Reception Threshold. This is the lowest level at which the patient repeats at least 50% of spondaic words correctly.

Tone

and

Speech

:

The

M

ost

C

omfortable

L

oudness level symbols will display on the graph when data points are stored.

Tone

and

Speech

:

The

U

n

C

omfortable

L

oudness level symbols will display on the graph when data points are stored.

Tone

only:

Select to display unaided or aided symbols on the graph. To change the symbol sets for

Unaided

/

Aided 1

/

Aided 2

, select

Tools > Curves and Symbols

.

Tone

only:The stimulus pulses 200ms on and 200ms off if this option is enabled.The pulse duration is configurable:

Select Tools > Options... > Audiometry > Tone > Measurement >

Pulsed

.

Speech

:

The data will be stored as a

W

ord

R

ecognition

S

core or

S

entence

R

ecognition

S

core.

This test requires monosyllabic words to be presented at the patient's MCL level or above.

The patient is instructed to repeat the words he or she hears.

Speech

:

Check

SNR

to report a Signal to Noise Ratio in the

SNR

column in the Speech test table.

•

Manual

Uses the fixed predefined SNR level.

•

Automatic

Calculates the SNR based on the channel level.

Set the difference in dB between the signal and the noise. If noise is louder in intensity than the signal, use a negative number.



3.5.2.3


Monitor

The signal level changes in 3 dB steps with each click of the arrow up or arrow down buttons.To change the signal level by more than one click at a time, use the mouse scroll wheel.The check boxes are used for enabling/disabling of monitoring. You can also define this in

Tools > Options > Audiometry > General > Measurement > Monitor

.

Ch1

,

Ch2

Click to enable monitoring of Channel 1 or Channel 2. The indicator displays the level of the signal.

Talk back

Talkback can be monitored if this option is enabled. The indicator displays the level of the signal.

Level

The signal level changes in 1 dB steps with each click of the arrow up or arrow down buttons.

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

Mic

For adjusting the sensitivity of the test microphone reflected on the VU meter (only used for Speech testing).

Source A

,

Source B

For adjusting the sensitivity of the signal coming from

Source A

or

Source B

reflected on the VU meter (only used for Speech testing).

3.6

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



3.6.1

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

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.



3.6.2

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

>

On-screen controls

>

Silence Mode

>

On

.

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

The Tone stimulus bar

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 ► 37 .

Frequency

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



3.6.3

The Speech stimulus bar

3.7

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.

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.

Stimulus bar

Work area

Feature boxes



3.7.1

3.7.2

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 ► 35

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 ► 39

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

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

• Blue = left

• Red = right

• Black = binaural

Audiogram

• 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)


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)


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.



Masking levels

• In

Dual Graph View

, the masking level used for masking the non-test ear will be 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

.

3.7.3

3.7.3.1

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 > Curves and Symbols...

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.



3.7.3.2

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.

3.7.4

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 > Curves and Symbols

.

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.

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.

3.7.5

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 Single Frequency Weber

Displays the results of a single frequency (500 Hz) Weber test.

• Lateralization options are:

Uncertain patient response (question mark),

Left (L),

Right (R),

Center (arrow up),

Blank (no result).



Stenger

Rinne

Reliability

Timer

Pure Tone Data

Tone Decay

Overlays

Multi Frequency Weber

Displays the results of the Weber test when performed at the standard audiometric frequencies (250 to 4000 Hz).

• Lateralization options are:

Uncertain patient response (question mark),

Left (L),

Right (R),

Center (arrow up),

Blank (no result).

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.

3.7.6

Tone editing options

When you right-click on the main screen in

Tone

mode, the following options appear:

Tone editing options

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”

Insert “Response at Limit”

• 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.

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



3.8

3.8.1

Work-flow related features

Selecting orientation

Select graph, table and control layout

Click

Select Orientation

on the toolbar 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.

3.8.2

3.8.3

Channel-specific Storing

You can measure and store the results for one ear by using

Ch 1

, and for the other ear by using

Ch 2

.

1. Select

Dual Graph View

.

2. Assign

Ch 1

and

Ch 2

routings to match the view order of the graphs. To do so, assign a stimulus to each channel (No

Masking), one test ear to

Ch 1

, and the other to

Ch 2

.

Note

•

Frequency Shift on Store is disabled when you use this feature.

ACP

• Use the dials and the control buttons to control the frequency, levels and stimulus.

• To store

Ch 1

results press the

Store

button on the left-hand side.

To store

Ch 2

results press the

Store

button on the right-hand side.

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.



3.8.4

3.8.5

3.8.6

3.9

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

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

.

The Speech test screen

Selecting the work area in the Speech screen

You can perform tests and view the speech test results in the work area. The work area can be shown in two modes:

•

Speech testing - tabular view ► 56

.



3.9.1

•

Speech testing - graph view ► 60

.

Selecting word or phoneme scoring

• See

Selecting word or phoneme scoring ► 44

Scoring and playing speech material

There are some basic differences in how the settings for


are applied and relate to each other in word or phoneme scoring, and in whether you use integrated OTOsuite Speech Material or speech recordings from other sources. These differences are described in detail in the following sections.

• Set up the

Control Panel

and select the speech material. See

Selecting speech material ► 48

Word scoring

•

Scoring words using integrated OTOsuite Speech Material ► 50

•

Scoring words using external sound source ► 52

Phoneme scoring

•

Scoring phonemes using integrated OTOsuite speech material ► 53

•

Scoring phonemes using external sound source ► 54

Editing options

•

Speech editing options - tabular view ► 59

•

Speech editing options - graph view ► 62

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).

See also

•

Storing SNR for Speech testing ► 59

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 > Scoring and Playing

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

Phoneme/Sentence scoring

Enable

Phoneme/Sentence Scoring

.

Word scoring

Does not apply to word scoring.

Calculate 'All Correct'

Score


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 > Scoring and Playing > 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 > Scoring and Playing > Number of items to play back

.





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.





3.9.2

Playing

•

Number of items to play back

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

Continuous Play-back

, 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

Continuous Play-back

, the scoring is set automatically.



Selecting speech material

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. Activate

Source A

or

Source B

in the

STIMULUS

section of the

Control Panel

.

Classic Panel Sunshine Panel

2. Select speech input from pre-recorded input sources for

Source A

or

Source B

from the list in the

STIMULUS

section of the

Control Panel

.

–

–

Int.CD

(CD material in CD/DVD drive)

Int.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).

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.

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.



3.9.3

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


.

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 > Score Presentation

.

• 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.



3.9.4

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 ► 44 .

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)




.

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 > Score Presentation

.

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

Store the word scores

See

Storing speech data ► 44



3.9.5

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 > Score Presentation

.

• 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.



3.9.6

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

Selecting the work area in the Speech screen ► 43

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

3.9.7

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 > Score Presentation

.

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

Store the phoneme score results

See

Selecting the work area in the Speech screen ► 43 .

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.



Procedure

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

2. Play the 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.

3.10

Speech testing - tabular view

Selecting tabular or graphical view

In the Speech test screen of the OTOsuite Audiometry module you can use either tabular view or graphical view.

1. To select the view you wish to use, select

Tools > Options > Audiometry > Speech > Speech View Mode > Tabular

View

or

Graphical View

.

General description

The tabular speech view consists of a table showing the measurement conditions for testing and displaying the speech data. The rows are color coded according to their respective routing.

The table adapts to the tests and adds a row for each measurement you make. You can also pin tests so that they are readily available for future testing.

Adaptive rows

The rows in the adaptive table always show the current measurement settings and the measurements you have made. A new row will be added to the table every time you make a new measurement.



Example

The Speech table showing the current measurement settings. Data has not been stored at this point.

The Speech table showing the three first measurements followed by a blank row with the current measurement settings ready to be stored.

Pinned rows

You can pin a row to make it available in advance in order to reflect the measurements usually performed in your clinic. A table with pinned rows will always look the same when you start testing a new patient.

This customized layout provides you with a consistent work environment and makes it easy to see what to do next, or if any measurement has been deliberately left out.

A measurement that is not pinned to the table is added automatically below the pinned rows.

Click 'n' Get (loading settings)

The Click 'n' Get feature allows you to perform a test from the predefined table simply by clicking the

Apply Settings

arrow button in the second column of the table. Click 'n' Get loads all the relevant settings including the integrated speech files.

Pinning a test

You can pin one test per measurement condition.

Note

•

You can pin a test to the table, if you have not already pinned an identical test. To edit a pinned test, make sure that User Tests are not write protected in the Configuration Wizard.

To pin a row, simply select the row, right-click and select rows by moving them up or down in the table.

Pinned Tests > Pin Test

. Here you can also rearrange pinned



58

Modifying Click 'n' Get for a pinned test

You can assign a different speech stimulus and/or transducer to a pinned test. This will load the desired word list, transducer, etc., when you use the Click 'n' Get feature.

Changing assigned speech stimulus for a pinned test

1. Select the speech stimulus, such as a specific integrated word list, or internal CD or line-in device, in the Control Panel and/or speech player.

2. Right-click on the

Apply Settings

button in the pinned test row, and select

Assign Selected Stimulus

.

Changing an assigned transducer for a pinned test

1. Select the transducer in the Control Panel.


Apply Settings


Assign Selected Transducer

.

Note

•

When you use Click 'n' Get to apply settings, the AC transducer as well as the speech stimulus are loaded as your preferred starting point. You can always adjust them in the Control Panel or in the Speech Player panel.

Example 1:

You typically use insert phones but you have a patient with an ear infection and you wish to use supra-aural headphones. Use Click 'n' Get to load the desired test, and simply switch to Phone in the Control Panel before you start the test.

Example 2:

You typically wish to start the Speech test by familiarizing the patient with a specific word list before starting the actual test with a different word list.. Use Click 'n' Get to load the desired starting point, and simply switch to any word list you wish to use after the familiarization.

Storing data in a row

To store data in a row, click the

dB

field in the relevant row or press

S

on your keyboard.

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.

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.



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

.

3.10.1

Speech editing options - tabular view

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

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.


Deletes an existing measurement.

Entry fields

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

.

Pinned Rows

Select to define a row as pinned. See also

Speech testing - tabular view ► 56

.

3.10.2

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.



3.11

Speech testing - graph view

General description

60

The Speech Graph screen displays the speech graph which includes SDT, MCL, UCL noted by a line (blue = left, red = right) at the corresponding dB level.

For SRT and WRS/SRS, or WRS/SRS with noise, symbols will be shown based on the location corresponding to the dB level of presentation and the percentage of correct responses.

The graphical speech legend

The graphical speech legend shows the measurement conditions for testing and displays the corresponding symbols from the graph. The legend rows are color coded according to their respective routing.

The legend adapts to the tests and adds a row for each measurement you make. You can also pin tests so that they are readily available for future testing.

Adaptive rows

The rows in the adaptive legend always show the current measurement settings and the measurements you have made. A new row will be added to the legend every time you make a new test.

Example

The adaptive Speech legend showing the current measurement settings. Data has not been stored at this point.

The adaptive Speech legend showing the three first measurements followed by a blank row with the current measurement settings ready to be stored.



Pinned rows

You can pin a row to make it available in advance in order to reflect the measurements usually performed in your clinic. A legend with pinned rows will always look the same when you start testing a new patient.

This customized layout provides you with a consistent work environment and makes it easy to see what to do next, or if any test has been deliberately left out.

A test that is not pinned to the legend is added automatically below the pinned rows.

Click 'n' Get

The Click 'n' Get feature allows you to perform a test from the predefined legend simply by clicking the

Apply Settings

arrow button in the second column of the legend. Click 'n' Get loads all the relevant settings including the integrated speech files.

Pinning a test

You can pin one test per measurement condition.

Note

•

You can pin a test to the legend, if you have not already pinned an identical test. To edit a pinned test, make sure that User Tests are not write protected in the Configuration Wizard.

To pin a row, simply select the row, right-click and select

Pinned Tests> Pin Test

. Here you can also rearrange pinned rows by moving them up or down in the legend.

Modifying Click 'n' Get for a pinned test

You can assign a different speech stimulus and/or transducer to a pinned test. This will load the desired word list, transducer, etc., when you use the Click 'n' Get feature.

Changing assigned speech stimulus for a pinned test

1. Select the speech stimulus, such as a specific integrated word list, or internal CD or line-in device, in the Control Panel and/or speech player.


Apply Settings


Assign Selected Stimulus

.

Changing an assigned transducer for a pinned test

1. Select the transducer in the Control Panel.


Apply Settings


Assign Selected Transducer

.



Note

•

When you use Click 'n' Get to apply settings, the AC transducer as well as the speech stimulus are loaded as your preferred starting point. You can always adjust them in the Control Panel or in the Speech Player panel.

Example 1:

You typically use insert phones but you have a patient with an ear infection and you wish to use supra-aural headphones. Use Click 'n' Get to load the desired test, and simply switch to Phone in the Control Panel before you start the test.

Example 2:

You typically wish to start the Speech test by familiarizing the patient with a specific word list before starting the actual test with a different word list. Use Click 'n' Get to load the desired starting point, and simply switch to any word list you wish to use after the familiarization.

3.11.1

Storing data in a row

To store data in a row, click the

dB

field in the relevant row or press

S

on your keyboard.

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.

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


.

Speech editing options - graph view

When you right-click on a measurement in the graph, the following options appear:

Options

Selected Point (e.g. WRS, Left,

Live, AC)

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

Deletes a selected data point.

Delete Point

Delete Curve

Insert No Response

%

All Correct score

Level

Deletes a selected data curve.

This will overwrite the current symbol with a No Response symbol.

If needed, change the score.

Is shown if

Calculate 'All Correct' score

is enabled in the


dialog.

If needed, change the level.



Options

Masking/Level2

Curve SNR

Displays the effective masking level of the measurement point (dB EML).

Displays the Signal to Noise ratio used for the entire curve (SNR).

When you right-click on a row in the graph legend, the following options appear:

Options

Selected Point (e.g. WRS, Left, Live, AC)

Identifies the curve in the graph that you wish to edit.

Info

If needed, enter information of your choice.

3.12

Speech feature boxes

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

Speech

main screen.

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

Tools > Options > Speech

.

Feature boxes

Pure Tone data

Stenger

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

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

Displays the results of a speech Stenger test.


3.13

Terms and abbreviations used in Speech testing

SDT

SRT

MCL

UCL

WRS/SRS

Speech Detection Threshold

Speech Recognition Threshold

Most Comfortable Loudness Level

UnComfortable Loudness Level

Word Recognition Score/Sentence Recognition Score

•

•

Score

Percentage of correct/incorrect words.

Level

dB level at which the words were presented.

•

•

[Msk]

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

SNR

Signal-to-Noise Ratio.



PTA

AI

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.


3.14

Special tests

3.14.1

3.14.2

Locally available special tests

Some special tests such as the QuickSIN and HörTech 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.

Pediatric testing

The Pediatric test in the OTOsuite Audiometry Module is a tool that complements the regular Tone test in order to facilitate hearing testing on young children. The Pediatric test features built-in VRA control, combinations of Tone and Speech stimuli, as well as collecting the child’s response to each stimulus presentation.

You can combine the unique Pediatric features with traditional MADSEN Astera² functionality such as FRESH noise, Talk to

Assistant, and flexible control options to efficiently test this difficult-to-test age group.

Pediatric testing using VRA (Visual Reinforcement Audiometry) is aimed at testing children from approximately 7 months to

2½ years of age. You can perform testing either as a Tone test, a Speech test, or a combination of both, switching between the two types at your convenience to keep the child's attention.

When you present a stimulus, the child will turn its eyes or entire head towards the sound source. You can reward the child by activating a lighted mechanical toy placed near the sound source.

The purpose of the test is to estimate frequency- and ear-specific hearing sensitivity and hearing loss type with the result being an estimation of hearing thresholds based on minimum response levels (MRSLs) that are closely connected to perceptual thresholds.

In order not to overly challenge the attention span of the child to be tested, it is extremely important that you have prepared software and equipment in advance. Also, it is important that you have a clear objective for the testing.

3.14.2.1

Navigating in the Pediatric test

Setting up for Pediatric testing

You can enable/disable a range of features, including VRA tools, for use in Pediatric testing. To do so, select

Tools > Configuration Wizard... > Configure... Audiometry

, and click next until the

Pediatric

configuration screen is shown. See


.

The main screen

A.

B.

C.

D.

E.

The control panel, where you adjust the settings required for testing. The Pediatric test screen has two main types of panels: The Control Panel and the Test Panel. See

The Control and Test Panels ► 66

The audiogram area. See

The audiogram area

► 68

.

Curve Selection box with Graph Control buttons. See

The Curve Selection box ► 69

.

SDT results (Speech Detection Thresholds).

See

The audiogram area ► 68 .

The Pediatric Test Panel, where you control the actual test. See

The Control and Test

Panels ► 66

.


3.14.2.2

The Control and Test Panels

The Control Panel

The Sunshine Panel without VRA


See also

The Sunshine Panel ►

23

.

The Classic Control Panel without VRA

Use the Classic Control Panel to select more advanced settings for testing.

See also

The Classic Control

Panel ► 26

.

The Sunshine Panel with VRA

Click the buttons to toggle between selections.

Note

•

This example does not apply if you are using

VRA with video reinforcement.

The Classic Control Panel with VRA

Select from the VRA drop-down lists in the

Test Options

panel.

The Test Panel

This is where you control the Pediatric test.


Without VRA

With VRA

Stimulus control

A.

Stimulus indicator (shows the stimulus being presented)

B.

C.

D.

Stimulus bar (shows stimulus type, transducer, routing, test ear color)

Decrease or increase frequency

Enable or disable stimulus

Tracking response

E.

Buttons for tracking responses: Response, Questionable

Response, and No Response.

Masking

F.

Masking indicator

G.

Masking ear indicator

H.

I.

Decrease or increase masking level

Enable or disable masking

VRA controls

See

Controlling and using VRA ► 68

.

A.

B.

Activate/deactivate left or right VRA

Activate/deactivate center VRA


3.14.2.3

The audiogram area

The audiogram is tailored to accomodate tracking of responses with respect to the dB range and the frequency range shown.

The gray and yellow highlights serve to distinguish between the different 5 dB steps.

Editing and managing curves

Right-click on the symbols in the graph to edit responses and curves.

You can manage your curves in the curve selection box.

Configuring the audiogram area

You can configure the audiogram area:

• to increase the audiogram area to 6 kHz,

• to include the Speech Detection Thresholds.

See


to set up these features.

3.14.2.4

Controlling and using VRA

The MADSEN Astera² supports specific VRA systems so that you can control them from the Audiometry Module. For further information please contact your supplier.

To enable using VRA, select

Tools > Configuration Wizard... > Configure... Audiometry

, and click next until the

Pediatric

configuration screen is shown. See also


.

You can control the VRA functions from OTOsuite, from the keyboard, or from the ACP.

1. If needed, select the VRA reinforcement types in the

Control Panel

.

2. Use the on-screen VRA buttons in the Test Panel to activate/deactivate visual reinforcement.


3.14.2.5

The Curve Selection box

You can manage your curves in the Curve Selection box.

Response views

Every measurement condition, such as AC, BC, SF, ear side, etc., has its own response view in the audiogram. This prevents the audiogram from cluttering up, and allows you to analyze the progress of the test or to plot minimum responses as an audiogram curve.

A new response view is created automatically when you change measurement conditions.

In the example you can see the right ear AC responses, as well as the plotted curve.

A.

Response views

B.

Graph control buttons

Graph control buttons

The graph control buttons beneath the graph can be used to switch between the measurement conditions that were used during testing. The buttons select the view and set up the controls for the applicable measurement conditions so that you can quickly switch between the conditions used.

Measurements that are stored as binaural or non-ear specific are represented by both right and left graph control buttons.

You can hide or display the different symbols and curves depending on your current needs, e.g. during testing or post-analysis.

Graph Control buttons

Hide Responses

Hide Audiogram

Lets you view the audiogram curves more clearly without showing the responses.

Lets you view the responses more clearly. This is particularly useful during post-analysis of the test progress.


Graph Control buttons

Hide Inactive Curves

This is particularly useful when you want to focus on one test condition at a time.

3.14.3

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.

3.14.3.1

Navigating in SISI


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

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 > On-screen controls

.

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

•

Play

button

Starts the test.



•

Stop

button

Stops the test.

Reset

•

Reset

button

Resets the score to 0% and 0/0.

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

72

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.


3.14.3.2

The test process

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 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.

3.14.4

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.

3.14.4.1

Navigating in ABLB


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


Routing

Left

Right

Left transducer is considered the ABLB test ear.

Right transducer is considered the ABLB test ear.

Test Options - ABLB


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.


74

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.



• Blue = left ear

• Red = right ear



Test controls




.


Store

•

•

•

•

Arrow up

increases the intensity.

Arrow down

decreases the intensity.

Arrow left

decreases the stimulus frequency.

Arrow right

increases the stimulus frequency.



ABLB data

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.


3.14.4.2


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

3.14.5

MLD (Masking Level Difference)

The MLD test is a measure of the masking needed to completely mask the test tone when the tone and the masking noise is in phase between both ears (SONO), compared with a condition when either the tone is 180 degrees out of phase between the ears (S

π

NO) or the masking noise is (SON

π

).

The difference in MLD threshold is automatically calculated when the necessary data for the different conditions are stored.

3.14.5.1

Navigating in MLD

In the MLD Control Panel you can start and stop the stimulus with

Continuously On

, select air conduction transducer with the

Insert

,

Phone

or

High Frequency

selections, set the stimulus increment size with

dB Step

and

Pulse

lets you choose whether to pulse the tone signal.

You can also select the MLD test conditions SONO, S

π

NO or SON

π

.

The section for

Monitor / Level

is common for all the audiometer test types.


Channel

Continuous ON

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

Continuous on

buttons on the ACP, the N(Ch1) and M (Ch2) keys on the keyboard).


Transducer

Insert

Phone

High Frequency

Test Options - MLD

Test Options - MLD

Signal (Ch1) dB Step




Noise (Ch2) dB Step

Presentation

Pulsed

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

5.

This determines the dB step size for the intensity of the noise signal. Options are 1, 2, and

5.

This determines the MLD test condition: SONO, S

π

NO or SON

π

. Toggles to the next condition, when you store data.

This determines whether you pulse the tone signal.

MLD 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 signal is currently being presented.



• Blue/Red = Binaural



Test Controls




.


Controlling intensity and frequency, and presenting and storing data

•

•

•

•

Arrow up

increases the intensity.

Arrow down

decreases the intensity.

Arrow left


Arrow right


• Presents the signal.

Present

Store


The MLD graph

MLD editing options

Editing options

Delete selected measurement

• Deletes the selected data point.

Delete all at xx Hz

• Deletes all data for the currently selected frequency.

Cancel

• Closes the window.

3.14.5.2


1. Establish and store the hearing threshold with the SONO condition.

2. Maintain the noise level and re-establish the threshold using either the S

π

NO or SON

π condition.

3. The MLD is calculated automatically.

3.14.6

DLI (Difference Limen Intensity)

This DLI test was developed by Zwislocki and Lüscher (1949) and was introduced as a procedure for establishing the test subject’s capability of detecting small variations of intensity in a tone signal.

The test consists of superimposing brief bursts of 0.2 to 5 dB intensity increments (DeltaL) 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 variations in loudness detected while listening to the continuous tone. The intensity increments should be changed every 3 seconds, and the result of the test is the smallest dB increment that could be detected.

3.14.6.1

Navigating in DLI


Channel

Continuous ON

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

Continuous on

button on the ACP, the N (Ch1) or M (Ch2) key on the keyboard).

Transducer

Insert

Phone

High Frequency

Routing

Left

Right

Test Options - DLI


DeltaL






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 0, 0.2, 0.4, 0.6, 0.8, 1, 2, 3, 4 and 5. Use the right

Attenuator

knob on the ACP, or use Shift+Arrows Up/Down on the keyboard to set the DeltaL.

DLI Stimulus Bar

A.

B.

C.

D.

E.

F.

G.

H.

Intensity

Stimulus indicator


Routing indicator

Test level

Stimulus bar color

Frequency

DeltaL


80

Intensity





• Blue = left ear

• Red = right ear



Test Controls




.


Store

• The

Up arrow

increases the base line intensity.

• The

Down arrow

decreases the base line intensity.

• The

Arrow left


• The

Arrow right



DeltaL up and down arrows

• The

Up arrow

increases the DeltaL modulation size.

• The

Down arrow

decreases the DeltaL modulation size.


Player/Timer box

• The timer is used for keeping track of when to change the

DeltaL

.

•

Play button

Starts the test and the timing.



•

Stop button

Stops the test and the timing.

•

Reset button

Resets the timer.

DLI data

Data display in DLI screen

Frequency dB

∆L

Audiogram

Threshold

• The frequency which was presented.

• The level/intensity.

• DeltaL - the result.

• Displays puretone audiogram.

• Displays puretone average.

DLI editing options

Editing options

Delete

Delete all

Cancel

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

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

• Closes the window.


3.14.6.2


The audiometer produces four intensity increments per second. Each increment has a rise time of 50 msec, a duration of

75 msec, and a decay time of 50 msec. The size of the increment (DeltaL) can be varied from 0 to 5 dB in steps (selected e.g. on-screen from the

DeltaL (dB)

selection list in the

Test Options

box).

During the test the

DeltaL

is decreased every 3 seconds until the patient no longer hears any changes in the signal, and the last registered

DeltaL

is stored as the result. The procedure should be repeated in order to verify the result.

3.14.7

Békésy (OTOsuite Bekesy audiometry)

Purpose of the test

Bekesy audiometry is a type of self-recording audiometry. The patient is presented with a stimulus, which decreases while the patient keeps the button pressed, and increases when the patient releases the button. The patient's threshold will be established as located between the points where the patient presses and releases the button.

The test uses both pulsed and steady tones.

Results may suggest middle-ear, cochlear, or eighth nerve lesions.

Description of the test

In OTOsuite you can carry out Bekesy testing in two different modes. Each mode has its own test screen and you can use the toolbar button to switch screens. The applicable screen is automatically selected when you start a test.

• Sweep frequency

This is the traditional method where the response tracings resulting from a pulsed and a steady stimulus can be compared for differential diagnostics. (The Jerger Method.)

• Fixed frequency

The level is increased and decreased without changing the frequency until the predefined number of level cycles is reached.

An average threshold level is calculated and plotted in an HL audiogram and can be stored as a regular audiogram.

References

Békésy G v, 1947. A new audiometer.

Acta Otolaryngol

(Stockholm) 35, p 411-422

Jerger J, 1960. Békésy audiometry in analysis of auditory disorders.

J Speech Hear Res 3

, p 275-287.

3.14.7.1


Preparing the patient

Instruct the patient in how the test progresses:

• The patient will hear a soft tone that is either pulsed or steady.

• The patient must keep the responder button pressed for as long as the tone can be heard.

• The patient must release the button immediately when the tone cannot be heard any longer.

• The patient must press the button as soon as the tone can be heard again.

• The stimulus can change to the other ear.

Carrying out the test

Start the test either by clicking the

Test All Frequencies

button or the

Test Single Frequency

button in the

Control

Panel

.


Test functions

Test All Frequencies button

Runs a complete test including all the test frequencies selected in the

Options

dialog.

Test Single Frequency button

Runs a limited test covering the currently selected audiometer frequency. This can be used e.g. for retesting a certain portion of the test, if needed.

Drop 20 dB button

Use the

-20 dB

button to instantly drop the level. This can be used if there is suspicion of malingering or psychogenic hearing loss. When you drop the level by 20 dB, the patient should stop responding instantly since the tone is presumably inaudible. The level will then gradually increase again and the test sequence will be resumed as soon as the patient starts responding again.

Talk Forward icon

Use the

Talk Forward

function to instantly stop the test. Disable the

Talk Forward

function to continue the test.

3.14.7.2

The test result

Test results are shown as plotted results.

Fixed Frequency results

For the Fixed Frequency test the results will be stored as an HL audiogram when you save the results.


Sweep Frequency results

3.14.8

LIPread

The OTOsuite LIPread speech test is designed to integrate multi-modal speech tests for playback in the OTOsuite software.

The purpose of the LIPread test is to test a person’s ability to understand speech with and without visual cues and noise.

The test consists of video presentations where the patient is prompted to repeat as much as possible of the sentences presented. The test can be presented with and without sound or video so that lipreading ability can be assessed for rehabilitation purposes.

When OTOsuite is used as a NOAH module, all historical LIPread data is always available on the screen and in reports so that the patient's progress can be followed over time.

Intended use

The OTOsuite LIPread speech test is intended for use in connection with hearing habilitation/rehabilitation performed by audiologists, speech therapists and other trained personnel.

System overview

• Testing in OTOsuite is supported by MADSEN Astera².

• OTOsuite with the module for performing the LIPread test is supplied on the OTOsuite Installation disk

• The LIPread speech material is supplied on a separate disk.

Installation

For instructions on installing OTOsuite, see the OTOsuite Installation Guide which is inserted in the OTOsuite Installation box, and the OTOsuite Reference Manual.

Whether you install OTOsuite or the LIPread speech material first is of no consequence.

1. When you have installed OTOsuite and the LIPread speech material, enter the LIPread license key in the OTOsuite

Configuration Wizard. Select

Tools > Configuration Wizard...

and click the

Configure

button next to

Audiometry

.

2. Click

Next

until you reach the screen for entering license keys and enter the license key.

3. If the

LIPread

tab is not shown in OTOsuite, enable viewing the tab in the

Configuration Wizard

.


3.14.8.1

Navigating in LIPread

For general information about navigating in the test screen, see also the OTOsuite User Guide.

The main screen consists of

• a

Scoring Counter

at the top of the screen. See

The LIPread Scoring Counter ► 85

• a

Player Panel

for selecting speech lists and controlling the test. See

The LIPread Player Panel ► 85

• a

List View

for viewing and scoring in the selected list during presentation. See

The LIPread List View ► 86

.

• a

Results Table

for viewing and comparing the results. See

The LIPread Results Table ► 87

.

3.14.8.2

The LIPread Scoring Counter

During playback and scoring, the

Scoring Counter

at the top of the screen shows

• the number of words in the list scored correctly of the total number of words in the list

• the percentage of correctly scored words

• the list currently being presented.

3.14.8.3

The LIPread Player Panel

The

Player Panel

is a group of buttons enabling you to control the test. You can select the speech list for the test, and you can play, pause, resume, and stop the test.

Player Panel

•

•

•

•

•

Play

During the test:

– the

List View

shows only the speech list that has been selected for the current test.

– you can click on any sentence to jump freely in the selected speech list.

– click the

Play

button to play back the selected sentence.

Stop

Stops play-back of the current sentence.

Store

Terminates the test and stores the result.

Reset

Terminates the test without storing any results.

List selection

drop-down list

Click the drop-down to select which speech list to use in the test.


3.14.8.4

The LIPread List View

When you start play-back of the selected speech list, the

List View

shows the selected lists.

Each sentence in a list has a number of highlighted key words that can be scored as

Correct

or

Incorrect

.

Words that can be scored are displayed in

bold type

.

The sentence being presented is shown at the top of the list. This is where you score correctly repeated words by clicking on them.

• When you score a word as

Correct

, it is highlighted in green.

• When you score a word as

Incorrect

, it is highlighted in grey.

Practice List

For practicing the test flow so that the client is familiar with the procedure before the actual test starts. Results from a practice list cannot be stored.

During play-back

An icon to the left of the sentence that is being presented shows the status.

Editing



Scoring

The key words are scored after play-back of each sentence. The key words to be scored are shown in

BOLD

type.

To score a word, click on it.

You can change a previous score by right-clicking the word and selecting

Change Score

.


3.14.8.5

The LIPread Results Table

During review (when the Player is in idle mode), the

List View

shows all lists that have been included in the

Results

table.

You can add a comment of your own choice next to each test.

Results Table

Ear

% dB

List

Info

Date and Comments

Shows which ear was tested.

Indicates the correct score.

Shows the stimulus and masking levels used in the test.

Shows the number of the tested list.

Displays the test conditions, for example whether sound was muted or video was included, etc.

Displays the date of the test and any comments you may have entered.

3.14.8.6

Preparing for LIPread testing

Preparing OTOsuite

1. Click on the

LIPread

tab in the

Audiometry

module.

2. Set up the test to suit your purposes: select

Tools > Options > Audiometry

.

– You can select whether to play the video instantly, or whether to briefly display specific screens in order to prepare the patient for the next presentation or present a topic cue for the next presentation.


– You can disable sound in order to assess the patient’s ability to lipread.

3. Select the speech list.

The list can be presented either through earphones or sound field loudspeakers.

4. Click the

List Selection

button to expand and select the list you wish to include in the test.

5. Test monaurally or binaurally. Insert earphones are recommended for monaural testing. Their high interaural attenuation typically makes masking of the non-test ear unnecessary.


You can use a practice lists to familiarize the patient with the test protocol.

1. Instruct the patient to repeat the sentences that are presented during the test.

3.14.8.7


88

1. Select the desired test list in the player.

2. Present the test with earphones or in a sound field.

3. Instruct the patient in how to respond to the presented material.

4. Score the key words highlighted in each sentence by clicking the words on the screen. You can also enter a full sentence score by clicking the

All Correct

button.

5. You can store results in the

Results Table

by clicking the

Store

button.

6. Click the table to review scoring data.


3.14.9

Tinnitus

3.14.9.1

Navigating in Tinnitus



Continuous ON

SIGNAL

•

Tone

•

Warble

•

FRESH Noise

•

•

•

NBN

WN

TRANSDUCER

•

Insert

•

Phone

High Frequency

ROUTING

•

Left

•

•

Right

Binaural

Test Options

•

dB Step

•

Pulsed

Description

The stimulus is continuously on and turns off when you present the stimulus.


• 125 Hz to 12,500 Hz is standard,

• 12,500 to 20,000 Hz is optional.



ab


Presents Narrow Band Noise as the stimulus type.

Presents White Noise as the stimulus type.






Stimulus is routed to both right and left transducer.

Function

This determines the dB step size for the intensity of the stimulus when presenting the tone manually.

Presents the stimulus as a pulsed tone.

aThe FRESH noise is implemented according to specifications of "Stimuli for Sound Field Audiometry: A Response to

Lippmann and Adams", G. Walker and H. Dillon, 1984 in Journal of Speech and Hearing Disorders, p 219, and H. Dillon

(2008), personal communication.

bFor more information read: "Narrow Band Noise Audiometry: The Effect of Filter Slope", Daneil J. Orchik and Nancy L.

Mosher, 1975 in The Journal of American Audiology Society, Vol. 1, No. 2, p. 50-53.


90

Test Options

•

Hz Step

Residual Inhibition Player -

Noise: 1 m

Function

This determines the dB step size for the intensity of the stimulus when presenting the tone automatically using the Play button.

The amount of time the tinnitus is absent after 60 seconds of noise stimulation at Minimum Masking Level + 10 dB.

Tinnitus Stimulus Bar

Function

A.

Intensity

B.

Stimulus indicator

C.

Transducer indicator

D.

Routing indicator

E.


F.

Frequency

G.

+/- 1 octave buttons

E.

F.

G.

A.

B.

C.

D.

Intensity

Stimulus indicator


Routing indicator

Stimulus bar color

Frequency

+/- 1 octave buttons

Description



Indicates the stimulus type for the channel.

Indicates the transducer for the channel.

Indicates the routing for the channel.


• Blue = left ear

• Red = right ear.

Indicates the current frequency.

Allows octave confusion testing without having to manually find the frequency.

The audiogram

The audiogram shows the patient's most current audiogram at the time of the evaluation.

Pitch and loudness data is plotted with a T symbol at the applicable level and frequency. This symbol also shows in the

Tone test audiogram and is included in Tone audiogram reports.

Tinnitus Evaluation table

The Tinnitus Evaluation table always shows the most recent data as default. You can also click the button showing evaluation date and time to review historical data.


Data display in Tinnitus screen

Evaluation date and time

New

Pitch Matching

Click to see a list of historical Tinnitus evaluations for the selected patient.

Clears the Tinnitus Evaluation table and creates a new table.

Loudness Matching

Hearing Threshold

Tinnitus matched to non-audiometric frequency does not have corresponding hearing threshold in the audiogram. Here you can measure and enter the patient's perceived hearing threshold for the tinnitus frequency. This threshold allows for displaying the tinnitus loudness in dB SL (sensation level).

Masking Noise Threshold

The minimum level at which the patient can detect the masking noise signal.

Min. Masking Level (MML)

The mimimum level where the masking noise masks the tinnitus.

Maskability

Residual Inhibition

The patient compares the loudness of the tinnitus with the loudness of the presented signal. The signal is adjusted up or down in level until the patient reports a match between them. The signal level (dB) is reported as the result.

Descriptor of the perceived degree of masking.

The amount of time the tinnitus is absent after 60 seconds of noise stimulation at Minimum Masking Level + 10 dB

Inhibition Characteristic

Note

The patient compares the pitch of the tinnitus with the pitch of a presented signal. The signal is adjusted up or down in frequency until the patient reports a match between them. The signal frequency (Hz) is reported as the result.

Descriptor of perceived residual inhibition.

Enter you comments or notes such as hyper-acusis, fluctuating, etc.

Tinnitus editing options

Right-click values in the Tinnitus Evaluation table for measurement information. Here you can also delete the data.

Tinnitus Questionnaires

See

Tinnitus questionnaires ► 92

.


3.14.9.2

Tinnitus questionnaires

Standardized tinnitus questionnaires are used to obtain a global index score of a patient’s perceived tinnitus severity, and many questionnaires are available for this purpose (C. W. Newman & Sandridge, 2004). A tinnitus-severity index score from a tinnitus questionnaire, however, should not be relied on as the sole indicator of the degree to which tinnitus affects a patient’s life.

A tinnitus questionnaire provides a standardized baseline of the patient’s perceived problem due to tinnitus, and it is essential to acquire this baseline prior to any testing or counseling.

Types of questionnaires

The Tinnitus questionnaires are available in a number of languages.

•

THI (Tinnitus Handicap Inventory)

The purpose of the THI questionnaire is to establish the severity of the patient's Tinnitus problems.

The Tinnitus Handicap Inventory (C. W. Newman et al., 1996) is one of the most widely used and best documented of the tinnitus questionnaires that currently are available.

The THI can serve as the primary outcome instrument. Patients should complete the THI to assess outcomes at intervals (e.g., every 3 months) during ongoing intervention, and prior to terminating intervention.

The THI contains 25 statements, and response choices are “no” (0 points), “sometimes” (2 points), and “yes” (4 points).

The index score ranges from 0 to 100. Handicap severity can be categorized based on the THI index score as follows

(Handscomb, 2006):

– Severe (58–100)

– Moderate (38–56)

– Mild (18–36)

– No handicap (0–16)

A change in the total index score of at least 20 points has been reported to indicate a statistically and clinically significant change in self-perceived tinnitus handicap (C. W. Newman & Sandridge, 2004).

The THI would be helpful in selecting those patients with tinnitus most in need of intervention.

–

References THI

Newman, C.W., Jacobson, G.P., & Spitzer, J.B. (1996). Development of the Tinnitus Handicap Inventory. Archives of Otolaryngology, 122, 143-148.

•

Newman, C.W., Sandridge, S.A., Jacobson, G.P. (1998). Psychometric adequacy of the Tinnitus Handicap Inventory

(THI) for evaluating treatment outcome. Journal of the American Academy of Audiology, 9, 153-160.

TFI (Tinnitus Functional Index)

The Tinnitus Functional Index (TFI) has documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness). It provides comprehensive coverage of multiple tinnitus severity domains.

–

References TFI

Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC,

Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. (2012). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. Mar-Apr;33(2):153-76.

http://www.ohsu.edu/xd/health/services/ent/services/tinnitus-clinic/tinnitus-functional-index.cfm


•

THS (Tinnitus and Hearing Survey)

The Tinnitus and Hearing Survey is a brief questionnaire designed specifically to assist patients and clinicians in determining how much of a patient’s reported problem is due to tinnitus and how much is due to hearing problems. The survey also contains two items that screen for sound tolerance problems.

The THS is not a validated outcome instrument, and therefore should not be used as a primary measure of outcome of intervention. The THS was designed to differentiate tinnitus-specific versus hearing-specific problems.

The THS contains three sections.

– Section A includes four statements that address tinnitus-specific problems unrelated to hearing problems.

– Section B contains four statements that focus on common hearing problems. The Section B statements are phrased to minimize any perceived effects of tinnitus on hearing function. Higher scores for Section A indicate a tinnitus-specific problem, whereas higher scores for Section B indicate a hearing problem. Results of this survey, along with results of the hearing evaluation, provide the clinician with the information needed to differentiate tinnitus- specific problems from hearing problems.

– Section C asks patients if they have sound tolerance problems. Affirmative responses to Section C should be discussed with patients to determine the potential need to focus on treating the sound tolerance problem before continuing with Tinnitus management counceling.

After completing the THS, patients should understand that the problems listed in Section A are problems that can be addressed with tinnitus management. Section B problems can be addressed with intervention specific to hearing, regardless of the cause of the hearing problem. Section C addresses possible sound tolerance problems.

–

References THS

http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp.

Using questionnaires

1. Click one of the

Questionnaires

buttons to access a questionnaire. To access a different one, right-click on the questionnaire button and select from the right-click menu.

When you select a questionnaire from one of the lists, the name of that questionnaire is then shown as the new name of the button.

A questionnaire viewer opens and displays the questionnaire.

All relevant patient and tester data is entered automatically at the top of the questionnaire.

2. Click the relevant selections. The selections will be circled in green.

3. When the selections have been made, the score with a description of the severity is shown at the end of the questionnaire.

4. To save and close the questionnaire click the red X-button in the top right corner.

The questionnaire is now listed in the

Questionnaire

field.

Reviewing or editing a questionnaire

• If you wish to review or edit the questionnaire, click the relevant row in the

Questionnaire

field to open the questionnaire viewer. If needed, you can change any values.

Selecting a new questionnaire

• To select another questionnaire, right-click on the button and select a new one from the list.

Deleting a questionnaire

• To delete a questionnaire, right-click on the relevant row in the

Questionnaire

field and select

Delete

.


Printing a questionnaire

• To print a questionnaire, click the

Print

icon in the top left corner of the questionnaire viewer.

3.14.10

TEN (Threshold-Equalizing Noise)


The TEN test is a tool for identifying dead regions (regions with no functioning inner hair cells and/or neurones) in the cochlea. Dead regions can be difficult to determine with standard pure-tone audiometry. Persons with dead regions may not benefit from hearing instrument amplification in those regions, and amplification may even reduce speech intelligibility. However, people with high-frequency dead regions may have some benefit from amplification for frequencies up to approximately 70% higher than the "edge frequency" of a dead region.

When the pure-tone signal frequency falls in a dead region, the signal will only be detected when it produces sufficient basilar membrane vibration at a remote region in the cochlea where there are surviving inner hair cells and neurons. The amount of vibration produced by the tone at this remote region will be less than in the dead region, and so the noise will be very effective in masking it. Thus, the signal threshold is expected to be markedly higher than normal.

Procedure

1. Select

Tone

in the Audiometry Module.

2. Perform a pure-tone test to register a pure-tone audiogram.

3. In

Tone

, select

TEN

as masking noise, and route it ipsi-laterally so that both the tone and noise are presented in the test ear.

The stimulus for each frequency of the pure-tone signal is presented at a level 10 dB above the established threshold.

For frequencies where the hearing loss is less than or equal to 60 dBHL, set the TEN level to 70 dBHL. This is not unpleasantly loud for most people, and it leads to a definitive result.

When the hearing loss is 70 dBHL or more at a given frequency, set the TEN level 10 dB above the audiometric threshold at that frequency. For example, if the audiometric threshold is 75 dBHL, set the TEN level to 85 dBHL.

4. If the TEN is found to be unpleasantly loud, or if the maximum TEN level of 90 dBHL is reached, you can set the TEN level equal to the audiometric threshold. This should still produce a definitive result.

It typically takes about 4 minutes per ear to perform the TEN(HL) test for all test frequencies.

Interpretation of the test result

The criteria for diagnosing a dead region at a specific frequency are:

• The threshold of the test tone in the TEN is 10 dB or more above the TEN level.

• The threshold of the test tone in the TEN is 10 dB or more above the audiometric (absolute) threshold.

Sources

Web site: hearing.psychol.cam.ac.uk

3.14.11

Loudness Scaling


The OTOsuite Loudness Scaling test complies with the ISO 16832 standard for Acoustics - Loudness scaling by means of categories.


Loudness Scaling is a tool for acquiring reliable knowledge about the user’s loudness perception of auditory stimuli for different presentation levels and frequencies. This information can be used for diagnostic and rehabilitative purposes particularly with regard to hearing instrument selection, fitting and verification.

The Loudness Scaling test in the OTOsuite Audiometry module offers an interactive and self-explanatory user interface for:

• a simple and time-efficient procedure to ensure general use in clinical environments,

• high reliability and straightforward interpretation of test results.

Description of the test

The patient uses a mouse or a touch screen as the patient responder connected to the PC running OTOsuite.

The test uses a single step loudness scaling procedure using either a 7-category or 11-category scale (not audible, very soft,

... , very loud, uncomfortably loud). The results are registered on the PC screen either as level loudness functions (“loudness growth curves”) or as equal loudness contours.

3.14.11.1 Navigating in Loudness Scaling



SIGNAL

•

Warble

•

FRESH Noise

•

ISTS

TRANSDUCER



ab


Presents filtered ISTS (International Speech Test Signal) as the stimulus type. To configure the bandwidth of the stimulus, click the

ISTS

button in the toolbar or select

Tools > ISTS Bandwidth

. You can set the width for each test frequency.








•

•

•

•

Insert

Phone

High Frequency

Speaker

ROUTING

•

Left

•

Right




Presents the stimulus through the connected speaker.



96

Test Options

METHOD

•

Adaptive

•

Non-Adaptive

•

Manual

Selects the adaptive mode where the patient is tested in two phases.

• In the first phase, the dynamic range is roughly estimated.

• In the second phase, the dynamic max level is calculated based on the presentation of stimulus as the max level presented in the first phase plus 5 dB.

Selects the non-adaptive mode where the patient is tested in two phases.

• In the first phase, the patient is instructed to respond to the softest sound

(the threshold) which the patient can hear. The level is then increased, and the patient is instructed to respond when the stimulus reaches the UCL.

• In the second phase, the threshold and the UCL from phase one are used as reference points for the rest of the test.

Selects manual mode, where you use the regular audiometer controls to perform

Loudness Scaling testing.


Test Options

•

Familiarization

MANUAL dB STEP

•

1, 2, 5

STIMULUS

•

Shuffle Frequency Order

•

UCL Offset

•

Condition

The Player Panel

You can run a predefined number of presentations in the test in order to familiarize the patient with the test process. The patient's responses will not be collected.

The number of presentations used to familiarize the patient can be set in

Tools >

Options > Familiarization Presentation Count

.

You can click the

Skip

button to interrupt the familiarization phase and start the actual test where the patient's responses will be collected.

Defines the intensity of the stimulus used.

Jumps between frequencies during the test instead of completing an entire frequency before going to the next frequency.

Defines the max level of the Loudness Scaling testing in relation to the UCL level from the Tone audiogram.

Aided or unaided.

A.

B.

Play/Pause and Stop buttons. Play opens the Patient Responder.

Select the frequencies at which you wish to perform the test for one or both ears.

3.14.11.2 The test process

The Patient Responder

The patient's response is entered using the Patient Responder window. Entering the response can be done either by the patient or by the operator by selecting the category bar corresponding best to the patient's perception of loudness. Even bars with no text can be clicked.

The Patient Responder window opens up on the screen where it was last used when the test is started.

Some patients may find the 7-category responder easier to use. This can be set in

Tools > Options > Number of Categories

.


Instruct the patient in how the test progresses:

• The patient will hear stimulus signals.

• When the signal is presented, the patient must select the category bar on the responder corresponding to the patient's perception of loudness.


• Explain the loudness categories. The rating scale consisting of the response alternatives will be presented to the patient during the test. The patient responder contains category bars.

Minimum and Maximum stimulus levels

The effective maximum level is the lowest level of Tone UCL + Offset and maximum level as set in

Options

.

The effective minimum level is the highest level of Tone THR and minimum level as set in

Options

.

The effective test range is shown as the light area between the shaded areas of the Loudness Contour graph.

Carrying out an automatic test

1. Start the test by clicking the

Play

button.

2. Monitor the patient during the automated test. You can pause and resume the test if necessary, and Talk Forward can be used at any time. The automatic test always repeats the last stimulus when resuming testing after a pause.

3. Some stimuli will be perceived as extremely loud.

4. The test automatically closes the Patient Responder window when the test is completed.

5. An automatic test can be supplemented with manual testing, if necessary.

Carrying out a manual test

1. When you use the manual test method, stimuli are presented the same way as in Tone audiometry.

2. Start the test by clicking

Play

. This will open the Patient Responder window.

3. The manual test can supplement an automatic test, whereas an automatic test cannot supplement a manual test.

Carrying out several tests

You can make one or more tests. They are displayed in dedicated view tabs at the bottom of the screen. A new tab is created whenever a new test setting is selected.

3.14.11.3 The test result

Equal loudness contours and level loudness function at 1000 Hz for the right ear.


The test view tab

If you make one or more tests, they are displayed in dedicated view tabs at the bottom of the screen. A new tab is created whenever a new test setting is selected.

Any historic Loudness Scaling tests will appear when you load the patient data in OTOsuite. Historical data cannot be deleted in OTOsuite, but must be done in the source file (e.g. NOAH session).

The name of the test view tabs contain the measurement settings and test date.

Editing test results

Right-click options in the function graph

Include selected point

If you have excluded a point from being calculated, you can include it in the calculations.

Delete selected point

Exclude selected point

Delete all points for this frequency

Delete all points for this ear

You can exclude a data point from being included in the calculations.

Right-click options in the test view tab

New Loudness Scaling

Delete this test tab

Select this item to make several Loudness Scalings using identical settings.

Select to delete from current view.

3.14.12

Oldenburg

The OTOsuite Oldenburg module is a module designed to interface with the Oldenburg Test software.

From the OTOsuite Oldenburg module you can

• launch the Oldenburg test software to perform tests,

• open, view, and delete Oldenburg test records,

• resume Oldenburg tests.

System overview

• The MADSEN Astera² audiometer

• OTOsuite

• The Oldenburg Test software

Installation

1. Install the Oldenburg Test software (not supplied by Otometrics).

2. Insert the Oldenburg license dongle in the PC (not supplied by Otometrics).

3. Calibrate MADSEN Astera² (see the MADSEN Astera² Service Manual).


4. Calibrate the Oldenburg Test software, if needed.

3.14.12.1 Using the Oldenburg module

Getting started

1. Launch OTOsuite.

2. Click the

Navigation Panel

and select

Oldenburg

in the

Audiometry

module.

– The

Oldenburg Measurement Panel

shows all installed tests.

– The

Oldenburg Measurements

main window shows test records, if any, that relate to the selected patient.

Testing from the Oldenburg Test software

1. If needed, click on

Settings

in the


, and adjust test settings.

2. Click on the test you wish to perform in the


.

A message indicates that OTOsuite becomes inactive and the Oldenburg Test software is launched.

3. Perform the test and save the results.

4. Exit the Oldenburg Test software. OTOsuite becomes active, and the


main window shows the new test record.

The test record lists the test name and a range of test-specific data for easy identification.

Viewing Oldenburg test records

1. Double-click on a test record in the


main window.


2. You can now view the test record.

Resuming Oldenburg tests

If needed, you can resume testing from the Oldenburg Test software, as long as the test record is from the current working day.

1. Double-click on a test record in the


main window.


2. You can now resume the test.

3. When you exit the Oldenburg Test software, a new test record is shown in the


main window in OTOsuite.

Deleting Oldenburg tests

You can delete obsolete or incomplete test records as needed, as long as the test record is from the current working day.

1. Click on a test record in the


main window.

2. Click the button


.

3.14.13

Ambient Noise Assessor

Note

•

The Ambient Noise Assessor feature is based on ANSI standard S3.1, and is available by special request only. If you are interested in this feature, please contact your local OTOsuite sales representative.


With Ambient Noise Assessor, you can use AURICAL FreeFit to measure ambient noise levels during audiometric tests in the

Tone

screen and in the

Speech

screen in tabular view. The permissible noise level is calculated according to ANSI

S3.1.

The


dialog indicates whether the current noise level is permissible for the current measurement according to ANSI S3.1. The permissible noise level depends on the frequency and level of the stimulus that is being tested, as well as other factors, such as the transducer type.

3.14.13.1 Selecting the FreeFit device in OTOsuite

You must select your FreeFit device in the configuration wizard before you can use FreeFit for the first time.

1. In OTOsuite, click

Tools

>

Configuration wizard...

, and then click the

Configure...

button for

PMM

.

2. On the

Select Your FreeFit

page, select your device.

– If the device is not listed, turn on FreeFit by pressing the power button on the device. Check the

My device is turned on and ready to be found

check box, and then click

Search

.

3. Click

Finish

twice to close the configuration wizard.

For more information about connecting FreeFit, see the "Configuring PMM" chapter in the AURICAL FreeFit and the Probe

Microphone Measurements Module Reference Manual.

3.14.13.2 Measuring Ambient Noise with FreeFit

To use the Ambient Noise Assessor to monitor noise levels while performing Audiometry, follow this procedure:

1. Fit FreeFit with counterweights. (For detailed instructions, see the reference manual for

FreeFit.)

2. Slide the probe cable into place so it fits snugly in the cable holder on an Ambient Noise

Assessor clip. Repeat with another clip for the second probe.

3. Place FreeFit on the patient's shoulders. Clip the probes to the FreeFit collar.

– Position the probes so that they are above the patient's shoulders.


4. Adjust each probe carefully:

– The reference microphone should face the ceiling.

A. Reference microphone

– Ensure that the probe housing does not touch the patient's clothing and that the microphone is not covered by anything, such as clothing or hair.

102

5. Open the audiometry control panel.

If the


is not already open, click the button on the Audiometry toolbar.

6. Press the power button on FreeFit. If FreeFit does not connect, ensure that your FreeFit has been selected in the

PMM configuration wizard. Also check the battery status of FreeFit. (See Charging, Powering and Connection Status in the reference manual for FreeFit.)

The


dialog indicates the status of the noise level:

Ambient Noise Status

The measured ambient noise level is below the maximum permissible level for the stimulus that is currently selected.

The ambient noise level is above the maximum permissible level calculated by the standard. Reduce noise if possible.

The measured ambient noise level is above the maximum permissible noise level.

However, the level is so low that it may be noise from FreeFit itself, rather than ambient noise.

A

Connect

button is displayed if FreeFit is not connected.

If you view the


dialog in an Audiometry test screen other than

Tone

or

Speech

, you can view the ambient noise bar graph, but no maximum permissible level is calculated, and therefore no status can be displayed. A question mark is also displayed if no audiometer is connected.


7. If you are using TDH39 headphones with Peltor noise reduction enclosure, select the

With Peltor

option.

Note

•

The ANSI standard used to calculate the maximum permissible noise level is based on use of the

TDH39 with Peltor noise reduction.

8. To see a live graphical display of ambient noise, click the

Show Details

button .

– The curve shows the maximum permissible ambient noise level for the selected stimulus.

– The columns show the current measured noise for each 1/3 octave band between 125 Hz and 8 kHz. Each column is green, orange, or yellow, corresponding to the color symbols described above.

– If the measured noise exceeds the maximum permissible level 2 seconds before or 0.5 seconds after the stimulus is presented, a warning marker is displayed at the corresponding frequency. The warning marker will disappear if a new measurement is made when the ambient noise level is OK. The warning marker also disappears if you switch to a new test frequency.

9. When the noise level is acceptable to you, you can store a point in the audiogram as you would normally.

– In the

Tone

screen, when a point is stored, the noise level status from the last presentation of the stimulus is stored.

A. Current noise status

B. Noise status at last stimulus -

automatically selected by OTOsuite

will be stored with audiogram point

– In the

Speech

screen, the noise level status is not assigned automatically because OTOsuite cannot judge if noise registered after the stimulus is ambient noise or the patient's answer. You can use the


dialog to keep an eye on the current noise level, and then present the stimulus when the status is OK (Green).

Then you can select the status in the dialog box before storing:


A. Current noise status

B. Noise status at last stimulus -

selected by user

- will be stored with audiogram point

The selected status will be stored when you store a point in the audiogram.

3.14.13.3 Noise level indicators in the audiogram

Tone audiometry

When you make an audiogram using the Ambient Noise Assessor, the background color behind each point in the audiogram indicates the following:

A. No background color: The noise level was below the maximum permissible level.

B. Yellow: The measured ambient noise level was above the maximum permissible noise level for the stimulus. However, the level is so low that it may be noise from the FreeFit itself, rather than ambient noise. (See

Minimum HTL per transducer type ►

106

.)

C. Orange: The measured ambient noise was above the maximum permissible noise level for the stimulus.

D. Gray: The status of ambient noise is unknown. Either

FreeFit was not activated when the point was measured, or the frequency was stored without the signal having been presented.


These indicators are stored with the audiogram. If the noise level was measured and was below maximum permissible levels for all points in a stored audiogram, a check mark is displayed in the bottom-left corner of the audiogram:

Speech audiometry

When you perform a test in the Speech screen using tabular view, you manually select the status in the

Ambient Noise

Assessor

dialog, and the selection appears as a background color behind each measurement in the table. The colors have the following meaning:

A. Orange: The measured ambient noise was above the maximum permissible noise level for the stimulus.

B. Gray: the status of ambient noise is unknown. Measurements stored with this status appear the same as measurements made without the Ambient Noise

Assessor activated.

C. Yellow: The measured ambient noise level was above the maximum permissible noise level for the stimulus. However, the level is so low that it may be noise from the FreeFit itself, rather than ambient noise. (See

Minimum HTL per transducer type ►

106 .)

D. Green: The noise level was below the maximum permissible level.

3.14.13.4 Activating the Ambient Noise Assessor automatically

You can use the toolbar button to open the Ambient Noise Assessor when you need it, or you can set the feature to open automatically.

In

Options

>

Audiometry

>

General

>

Measurement

,

Misc.

you can set

Show Ambient Noise Assessor

to

Yes

. Then the


dialog will open automatically when you open the

Tone

or

Speech

tab in Audiometry.


3.14.13.5 Minimum HTL per transducer type

The following table describes the minimum HTLs for which the Ambient Noise Assessor can measure ambient noise, for various transducers. For stimuli below the given level, the Ambient Noise Assessor cannot distinguish between noise produced by the transducer and ambient noise. For stimuli below the minimum level, the ambient noise status indicator will be yellow.

Transducer Minimum HTL (dB HL)

Bone

Supra Aural, TDH 39/MX41

TDH39 with Peltor enclosure

Insert

30

15

0

-10

3.15

Test controls (ACP, keyboard, mouse)

The following sections describe ACP controls, PC keyboard controls and PC keyboard shortcuts for accessing all basic functions.

3.15.1

ACP front panel layout

When you use the ACP, you can show/hide the OTOsuite Control Panel: press

F12

on the keyboard.

You can access all basic functions directly by using the buttons and knobs on the MADSEN Astera² ACP front panel.

The button light indicators

Each button has its own function. Some buttons have a light to indicate whether the function is currently active. For the buttons to light up, launch the OTOsuite Audiometry Module.

3.15.2

Enable/disable buttons

• Press the button to enable.

• Press the button again to disable.

Radio buttons

• Toggle function: Press the button to enable. Any corresponding button will automatically be disabled.

ACP front panel controls

The ACP buttons and controls are grouped according to their function and how frequently they are used. The buttons in the

Channel 1

and

Channel 2

columns reflect the

Control Panel

in the OTOsuite Audiometry Module.


Test controls ► 107

A.

Channel 1 - Level and on/off controls

B.

C.

Common level and frequency controls

Channel 2 - Level and on/off controls

Test related controls ► 109

D.

Common level step size, pulsed on/off

E.

User Test selection

Monitoring controls ► 109

F.

Monitoring - Selection and level,

Operator monitoring and level

G.

Talk forward

CH1 and CH2 controls ► 110

H.

Channel 1 stimulus

I.

Channel 2 stimulus

Test type controls ► 112

J.

Test types

Speech test controls ► 113

K.

Speech and Pediatric test controls

3.15.2.1

Test controls

These test controls include the

HL attenuator

controls,

Frequency

controls, the

Continuous on

,

Stim. Lock

,

Tracking

and

Talk forward

buttons, and

VRA

activation buttons. The

Store

buttons are located just above these controls.


108

HL attenuator controls

For adjusting:

• the test signal intensity level,

• the masking intensity level,

• operator microphone level,

• monitoring levels,

• the talk-forward level.

Stimulus buttons

Presents the selected stimulus. To reverse this function, press the

Continuous On

button and press the

Stimulus

button to stop presentation of the selected stimulus.

Continuous On

When activated, the stimulus will be continuously on (the button is lit).

To disable continuous presentation, press the

Continuous On

button (the button is not lit). When the

Continuous On

button is disabled, the stimulus is only presented when you press the

Stimulus

button.

Frequency buttons

Press to select the frequency at which the stimulus is presented.

• The left

Frequency

button quency, decreases the fre-

• The right

Frequency

button quency.

increases the fre-

Stim. Lock

Presents the stimuli from both channels simultaneously, when you press one of the

Stimulus

buttons.

Activate VRA

Activates the Visual Reinforcement on your left-hand side during Pediatric testing.

Tracking

Changes the level of the stimulus in each channel by the same amount.

Activate VRA

Activates the Visual Reinforcement on your right-hand side during Pediatric testing.

Store

Press to store data points in the OTOsuite Audiometry Module.


3.15.2.2

Test related controls

dB Step

Determines the dB step size for the intensity of the stimulus and masker. Options are 1, 2, and 5 dB.

Pulsed

Pulses the stimulus 200ms on and 200ms off. The pulsing affects the Tone, Warble, and

FRESH Noise stimulus.

User test

To select predefined test setups:

1. Press

User Test

. The

Test Selector

window appears on the PC screen.

2. Turn one of the

Attenuator

knobs to scroll through the list.

3. Press

User Test

again to select the highlighted user test.

3.15.2.3

Monitoring controls

Monitoring On/Off

CH1

The

CH 1 On/Off

button enables/disables monitoring of Channel 1.

CH 2

The

CH 2 On/Off

button enables/disables monitoring of Channel 2.

Talk Back

The

Talk Back On/Off

button enables/disables monitoring of the patient's speech in the operator's monitor headset.

Monitor Speaker

The

Monitor speaker

button enables/disables the monitor speaker built into the ACP.

Assistant (microphone)

Enables/disables the

Assistant microphone

.

Monitoring level

CH1/CH2

You can monitor Channel 1/Channel 2.

1. Press and hold the

MONITOR

button next to

CH 1

or

CH 2

and turn one of the

Attenuator

knobs to determine the intensity of the signal.

When you press and hold the

CH 1

or

CH 2

button, the level is displayed on the PC screen in the Control Panel. The level will be adjusted in 3 dB steps.


Talkback

You can monitor the talkback.

1. Press and hold the

Talkback Monitor

button and turn one of the

Attenuator

knobs to determine the intensity of the signal.


Talkback

button, the level is displayed on the PC screen in the control panel. The level will be adjusted in 3 dB steps.

Operator microphones/monitoring transducer

Mic. Level

To set the microphone level, press and hold the

Mic. Level

button and turn one of the

Attenuator

knobs.


Mic. Level

button, the level is displayed on the PC screen in the control panel. The level will be adjusted in 1 dB steps.

Headset

Press to enable the operator headset boom microphone.

When you enable the headset microphone, you disable the desktop microphone.

Desktop

Press to enable the desktop microphone.

When you enable the desktop microphone, you disable the headset boom microphone.

Talk forward

Press to enable and speak directly to the patient. Press again to disable when done.

To set the microphone level, press the

Talk forward

button in the

Operator Mic.

column.

The

Talk Forward

window will appear on the screen. While keeping the

Talk forward

button in the

Operator Mic.

column pressed, turn one of the

Attenuator

knobs to adjust the intensity of the signal.

3.15.2.4

CH1 and CH2 controls

The buttons in the

Channel 1

and

Channel 2

columns are identical, making it easy for you to activate the required functions for each channel.

Stimulus types

Tone


Warble

Presents a warbled pure tone as the stimulus type. This stimulus type should be used for soundfield testing to avoid any standing waves.


FRESH Noise


ab


When FRESH Noise is selected under the stimulus parameters it should only be used as a stimulus (not a masker) because it is calibrated as a stimulus.

Mic.

Present live voice as the stimulus type.

Source A

Delivers the speech material from Source A. The options are:

• Int CD (internal CD ROM built into the PC),

• Int File (stored on hard drive), or


Source B

Delivers the speech material from Source B. The options are:

• Int CD (internal CD ROM built into the PC),

• Int File (stored on hard drive), or


Masking type

NBN

Presents a narrowband noise as the masking type. When narrowband noise is selected under the masking parameters it should only be used as a masker (not a stimulus) because it is calibrated as an effective masker.

NBN is only available during tone testing.

SWN

Presents a Speech Weighted Noise (Speech Noise).

Speech weighted noise is only available during speech testing.

WN

Presents a white noise as the masking type.

White noise is available for both tone and speech testing.

Transducer

Insert

Presents the stimulus or masker through the insert earphones.

Phone

Presents the stimulus or masker through the supra-aural headphones.







High Frequency

Presents the stimulus or masker through the high frequency headphones.

Bone

Presents the stimulus or masker through the bone oscillator.

Speaker

Presents the stimulus or masker through the soundfield speakers.

• If you are using only 2 speakers, the routing is selected with the routing controls (left, right, binaural).

• If you are using only 2 speakers, you can set up a channel to provide stimulus/masking via a different transducer (e.g. when providing masking to one ear and stimulating the other ear using the soundfield speakers).

Routing

Left

The stimulus/masker will be presented to the left transducer.

Right

The stimulus/masker will be presented to the right transducer.

Binaural

The stimulus/masker will be presented to both the left and right transducers.

3.15.2.5

Test type controls

Aided

Displays the aided symbols on the graph in the OTOsuite Audiometry Module when data points are stored.

Aided

can be selected in combination with any other test type.

TONE

THR (Threshold)

Displays the typical audiometric symbols for air conduction, bone conduction (masked or unmasked) on the graph when data points are stored.

MCL

Displays the

M

ost

C

omfortable

L

oudness symbol on the graph when data points are stored.

UCL

Displays the

U

n

C

omfortable

L

oudness symbol on the graph when data points are stored.

SPEECH

SDT


S

peech

D

etection

T

hreshold.


SRT


S

peech

R

eception

T

hreshold.

MCL


M

ost

C

omfortable

L

oudness level.

UCL

The data will be stored as an

U

n

C

omfortable

L

oudness level.

WRS/SRS


W

ord

R

ecognition

S

core or

S

entence

R

ecognition

S

core.

3.15.2.6

Speech test controls

Speech material controls

Play/pause

The button toggles between

Play

and

Pause

.

•

Play

•

Press the play button

Pause

to start the presentation of the word list.

•

During presentation of the word list, press the play button ation. The button flashes when the test is paused.

Continue play

Press the play button to pause the presentto continue presentation of the word list.

Stop

•

Stop

Press the stop button

Speech counter controls

to stop the presentation of the word list.

Incorrect/Correct

•

Word Counters

Press

Correct

to count correct responses and

Incorrect

to count incorrect responses.

Reset

will return the counter to 0/0.

The next word will proceed when you have scored the word as correct or incorrect.

See also

Scoring words using integrated OTOsuite Speech Material ► 50

information.

for more


3.15.3

PC keyboard controls

Pediatric

•

VRA C

Press to activate the central Visual Reinforcement during Pediatric testing.

•

Score as uncertain

Press to score the word as uncertain.

•

Score as incorrect

Press to score the word as incorrect.

•

Score as correct

Press to score the word as correct.

For PC keyboard controls, see the "Documentation" folder on the OTOsuite installation medium (disk or memory stick).


4

4.1

4.2


It is important to prepare properly before making measurements with MADSEN Astera² 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


4 Preparing for testing

4.3

4.4

4.4.1

• insert phone(s)

• bone oscillator

• patient responder.

MADSEN Astera² 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 Manual).

• Make sure MADSEN Astera² is switched on.

• Make sure the connection between the Audiometry Module and MADSEN Astera² is enabled.

See


.

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.

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.

4.4.2

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.



4.5

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.

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 by selecting Binaural bone in the routing section of the control panel.

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.



Frontal bone placement

1. For frontal bone placement, place the flat round part of the bone oscillator securely on the middle of the forehead about an inch (2.5 cm) below the hairline.

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


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 200 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 Examples of audiometric testing

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.


– 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).

Testing the pediatric patient

Assessing speech detection threshold (SDT) 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. For very young children, often the responses obtained are above threshold. It may take several visits to obtain a complete audiogram.

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.

– Make the test sound exciting and fun. Tell the patient about the toys you have in the booth so that the patient is more comfortable with the testing.

– Use the person accompanying the child as a resource for information about the patient's hearing, including which ear might be the 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. Depending on the child's comfort level, you might decide to do testing in soundfield. However, if the child will allow it, properly place the earphones. Younger children will usually tolerate insert earphones better than supra-aural earphones. See

Proper transducer placement ► 117

for more detail.

– It is helpful to have an extra set of earphones for the person accompanying the child to wear to show the child that it is okay to wear the earphones.



5.2.2

5. For infants less than 6 months old, use monitored live-voice to present stimuli (like the patient's name) and observe the patient for behavioral responses.

– For infants older than 6 months, use the head-orienting reflex for Visual Reinforcement Audiometry (VRA).

– For toddlers, use social reinforcement for Conditioned Play Audiometry (CPA).

– If the child is old enough, use a picture board depicting SRT words and ask the child point to the picture corresponding with the word heard. Use words with which the child is likely to be familiar.

– All of the above are examples of Speech Detection Threshold (SDT).

6. If using play audiometry or a picture board, condition the patient to respond as desired before beginning the testing.

7. Make sure that the control panel of the OTOsuite software or the MADSEN Astera² ACP is set to the correct transducer and desired routing and sound level.

– Make sure that speech detection threshold (SDT) is selected.

8. Begin the test in the ear suspected to be the better hearing ear.

9. It is recommended that children be tested using an ascending approach.

– Start at 10 dB and increase the level of the speech stimulus until the child responds. This will ensure that you are not conditioning the child at a level that he/she cannot hear.

– Once you identify a level that is clearly audible to the patient, confirm that the response instructions are understood by practicing the response task.

10. It is best to use recorded speech to reduce variability. However, younger children need constant reinforcement to keep their attention and therefore presenting the speech material using live-voice is most common.

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


– 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 out of three trials. This is the SDT.

– Once the SDT is obtained, store the response.

12. If the SDT of the test ear and the SDT or PTA of the nontest ear differ by 45 dB or greater, masking is needed.

– If the SDT of the test ear and the bone conduction PTA of the nontest ear differ by 45 dB or greater, masking is needed. It can be more challenging to use masking with children, as they may become confused when masking is presented. However, masking should be attempted if it is warranted by the test results.

13. Switch to the other ear and repeat steps

9

to

12

.

Assessing pure tone threshold using the Hughson/Westlake procedure

1. Depending on the child's comfort level, you might decide to do testing in soundfield. However, if the child will allow it, properly place the earphones. Younger children will usually tolerate insert earphones better than supra-aural earphones. See


for more detail.

– It is helpful to have an extra set of earphones for the person accompanying the child to wear to show the child that it is okay to wear the earphones.

2. For infants under 6 months, it is difficult to get reliable behavioral pure tone responses.

– For infants older than 6 months, use the head-orienting reflex for Visual Reinforcement Audiometry (VRA).

– For toddlers, use social reinforcement for Conditioned Play Audiometry (CPA).



3. Make sure that the control panel of the OTOsuite software or the MADSEN Astera² ACP is set to the correct transducer and desired routing, sound level, and frequency.

– Make sure that threshold (THR) is selected.

– If presenting in soundfield, select

Warble

for the stimulus type.

– If testing with earphones, switching between tone, pulsed tone, warble and FRESH noise will keep the patient's attention longer.

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

5. Start the testing at 1000 Hz.

6. It is recommended that children be tested using an ascending approach.

– Start at 10 dB and increase the level of the speech stimulus until the child responds. This will ensure that you are not conditioning the child at a level that he/she cannot hear.

– Once you identify a level that is clearly audible to the patient, confirm that the response instructions are understood by practicing the response task.

– Present the tone for 1 to 2 seconds.

7. If the patient responds to the initial stimulus 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. (Because you want to obtain the most information as quickly as possible, you may prefer to decrease the level in 20 dB steps and increase in 10 dB steps until you get close to threshold.)

– 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 out of three trials. This is the threshold.

– Once the threshold is obtained, store the response.

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

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

– Remember, children need constant reinforcement to keep their attention.

9. Switch to the other ear and repeat steps 5 to 8.

10. If there is 40 dB or greater difference 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. It can be more challenging to use masking with children, as they may become confused when masking is presented. However, masking should be attempted if it is warranted by the test results.

11. 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.

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

13. Properly place the bone oscillator. See


for more detail.

14. Instruct the patient and reinforce their participation (for example, "Good Job!").

15. Make sure that the control panel of the OTOsuite software or the MADSEN Astera² ACP is set to the correct transducer and desired routing, sound level, and frequency.

16. Repeat steps

5

to

8

.



5.3

5.3.1

5.3.2

– 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.

17. Once all air and bone conduction thresholds are determined, the PTA for each will appear in the

PTA/AI

box.

– The Articulation Index (AI) and the overlay options can be used for counseling the person accompanying the child.

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

19. Click in the

Reliability

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

Good

,

Fair

, or

Poor

.

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.

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.



5.3.3

5.3.4

– 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.

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."



5.3.5

5.3.6

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.

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.





5.3.7

5.4

5.4.1

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.

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.



5.4.2

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


(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


(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

6.1

6.2

Unpacking and installing

This section applies both to MADSEN Astera² and the Audiometer Control Panel (ACP). If the ACP is not part of your configuration, disregard the instructions relating to the ACP.

To install and get started with MADSEN Astera² and the OTOsuite Audiometry Module, follow the sequence below:

• Install OTOsuite on the PC before you connect to MADSEN Astera² from the PC.

• Unpack MADSEN Astera² (see

Unpacking ► 131

).

• Assemble MADSEN Astera² (see

Installing MADSEN Astera² and the ACP ► 134

)

Assembling the ACP ► 137

• Run the OTOsuite Configuration Wizard to connect to and set up communication with MADSEN Astera². (See


).

Unpacking

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.Visually inspect the equipment for possible damage.

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

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

Storing

If you need to store MADSEN Astera² before you put it into operation, follow the guidelines below:

• Store MADSEN Astera² and accessories in the boxes provided to protect the equipment from damage.

• Store MADSEN Astera² and accessories in a dry environment.

See also

Transport and storage ► 164

.


6 Unpacking and installing

6.3

6.3.1

Views of MADSEN Astera²

MADSEN Astera²

Front view - with cable cover Front view - without cable cover

A.

B.

On/Off indicator

On/Off switch

A.

B.

On/Off indicator

On/Off switch

Rear view - Connection panel

6.3.2

ACP

Front view

MADSEN Astera² is operated from either the software or the ACP front panel.

The ACP front panel controls are described in detail in

ACP front panel controls ► 106

.



Front view

Rear view

The rear panel contains the sockets for connecting various accessories, the sockets for connecting the ACP to MADSEN

Astera², and the USB socket for connecting to the PC. See also


.

Rear view - Connection panel



6.3.3

Total system view

MADSEN Astera² - ACP - PC connection setup

6.4

Installing MADSEN Astera² and the ACP

This section provides you with instructions on how to assemble and install MADSEN Astera² and the ACP.

Caution

•

Install the OTOsuite Audiometry Module on the PC before you connect MADSEN Astera² and the ACP to the PC.

• Before you start using MADSEN Astera², it is recommended that you leave it at room temperature for 30 minutes - particularly if it has been stored at very cold or warm temperatures, e.g. if it has been in a car.

• Choose between placing MADSEN Astera² on the desktop or mounting it on the wall using the wall mounting plate.

Safety aspects

To ensure safe performance, MADSEN Astera² and the ACP must be correctly installed and the requirements listed in


and

Technical specifications ► 161

must be complied with.

Cooling requirements

There are no specific cooling requirements. However, wall-mounting the MADSEN Astera² with the cable connections pointing upwards is the best position for ensuring optimal cooling of the audiometer.

Caution

•

Do not place anything on top of MADSEN Astera².



6.4.1

Caution

•

Make sure that MADSEN Astera² is placed in a well ventilated location.

• Place MADSEN Astera² and the ACP in locations away from sources of heat and direct sunlight.

• MADSEN Astera² and the ACP must not come into contact with liquids.

Installation sequence

1. Install the OTOsuite Audiometry Module on your PC.

2. Assemble and set up MADSEN Astera².

–

–

–

Assembling MADSEN Astera² ► 135

Wall-mounting MADSEN Astera² ► 136

, if needed.

MADSEN Astera² connection panel ► 142

3. Assemble and set up the ACP.

–

–

–


Connecting the ACP to MADSEN Astera² ► 138

Connecting accessories to the ACP ► 141

4. Switch on MADSEN Astera².

5. Run the Configuration Wizard in OTOsuite to connect to and set up communication with MADSEN Astera². See see


.

Assembling MADSEN Astera²

Removing the cable cover

1. To remove the cable cover from MADSEN Astera² press the releases on both sides of the cable cover, swing the cover up into vertical position and lift it off MADSEN Astera².

2. Lift off the cable cover.



MADSEN Astera² without cable cover.

Securing cables to MADSEN Astera²

1. Secure the cables to the back of MADSEN Astera² with the rubber bands provided.

Mounting the cable cover

1. Remount the cable cover by inserting the blue tags of the cable cover into the grooves of MADSEN Astera² and swinging the cover into place until you hear a click.

6.4.2

Wall-mounting MADSEN Astera²

You can hang MADSEN Astera² on the wall, orienting it in one of three positions:



While tools are needed to attach the wall-mount plate to the wall, no tools are needed for mounting or dismounting

MADSEN Astera² on the wall-mount plate.

Note

•

Make sure that you use screws specifically suited for the type of wall on which you will be hanging the

MADSEN Astera².

1. Mount the wall-mount plate securely on the wall.

2. Fit the screws through the slots marked by the red arrows.

3. Hang MADSEN Astera² on the wall-mount plate.

6.4.3

Assembling the ACP

MADSEN Astera² - ACP - PC connection setup

If you are using the ACP:

1. Unfold the feet of the ACP.

2. Place the ACP in front of the PC monitor.

3. Connect the ACP to MADSEN Astera². See

Connecting the ACP to MADSEN Astera² ► 138

.

4. Connect the ACP to the PC. See

Connecting the

ACP to the PC ► 139

.

5. Connect accessories to the ACP. See

Connecting accessories to the ACP ► 141

.



6.4.4

Connecting the ACP to MADSEN Astera²

138

Cabling

Caution

•

Make sure that each jack, as depicted on each end of the cable, connects with the specific sockets on the ACP and MADSEN Astera².

All four cables for connecting accessories are joined in a bundle and color-coded for easy connection:

• Yellow: Operator desktop microphone

• Green: Operator monitor headset, headphones

• Pink: Operator monitor headset, boom microphone

• Gray: Operator monitor speaker

Connecting

1. Remove the cable cover from

MADSEN Astera².

2. Connect the ACP to MADSEN

Astera².

The connections are located at the back of the ACP.



Operator desktop microphone

• If you are using a desktop microphone, connect the yellow cable in the cable bundle from the

Operator desktop microphone

socket in the MADSEN Astera² rear panel to the


socket in the ACP.

Operator monitor headset with boom microphone

• Connect the green cable in the cable bundle from the

Operator monitor headset - headphones


Operator monitor headset headphones

socket in the ACP.

• Connect the pink cable in the cable bundle from the

Operator monitor headset - boom microphone


Operator monitor headset

- boom microphone

socket in the ACP.

Speaker, built into the ACP

• Connect the gray cable in the cable bundle from the

Operator monitor speaker



socket in the ACP.

6.4.5

3. When you have connected the accessories, slide the cable cover onto MADSEN Astera² and click it into place.

Connecting the ACP to the PC

The ACP is powered from the PC through a USB connection.

Caution

•

Install the OTOsuite Audiometry Module on the PC before you connect the ACP to the PC.

Caution

•

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

Caution

•

Do not connect the ACP to the PC by using a bus powered hub (USB hub without external power supply).

It cannot provide sufficient power to the ACP. The Power on LED on the ACP will flash to indicate an error. Use instead a USB hub with external power supply.



140

The following applies only when used with the specified power supply, External power supply, Delta Electronics Inc., type MDS-090AAS24:

The installation must be carried out in accordance with Medical Electrical Systems clause 16 in IEC 60601-1

(3rd), AAMI ES60601-1 and CSA C22.2 NO. 60601-1-08-CAN/CSA. 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 (3rd).

The following applies only when used with the specified power supply, XP Power, type PCM80PS24:

The installation must be carried out in accordance with IEC 60601-1-1, UL 60601-1 and CAN/CSA-C22.2 NO

601.1-90. The supplementary provisions on the reliability of electro-medical systems.


• The connected equipment must comply with IEC 60601-1 (2nd) and/or IEC 60601-1-1.

Any PC connected to the ACP must comply with the requirements of UL/IEC 60950, "Safety of information technology equipment, including electrical business equipment".

Only the supplied cable must be used for the connection.

Direct connection to PC using single USB cable

Caution

•

Make sure that the total length of the USB cable used for connecting the ACP to the PC does not exceed

3 meters (10 feet).

1. Unfold the feet of the ACP.

2. Place the ACP in front of the PC monitor.

3. Plug one end of the USB cable into the USB socket located in the ACP rear panel and the other end of the cable into a USB socket on the PC.

Connection to PC using externally powered USB hub

Caution

•

If the PC, the externally powered USB hub and the ACP are connected, make sure that you switch on power to the hub before or right when you switch on the PC. This is to ensure that the USB connection between the PC and the hub is established correctly. This connection is established when the PC is switched on.



6.4.6

Caution

•

If you are using an externally powered hub, no individual USB cable must exceed 3 meters (10 feet).

Power up sequence with externally powered USB hub

1. Connect the externally powered USB hub to the mains socket and switch it on.

2. Plug the single USB cable from the externally powered USB hub directly into a USB socket on the PC.

3. Connect the USB cable from the externally powered USB hub to the USB socket located in the ACP rear panel.

Connecting accessories to the ACP

• Connect the operator monitor headset, the boom microphone, and the desktop microphone (if needed), to the ACP.

Operator monitor headset with boom microphone

• Connect the operator monitor headset to the

Operator monitor headset

socket.

The jack is marked with this symbol.

• Connect the boom microphone on the monitor headset to the

Operator boom microphone

socket.





• If you are using a desktop microphone, connect it to the


socket.

6.5


MADSEN Astera² connection panel

Caution

•

Install OTOsuite on the PC before you connect to MADSEN Astera² from the PC.

The following applies only when used with the specified power supply, XP Power, type PCM80PS24:

The installation must be carried out in accordance with IEC 60601-1-1, UL 60601-1 and CAN/CSA-C22.2 NO

601.1-90. The supplementary provisions on the reliability of electro-medical systems.


• The connected equipment must comply with IEC 60601-1 (2nd) and/or IEC 60601-1-1.

except for the PC, and equipment connected to the line in and the line out sockets of MADSEN Astera².

The following applies only when used with the specified power supply, External power supply, Delta Electronics Inc., type MDS-090AAS24:

The installation must be carried out in accordance with Medical Electrical Systems clause 16 in IEC 60601-1

(3rd), AAMI ES60601-1 and CSA C22.2 NO. 60601-1-08-CAN/CSA. The supplementary provisions on the reliability of electro-medical systems.


• The connected equipment must comply with IEC 60601-1 (3rd).

except for the PC, and equipment connected to the line in and the line out sockets of MADSEN Astera².

See Technical Specifications,

Power supply

.

See also


and

General warning notes ► 158

.

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

Configuring the Audiometry

Module ► 147

.

The connections are located at the back of MADSEN Astera².



E.

F.

G.

H.

A.

B.

C.

D.

Patient Responders ► 143

Insert earphones ► 143

Headphones - air conduction ► 143

High-frequency headphones - air conduction ► 143

Bone oscillator ► 143

Operator monitor headset - headphones ► 144

Operator monitor headset - boom microphone ► 144

Operator monitor speaker ► 144

M.

N.

O.

P.

I.

J.

K.

L.

Operator desktop microphone ► 145

Talkback microphone ► 145

Assistant monitor headset ► 145

Sound field speakers (power output) ► 145

External power supply ► 145

PC/USB connection ► 146

Line-in ► 146

Sound field speakers (line output) ► 146

Note

•

Blue corresponds to Left and Red corresponds to Right.

Patient Responders

• If you are using only one Patient Responder, plug it into either of these sockets.

• If you are using two Patient Responders, you can set up the specific

Left

and

Right

separation of the Patient Responders in see


.

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).

Headphones - air conduction

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

Headphone

sockets.

High-frequency headphones - air conduction

• Plug the high-frequency HDA 200 headphone cables (red and blue jacks) into the Right and Left

High-frequency headphone

sockets.

Bone oscillator

Mastoid

• If you are using a standard bone oscillator for Mastoid placement, plug it into the

Mastoid

socket (the socket pointing to the Mastoid location on the client).



Forehead

• If you are using a bone oscillator for Forehead placement, plug it into the

Forehead

socket (the socket pointing to the Forehead location on the client).

Two bone oscillators

• If you are using two bone oscillators, plug the mastoid bone oscillator into the Mastoid

Bone

socket, and the forehead bone oscillator into the Forehead

Bone

socket.

Note

•

If you switch between mastoid and forehead bone vibrator placement, for calibration to be correct you must select the Configuration Wizard and switch the bone oscillator default placement.

Operator monitor headset - headphones

Note

•

This applies if you are not using the ACP.

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


Operator monitor headset - boom microphone

Note

•


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



Note

•


Connection for the operator monitor speaker, built into the ACP or as a desktop version.

• Plug the operator monitor speaker into the


socket.




Note

•


Connection for the operator desktop microphone.

• Plug the desktop microphone into the


socket.


Talkback microphone

Connection for the talkback microphone.

• If you are using a talkback microphone, plug it into the

Talkback microphone

socket.

• Position the talkback microphone in the sound booth facing the client.

Assistant monitor headset

Connection for the assistant monitor headset.

• If you are using an assistant monitor headset, plug it into the

Assistant monitor headset

socket.

Sound field speakers (power output)

Connections for sound field speakers using the built-in amplifiers (4 speakers are currently supported in the software).

• Connect the left speaker to the socket labeled 1, and the right speaker to the socket labeled 2.

• If you are using more than the 2 standard speakers, set up the configuration in the OTOsuite Configuration Wizard. See the OTOsuite Installation and User Manual.

External power supply

Warning

•

Use only the power supply provided by Otometrics.

Warning

•

MADSEN Astera² is not provided with a mains switch.

To connect MADSEN Astera² to the mains supply, plug the mains plug into the wall mains outlet.

To disconnect MADSEN Astera² 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

Power supply

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.



PC/USB connection

Caution

•

Install OTOsuite on the PC before you connect to MADSEN Astera² from the PC.

To connect MADSEN Astera² 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 MADSEN Astera². 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.

Line-in

Connection for any line-in device (e.g. CD player or tape recorder).

Caution

•

When you connect other electrical equipment to MADSEN Astera², remember that equipment that does not comply with the same safety standards as MADSEN Astera² can lead to a general reduction in the system's safety level.

Sound field speakers (line output)

Connections for sound field speakers using external amplifiers (5 speakers are currently supported in the software).

• Blue: connection for speakers 1 and 4.

• Red: connection for speakers 2 and 5.

• Black connection for speaker 3.


7 Configuring the Audiometry Module

You must run the

Configuration Wizard

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 > Configuration Wizard...

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

.

– If you are having problems connecting to a device that is included in the list, click on

Repair

.

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.

Audiometer Configuration

Responders

Single:

• For use with one patient responder. The response will be shown in single color on the screen. Connect the single responder to either of the patient responder sockets on the MADSEN Astera² rear panel.

Dual-ear specific:

• For use with two patient responders, one for each ear. The response will be shown in dual color on the screen. Connect the corresponding responder to the relevant patient responder socket on the MADSEN Astera² rear panel.



Audiometer Configuration

Insert phone selection

Mono insert:

• If you only wish to use a single insert for masking, select the mono insert.

Note

•

If you use only one insert, make sure that it is connected to the Left insert socket on the MADSEN Astera² rear panel.

Bone oscillator placement

Dual insert:

• If you wish to use insert phones as a standard transducer, select the dual insert.

Connect the corresponding transducer to the relevant insert sockets on the

MADSEN Astera² rear panel.

Mastoid

• If you wish to use mastoid placement of the bone oscillator, select Mastoid. This selection will enable the calibration data entered for mastoid placement. Connect the mastoid bone oscillator into the Mastoid socket on the MADSEN Astera² rear panel.

Forehead

• If you wish to use forehead placement of the bone oscillator, select Forehead. This selection will enable the calibration data entered for forehead placement. Connect the mastoid bone oscillator into the Forehead socket on the MADSEN Astera² rear panel.

Test Type

Show xxxx 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 Assistant

Masking Criteria

Air-Bone Gap Criterion

Define the masking criteria for Insert phone(s), earphones, and high frequency earphones.

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



Frequency Specific Warble

Depth/Rate

Enable Frequency Specific

Warble

Define the depth and rate for using frequency specific warble.

Click to enable or disable.

Preferences

Enable BSA (United Kingdom only)

Use Masking Threshold

SRT Designation

Enable Portable Sound-Field

Audiometry

• 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.

• 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.

• Select to allow manual calibration of speaker signal for free-field speech audiometry.

Pediatric

VRA Device

Enable Center Device

Enable 6 kHz

Enable SDT

Store Unmasked SF as

Unspecified Ear

Store Unmasked BC as

Unspecified Ear

Select the type of Visual Reinforcement you wish to use. The applicable VRA buttons will be enabled in the Pediatric test panel, on the keyboard, and on the ACP.

If you have selected OTOsuite Pediatric with VRA, you can add a center VRA device to your test. A center VRA button will populate the Pediatric test panel.

Enable to enlarge the audiogram to show up to 6 kHz.

Enable to allow for storing Speech responses in the Pediatric audiogram.

Stores the unmasked sound field measurements as binaural data. Switching on contralateral masking enables storing the data to the selected stimulus ear.

Stores the unmasked bone conduction measurements as binaural data. Switching on contralateral masking enables storing the data to the selected stimulus ear.




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 ► 151

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.


8 Communicating with the device


9

9.1

Maintenance and calibration

MADSEN Astera² requires no preventive maintenance except for regular calibration of the transducers.

See

Calibration ► 154

.

Service and repair

It is recommended that you keep the packing material in which MADSEN Astera² 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 MADSEN Astera² cabinet.

9.1.1

9.2

Fuses

MADSEN Astera² has no user-accessible fuses.

Cleaning

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

Cleaning the device

Make sure that the instrument is kept clean and free of dust:

• Remove dust using a soft brush.

• To clean the cabinet, use a soft, slightly damp cloth with a small amount of mild detergent on it.

Caution

•

Do not allow any moisture inside the instrument!

Cleaning accessories

Headphones

The headphones are in constant contact with the patient, and should therefore be kept clean.

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

Eartips for Insert Earphones

Warning

•

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


9 Maintenance and calibration

9.3

The eartips are disposable and therefore should not be cleaned or re-used. There are no special requirements for the disposal of the eartips.

Bone oscillator

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

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.

• 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.

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

• 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

Symbols used ► 157

and


.

11.1

Symbols used

MADSEN Astera² complies with the standards listed below.

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 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.

MEDICAL - General Medical Equipment as to electrical shock, fire and mechanical hazards only in accordance with medical- general medical equipment ANSI/AAMI ES60601-1 (2005), CAN/CSA-C22.2 No. 60601-

1 (2008) 90 EA.

11.2

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 - MADSEN Astera² connection panel

Isolated connectors

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

Note

•

The safety standards listed in

Standards and safety ► 157

do not apply to the isolated connectors used in the MADSEN Astera² audiometer.

Fig. 2

Connectors isolated from patient transducers - MADSEN Astera² connection panel

11.3

General warning notes

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

2. MADSEN Astera² 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. 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.

12. For safety reasons, accessories connected to the equipment's outlet fittings must be identical to the type supplied with the system.

13. 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.

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

15. 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 MADSEN Astera² be restricted.

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

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

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

18. Use only the specified power supply.

See 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 requirements as this product (e.g. PC and/or printer) may lead to a reduction in the overall safety level of the system.

The equipment must comply with UL/IEC 60950.

The following applies only when used with the specified power supply, XP Power, type

PCM80PS24:

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 IEC 60601-1 (2nd) and/or IEC

60601-1-1 and UL 60601-1 and CAN/CSA-C22.2 NO 601.1-90.

The following applies only when used with the specified power supply, External power supply,

Delta Electronics Inc., type MDS-090AAS24:

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 IEC 60601-1 (3rd), AAMI ES60601-

1 and CAN/CSA-C22.2 NO. 60601-1-08-CAN/CSA.

Do not touch the output DC plug of the power supply or connectors of the device or connected devices and the patient at the same time.

19. To comply with Medical Electrical Systems in IEC 60601-1-1 or IEC 60601-1 (3rd) computer and printer must be placed out of reach of the client, i.e. not closer than approx. 1.5 meters/5 ft.

20. Do not touch non-medical parts, such as the laptop/computer or printer and the patient at the same time.



11.4


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.

11.5

Manufacturer

GN Otometrics A/S

Hoerskaetten 9, 2630 Taastrup

Denmark

( +45 45 75 55 55

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

11.5.1

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.



12.1

MADSEN Astera²

MADSEN Astera² is type 1066 from GN Otometrics A/S.

Channels

Two separate and identical channels

Frequency range

TDH39 earphones:

HDA 200/HDA 300 earphones:

Insert earphones:

BC:

SF:

Tone accuracy:

FRESH noise stimulus:

Standard frequencies: 125 - 12500 Hz





> 0.03%

Available in entire frequency range within the transducer specified range.

(for SF 125 - 12500 Hz). Accuracy 0.3%

Available in entire frequency range

1/48, 1/24, 1/12, and 1/6 oct, 1 Hz step

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.

• Pulsed FRESH noise

Masking types

• Narrow Band Noise

– AC and BC

– SF

• Speech Weighted Noise

– AC and BC

– SF

Correlated

Non-correlated

A

Correlated

Non-correlated

A



• White Noise (Wide band noise)

– AC and BC

– SF

Correlated

Non-correlated

A

A. A maximum of 3 non-correlated simultaneous masking signals.

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 20000 Hz: ±5 dB

250 to 5000 Hz: ±4 dB

5000 to 8000 Hz: ±5 dB

Level resolution

1, 2, or 5 dB step resolution over the entire range

HL Range

Maximum output will be limited by the transducer.

AC:

BC:

SF:

-10 to 120 dB HL (500 to 4000 Hz; supra-aural earphones)

-10 to 80 dB HL (1500 to 3000 Hz; mastoid placement)

103 dB HL (Note: with external amplifier)

Total harmonic distortion

Air < 2.5 %

Bone < 5 %

Selectable transducers

AC:

BC:

SF:

TDH39, HDA 200/HDA 300, and Insert Earphones

Bone vibrator (Mastoid / Forehead)

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

Astera², or

• Sound field speaker with built-in amplifier or external amplifier, with both types using the line output from MADSEN Astera².

Transducer options depend on how MADSEN Astera² is ordered and calibrated.



Outputs

AC:

BC:

SF power output:

SF line output:

3 x 2 mono jacks, 1/4 "

2 x mono jacks, 1/4 "

5 x terminals,

5 x 40 W peak, 8

Ω load

3 x mini XLR 6 pin

5 x +6 dBu, balanced

External inputs

CD/Analog line in:

Talk Back microphone:

Static force of transducer headbands

TDH 39:

0.2 to 2.0 Vrms, 10 k

Ω

2 x RCA phone

• Electret microphone

• Input voltage: 0.002 to 0.02 Vrms

• Input resistance: 2.21 k

Ω

.

• 3.5 mm jack

Stimulus presentation

Normal:

Continuous ON:

Pulse:

Pulse duration:

Operator accessories

Operator monitor speaker

The signal is presented when the

Stimulate

button is pressed.

The signal is interrupted when the

Stimulate

button is pressed.

The signal is pulsed.

225 ms on and 225 ms off (default).

Operator monitor headset - headphones

Operator monitor headset - boom microphone

Operator desktop microphone

Assistant monitor headset

• 1.5W 8

Ω

, connected between tip and ring, sleeve floating

• 3.5 mm jack

• 40 mW 16

Ω

• 3.5 mm jack


• Input voltage: 0.002 to 0.02 Vrms,


Ω

.

• 3.5 mm jack


• Input voltage: 0.002 to 0.02 Vrms,


Ω

.

• 3.5 mm jack

• 40 mW 16

Ω

• 3.5 mm jack

4.5 N ±0.5 N



Bone vibrator:

HDA 200:

HDA 300:

USB port connector

Type:

Interface:

Speed:

Transport and storage

Temperature:

Air humidity:

Air pressure:

5.4 N ±0.5 N

10 N

10 N

USB device port

USB 2.0

Full-speed (12 Mb/s)

-30°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:

Air pressure:

Continuous

+15°C to +35°C (59°F to 95°F)


980 hPa to 1040 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 MADSEN Astera² has been stored in a cold environment.

Disposal

MADSEN Astera² can be disposed of as normal electronic waste, according to WEEE and local regulations.

Dimensions

Approx. 325 x 255 x 60 mm (12.8 x 10 x 2.4 inches)

Weight

Approx. 1.3 kg (2.85 lb)

Power supply

External power supply, types:

Delta Electronics, Inc.

MDS-090AAS24

Output: 24 V DC, 3.75 A

Input: 100-240 V AC, 50-60 Hz, 1.5 A - 0.75 A



XP Power

PCM80PS24

Patient Safety when used with the specified power supply, Delta Electronics,

Inc., type MDS-090AAS24:

• Complies with IEC 60601-1 (3rd), Class 1, Type B; AAMI ES60601-1; CSA

C22.2 NO. 60601-1-08-CAN/CSA.

• EMC: IEC 60601-1-2

Output: 24 V DC, 3.33 A max

Input: 100-240 V AC, 47-63 Hz, 1.1 A - 0.45 A

Patient Safety when used with the specified power supply, XP Power, type

PCM80PS24:

• Complies with IEC 60601-1 (2nd), Class 1, Type B; UL 60601-1; CAN/CSA-

C22.2 NO 601.1-90.

Power consumption

< 90 VA

Mains cables

8-71-240 POWER CABLE, W/ SCHUKO PLUG

8-71-290 MAINS CORD, H05VV, DK PLUG

8-71-80200 MAINS CORD, H05VV, UK PLUG

8-71-82700 POWER CABLE AUSTRALIA

8-71-86400 POWER CABLE CHINA

7-08-027 MAINS CORD, H05VV, CH PLUG

7-08-017 POWER CABLE, SJ, US HOSP. PLUG

Standards

Audiometer:

Patient Safety:

EMC:

IEC60645-1, Type 1, IEC60645-2 and ANSI S3.6

Patient Safety when used with the specified power supply, Delta Electronics,

Inc., type MDS-090AAS24:

• Complies with IEC 60601-1 (3rd), Class 1, Type B; AAMI ES60601-1; CSA

C22.2 NO. 60601-1-08-CAN/CSA.

• EMC: IEC 60601-1-2

Patient Safety when used with the specified power supply, XP Power, type

PCM80PS24:

• Complies with IEC 60601-1 (2nd), Class 1, Type B; UL 60601-1; CAN/CSA-

C22.2 NO 601.1-90.

IEC 60601-1-2

12.2

ACP

Outputs

Monitor headphone

Boom microphone

Desktop microphone

3.5 mm jack (32

Ω

.)

3.5 mm jack

3.5 mm jack



Inputs

Monitor headphone

Boom microphone

Desktop microphone

Built-in monitor speaker

Operator interface

• 76 buttons (61 with built-in LEDs)

2 rotary knobs (32 steps in each rotation)

3.5 mm jack (32

Ω

.)

3.5 mm jack

3.5 mm jack

3.5 mm jack (8

Ω

.)

USB port connector

Type:

Compliant:

Speed:

Transport and storage

Temperature:

Air humidity:

USB device port

USB 2.0

Full-speed (12 Mb/s)

-30°C to +60°C (-22°F to 140°F)


Operating environment

Mode of operation:

Temperature:

Continuous

+5°C to +40°C (41°F to 104°F)

Air humidity: 30% to 90%, non-condensing

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

Warm-up time

< 1 minute

Disposal

MADSEN Astera² ACP can be disposed of as normal electronic waste, according to WEEE and local regulations.

Dimensions

Approx. 410 x 290 x 36 mm (16.1 x 11.4 x 1.4 inches)

Weight

Approx. 2.1 kg (4.6 lb)

Power supply

No external power supply. Supplied by the USB (5 V).

Note

•

If you are using a USB hub, use a powered USB hub.



Power consumption

Normal operation: < 360 mA 5 V

Suspend mode: < 500

µ

A 5 V

Standards

Patient Safety:

EMC:

Complies with IEC 60601-1, Class 1, Type B; UL 60601-1;

CAN/CSA-C22.2 NO 601.1-90.

IEC 60601-1-2

12.3

Accessories

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

MADSEN Astera²

• Audiometer Control Panel (ACP)

• TDH 39 headphones

• HDA 200 headphones for high-frequency audiometry/HDA 300 headphones for high-frequency audiometry

• Otometrics insert phones

• Bone oscillators: NB-71, B-71

• Sound field loudspeakers

• Monitor headphones with boom microphone

• Assistant headphones

• Desktop microphone

• Talkback microphone

• Monitor speaker

• Patient Responder (one or two)

• Power supply and mains cable

• Wall mounting plate

• Connection cables

• AURICAL FreeFit

• MADSEN Astera² Reference Manual

• MADSEN Astera² User Guide

ACP

• USB cables

• Wrist support

12.4

Notes on EMC (Electromagnetic Compatibility)

• MADSEN Astera² 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 MADSEN Astera².

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

MADSEN Astera² isintended for use in the electromagnetic environment specified below. The user of MADSEN Astera² should ensure that it is used in such an environment.

Emissionstest Compliance Electromagnetic environment - guidance

Group 1 RF emissions

CISPR 11

RF emissions

CISPR 11

Class B

MADSEN Astera² 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.

MADSEN Astera² issuitable 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.

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


Immunitytest 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 bethat 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 bethat of a typical commercial or hospital environment.



Voltagedips, short interruptionsand 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

5cycles

70% U

T

(30 % dip in U

T

) for

25cycles

<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 bethat of a typical commercial or hospital environment. If the user of the MADSEN Astera² requires continued operation during power mains interruptions, it is recommended that the MADSEN Astera² bepowered from an uninterruptible power supply or a battery.

Power frequency

(50/60 Hz) magnetic field

IEC 61000-4-8

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

U

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

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


Immunitytest IEC 60601 test level

Compliancelevel Electromagnetic environment - guidance

Radiated RF

IEC 61000-4-3

3V/m

150 kHzto 80 MHz

3V/m

80MHz to 2.5 GHz

3V/m Portableand mobile RF communications equipment should be used no closer to any part of

MADSEN Astera²,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

for 80MHz to 800 MHz d = 2.3

for 80MHz 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 strengthsfrom fixed RF transmitters, as determined by an electromagnetic site survey, a should beless 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 MHzand 800 MHz the separation distancefor the higher frequency range applies.

Note 2

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

a. The ISM(industrial, scientific and medical) bands between 150 kHz and 80 MHzare 6.765 MHzto 6.795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHzto 27.283

MHz; and 40.66 MHzto 40,70 MHz.

b. The compliance levels in the ISMfrequency bands between 150 kHz and 80 MHzand in the frequency range 80MHz to 2.5 GHzare intended to decrease the likelihood that mobile/portable communications equipment could cause interference if it isinadvertently brought into patient areas. For this reason, an additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in these frequency ranges.

Field strengthsfrom fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios,amateur radio, AM and FMradio 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 MADSEN Astera² is used exceeds the applicable RF compliancelevel above, the MADSEN Astera² should be observed to verify normal operation. If abnormal performance isobserved, additional measuresmight be necessary, such as reorienting or relocating MADSEN Astera².

Over the frequency range 150 kHzto 80MHz, field strengths should beless than 3 V/m.

Recommended separation distances between portable and mobile RF communications equipment and MADSEN Astera²

The MADSEN Astera² is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the

MADSEN Astera² can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the MADSEN Astera²as 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 kHzto 80 MHz d = 1.2

80MHz to 800 MHz d = 1.2

800 MHzto 2.5 GHz d = 2.3

0.01

0.1

0.12

0.38

0.12

0.38

0.23

0.73

1

10

100

1.2

3.8

12

1.2

3.8

12

2.3

7.3

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 MHzand 800 MHz the separation distancefor the higher frequency range applies.

Note 2

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


Index

A

ABLB 127

Accessories

specifications 167

AI 64

Assistant

talk to 18

Assistant monitoring headset con-

nection 145

Audiogram combined,

enabling/disabling 17

show combined view, Audiogram

Module 17

show split view, Audiogram

Module 17

viewing frequency range 18

viewing left-right 17 viewing legend box 17 viewing right-left 17

work area in screen, Audiogram

Module 35

Audiometry

preparing for testing 13 training 13

user interface 119

B

Bone vibrator

connection 143

C

Calibration 154 certificate 154

CD/tape connections 146

Cleaning

accessories 153 device 153

Client

inspecting the ear 116


Combined audiogram


Configuration Wizard 147

Connections assistant monitoring

headset 145

bone vibrator 143

CD/tape 146

desktop microphone 145 external power supply 145

headphones 143 insert phone 143

monitor speaker 144 operator boom microphone 144 operator headphone 144

patient responder 143

PC/USB 146

SF speakers 145 talkback microphone 145

USB, ACP to PC 139

Control Panel

OTOsuite description 23, 26

Sunshine Panel 23

Controls 106

ACP 106

Curves and symbols 37

selecting 20

D

Desktop microphone

selection 18

Desktop microphone

connection 145

F

Firmware update, test devices

(Aud.) 151

Frequency

specifications 161

Frequency range, audiogram

viewing 18

FRESH noise 27, 89, 95, 111

Front panel 106

Index

171

Index

172

G

Getting started

OTOsuite 13

H

Headphones

connections 143

operator phone connection 144

Headset boom microphone

selection 18

Headsets assistant monitoring

connection 145

HL

range specifications 162

Hygienic precautions 116

I

Icons combined view, Audiogram

Module 17

split view, Audiogram

Module 17

Insert phone

connections 143

Installation

powering 139

Installing

OTOsuite 84

Intended use

Audiometry Module 10

Interrupter

specifications 163

ISTS, stimulus type 95

K

Keys 106

L

Left - Right audiogram

viewing 17

Legend box, audiogram

viewing 17

Level

specifications 162

Line in

connections 146

LIPread Player Panel 85

List View 86

M

Masking assistant


Masking Assistant 20


Masking types

specifications 161

Measurement menu

desktop/boom microphone 18

Monitoring 18

talk forward 19

talk to assistant 18

Measurement menu (Aud)

desktop/boom microphone 18

Monitoring 18

talk forward 19

talk to assistant 18

Menu bar

OTOsuite 15

Microphones desktop microphone

connection 145

operator boom microphone con-

nection 144

talkback microphone

connection 145

Monitor speaker connection 144

Monitoring 18

N

Narrow Band Noise, stimulus

type 89

Navigating 85

LIPread player panel 85

list view 86

results table 87

scoring counter 85

scoring words 86


Navigating in Audiometry 119

O

On-screen controls 32

Operator boom microphone con-

nection 144

Operator headphone

connection 144

OTOsuite

menu bar 15

Overlays feature box;Feature box

overlays 40

viewing 17

P

Patient preparation 115

Patient responder 20

connection 143

PC/USB connection 146

Power supply

connection 145

Powering 139

Preparing for testing 87

Audiometry 13

inspecting the client’s ear 116

Pure tone data feature box;Feature box

pure tone data 40

Q

Quick testing 88

R

Reliability feature box;Feature box

Reliability 40

Results table 87

Right - Left audiogram

viewing 17

Rinne 127

feature box;Feature box

Rinne 40


Index

S

Safety

Audiometry Module 157

Scoring counter 85

Scoring words 86

Screens

Speech 43

Tone, Audiogram Module 34

Select orientation

toolbar 19

SF speakers

connection 145

Silence Mode 33

SISI 128

Speakers

SF connections 145

Special tests

how to 125

Specifications

accessories 167

Specifications, technical 161

Speech test

graph view 60

scoring words 50, 52

speech material 48

tabular view 56

terms and abbreviations 63

the counter/player 50, 52-53,

55

the Speech screen 43

viewing speech list 51, 54

work area in screen 43

SpeechLink 100

views 132

Stenger feature box;Feature box

Stenger 40

navigation, speech 63

speech 126

tone 125

Stimulus modulation

specifications 162

Stimulus types

FRESH 27, 89, 95, 111

173

Index

174

ISTS 95

NBN 89

specifications 161

Tone 27, 89

Warble 27, 89, 95

WN 89

Storing 131

Sunshine Panel 23

Symbols and curves

selecting 20

T

Talk forward

selecting 19

Talk to assistant 18

Talkback microphone

connection 145

Technical specifications 161

Test devices

connecting 151 information about 151

views 132

Test devices (Audiometry)

firmware update 151

Test report 154

Testing

preparing 87

scoring words 86

Tests

Speech screen 43

Tone screen, Audiogram Mod-

ule 34

Timer feature box;Feature box

Timer 40

Tone decay feature box;Feature box

tone decay 40

Tone test the Tone screen, Audiogram

Module 34

Tone, stimulus type 27, 89

Toolbar

select orientation 19

Tools menu


Tools menu (Aud)


Training

Audiometry 13

Transducers

calibration 154

headphone connections 143 insert phone connections 143

specifications 162

U

Unpacking

the test device 131

USB

PC/USB connection 146

USB connection, ACP to PC 139

User interface 119

V

View menu

audiogram legend 17 combined audiogram 17

frequency range 18

left-right audiogram 17

Masking Assistant 17

Overlays 17 right-left audiogram 17

View menu (Aud)

audiogram legend 17 combined audiogram 17

frequency range 18

masking assistant 17

Overlays 17

W

Warble, stimulus type 27, 89, 95

Warning notes

Astera 157-158

Weber 126

feature box;Feature box

Weber 39

multi frequency 40

single frequency 39


White Noise, stimulus type 89

Index
