AURICAL Aud Reference Manual Oct 2014

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© 2014, 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 2014-10-30 Technicalsupport Please contact your supplier.

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Otometrics - AURICAL Aud

Table of Contents 1

Introduction to AURICAL Aud 1.1 AURICAL Aud 1.2 HI-PRO 1.3 AURICAL speaker unit 1.4 The OTOsuite Audiometry Module 1.4.1 NOAH 1.5 Intended use 1.6 About this manual 1.6.1 Installation and Assembly 1.6.2 Safety 1.6.3 Training 1.7 Typographical conventions 1.7.1 Navigation

7 7 8 8 8 9 9 10 10 10 10 10 11

2

Navigating in the OTOsuite Audiometry Module 2.1 The Audiometry Module main window 2.2 Menus and toolbar icons 2.2.1 File menu 2.2.2 Edit menu 2.2.3 View menu 2.2.4 Measurement menu 2.2.5 Tools menu 2.3 The Patient Responder indicator 2.4 The Masking Assistant 2.5 The Control Panels 2.5.1 Quick Select - Tone 2.5.2 Quick Select - Speech 2.5.3 Test Options 2.5.4 Monitor and Level 2.6 The stimulus bar 2.6.1 Test controls 2.6.2 The Tone stimulus bar 2.6.3 The Speech stimulus bar 2.7 The Tone test screen 2.7.1 The work area in the Tone screen 2.7.2 The audiogram 2.7.3 Curves and symbols selection 2.7.3.1 Selecting a symbol or curve 2.7.3.2 Creating new symbols 2.7.4 Compare audiograms 2.7.5 Tone feature boxes 2.7.6 Tone editing options 2.8 Work-flow related features 2.8.1 Selecting orientation 2.8.2 Automatic frequency/level shift when storing 2.8.3 Stimulus duration 2.8.4 Ear shift frequency and level setting 2.8.5 Saving non-stimulus channel as masking 2.9 The Speech test screen

13 13 14 14 14 15 16 17 18 18 20 21 22 24 25 26 27 28 28 29 29 30 32 32 33 33 34 36 36 36 37 37 37 38 38

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3

4

2.9.1 Selecting word or phoneme scoring 2.9.2 Selecting speech material 2.9.3 Scoring words using integrated OTOsuite Speech Material 2.9.4 Scoring words using external sound source 2.9.5 Scoring phonemes using integrated OTOsuite speech material 2.9.6 Scoring phonemes using external sound source 2.9.7 Saving source levels for speech material 2.10 Speech testing - tabular view 2.10.1 Speech editing options - tabular view 2.10.2 Storing SNR for Speech testing 2.11 Speech testing - graph view 2.11.1 Speech editing options - graph view 2.12 Speech feature boxes 2.13 Terms and abbreviations used in Speech testing 2.14 Special tests 2.14.1 SISI (Short Increment Sensitivity Index) 2.14.1.1 Navigating in SISI 2.14.1.2 The test process - SISI 2.14.2 ABLB (Alternate Binaural Loudness Balance) 2.14.2.1 Navigating in ABLB 2.14.2.2 The test process 2.14.3 TEN (Threshold-Equalizing Noise) 2.14.4 Ambient Noise Assessor 2.14.4.1 Selecting the FreeFit device in OTOsuite 2.14.4.2 Measuring Ambient Noise with AURICAL FreeFit 2.14.4.3 Noise level indicators stored with measurements 2.14.4.4 Activating the Ambient Noise Assessor automatically 2.14.4.5 Minimum HTL per transducer type 2.15 Test controls (keyboard, mouse) 2.15.1 PC keyboard controls

38 42 44 46 47 48 49 51 54 54 55 57 58 58 60 60 60 63 63 63 66 66 67 67 67 71 72 72 73 73

3

Preparing for testing 3.1 Preparing the test environment 3.2 Preparing the test equipment 3.3 Listening check 3.4 Preparing the client 3.4.1 Hygienic precautions 3.4.2 Inspecting the client’s ear(s) 3.5 Proper transducer placement

75 75 75 76 76 76 76 77

4

Examples of audiometric testing 4.1 Testing the older child or adult patient 4.1.1 Assessing pure tone threshold using the Hughson/Westlake procedure 4.1.2 Assessing pure tone or speech most comfortable loudness level (MCL) 4.1.3 Assessing pure tone or speech uncomfortable loudness level (UCL) 4.1.4 Assessing speech reception threshold (SRT) using the Hughson/Westlake procedure 4.1.5 Assessing word recognition score 4.2 Special Tests 4.2.1 Performing Tone Decay using the Modified Carhart Method 4.2.2 Performing a pure tone Stenger 4.2.3 Performing speech Stenger 4.2.4 Performing Weber 4.2.5 Performing Rinne

79 79 79 80 80 81 81 82 82 83 83 84 84

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4.3

4.2.6 Performing Alternate Binaural Loudness Balancing (ABLB) test 4.2.7 Performing Short Increment Sensitivity Index (SISI) test Testing with sound files 4.3.1 Playing sound files without word lists 4.3.2 Playing sound files with word lists

85 85 86 86 86

5

Unpacking and Installing 5.1 Requirements to the location 5.1.1 Requirements to noise in the test environment 5.2 Unpacking 5.3 Storing 5.4 Views of AURICAL Aud 5.4.1 AURICAL Aud 5.4.2 AURICAL Aud - with HI-PRO 5.4.3 AURICAL speaker unit 5.5 Connection panels 5.5.1 AURICAL Aud connection panel 5.5.2 Built-in HI-PRO connection panel 5.5.3 AURICAL speaker unit connection panel 5.6 Assembling AURICAL Aud 5.7 Desktop or wall installation 5.7.1 Connecting accessories and PC to AURICAL Aud 5.7.2 Mounting AURICAL Aud on the mounting plate 5.8 AURICAL speaker unit installation 5.8.1 Connecting cables to the AURICAL speaker unit 5.8.2 Connecting accessories and PC to AURICAL Aud 5.8.3 Mounting AURICAL Aud on the AURICAL speaker unit 5.9 Powering AURICAL Aud

89 89 89 90 90 90 90 91 92 92 92 96 96 97 98 98 99 99 100 102 103 103

6

Configuring the Audiometry Module

105

7

Communicating with the device 7.1 Reconnecting to the device 7.2 Updating device firmware

107 107 107

8

AURICAL Aud with HI-PRO

109

9

Maintenance and calibration 9.1 Service and repair 9.1.1 Fuses 9.2 Maintenance 9.3 Cleaning 9.4 Calibration

111 111 111 111 111 112

10 Troubleshooting 10.1 Powering 10.2 Software/device communication 10.3 HI-PRO

113 113 113 113

11 Standards and Safety 11.1 AURICAL Aud 11.2 Warning notes

115 115 116

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5

11.2.1 Connector warning notes 11.2.2 General warning notes 11.3 The OTOsuite Audiometry Module 11.4 Manufacturer 11.4.1 Responsibility of the manufacturer

116 116 118 118 118

12 Technical specifications 12.1 AURICAL Aud 12.2 HI-PRO (built-in) 12.3 AURICAL speaker unit 12.4 Accessories 12.5 Notes on EMC (Electromagnetic Compatibility)

119 119 123 123 124 124

Index

6

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1

Introduction to AURICAL Aud

1.1

AURICAL Aud AURICAL Aud is a PC-controlled audiometer for testing a person's hearing. The audiometer, which is connected to a PC via USB, is operated from the OTOsuite Audiometry Module PC software. With AURICAL Aud you can perform all standard audiometric tests, tone and speech audiometry and special tests. The intuitive graphical user interface and the user test feature enable you to carry out your tests with very little effort. You can connect other devices easily through the built-in USB Hub, and AURICAL Aud provides the necessary connections to carry out counseling using the OTOsuite Counseling and Simulations module.

Configurations AURICAL Aud is available as: • part of the integrated AURICAL system •

a separate audiometer

Each configuration is available with an optional built-in HI-PRO and an optional AURICAL speaker unit. AURICAL Aud can be placed on the desk top, mounted directly on the back of the AURICAL speaker, or, if the optional kit is used, it can be mounted on the wall or under the desk.

Operating AURICAL Aud •

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

•

From the OTOsuite Audiometry Software Module, which is NOAH compatible, you can monitor test results, create User Tests, store and export data, and print reports. Test intensities and frequencies as well as the current test settings and other information are shown on the PC monitor.

•

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

Outputs AURICAL Aud supports the following types of output: • One set of headphones. The supported headphone types are: –

TDH39 headphones

–

TDH39 with ME70

–

Holmco

–

HDA 200/HDA300

•

Insert phones

•

Bone oscillator

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7

1 Introduction to AURICAL Aud

•

1.2

2 sound field speakers. The speakers can use either the power amplifier built into AURICAL Aud or an external power amplifier.

HI-PRO AURICAL Aud is available with an optional built-in HI-PRO (Hearing Instrument Programming Unit). The HI-PRO serves as a standardized interface between OTOsuite and programmable hearing instruments, and can serve as a remote control for programmable hearing instruments. In the HI-PRO section of the AURICAL Aud cabinet there are two connectors for the cables to the programmable hearing instruments (or remote control), so that both a left and a right hearing instrument can be programmed. The PC software for programming the hearing instrument is made by the hearing instrument manufacturer. The cables for connecting hearing instruments to HI-PRO are supplied by the hearing instrument manufacturer.

1.3

AURICAL speaker unit AURICAL Aud is available with the optional AURICAL speaker unit. The AURICAL Speaker is for use with AURICAL FreeFit and the PMM and Counseling and Simulations modules in OTOsuite. The speaker unit can be attached to an AURICAL Aud audiometer or to an AURICAL Aud that is not enabled as an audiometer. You can use AURICAL Aud to connect and drive the accessories for OTOsuite PMM and the OTOsuite Counseling and Simulations module. The speaker unit also contains a built-in charger for FreeFit.

Note • The instructions for assembly are the same, whether or not the audiometer is activated.

1.4

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 AURICAL Aud as the test device.

The OTOsuite Audiometry Module 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 •

8

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

Otometrics - AURICAL Aud

1 Introduction to AURICAL Aud

•

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

1.4.1

•

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.

1.5

Intended use AURICAL Aud 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.

AURICAL Aud with HI-PRO and the Audiometry module Users: audiologists, ENTs, hearing instrument dispensers and other health care professionals. Use: As for AURICAL Aud, and hearing instrument fitting.

Speaker unit Users: audiologists, hearing instrument dispensers and other health care professionals.

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1 Introduction to AURICAL Aud

Use: The AURICAL speaker unit is intended to present audio signals for use with AURICAL Aud and the Audiometry module, with AURICAL FreeFit and the OTOsuite PMM module and the OTOsuite Counseling and Simulations module.

1.6

About this manual This is your guide to installing, calibrating and using AURICAL Aud 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 AURICAL Aud and the Audiometry Module for the first time.

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

1.6.1

Installation and Assembly Unpacking ► 90 and Assembling AURICAL Aud ► 97 contain a full description of unpacking instructions and how to assemble the device. For instructions on installing the software, see the OTOsuite Installation Guide.

1.6.2

Safety This manual contains information and warnings which must be followed to ensure the safe performance of AURICAL Aud.

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 ► 115.

1.6.3

Training It is recommended that you read this manual and try out test scenarios before you start operating AURICAL Aud so that you are familiar with both the device and the software program before testing a patient.

1.7

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.

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1 Introduction to AURICAL Aud

Note • Indicates that you should take special notice.

1.7.1

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

Otometrics - AURICAL Aud

Click the Set options icon on the toolbar or select Tools > Options...

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1 Introduction to AURICAL Aud

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2

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 ► 29

•

The Speech test screen ► 38

Special tests are described in: •

2.1

Special tests ► 60

The Audiometry Module main window The basic OTOsuite functions are described in the OTOsuite User Guide.

Audiometry elements

A. Audiometry toolbar B. Control Panel C. Work area

Otometrics - AURICAL Aud

D. Stimulus bar E. Masking level indicator F. Stimulus marker

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2 Navigating in the OTOsuite Audiometry Module

2.2

Menus and toolbar icons General icons - see the OTOsuite manual

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

Tone audiometry

Speech audiometry

2.2.1

File menu Menu item

Icon

New Audiogram

2.2.2

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

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.

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2 Navigating in the OTOsuite Audiometry Module

2.2.3

View menu Menu item (Tone) Masking Assistant

Icon

Description Enable or disable the Masking Assistant. The Masking Assistant causes an unmasked threshold to flash repeatedly if masking is recommended. •

Overlays

See The Masking Assistant ► 18.

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 ► 34.

Combined Audiogram

Combined View •

Click to view both ears in a single audiogram.

Split View •

Click to view separate audiograms for each ear.

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

Left - Right

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).

Right - Left

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).

Audiogram Legend

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.

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2 Navigating in the OTOsuite Audiometry Module

Menu item (Tone)

Icon

Description The graph shows up to 20,000 Hz. AURICAL Aud presents stimulus up to 12,500 Hz.

Standard / All / High frequencies

•

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.

Frequency resolution

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.

2.2.4

Measurement menu Menu item Monitoring

16

Icon

Description Enables or disables the monitor speaker for monitoring stimuli presented to the patient from the Stimulus or Masking channel.

Otometrics - AURICAL Aud

2 Navigating in the OTOsuite Audiometry Module

Menu item

Icon

Description 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.

Talk Forward

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.

2.2.5

Select Orientation

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

Scoring and Playing

See Selecting word or phoneme scoring ► 38.

Ambient Noise Assessor

See Ambient Noise Assessor ► 67.

Tools menu Menu item Curves and Symbols

Icon

Description 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 ► 32.

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2 Navigating in the OTOsuite Audiometry Module

2.3

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).

Single Responder setup •

Green Indicates that the patient is pressing the Patient Responder.

2.4

The Masking Assistant If the Masking Assistant is enabled, it will at all times check for frequencies that may require testing with masking. This also applies to old audiograms imported from NOAH or XML as long as a supported transducer was stored with the data. The Masking Assistant is a tool provided to help you with an indication that there may be frequencies where testing with masking1 is recommended. • The audiogram symbol will flash at the specific frequencies where contralateral masking may be recommended2. •

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

AC test ear

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 Meas-

urement 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.

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2 Navigating in the OTOsuite Audiometry Module

Terminology ACc

AC contra

BC

BC

BCc

BC contra

Min IA

Minimum inter-aural attenuation.

When is masking required? Masking is recommended when the following conditions are met: AC

AC > ACc + Min IA or

AC > BCc + Min IA

BC

BC < AC - x* dB

Only stored thresholds measured without masking are checked. Levels which did not evoke a response are excluded from the check. This means that as soon as a masked threshold has been stored, the flashing stops for that frequency. * denotes configurable Air/Bone gap criterion (Tools > 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

125

35

Katz & Lezynski, (2002)

250

48

Munro & Agnew, BJA (1999)

500

44

Munro & Agnew, BJA (1999)

750

40

N/A - fulfill traditional approach

1000

48

Munro & Agnew, BJA (1999)

1500

40

N/A - fulfill traditional approach

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.

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2 Navigating in the OTOsuite Audiometry Module

Hz

dB

2000

44

Munro & Agnew, BJA (1999)

3000

56

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

4000

50

Katz J / Munro & Agnew, BJA (1999)

6000

44

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

8000

42

Katz J / Munro & Agnew, BJA (1999)

Min IA insert phone

2.5

Hz

dB

125

60

N/A - traditional value

250

72

Munro & Agnew, BJA (1999)

500

64

Munro & Agnew, BJA (1999)

750

60

N/A - traditional value

1000

58

Munro & Agnew, BJA (1999)

1500

60

N/A - traditional value

2000

56

Munro & Agnew, BJA (1999)

3000

58

Munro & Agnew, BJA (1999)

4000

72

Munro & Agnew, BJA (1999)

6000

54

Munro & Agnew, BJA (1999)

8000

62

Munro & Agnew, BJA (1999)

The Control Panels Click the Control Panel icon in the toolbar to activate the Control Panel.

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Otometrics - AURICAL Aud