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Cochlear Implant Processor Information, Instructions

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5. LET EET rg Bag LS Ltd eue S Re e A al AEDCENEL YS i Bag cent Ages d ge ESI Shwe Spare Right n D if dat SH ng t Dg Ct E Gg Pat arog le ia Ai ECCE UM and TRAD Left aa qoo agre Pros qr tee Ar se Pigh res amd rm MPa iod eg o Left M672 Lupe peg a t ThE Rom due Fight Ii ANER KEE 5 ou uela XE kt F ES dur he RE ee Sle SS rt D 3e take iE BSE ES ons Spare Rag Ke Ze Pe r EM dee Ara Faght Qua i d ye ran CRE fee Right Li Pa n Zeg 2 ak hr sido inet Left Orie Aum Dag tax pe Terre Fight 0630 keck Seton te Tents Fight AT ares Phone nau export an Exjxmt AN CS vr Left 578 p d e MET TENANT oes pant Rif PUTI ipu ee E A Diver CAM Lef FE abere ae Cs Ue IT Thea Spare Fa Gre Zeien KZ pas 5x pe CENSURE vee Fa 3045 Zei seg ose n na e _ iat TE on Care Bue mre AAA rudem Pfs PT od In the patient file it is possible to view the following information e The patients name e The processors status if the current processor is a spare device e The implanted side e The associated patient file name Warning Selecting the correct implanted ear side is critical For safety reasons it is not possible to select a patient s left ear if the processor is associated with the right ear Furthermore the side that the ear is on is indicated in associated patient s file name for all new patients For ex
6. e Log out and change users starts the procedure to end the fitting session which includes several steps saving the patient file saving to removable storage media programming the processor then prompts to switch users e Quit same as the previous option but closes the software at the end of the procedure 7 New patient The identity card provides information about the patient and the type of implant used implant processor It also informs the user about the patient s etiology The identity card is composed of three main tabs e Required Information necessary for identifying the patient and the cochlear implant system that is assigned to him her e Optional General information about the patient and implantation center e Medical Information about the patient s hearing loss etiology length of time etc It is now possible to include multiple systems implants or processors used by the patient in this identity card Their status is automatically displayed for example current processor spare being repaired etc a Required The information contained in this window must be filled out completely in order to validate the identity card and gain access to the fittings window this is particularly important for the first fitting Patient identity card e Identity Lo eee ren Last name ENN First name mn e Implant EM pn Type of implant Surger
7. A cursor going from O to i0dB reflects the position of the processors selector wheel highest to lowest position The audiologist is thus able to start the talk over test by testing different sound levels It is also possible to let the patient adjust the selector wheel position him herself check the box in such case in order to define the most comfortable level In the example above setting a Saphyr SP processor 5dB of attenuation makes it possible to test the denoising level associated with the middle position of the selector wheel and thus evaluate the patient s hearing comfort at this position In the same example if the level defined in the Denoising fittings window is OdB and during the advanced talk over test the patient prefers 5dB One can set denoising parameter to 5dB in the denoising window and then lock the selector wheel s position in the Button control window to force the denoising to always be 5dB In the same example for a Digi SP or Digisonic BTE processor if the level defined in the Sensitivity fittings window is 35dB and during the advanced talk over test the patient prefers 5dB One can set sensitivity parameter to 40 dB in the Sensitivity window and then lock the selector wheel s position in the Button control window to force the sensitivity to always be 40dB Important Depending on the setting chosen by the audiologist for using the potentiometer the advanced talk over test may also ma
8. be Exe ABLE EN D oem E a PE PAUL D Pa ten E a Base Ferre Eeid E aim EY main R ere P T LA Mapa 5 a Ls Vora ls BIE Doran rte ALIS PL bert ra dod lin Fin bo ER D Opto Gap Sent iS bas Ei Pap 4 d Ge CER curare TPE igre ow TN te EI Fl Mapt P gegn hia ef ormed ze DARU USER D seated E bas Sn SF ELE Pi A ET Maps Fab vier aed ze ELE ER OTRO St St P LITE Mar ce PI Pee p Fa ELAH 2 f yee mp Sege P Meng 2 ee ee Pate hr LE GIRE E Tr an ap i is Fa worms E SUPPORT P3 os at 5 Ser EINE n 3 Tigre hia formed bee FORE ages mar I7 The following information is provided about each saved session Fitting date Fitting time Processor type and serial number Map numbers of the different programs The person who performed the fitting Any comments noted by the audiologist during the fitting fittings that were programmed into a processor have the prefix PGR The information in the Processor section enables the user to track the processors being used over time type and reference Whenever a fitting parameter is changed and saved to the computer the MAP number increases by one Difference between SX mode and session mode The difference between Px mode and session mode refers to the ability to n
9. Digisonic DX XX IA XXXX to XX JD XXXX W Digisonic Convex XX E XXXX Digisonic SP XX H XXXX to XX K XXXX Digisonic SP Binaural XX J XXXX or XX L XXXX Cancel b Optional Optional information makes it possible to provide general information about the patient address telephone number date of birth gender It is also possible to fill out information about the implantation center and follow ess Ex up to fittings This information is automatically added according to information msn creme uses that was provided when installing the Digimap SP software Pian C Ge e ldem a Ta Chemin che Tr ferred ontent in the Optional tab is not required in order to validate the identity NDA aber card Phone HAAN Ire gd Deth ee w Garda LI Ui fa adr i nmm scha F ES ey PR orp ch Fang ms er CaA rem sr Pere mar Li IA C Medical The Medical tab makes it possible to add additional information about the patient s EXE he Dur etiology and the duration of the hearing loss Acade This information is not required in order to validate the identity card TT 7 2 Open os ame jJ see rate a Local patient file It is possible to open a patient file that has been saved in the computers local database TPL RE JE Pid rod Pewee St Er Fri er Fie Hare d WI pech Rag Ir Sage qe enr
10. b Suggestions for use It is recommended to automatically adjust the transmission power especially for the first fitting The patient may eventually sense a slight decrease in volume which can be compensated by increasing the intensity by one machine unit It is better to carry out this measurement at the very beginning of the fitting session The processor s current consumption can then be checked at any time during the fitting session after adjusting the thresholds by starting the talk over test A bar graph displays the average amount of current used The colored display makes it possible to distinguish between the different levels Green normal current consumption level working properly Orange high current consumption level Hed excessive battery use great risk of short battery life or intermittent power The maximum current consumption level is also displayed for information purposes as a vertical line in the current consumption window Current consumption B consumption x Current consumption Lal consumption E3 High levels of current consumption are rare for Saphyr SP and Zebra processors However excessive battery use may be detected particularly if transmission power has been manually adjusted If this occurs it is essential to manually decrease the transmission power value while using a talk over test to make sure that the level of loudness is satisfactory or to change the other parameters that mig
11. Patient sessions all of the fittings saved in the patient file e Save fittings saves the fittings in the patient file not to be confused with programming the processor Fitting management copies one program to another Enable all electrodes selects and activates all electrodes e Duration of stimulation various functions that are useful for easily setting thresholds increase decrease all thresholds interpolate etc e Endofthe fittings session starts the procedure to end the fitting session which includes several steps saving the patient file saving to removable storage media programming the processor Zil Cancel the change Undo Fatient sessions Adjustments recap Save adjustments Generate an anonymous File of adjustments Print the adjustments Adjustment manager Enable all the electrodes Presets Fast adjustments Durations of stimulations Selection End of the adjustments session Adjustments Processor Tests Tools Settings Help Ctrl F Ctrl 5 Ctrl P Ctrl Ctrl E Ctrl T If the change made during the fitting session is unsatisfactory it is possible to undo it by clicking this function or by using the shortcut CTRL Z 2 2 Patient sessions Map numbering The Patient sessions window displays all of the historical fitting sessions saved in the patient file This window can be accessed at any time during a fitting a n patient patient Fe EI T Pn
12. Warranty Details for DigisonicSP Cochlear Implant The internal implant warranty LUvears The Behind The Ear Processor warranty for 3 years from date of switch on against manufacturing defects Accessories Antenna Cable 3 months Drying Kit if applicable Antenna Magnet Hook and the tester year No warranty on batteries clip on cover support loop case transport pack etc The warranty applicable is as per standard company policy Defects due to misuse or physical damage will not be covered under warranty Please refer to our standard warranty document for complete details For Alps International Pvt Ltd Sales maa Fitting Guide for the implant Digisonic SP with a Saphyr processor I step For the first use a user should be created Follow the instructions for creating a new user Define user name and password Please Ss gin Password Forgotten password Change my password Quit the program Firstname Login i Password again Sentence Rights User Authorized characters a z 0 9 _ Create user Cancel Complete all lines and finish Create user Lastname qwertzui Firsiname Zul Login qz Password eses Password wees again 7 Sentence name of DODO Rights User Authorized characters a z 0 3 _ Create user Cancel Be careful h D k _ ET Ple
13. 8096 mix Mic Aux in one program and a 50 5096 mix in another e Assess the level of perception and comprehension through a talk over test using the Mic Aux configuration If necessary modify the audio mix in order to get the performance expected from the FM system and adjust the Overall gain and Analog gains parameters according to the patient s level of comfort b Telecoil If using an amplifier with an induction loop turn on the transmitter w Microphone Input tains Telecoil lz w dp Telecoil optimization 7 7 0 d Aux input 50 50 Microphone L Telecoil Global gain 0 0 dB Activate the Telecoil function in the Control Auxiliary Input menu Define the audio mix between the processor s microphone and the auxiliary input The default configuration is 50 50 but it can be adapted differently according to the conditions of use movie theater conference hall personal system etc e Assess the level of perception and comprehension through a talk over test using the Mic Aux configuration If necessary modify the audio mix and adjust the Overall gain and Analog gains parameters according to the patient s level of comfort e fthere is persistent background noise with the induction loop it may be helpful to use the Telecoil Denoising function which can be adjusted from O to 4 We have tested various accessories that we recommend for using with the T
14. Most tests require an external data gathering device to be synchronised with the DIGISTIM SP USB These tests described in the following paragraphs are included in the DIGISTIM SP software Impedance readings An impedance reading checks that the electrodes are working correctly and the quality of the contact between the electrodes and the cochlea This reading is only possible for Digisonic SP implants E ZK Xx 2x k s 4 3 NT KEE RER CRE HEE RAR HTH Sai 2 4 8 6 7 8 a wn pn NW EET ud s x U 3 SS Rb UOI 28D LE LE LS LE LE LE LE LE LS LE LE LE 238 LE LE Lx Example of an impedance reading for a patient implanted with a basic Digisonic SP with 20 electrodes To carry out the reading Place the antenna on the patient opposite the implant e Only use the cable supplied with the DIGISTIM SP USB system e Click on Measure or press the space bar on the computer keyboard e The antenna must not move whilst the reading is being taken The reading commences after an adjustment phase that usually lasts for 2 or 3 seconds The refresh rate is approximately once a second automatic refresh detects any problems of intermittent contact To stop the reading simply click on Stop stimulation or press the bar space or switch to a different heading You can save the current reading by clicking on Save This also stops the reading Standa
15. The procedure to end the fitting session consists of the following steps e Save the current fitting session in the patient file YES e Save to a removable storage media OK or cancel e Program the current fittings in the processor YES otherwise the initial pre connection fittings will be restored When the processor has finished being programmed the software displays the updated Map numbering oince the Digi SP K processor does not have a selector wheel the display window for this potentiometer does not appear Disconnect the processor check that the selected program corresponds to the program to be used then put the device back on the patient s ear mad DIGISTIM SP 3452 E METTE basia RE BE re igistim SP Manuel Utilisateur User Manual C M ch neurelec SEE FEEL HEAR LINE a Creating a new patient file The software suggests creating a new patient ID form as soon as the connection is made if the patient file does not already exist in the local C Import identity from Digimaso 2002 5P patient File Case of a new patient Simply click on Fill in patient identity cara to call up a new Patient card ready to be filled out equivalent to the File New patient option All fields marked with an asterisk are compulsory ard must be completed Identity Hame Same Adone Date o birth rende iv eiert ingl typa wl TT o Electicde type m
16. from the current measurement to previous ones Simply click on Compare measurements and select the historical measurement you want to compare with from the list provided 37 38 Note Click Print to print a copy of the current impedances Note you can also print these values from a fittings along with other information recap by going to the Fittings Print the fittings menu e Measuring impedances is available for Saphyr SP Zebra and Digi SP K processors it is not available for other processors including Digi SP K cx 32 Thresholds The Thresholds window shows current electrical threshold values Min column and comfort values Max column for each active electrode These values are graphically represented as a horizontal bar with Min as the left edge and Max as the right The last column on the right hand side calculates the dynamic range in dB It is calculated as the ratio between Max and the Min expressed in dB Min and Max values are expressed in us and can be changed in intervals of us over a range between and I20us in some special cases the maximum duration can be greater than this The frequency band attributed to each electrode is displayed next its bar Each numbered line corresponds to an electrode Electrode 20 is the most apical electrode for low pitched sounds and electrode Tis the most basal At the beginning of the first fitting all of the electrodes are disabled and greyed out khane
17. RN Feld requred Patient card Important Pay particular attention when entering the type of implant the patient has Entering the wrong type could lead to inappropriate and even painful stimuli when the test is launched Once the card has been validated a corresponding patient file is automatically generated and saved locally in a computer directory The readings can start Comment If the patient file does not exist in the computer it is possible to import a Patient card from a Digimap patient file Click on Import a Digimap 2002 SP file in the dialogue box that opens on connection b Consulting an existing patient file If the patient file already exists simply load it from the local directory on the computer containing all patient files To do so go to File Local patient files access List of local patient files Simply highlight the relevant patient file on the list of patient files and click on Select The file is then loaded into the software and displayed as the current patient file Comment It is also possible to load a patient file from a floppy disk or any other removable storage device by going to File Head patient disk Tests The DIGISTIM SP USB system is used to carry out a certain number of tests to check on the one hand that auditory implants in the Digisonic SP and Digisonic ranges are working properly and on the other hand to measure implanted patients auditory responses
18. Eran Qubs Donisgursben fud SAPHYR Switch e SIS Figure 2 MAP after fitting at a first fitting o Incase of a child trained and adults Check for the Max and Min using the group stimulation in the following way e E20 El6 e EIS EIl0O e E9 E4 e E3 El o Select one group of electrodes Click on one electrode and then click ctrl and click on the following electrodes until the eroup is highlighted and defined DIGIMAP SP Patients R glages Processeur Essais Outils Configuration Aide NOM Prenom 9 Oreille Gauche Processeur EE DSP 3 9 Rev 0 Implant Digisonic SP KIEFER HE Fen tre principale CH Fen tre compl mentaire _ After this click on Max or Min in order to manipulate and move the C and T of the eroup Here the Max Patients R glages Processeur Essais Outils Configuration Aide NOM Prenom 9 Oreille Gauche Processeur SAPHYR 08 Fen tre principale E Here are the Min DIGIMAP SP Patients R glages Processeur Essais Outils Configuration Aide NOM Prenom 9 Oreille Gauche d d Ge ur Hectrode ee Me vu 326 Hz i SP 3 9 Rev 0 EN nv Repeat the procedure on several groups of electrodes it is required to have 4 groups in order to use the interpolation function coco 07 2 8 7 787 NN TN a se Patients R glages Processeur Essa Qutil
19. Hz 5 5 0 Presets fast adjustments Ctrl T cab 5 5 0 Durations of stimulations d Increase all the thresholds Ctrl I Export the history of the adjustments CSV file Decrease all the thresholds Ctrl U SpE 4 d Export the current adjustments CSV file Tilt all the thresholds Ctrl G bel bh 5 5 0 Currents adjustments gt DSP bloc parameters Untilt all the thresholds Ctrl F 46 40 8 End of the adjustments session ees Ctrl 0 5 5 0 Estimate the Min thresholds Ctrl M t 5 5 9 Settings of the thresholds estimation function 5 0 SEIKSKSE STT HET TC 5 5 0 HP Ts To 5 5 0 6 36 T 90 I00 ID L20 The following window shows up 3 ss ee ee eee Patients Adjustments Processor Tests Tools Settings Help Processor E Max Dyn dB 5 5 SS Jl elei Jl 5 Ts 5 5 Ts Ts Te x ch LE Ip 40 5 5 5 5 5 Comments 2 8 8 Main Window Supplementary Window Be careful this action will modify the length of the stimulations of several electrodes Do you really want to interpolate HN Yes I Gei EL dell 4 acht H02 Hz 4883 H 3 i an a CH 2 te 5794 Hz 683 aid A RE 0 IO 20 30 40 50 50 70 80 90 I00 II0 I20 gt c KI e e e o Click yes DIGIMAP SP el x Patients R glages Processeur E
20. fitting SESSION Whenever a MAP is changed and saved the MAP number is increased by one The user can assign a specific MAP to each program P4 P2 P3 P4 in a dialog box at the end of the fitting session The same number appearing in multiple programs means that these programs are identical An empty program is represented by Fl Empty Current program CO History program OEmpy E Current program History program Empty Current program History program Empty Current progam History program Before programming the processor it is good practice to view the programs that will be programmed It is also advisable to check if the program selector is locked or unlocked as desired and whether the auditory alarm is configured as desired 24 3 Processor Menu The Processor menu provides options for interfacing with a processor The following options are available in this menu they will be presented later on in this document e Connect see the section entitled Connection page 54 process for connecting the Processor Tests Tools Settings He processor to the settings interface Connect Fl2 e Heiitialize the processor resets the processor m e Update Digisonic software reprograms the version of the DSP software for Digisonic SP initiale the pre processors DIGISONIC software update 3 Heinitialize the processor This option
21. high pitched electrodes around an electrode chosen by the audiologist by rotating the setting around this reference electrode this function is unavailable for setting a Digisonic SP Binaural implant The purpose of this function is to more easily balance the low and high pitches of the perceived sound without having to check all of the thresholds again P roce dure 3 e Select the reference electrode by clicking on its Min or Max threshold It is strongly recommended to use a middle electrode electrode j0 for example as the reference electrode e Apply a Tilt to the thresholds in order to Increase the Min and Max thresholds of the electrodes below the reference electrode in this example electrodes through 9 Decrease the Min and Max thresholds of the electrodes above the reference electrode in this example electrodes through 20 This function can also be accessed using the shortcut CTRL G Here are the results from the previous Map after carrying out 45 Tilt actions ee e M mex ll Lan e Sai e Apply a Tilt to the thresholds in order to Decrease the Min and Max thresholds of the electrodes below the reference electrode in this example electrodes through 9 Increase the Min and Max thresholds of the electrodes above the reference electrode in this example electrodes through 20 This function can also be accessed using the shortcut CTRL F Here are the results of the origina
22. in a new window Patient identity card o We Requested Complementary Medical Identity Print Print Surname First Mame Implant s mmm Add mn Number EA Processor s RSR Number Microphone OK Abbrechen Fe Hire 0 Abbrechen He e Complete o Name o First Name o The processor connected and serial number is automatically known and shown o Complete the intervention date the ear of implant the type of implant with serial number Make sure the Serial number follow this expample with a capital letter 00 K0000 s Valider New Implant Surgery date Wlan 20 Er Implanted side Left Left Implant type Digisonic SP Electrode array type 20 Electrodes 20 Electrodes Implant serial number pio EE GU Accept Cancel Cancel Click final accept The fitting window appears LE Patents Annie Processor Tests Tools Settings Help Za mm EE ZI H TEn HETET Comments T0200 Iw GG D Rm FE EEN EE Cell Ts Te Te SE ET EIT TER TDI n Activer all electrodes It works with double click on the single electrode or by choosing the CTRL E in order activate all electrodes Do you want to enable all the electrodes ee a lick yes to confirm With the Saphyr you can measure the impedance Click the option Impedances and measure lt E e Li ees Pa
23. low stimulation and low voice Increase the C levels one time e Gotothe window CONTROL O Verify that the options for the patient are met and the manipulation is set to the defined values The fitting in Pl is done V Save the fitting by a click to the icon of the disc in the menu of short cuts e E Click on the icon Adjustment Management to copy this program to another program e Copy Pl into P2 P3 and P4 CRM ES a Adjustments management MT S Copy adjustment Copy from Towards adjustment To Origin of fitting Default values Pi cancel Example for a Digi SP with only 2 independent programs Gestion des r glages NNNM Copie du programme Vers le programme Origine z gl v ide P4 R glage en cours P3 Historique P4 mE Commentaire Valider Annuler o e Change the fitting in P2 P3 P4 to a higher or a lower setting according to the intension of fitting e Click on the Adjustment menu on end of adjustement setting Session end O nr Save adjustment in patient file Click on YES to save this fitting and write it into the processor Current adjustments saving ue Informations Remark gt A OK Cae Cancel DCN ses Name the fitting on the window showing up to leave comments Click on ok Fin de la session de gage 7 souhaitez vous prog
24. or if the Min thresholds of all electrodes are too low below Zus and the levels have already stabilized generally 6 months after first fitting e Increase the intensity value if the dynamic ranges of all electrodes are too wide more than 60ys or if the Max thresholds are too high above j0OOus this will help reduce battery consumption e The intensity should be adjusted before setting the Min and Max thresholds If the intensity value is significantly modified during the fitting session the Min and Max thresholds must be re adjusted and the Max thresholds must be lowered before stimulating the patient Warning any significant change in intensity will cause a noticeable change for the patient We suggest that you save the old fittings in another program For the first fitting Make sure that all electrodes have a Min threshold that is greater than Sus and less than 60us Al Transmission power Transmission power represents the energy sent by the processor which is needed to power the implant and make it function correctly The transmission power value is expressed as a percent and can be changed by intervals of IG between 5 and I0096 the minimum value 5 corresponds to the minimum level of transmission power that can be sent by the processor Transmission power depends on many parameters particularly the thickness of the skin After implantation the thickness of the skin between the antennas usually stabilizes
25. patient in the local database the software will ask if you want to merge the data The software will then copy the patient file from the storage media to the local database and will rename it with the name format last name first name numbers The program will then automatically begin searching for duplicated files Select the two relevant files as indicated in the section entitled Merge files page 45 7 5 Export a patient file The Export a patient file function copies a file stored in the local database to the external storage media USB key or other CS 5 ADJ filles Ip 7 6 Email a patient file The Email a patient file function sends the settings by email by automatically including them as an attachment in a new email This function obviously requires the use of an email software program that has been previously installed and configured in Windows Microsoft Simple MAPI compatible Nofe If no email program has been installed on the computer or if the program is not compatible it is still possible to send the patient file by email using the Neurelec email server To do so the parameters must be configured in the Settings Preferences Internet menu 2 Fittings Menu The Fittings menu provides access to various options for managing a fitting session in progress The options listed below are available in this menu The most frequently used options will be presented further on in this document
26. patients or from the same patient with 2 different implants and the files cannot be merged e Next click on Start the merge to begin the merge Pati T file Haein Lon Ke List of Found patients salit of the patient Fles ko be merged Rekablity 9 SS Marre Address Fie Nae pimi an ed PATIENT PATIENT Rat patient patient MY PATIENT ndi A summary appears in order to make sure one last time that the files are really from the same patient Click on Accept 30 allows Neurelec to keep data adjustments v Patient s speaker size f the processor is electro scousti z se z v the Oke x sesame EA ss OOO Digsenic SP THOT pe DOS KO Elies Current Note If the software detects several active processors and or implants current or spare status the following message will appear in order to select the right processor implant Firion Confirm the patients identity identity implantation canter Surname Warning Several precautions are taken to avoid merging files inappropriately If the reliability index is less than 77 but the files really are identical it is still possible to resolve the problem by clicking on Edit the identity card for one of the two patient files and changing the fields so that the two files to be merged are as similar as possible b Automatically renaming patient files In order to avoid conf
27. resets the connected processor in order to completely clear its parameters Using this option causes the processor to permanently lose all This procedure can only be carried out on a processor that is already connected mm Reinitialise processor and lasts only a few seconds The connection with the processor is automatically interrupted once it is reset Cancel jJ This step is strongly recommended when exchanging a processor that is already programmed a processor onto which a new patient file must be loaded but which is already programmed with another patient file in order to avoid the risk of unsuitable or even painful stimulation In such case it is recommended to first reinitialize the processor then load the new patient file during the connection process Processor 3 2 Update the processor mm Digimap SP automatically prompts you to reprogram the processor when it is connected If you have already clicked No you can still choose to reprogram during the fitting session by going to the Processor menu A moa erem vwersen kr the Gas EN mosis a i Jo update i Curent ren 6 Be 0 This option reprograms the processor in order to update the DSP software version Vernon gie updating 2 2 Rev D De peu sait the pr sider pren t f mr It will only prompt you to update if you are also using the latest version of the programming system for example Digimap SP 3 4 3 will prompt to reprogram the processor w
28. selector wheel s current position This window reminds the user that the fittings have been configured to be used when the selector wheel is in position 3 unless the potentiometer has been configured using Analog gain ntrol i a Adjust the potentiometer then Accept to re activate talk over Potentiometer Current Position 9 8 dB After confirming this window communication with the processor is terminated e Turn off the processor e Disconnect the processors interface cable e Re insert the batteries and turn on the processor while checking the position of the selector wheel of Ill APPENDICES B Setting the DIGI SP K except Digi SP K cx processor Important Because the fitting procedure is very similar to the procedure for setting the Saphyr SP processor only the steps that are specific to the Digi SP K processor are listed in this section See the method for setting the Saphyr SP processor for all steps not mentioned here Il Connection Connect the interface to the computer s USB port and plug the interface cable s mini DIN connector into the interface The processor must be turned on and the battery in its compartment Connect the other end of the interface cable to the battery compartment socket Open the software program then choose Processor Connect While communicating with the processor the Digimap SP software reads the fittings contained in the processor There are several possible con
29. software s drop down menu Before going into detail about the options available during a talk over test it is important to introduce the current consumption feature ms urrent consumption Ie urrent consumption The current consumption window displays the average amount of current used by the connected processor during any talk over test standard or advanced The indication of this level gives you information about the device s battery life This current consumption window displays an immediate snapshot of the processor s consumption level in a horizontal bar The amount of current is indicated in milliamperes mA It is displayed in three distinct zones e Green zone O I5mA normal consumption e Orange zone I5 25mA borderline consumption e Red zone gt 25mA overconsumption Overconsumption rarely occurs with a Saphyr SP or Digi SP behind the ear processor It is however important to check this parameter particularly during the first several fittings in order to assess whether it is necessary to change the fitting the thickness of the skin has a direct impact on the transmission power and thus on consumption Nofe When fitting a Digi SP K processor current consumption is not displayed e During a standard talk over test shortcut or menu Fittings Talk Over For Saphyr SP and Saphyr CX or Zebra processors the minimum noise level corresponds to the relative value that has been defined in the fi
30. user then just needs to select this patient file in order to start see eg LS El a PATIENT Papert nigra m k G ert Ger rat the fitting session C sar eer It is also possible to get the following information whether the processor being used is a spare device the processors serial number and the name of the corresponding patient file Note During maintenance it is recommended to use the simplified procedure described above by selecting the Choose another patient file function in the window i X 09 9 B Reprogramming rrr At the end of the connection process the software offers to reprogram the processor if the DSP Digital Signal Processor software version is not up to date Reprogramming gives the audiologist access to new fitting features and allows the patient to benefit from technological advancements The version suggested by the software depends on the type of processor connected Saphyr Zebra Digi SP Digisonic BTE It is possible to decline reprogramming and update this later from the Processor Update Digisonic software menu However itis recommended to always reprogram the processor when prompted to do so C Fitting parameters IN Main Window 7 7 Impedances The impedance measurement measures the resistivity between the electrode and its surrounding environment This enables you to make sure that the internal part and electrodes are functioning correctly and that the electrode tissue contact is go
31. 4 months after the operation It is therefore likely that this parameter will be need to be lowered during the first few months after surgery 43 44 Transmission Power EES It is recommended For the Saphyr SP processor not bo exceed 30 a Procedure A default value bpGlis automatically given for all activations Automatic fitting The Digimap SP software offers to automatically adjust the transmission power value This makes it possible to apply the most appropriate value to avoid excessive battery use due to poor battery life power cutting out in a noisy environment modifying the loudness according to the sound environment or not enough power poor power supply to the implant inconsistent threshold settings It is therefore recommended to click the Auto button The transmission power is then automatically calculated Manual fitting It is also possible to adjust the transmission power manually using the left and right arrow keys or by moving the cursor with the mouse However it is strongly recommended to use the value proposed by the software after calculation Nofe For Saphyr SP and Digi SP K processors it is no longer necessary to remove and reconnect the antenna as is the case for Digi SP processors Simply click on Auto to start the measurement which automatically occurs by communicating with the patient s implant This cannot be done with the Digi SP K cx processor
32. CO Lohan Locked Pasion IE vj LED LED LJ Ge duri stimulation Gn during stimulation Flashing when batteries ane lw Flashing when batteries are low Audie Poe Aude Paadback CL Program Change Ucn on Erik Program uitiin eae Ce f I or batteries vue SSES rm E riese 50 cw Sof dynamic m Fr v of dnamics Threshold S 5 dees F otenbiometer Deeg Cbesctivate C Acid eidem ae Ferre Gain adjustment Di e SS nee Ep Festune Gm aa parent w EE ENTE 5 ineat Fri Mc n pil ER eri Sele di mum gt Sr g2 a Program selector This control is used to select the various programs configured by the audiologist This switch has 4 positions for the 4 available program settings The selector can be locked upon request particularly for young children In such case click on Lock then choose the program in the drop down menu that will be used regardless of the selector s position Only previously set programs are available as choices in the drop down menu It is not always necessary to activate all 4 programs The audiologist can define the number of active programs to 4 with the patient depending on his her needs and listening conditions A few reminders e The Current Position displays the position of the processors selector at the present moment This feature makes it possible to check that the selector is functioning properly This feature for information only It d
33. P2 4507 Former spare Maintenance Declassified or temporary inactive Continue Note IF vau click on Cancel communication with processor will be interrupted Cancel Information about the implant is filled out in the window below This window can be accessed by directly clicking on the implant in question or when identifying a new implant if this is the first fitting by clicking on the Add button e Surgery date a calendar is provided to help you select the correct surgery date e Implanted side left right it is very important to correctly specify the side that the patient was implanted on especially in the event of bilateral or binaural implantation Implant type from the Digisonic or Digisonic SP range EU mplant EH date Electrode type the types of listed compatible electrode arrays depend Rosia Left on the type of implant selected For example for a Digisonic SP implant the electrode arrays can be 85 20 electrodes standard ABI multi array Implant type Digisonic SP E 2 EA IZ etc e Implant serial number the serial number can be found in the operative Fiore en re 20 Electrodes i report from the surgical procedure or on the patients cochlear implant owner card This serial number comes in the same naming format regardless of the type of implant in question 2 numbers capitalized Implant serial number reference letter 4 numbers DR 00
34. Remove the processors batteries Turn on the processor by turning the selector wheel to position 2 or 3 Plug the interfaces programming lead into the processors programming socket Warning the programming lead used to connect to a Saphyr is not the same as the lead used for the Digi SP processor see the instructions for using the Digimap SP USB interface 35 36 e Start up the Digimap SP 3 4 software e Click Processor connect or use the shortcut EI Warning Connecting a processor should not be done while the processor is attached to the patient Nofe M you do not begin by connecting a processor you can still look up and open an existing patient file or create a new one It is sometimes useful to create a patient file before the patient arrives Different situations may occur when connecting a processor Il Unprogrammed processor 7 UI Patient file not saved in the computer first fitting p nt file Processor contains na data For the first fitting if the processor is new and the patient file does not exist in the local database the software prompts you to create a new patient file upon Would vau like to connection oimply click on Create the file for this patient to open a new identity card to fill EE fila fey Es psu out After confirming this card the corresponding patient file is automatically generated and the processor can now be set Select another patient file from local list 32 Patient file
35. SAPHYR The 4th generation of BIE Unique Precious Essential x SEE FEEL HEAR LIVE SCIUNT SA ONU THE RESULT OF TEAMWORK AND YEARS OF EXPERIENCE ALPSESNeurelec New dual DSP electronic platform New signal processing CRYSTALIS with improved audiometric results large IDR Ultra Low Noise Auxiliary connection and integrated Telecoil Almost 026 lighter while increasing robustness and reliability New packaging and accessories Downward compatibility with previous implant generations UNIQUE PRECIOUS ESSENTIAL THE PERFORMANT TECHNOLOGY MICROPHONES 2 omnidirectionnal o FITTINGS CONTROL Gain control Denoising control Switch on off PROGRAM SELECTOR 4 independant programs ANTENNA LEAD Robust connection 3 colours available ANTENNA 3 colours available 3 MAGNET 4 standard strenghts available neurelec ALPS ESI Neurelec ALPS ESI Neurelec ADJUSTABLE HOOK 2 models available adaptable to the ear 3 AUXILIARY CONNECTION Large compatibility with accessories BATTERIES 2 zinc air Batteries for 3 4 days Possibility of rechargeable P675 batteries I PARENTAL CONTROL Audio output with earphones for microphone testing LED control power on and low battery indicator neurelec neurelec LIGHT LIKE A BUTTERFLY e Weight 0g 20 with 2 batteries e Adiscret ergonomic friendly design which respect
36. SP with LED reprogrammed with a DSP software version below 2 2 Digisonic BTE During this test it is preferable to hold the device or set it down 20 30cm from you The level displayed generally varies between 50 and 40dB negative scale or 40 50dB positive scale in a quiet sound environment Whistle or clap your hands to watch the variation in the level The following results may indicate that there is a problem with the microphone microphone that is dirty blocked has moved or is defective e Abnormal level in a normal sound environment between 90dB and 60dB on the negative scale between 0 and 60dB SPL on the positive scale e Little variation in the level when noise is made whistling clapping etc If this type of abnormality is observed it is recommended to send the processor back to Neurelec s Customer Service Department Noze In the event that a program has been configured with a directional microphone it is important to check whether the front and rear microphones are functioning correctly using the vu meter 5 Tools Menu 5 Il Files Tools a Merge files The Merge files function makes it possible to eliminate duplicate patient files in the local database see the section entitled Find duplicated files page 49 The function merges sessions from two similar patient files according to similarities between the identity cards 29 It is recommended to merge all duplicate files that are found using the me
37. The backup location of the Patients file containing all of the patient files saved on the computer Herde LED Es Prae dcbct ha LF Le pai m ber Dt LN Mes Cen hus pir Fen gi Een det of Der Using the Neurelec USB key A USB key is included in the Neurelec processor packaging and replaces the floppy disks that E SC were previously provided for storing the fittings for each patient Dp If the user wishes to read and save the patient file to the Neurelec USB key during each i fitting session it is first necessary to set the parameters in the Files window using the following functions Ut fa Pepa pars Fg e Record automatically the file of the patient file on the media below at the end of the fitting e Use the Neurelec USB patient key Heric WED E Prae Important PTS PI be For the first fitting the patients Neurelec USB key must be synchronized with his her processor To do so it is recommended to follow this procedure e Connect the processor e Start the connection e The following message appears click NO fe ci Ps poseer len el caribe pasteur y Fit et od Cire mcm 33 34 DIGIMAP SP gg DigiMap SP Have you repatriated locally the data of the floppy disk key USB of the patient before connecting to the device This operation must be made at least once Cliquez on NO if you want to read the media of the patient Click on YES to continue the connection ignoring the flap
38. acces historical programs click History This will display a list of all of the fittings saved in the patient file Select the desired session and them copy the programs you desire see Map numbering A d purs Denis management t3 Cone dhimet Cony From Towards adjustment To Origin of irg Empty NEC 7 PA mE Co Current adjustment PA Pe Pz P3 7 P3 P4 P4 Hilary i nae Mari Precessnr Comments omiin 755 SAPHYR SP L983 ISDE Gs SAPHYTR SE JILL wS 6 SA TOTR SP COLLIS Fran GHASIA 6 SP COLLES Meche Sr SAPHYR SF CAL L LA Poa OPE Ss SAPHYR P NLL LI Cfa AL de SAPHTR SP IL LL PR dud MO 4 SAPE SP CLLLT ded teenie 4 Sarre SF COLL Pig R glage Initial MAFF Ann SAP Sp AL LL Pigge Ir ind AS 55 SAPHYR SP CL LAN R gie mkin Ee pah aT pi i gy SAPHTR SF CI LE Riggs mia mem L d SAPHYTR SP CL LE Reglage mia ial E A This option is always used when the program that will be used from day to day has been validated with the patient and the audiologist wishes to define another program For example the window above indicates that program P2 the program is automatically displayed by the software when the processor is connected which is from an earlier session that has been selected in the list after clicking on History will be copied to current program position HI The program P can then be changed fur
39. according to the impedance e Voltage mode the voltage is constant the current varies according to the impedance a Procedure e Choose the stimulation mode the default stimulation mode is the current mode Adjust the intensity value A default value is automatically given for all activations This value depends on the stimulation mode selected and corresponds to the recommended minimum value Default value in current mode 70 Default value in voltage mode 50 The intensity value can be changed using the left and right arrow keys or the and buttons displayed on the screen For safety reasons the intensity can only be changed by intervals of one MU machine unit at a time b Suggestions for use Stimulation mode It is recommended to keep the current mode which is selected by default unless fittings for the patient are changed requiring this setting to be readjusted The default intensity value is 70 MU current mode It is possible to change this value during the fitting session with the patient particularly when changes in the Min and Max thresholds require to do so It is better to have a fairly wide electrical dynamic range 20us in order to have as many levels of loudness as possible Intensity It is recommended to modify the intensity in the following cases in reference specifically to the dynamic range of middle electrodes e Decrease the global intensity value if the dynamic ranges are too narrow less than jODusl
40. ample Last name First name l adj is for a patient who received an implant in his her left ear To open the fitting click the patient file and select Open Patient Sessions This will list all available historical patient sessions The patient file can also be deleted from the local database using the button Delete File The Export All function copies the patient files to a folder in csv format The Print function prints a list of the patients with their addresses and telephone numbers b Local patient file for the opposite side In cases of bilateral not binaural implantation once the fitting is finished on one side it is possible to select the patient s other side directly from this function The assigned shortcut is CTRL K It can be used as long as the two files left and right have already been created Us C Saphyr demo file The Saphyr demo file is a preset fitting template used to view most of the parameters available during a fitting without having to connect a processor please note some parameters are not visible in the fittings window if no processor is connected This file is a useful tool for demonstrations particularly during training on how to use the Digimap SP software 7 3 Identity card The identity card function makes it possible to access general information that has been provided about a patient whose patient file already exists Two options are available e Edit This function di
41. ase check and confirm that you want to create the following user A Please check your password because if prohibited characters are entered they could be converted Login qz Password pass Lastname qwertzui Firstname zui Rights user Ja Mein Verify and confirm with Yes Close the window and click the digimap icon The login window will appear Digimap 24 Please open a session lt a Please ope Ss a new user Forgotten password Change my password Quit the program The software will open like this you can set up the language into English French or Italian in the configuration mode DIGIMAP SP Patients Adjustments Processor Tests Tools Settings Help rocessor Implant Programming System for Comments 28 8 8 8 Digisonic and Digisonic SP CI Main Window Version 3 4 Supplementary Windov kg A neurelec First fitting Connect the CS45 cable with 5 point connection specifically for Saphyr and Digi SPK with the interface Digimap USB Connection o Processor light flashes but the wheel of the processor has to be on volume L 2 or 3 At 0 the device is off o No battery in the battery compartment o Watch the green light of the interface Select Processor in the menue o Click Connection or as a short cut Ei o Click Patients and select on the drop down menu new patient The new identity card for the patient will show up
42. atient s identity card Any change of processor is also specified using the system s serial number which is indicated in the Processor column of the patient sessions history Spare processor Q Permanent exchange Processor of the patient is Q Maintenance Declassified or temporary inactive Continue Note IF vou click on Cancel communication with processor will be interrupted Cancel 2 Processor that is already programmed 2 7 Patient file not saved in the computer new PC Patient file x or change of center Processor contains patient File If the patient file programmed in the processor does not already exist in the patient patient local database the software can read the patient data that is stored in the device and create a corresponding local patient file for you Patient File does not exist Would vou like ta By clicking on Create the file for this patient the software automatically displays the identity card containing all of the information from the processor Create a file For this patient simply validate the card to create the patient file in the computers local list and begin the fitting session Select another patient file from local list 2 2 Patient file saved in the computer standard fitting During a standard fitting the patient s data is read from the connected processor ETT TET e ET TT E GE The computer determines which patient file is associated The
43. atient s tonotopy About Advanced Stimulation Tonotopic reversal The Advanced Stimulation window enables you to perform an electrode sweep in order to balance the sound level It also makes it possible particularly during specific fittings to change the order of the electrodes in order to assign the patient MAL a new tonotopy 3 Mn IO mm SOHO arm Wer m The basic approach of the test is to compare the frequencies perceived between TERES MH two different electrodes The electrode order is usually displayed in the advanced 5 o mison stimulation window going from top to bottom from the lowest pitched electrode to the n Persad highest pitched electrode If the comparison between the two electrodes does not T match up with this predefined order then it is necessary to reverse their positions i HUET In such case use the Up or Down buttons to change the position of the selected ug electrode t Hu When all of the electrodes have been tested and any necessary changes made 7 owe close the advanced stimulation window The system then displays a dialog box that D allows you to confirm the changes made and directly display the new frequency distribution if applicable J dvance d Stimulation ES order has changed IF vou Accept these modifications Frequency distribution will be subsequently changed ta maintain Low Freq to High Freq distribution Cancel changes Con
44. ation about a fitting session Select the program from the drop down menu at the top of the window in order to go to a summary of the corresponding parameters The shortcut for accessing the fittings recap is CTRL R The printed recap displays certain parameters graphically thresholds frequency distribution gains etc 2 4 Save fittings This function enables you to save the current fitting in the patient file at any time It is particularly recommended to add a comment during each save which will be displayed in the history of patient sessions Current adjustments saving Informations Remark bum fees tes The comment displayed in the vertical column of the fittings window is automatically copied to the Save fittings window when saving at any time during a fitting or at the end of the fitting procedure This comment can be changed which is particularly useful during the final save The shortcut for saving a fitting is CTRL S 2 2 5 Print the fittings The Print the fittings function lets you print the fittings recap displayed on the screen 2 6 Fitting management The Fitting management option copies all of the parameters from one program to another program It is possible to copy parameters from one program in a current fitting session to another program in the same session or from any program from a previous fitting session into a program in the current session To
45. bserved at 20 it is safe to proceed to the talk over test An advanced stimulation test should also be done to evaluate the perception of sounds at low levels so tests at 50 or even 30 and 0 can be carried out to determine whether the fittings are effective About advanced stimulation Advanced stimulation makes it possible to check whether the loudness of each electrode is balanced correctly with other electrodes thus enabling you Advanced Stimulation to check the threshold fittings that were previously made d Hold down the SHIFT and CTRL keys to select a group of electrodes then k lt EP J choose the desired level of stimulation expressed as a percentage relative to dle E a the Max level Click on Stimulation to start a sweep ofthe selected electrodes SE The patient must then indicate the perceived level of these electrodes with Stimulation the goal being to obtain the same sound level If one electrode stands out as having a level that is too low or too high return to the Thresholds window and E manually adjust that electrode is 2s 35 Click on the arrow to switch the order of stimulation low to high pitched electrodes or the reverse Up Down e Poo Ro Ch oco D Talk over test For safety reasons it is necessary to lower the intensity by 2 units and allow the child to relax and engage in a fun activity It is also essential to maintain silence in th
46. contain several frequency bands which are displayed in the same color 49 For Afosbeeur Freee Fest Dm eden cub PATIENT Patient Lut e arb nean Vans as K 5h kh B h HR HHH im ell BEERS ULL ana NC D a EN Hl TH ee G FU H EN M Co EE Fa a Procedure The default value is OdB For most situations this is best The denoising level can be globally changed for all of the electrodes using the Increase or Decrease buttons The value can also be changed for each frequency band by moving the brush with the mouse and clicking on the desired level or by using the arrow keys b Suggestions for use It is recommended to keep the denoising level as close to OdB as possible because this maximizes the information sent to the processor The default of OdB is the ideal and recommended value Nofe The patient has a potentiometer on the processor which can be set to adjusting the denoising level see the section entitled Potentiometer page 76 This control has a range of J00D that extends between the set level e g in the default case OdB and JOB relative to the set level e When the potentiometer is at position 3 the denoising value is the set level as defined in the denoising window e g in the default case OdB e n position O just before the off click the denoising level will be 0 dB from the set level 0dB in this
47. d electrodes Pro cedure i Define the Comfort thresholds Max levels for the 4 sets of electrodes Select the following electrodes by pressing Ctrl G E20 EI E7 5 or the most basal electrode Use the interpolation function Fittings Duration of stimulation Interpolate Ctrl O to apply the interpolated smoothing across electrodes r e Le i Li uh TA Figure 3 interpolation of the MAP g IM NE IMD LE IMT RE NA PE IN y r J d 3 4 PELE EELEL ELEEREELEGL Ea p D CE rE o o o if I kb D Automatically estimating the Min thresholds It is often difficult to determine the Min thresholds for children The Min thresholds can be automatically adjusted to 30 of the Max levels by Click the function Estimate Min thresholds Fittings Duration of stimulation Estimate Min thresholds Ctrl M A confirmation message will appear Accept The Min thresholds are now set to be 30 of the of the Max threshold levels vi i d L III T3323 m MC FCR CPC ia oH RE ETT I d y T L i a Confirmation before talk over testing To avoid over stimulation during the first talk over test it is recommended to use the advanced stimulation function at 400 and 2006 of the Max thresholds If no discomfort is o
48. de s rie 3 9 Rev 0 Commentaire 29 03 20 8 Fen tre principale Fen tre compl met ataire E Max Dyn dB SERENE RRR RRR RRR RRR ET CT ETH HET HOT ITT SERENE RR RRR SD RRR CES SCENENE HT o Select 4 active electrodes with the help of the combination Ctrl click left on the 4 electrodes choosen p J oreine Gauche PI o Always include the most basal and the most apical electrode into the interpolation Select the electrodes which are homogen over the complete range of all electrodes Example over the whole range of 20 active electrodes E20 DK E7 o El DIGIMAP SP LEM X Patients R glages Processeur Essais Outils Configuration Aide NOM Prenom Processeur O EA X UO 0 SAPHYR Num ro de s ri DSP 3 9 Rev 0 Implant Digisonic SP DR 00 K 0000 RE 20 Electrodes Commentaire 2040 32070 Fen tre principale Q Fen tre compl mentaire Contr les Bloc notes o After this click on adjustments durantion of stimulation interpolate Q DIGIMAP SP ci aiea Patients Processor Tests Tools Settings Help Patient sessions Adj Ctri R Min Max Dyn dB ER wg SH 326 Hz Ss j8 38 8 Save adjustments Ctrl S Print the adjustments cap Ei e s a Adjustment manager Cou o5 Enable all the electrodes Ctrl E 2 746
49. e fitting room During the talk over test various things will be evaluated e Verifying detection Generating small sounds at low to medium intensity levels e g voice calibrated objects that make sounds e Verifying high intensity perception Toys that make intense sounds e Verifying pitch low notes high notes Method for setting thresholds in adults Using patient feedback efficiently can speed up the fitting process the following approach is a preferred and faster method to get to the proper MAP e Stimulate the electrodes in groups until the patient describes a weak sensation Min threshold for each group as well as a comfortable sensation Max threshold for each group e Electrode groups are presented in the conventional way see clinical audiometry ID 27 IU 8 5 to the most basal electrodes 20 to 76 e Once the Min and Max thresholds are obtained for the 4 electrode groups Interpolate Ctrl O e Aninitial MAP is created e Use advanced stimulation to control the Max thresholds at 70096 72096 to avoid over stimulation on first talk over Adjust the electrodes one by one if necessary e Talk over test e Adjust the overall volume using the intensity level based on the patient s feedback m Figure 5 interpolation of Min and Max thresholds Dy Summary the shortcuts Action Keystrokes Mouse actions Enable disable an electrode Use the Ins Del keys Double click the electrode number Select the p
50. e into account the stimulation mode patients usually prefer a higher number when using constant current mode than constant voltage The number of intracochlear and therefore enabled electrodes is a primary factor In most cases N is between 8 and 2 when the total number of active electrodes M is 45 to 20 Generally the earlier implantation occurs the higher N is Conversely the number of peaks may be limited if implantation occurred later on or if there is an associated disease For example in cases of long term hearing loss adjust the number of peaks to the default value of IO then reassess this number over the course of multiple fittings In cases of sudden or progressive hearing loss treated with early implantation set the number of peaks at 72 then quickly reassess this number and increase it over the course of the next few fittings These values are provided for informational purposes and must of course be adapted to suit the fitting method used each patient and each patient s etiology In general e Increase the value to improve sound quality The volume may be reviewed and decreased if necessary e Decrease the value if the patient has trouble hearing speech detects resonance or has trouble discriminating 3 Controls 3 T Button control This window allows you to manage all of the controls that are available to the patient resp am Sack ch Program Sabh Locked Current position PL 2 Loch Care cen Pi aliuncha
51. e software To do this see the method used for the Saphyr SP processor 2 3 Controls The micro processor has a push button for selecting programs and an indicator light Push button The Digi SP K processor can store up to 4 independent programs D P2 P3 PA When the device is turned on every time the push button is pressed the next program is accessed programs follow one after the other in the order PI P2 P3 P4 DI etc If not all of the programs are activated reenen s ch Program patih during the fitting session the processor Clock Diodes will only allow active programs to be 5 in ncked D Uniche selected ne docu gt v KW If the push button is locked the Locked HF Locked position a v position must be selected in the drop im me down menu This program will then be used every time regardless of whether Libia simi Clon during stimutstion or not the push button has been pressed LI Festina shen hatteries are kuy O Flashing wen batteries are low down Indicator light Puadichee eebe audere Feedback C Prageam change Erop an change The four color indicator purple blue jr batterie 0000 green red can be programmed and makes it easy to identify the status of meses 4 v code i4 v the processor Threshold 80 el of dynamics Frs ien he eed cic e Purple Turning on the indicator shines purple briefly 2 seconds to indicate that the processor is powering on e Blue Cho osing a p
52. ecrease the volume if the voice is too loud e Increase the volume if the voice is too quiet For young children it is recommended to test the fitting level using musical instruments or loud noises The Volume parameter compresses the dynamic range of the electrodes In order to avoid saturation of the compression for extreme fitting values 3dB or 3dB it is recommended to adjust the parameter between 2dB and 2dB If the level of loudness is still too low or too high it is recommended to recheck the electrical parameters which may be undervalued or overvalued Lastly also check the magnetization of the antenna an antenna that is not held in place well may reduce loudness 2 3 Denoising The Denoising parameter changes the minimum noise level by preventing stimulation for acoustic signals below the set threshold Only information from sound levels above the denoising threshold are processed Denoising is expressed in decibels dB and can be modified by intervals of IO between OdB and 33dB for each frequency band in the system s spectrum In the Denoising window the horizontal axis represents frequency Hz and the vertical axis indicates the denoising level dB All of the frequency bands obtained with FFT during signal processing are displayed as vertical bars The shaded bars correspond to inactive frequencies in the frequency representation A single electrode whose number is displayed at the bottom of the window may
53. ection is indicated in the window When using the Neurelec floppy disk you must select the path for the storage media by clicking on the button Neurelec USE Key Path Auta detect the path of the USB Kep Auta Nofe The patient file can only be saved on the patient s own storage media Furthermore it is strongly recommended not to save the final fittings on a storage media that contains several patient files A backup copy of a patient s files can be made using the Patients Export a patient file function 3 Programming the processor This final step saves programs the patient file in the processor oeveral choices are offered e Yes the programming procedure is begun It only takes a few seconds e No the programming procedure is declined The initial fittings before the processor was connected are restored e Cancel the programming procedure is canceled and the software remains in communication with the processor in order to go back to the fittings window Nofe The procedure to end the fitting session can be canceled by closing all of the displayed messages When the processor has finished being programmed the software displays the updated Map numbering mm ession end aM following map numbers are allocated Pl Map 5 Do you want ta print now When the programming procedure is complete the message below appears unless the potentiometer has been locked in the fittings window The cursor indicates the
54. ed from hearing loss for a long time e Unstable sensation no Max thresholds Changing the thresholds During a fitting the Min and Max thresholds can be changed as follows use the mouse to click the and buttons for the electrode in question or press the left and right arrow keys The Enter key allows you to toggle between adjusting the Min threshold value and the Max value Hold down the SHIFT or CTRL button while selecting the desired electrodes then double click on the Min or Max column heading to change all of the thresholds of a group of electrodes at the same time Itis possible to change all of the Min or Max thresholds at once by double clicking at the heading Min or Max of the corresponding column The change is then applied to all of the electrodes simultaneously It is generally recommended to set the Min threshold at the Barely audible level described by the patient and the Max threshold at the Loud but Comfortable level e fthe dynamic range is too wide for all of the electrodes increase the intensity see the section entitled Intensity page 63 and readjust the thresholds Warning always lower the Max thresholds before stimulating the patient e fthe dynamic range is too narrow after several fittings decrease the intensity and readjust the thresholds Stimulation The thresholds are determined for each electrode by stimulating that electrode Stimulation can be started using the shortcut icon
55. eedback in this window when testing thresholds and for P JP advanced stimulation Paced probable cis estt CIC M0 Fe present For ali ates es d pe eique d mandar u CT rape cepere or camem DER a reden w t Cia 5 rs irs Zei ipigi Seale fe 2 Lr fab Ww pp LII I Srl smith donee seme L m mmm am 6 2 Forts The Digimap SP software is compatible with the Digimap SP USB interface which is automatically ee Se Langage Fors re brepare configured by default when the software is installed Dress aonr This software can also function with an older model of the interface that uses a serial port Canal por meg eod In such case the port settings must be changed in the Ports window IHH THE DAR FENTE OR kem deo ie Diae P LEE LO mena pot GERA po It is also possible to change the settings for using the Digiscope tool built in sensor within the Digimap SP USB settings interface or connecting to the computer s parallel port if it is an older model ET E Desa LEE 5 Parallel pct 6 3 Files ES mnn Fe pages geng The Files option enables you to define e Backing up files automatically to removable storage media at the end of the fitting session he patient s Neurelec floppy disk The patient s Neurelec USB key DEE e The location of the storage media that the patient file will be automatically saved to at the end of the fitting session e
56. elecoil Ask the Neurelec Customer Service department for a list of these accessories D Other program Once the current program for example P has been adjusted and accepted by the patient it is then possible to define other programs that are totally independent from one another For example e P quiet P2 average P3 comfortable P4 loud e P old P2 new P3 accessory PA Telecoil PTEP2ZeI ePA The different programs are generally similar and few parameters differ from one another It is therefore easier to copy one program to another then make the desired changes To do so click on the Fitting management shortcut in the software Choose the source program and the program that it will be copied to then confirm The Digimap SP software automatically switches Kms Lz to displaying the copied program which can then be changed if necessary somme ctm RSR nll according to the patient s needs eee Empty Pi seems UE Or The source fitting may come from ee P3 P4 e The current session e A previous session click on History to open the patient session history window Then select the desired session from the displayed list and click Date Mags Pearse Select fitting p em In the example above program P3 is copied to program P2 from an earlier fitting session on 07 23 2000 This may be useful if the patient wishes to save the current fitting in a program as a precaution before moving on to a new f
57. ession mode and select the entire session including the example above for MAPS 4 3 and 2 respectively existing in programs P P2 and P3 Click on the session in the green circle I8 SS P sessions zebra zebra JE ce B 3 ER 46 Expand all Pz Map 46 Fed Performed by Siw SAM Reduce all c Eg niGatapnz Lean ZEBRA A II3 PGR Maps 45 46 ES Fi Map 45 Performed by ROOT MEURELEC SA FE Map 46 Performed by ROOT NEURELEC El llz3lz0iz 5 23 ZEBRA ZEIL Maps 45 46 zd Pl Map 45 Performed by ROOT NEURELEC Pz Map 46 Performed by ROOT MELIRELEC P otzaapnz enz ZEBRA A UI3 PGR Maps 45 46 NE Pi Map 45 Performed by ROOT NEURELEC P2 Map 46 rarl Performed by ROOT HEURELEC ES oitzatanz pen ZEBRA ZIL II3 Maps 45 46 Sum up zd Pl Map 45 Performed by ROOT NEURELEC SA 7 Map 46 rari Performed by ROOT NELIRELEC PR otzatanz SA ZEBRA SI I3 PGR Maps 45 46 E E Pi Map 45 Performed by ROOT HEURELEC P2 Map 46 rar Performed by SAV SAV ES niizajz i2 I5 47 ZEBRA EI I3 Maps 45 46 Prink zd Pl Map 45 Performed by ROOT NEURELEC SA Di Map 46 rar Performed by SAY Say Quit Open the adjustment When the session is selected the user then has access to all of the existing programs in this session as shown below n Im oie 2 3 Fittings recap This option displays all inform
58. example 2 4 Stimulation This window enables you to adjust the number of significant peaks extracted from the signal s spectrum in each stimulation frame see the section entitled Programming strategies page 69 The extraction uses an N of M strategy as presented in the graph below e Nisthe number of electrodes stimulated during each pass through the electrode array e Mis total number of electrodes enabled during the fitting The stimulation frequency is determined when choosing the programming strategy Energy dB Figure showing the extraction of peaks N of M Electrodes M i9 48 IT IE H 9 8 7 amp 5 4 32 The value of the Stimulation parameter is therefore expressed in the number of electrodes and can be modified from to M total number of available enabled electrodes i 2 3 4 5 amp 8 a mm 4 up t it 8 9 0 a Procedure The default value is 2 for monaural devices and 6 for binaural devices The number of electrodes stimulated per frame can be changed by moving the slider with the mouse or by using the left and right arrow keys b Suggestions for use The Stimulation parameter is set during the talk over test by having the patient provide feedback about the fittings when a varying number of electrodes are stimulated This parameter depends particularly on the patient s etiology the length of time of their hearing loss and when they received their implant It must also tak
59. f the electrodes Persistent saturation in the red zone can be attenuated by changing certain parameters Gains parameters for the frequencies in question thresholds etc A boul the Advanced Dr LSCOPE Like the advanced talk over test a specific window opens enabling you to change the denoising analog gain sensitivity level depending on the processor generation in order to assess the perceived sound level based on the position of the selector wheel b Vu meter The vu meter is a tool which shows the real time signal from either of the processors microphones front and rear or from any auxiliary device connected to the processor This test does not require the participation of the patient and processor does not stimulate any electrodes during the test To start the test click on the vu meter icon in the left hand column of the Digimap SP software so that the dialog box appears Then select the microphone or aux input to view its level Front mic Depending on the type of processor connected the scaling will be different e Positive scale from O to i00dB SPL for the processors Saphyr SP and CX Zebra Digi SP K Digi SP with LED that has been reprogrammed with DSP software version 2 2 or higher Digisonic BTE with LED that has been reprogrammed with DSP software version Gor higher Negative scale from O to 90dB dB relative to the full scale for the processors Digi SP without LED Digi
60. firm changes Display Frequency Distribution Window El Programming strategies The programming strategy used in the processor defines the way that information is sent to the implant and distributed among the active electrodes It defines the stimulation frequency that is applied to each stimulation frame Neurelec s recent technological developments in the field of signal processing have made it possible to include new programming strategies for the latest generation of processors Crystalis This programming strategy is based on the same concept as the strategy used for Digisonic and Digisonic SP processors However several improvements have been made Clearer sound even at low intensities Flat audiogram which is comparable to that of a normally hearing person Control of the amount of information sent Limited electrical interactions diaphony Improved reduction of background noise a Procedure A default value of 600Hz is automatically given as the stimulation frequency for all activations This is a recommended value but it may be changed by using the left and right arrow keys or by moving the cursor displayed on the screen b Suggestions for use For the first fitting the default value given for stimulation frequency is 600Hz This is just an indicative value Some patients may prefer slower or faster stimulation Fittings made to the stimulation frequency must take into account a set of other interrelated parame
61. for it in the software or using the F2 key It is possible to continue changing a threshold during stimulation by using the displayed and buttons or the left and right arrows but only those buttons Using any other button will stop stimulation The frequency of the sound feedback for the audiology during testing reflects the frequency for the patient defined in the fitting parameters Furthermore in the Settings Preferences Stimulation menu it is possible to change this calibrated stimulation continuous or intermittent stimulation and sound feedback for the audiologist The system uses intermittent stimulation by default b Suggestions for use Method for adjusting thresholds in children Preliminary precautions The child and his her family should be present and well informed The audiologist should have the patient file and the surgical report to ascertain if there are any extra cochlear electrodes which should not be enabled at switch on The speech therapist who will handle the child s after care should be present First things to do e The Digimap default parameters should be used as a basis particularly for anything relating to items in the supplementary and strategy window e The transmission power must be measured and set a typical value is 5 and not more than 30 for Saphyr SP e Animpedance measurement will ensure the internal part and all the electrodes are working properly e Enable all electrodes by using the Ctr
62. hly likely that any breakdown you may encounter is quite simply due to a problem linked to recognition of the drivers or a problem linked to the USB port Therefore in the event of a problem with the DIGISTIM SP USB system kindly refer to the following problem solving guide If the guide fails to provide a solution to your problem then contact Meurelec s after sales department it alone is qualified to maintain its products Problem Possible cause Solution The READY light does Problem with US not come on connection Ensure that the USB cable is linked to a USB port on the computer and nat to a self powered HUB and that the interface itself is properly connected There may be too many peripherals connected to your computer s USB ports In this case unplug some of them including the DIGISTIM SP USB and then try to reconnect it Problem installing Repeat the procedures the drivers described in page 57 of this User Manual If tne problem is not resolved il may reside in the computer If this is a possibility please try using a different computer before contacting Neurelec s after sales department The READY light is on Wrong version of but the DIGISTIM SP the software software refuses to connact to the DIGISTIM SP USB unit The STIM light does not Problem installing glow green when the Ihe drivers DIGISTIM SP software is launched The STIM light does not Equi
63. ht be causing excessive battery use elevated Max thresholds denoising value high number of active electrodes per frame stimulation frequency ta Frequency distribution Frequency distribution represents the band of frequencies associated with each active electrode This makes it possible to merge the 64 bands obtained using FFT into 20 values Amplitude Amplitude Till ee e JN sed 333 Hz No of b electrodes Compare Peak Compare Peak and Peak and Peak The displayed frequency value is expressed in Hertz Hz and can be changed by intervals of I22Hz or 20Hz depending on the processor generation Each electrode is represented horizontally like in the Thresholds window The right hand columns indicate the Min and Max frequencies of the assigned band This frequency band is also represented graphically by a horizontal bar whose left and right ends correspond to the Min and Max values shown emilee ES 4 au 3 se un M HA O fna area Fa Per Sp S ae Es ST i CU E ISTE NU M i EE pre rv mu Di au aut mu 3 Beu ww Su sra A d NES The frequency distribution can be adapted automatically manually or it can be customized semi automatic The default distribution Standard distribution is applied linearly to the low frequencies and logarithmically t
64. ication Comments Management of parameters e e e Shortcuts 2l System identification The information stored in the identity card is sent to the main settings interface so that ee Processor the audiologist can see it at all times BUR Serial Number Aer Processor DSP 3 2 Rev 0 Build 2 Type of processor Implant Serial number Digisonic SP DSP software version se ils eiie e implant Type of implant Comments Map Serial number Type of electrode array Simply click on the image to display the patient identity card Nofe If you are connected to a patient s processor the information displayed processor type serial number and DSP version corresponds to the connected processor However when looking up a file without a processor connected the information corresponds to the processor that was attached during the fitting performed on that fitting s date 2 Comments The comments field makes it possible to view and add any notes that arise during a fitting session Click on this field to activate it and use the Enter key to save the changes gout First adjusment Each program has a comments field P4 P2 P3 P4 Comments are displayed automatically as part of the Save fitting command including at the end of the fitting procedure This field also indicates the Map number see the section entitled Patient sessions page 32 that ha
65. icrophone from 8 to 30 dB e elecoil from O to i5dB e Auxiliary input from O to 3OdB depending on the accessory used Nofe If the potentiometer is locked Deactivated in the Analog gain function the value defined is the value set in the Controls Microphones window default value of 2408 3 2 Microphones The Saphyr SP and Zebra processors include two omnidirectional microphones This parameter lets you select the microphone that is used to pick up the sound signal Microphone selection Input gains Front mic 24 Iw dB Rear mic Furthermore it is possible to define the value of the amplification gain for the input assigned to the selected microphone in this window o3 This test can be performed as a talk over test with the patient by first choosing the configuration Mic only then Aux only in order to compare the difference between the two Itis also possible to perform the test using the Digiscope in order to check the saturation levels by first choosing the configuration Mic only then Aux only e You may need to modify the Gains the auxiliary inputs Analog gain or Aux gains in order to balance the levels of the two inputs e Define the audio mix between the processors microphone and the auxiliary input The default configuration is 50 50 but it can be adapted differently according to the conditions of use conference hall classroom etc For example define a 2096
66. in as a user Once the software has been installed you will need to log in as a User Each user will have his her own user name and password When using the Digimap SP software for the first time click Create a new user to create your user account agin Password Create a new user Change my password A window will open to guide you through entering the required information All fields are necessary One the form is completed click Create the user EB ET Lans o reis D Frslnase Firstname regieur La Log _ d Loop rr e Parent Faspeond sees Le Sc 9 mm m 4 Sentence o Sante rune Rapiis Rights User fudhrorined characters 4 2 0 9 _ Fudborined che a Lee 4 2 0 9 _ A window will open to validate your account information To create the validated account click Yes Please check and confirm that you want to create the Following user Please check your password because if prohibited characters are entered they could be converted Login rr Password L 24 Lastname regleur Firstname regleur Rights user ui Mon Once the user account is created the login window will appear Note that this window is the first window that opens when Digimap SP software is launched Enter your login information and click on Enter MYNAME X B Description of the fittings window The Digimap SP 3 4 3 programming sy
67. ion is particularly important for resolving connection problems caused by using an outdated version for example On line help will be available soon Il FITTING PROCEDURE Important The rest of the document presents the generic steps for a typical fitting session when using a Saphyr SP processor Fitting instructions for the other generations of Neurelec processors Saphyr CX Zebra Digi SP K Digi SP Digisonic BTE and Digisonic BW are available in the Appendices section of this manual Before connecting a processor the Digimap SP USB settings interface must be correctly installed and recognized by the computer To do so refer to the instructions that come with the Digimap SP USB interface The green light must be constantly on When using the Digimap SP software for the first time a personal user account must be created by clicking on Create a new user see the section entitled Logging in as a user page 20 When the personal user account has been created the login window will appear on screen This window is displayed whenever the Digimap SP software is opened Enter the information in the login window then click Enter Login Password r nrm a e ER ten asswu rd D M D g M rograemmi ng System for A a D D gisonic and Digisonic SP CI Version LE D Je neurelec A Connection Connected the processor by following the procedure below
68. ith DSP software version 3 0 Reprogramming gives the patient the ability to benefit from the latest updates that are compatible with the type of processor in question to manage auxiliary inputs automatically optimize transmission power etc The window indicates the processors current version and displays the possible versions for reprogramming in a drop down menu It is always recommended to program the device with the most recent version in this example version 3 0 4 Tests Menu The Tests menu provides access to various options for managing a fitting session in progress Tests Tools Set The options listed below are available in this menu The most frequently used options will be presented Stimulation further on in this document Voice k e Stimulation Normal stimulation of one or several electrodes shortcut F2 Advanced stimulation shortcut F3 Measures F e Tests Talk over test Advanced talk over ability to select the denoising level or sensitivity level for the Digi SP and Digisonic BTE processors during talk over testing e Measurements Digiscope view the saturation level of each electrode Advanced Digiscope Digiscope function with the added possibility of adjusting the parameter value associated with the wheel settings in real time Vu meter checks the integrity of the microphones and the Telecoil AUX inputs 25 4 Il Stimulation a Stimulation The Stimulation function shor
69. itting session Mong E Lea se 56 All these indications can be adapted and adjusted for each patient in order to provide the greatest hearing comfort for each patient E End fitting session Once fittings are complete and the programs have been validated with the patient in the talk over test you can then proceed to close the fitting session Go to the Fittings End of the fittings session menu The procedure to end the fitting session consists of the different steps described below Il Save in the patient file This step saves the final version of the fittings in the patient file that is stored locally on the computer It corresponds to the Fittings Save fittings option ees adjustments saving Informations Remark gt Cancel It is possible to decline saving in which case the software automatically goes to the next save step However it is recommended to save the final version of the fittings in order to have an up to date patient file The comments added in the software column are automatically displayed in the save patient file window It is of course possible to make changes before confirming 2 Save to the storage media This step is optional and is not the default unless a storage media floppy disk or USB key has been detected configured and validated in the Settings Preferences Patient files menu If the Neurelec USB key is connected it is automatically detected and the conn
70. ke it possible to adjust the analog gain for Saphyr generation processors used with non binaural implants see the section entitled Potentiometer page 76 4 3 Measurements a Digiscope The Digiscope is shows the signals sent by the processor to the electrodes in response to sound This tool enables you to e Test a fitting by checking the stimulation levels of each electrode in real time e Test the integrity of the cable antenna and microphone and identify possible device problems The Digimap SP USB interface includes a Digiscope sensor that is compatible with all Digisonic and Digisonic SP processors To use the Digiscope e Hold the antenna on the interface as shown note there is no magnet in the Digibox e Open the Digiscope window by clicking on the shortcut or the Fittings Digiscope menu from the Digimap SP software KE Check if processor i switched on and antenna connected to Digiscope Les Nofe If you cannot view the Digiscope check the settings in the Settings Preferences Ports menu make sure that the Digimap SP USB interface is selected SE e u mS TheDigiscope window displays the active electrodes on the horizontal axis with their corresponding frequency bands The saturation level which is expressed as a percentage of the dynamic range O to I00 is represented on the vertical axis opeak at a normal volume and check the saturation level of all o
71. l E shortcut be sure to consult the surgical report to determine if any extra cochlear electrodes exist which should be disabled Testing Max thresholds e Stimulation by group of electrodes he goal is to quickly define the child s Max thresholds Maximum of 5 electrodes per group Electrode groups are presented in the conventional way see clinical audiometry e Jb 2i e 0 6 e 5to the basal electrode group e 20 78 Define the selection area Shift G red circle Double click the Min or Max area shown in green 39 Area to select before starting stimulation by pressing F2 Bes RER urs COH HO Ts Te H k AJ wAw hX A hA 33 H I TI Figure I stimulation by group e Press F2 or the Spacebar to begin stimulation e Test the comfort thresholds Max e Fach group of electrodes is stimulated together This is indicated by flashing the horizontal bars of all grouped electrodes together yellow circle e The perceived loudness when stimulating a group of electrodes together will be louder than when stimulating a single electrode 40 alone summation effect mi P SP Palais bine Ber oi wh leo ih patient patient g T ES Figure 2 stimulating an electrode group Interpolation function Once the Max thresholds of the 4 groups of electrodes has been determined an interpolation creates a smooth profile across all enable
72. l Map after carrying out 5 Tilt ren Seer basses em Cue Se pa nalient patient KS COEN BEG C PEREC es Less H j c Interpolate The Interpolate function lets you create a Map using 4 Min thresholds and 4 Max thresholds this function is unavailable for setting a Digisonic SP Binaural implant A 4th order polynomial interpolation is performed using the 4 Min and Max thresholds to produce a uniform MAP without having to test all of the patient s Min and Max thresholds Pro cedure j e It is first necessary to define the Min and Max thresholds of 4 electrodes Always choose the most basal and most apical electrode usually electrode 20 and Choose the 2 other electrodes so that the 4 electrodes will be evenly distributed among all of the active electrodes do not choose electrodes i2 and 3 Here is an example of 4 tested electrodes Wen REES bee fen Cos Cane mad a nalient patient SE ELS e Once the Min and Max thresholds have been determined for the 4 electrodes the interpolation procedure can now begin Selectthe 4 electrodes by holding down the CTRL key while clicking on the 4 electrode numbers the numbers in the Electrode column in the thresholds window Go to the Fittings Duration of stimulation menu and click on Interpolate shortcut CTRL O A warni
73. ladij Le TT Left 5032 aris rum beh Lach a ream Spare Right 7576 av dnd rad P Left F695 d cbe afi Delete File Mois foods Right 6584 abra ele Seil r ach MONTE TIT ent Spare Right B32l ev Fs d awemarie r adj Export All GH Dus ie Left 445 aai phare adj OL uk m Left g29 armar rely Lach ams nui Right 2 9 amr rl radi Sp ee ui Spare Left 8384 gil bel seis Fell s jar lad di run Print LL comme n Right a ew radi v A Ene Left ages com Il D Close This type of file must be updated manually by the user The software will automatically prompt you to do so when the file is opened Click OK to access the identity card and fill in the missing fields zu D AA identity card of the patient is missing required information Please complete the missing information NN Don SP 0 Electrodes m If some of the information requested is unknown particularly the implants serial number and or surgery date the file can be populated at that time with a generic serial number and or any surgery date in order to move forward with the fitting procedure C Finding duplicated files The Find duplicated files function causes Digimap SP to automatically start searching for patient files in the local database that may be duplicates The goal is to make it easier for the user to update the local database 6 Settings Menu The Settings menu allo
74. lating by pressing F2 Use the arrows right and left Using the mouse Click SHIFT or CTRL and continue to select the electrodes to highlight them followed by stimulating the short cut in the management tool bar with Stimualtion Click on the bottons indicating and represented on the right and left of the electrodes Switch between the Use Enter for back and Clcik on the bottons and thresholds Min Max force or TAB for switching corresponding to the from min ot max threshold if interest Start Stop the stimulation Use the short cut F2 Click on stimulation short cut in the management bar o Incase of a very young child Draw a first MAP of the fitting with the following parameters usually the patient does not respond to this setting of the T and C Papenti glage Froceseur Einer Cut Configuration SAPHYR Switch on Oreille Droite p p i gt ass D IB A Ku 40 CH E n aj s9 UA nu uu Figure L Dret MAP Advanced Stimulation e The minimums are balanced from minimum e Incase of no reaction double clikc on Min red circle and increase by steps of 2 until a reaction is recognized Test via advanced stimulation e Incase of reaction reduce by steps of 3 all T levels e Adjust the C levels according to the responses you see on the patient Test life mode and the voice test sounds and phonems E Papenis B glages Process
75. mfort The attenuation value applied to a frequency band is expressed in decibels dB and can be modified by intervals of dB between O and 200 The Gains window appears as a diagram The horizontal axis represents the frequency spectrum Hz and the vertical axis indicates the attenuation level dB All of the frequency bands obtained with FFT during signal processing are displayed as vertical bars The shaded bars correspond to inactive frequencies in the frequency representation A single electrode whose number is displayed at the bottom of the window may contain several frequency bands which are displayed in the same color d DIGIMAP SP m SE haters Shoes Protec Test Toot Zeiten Help PATIENT Patient CL CES KI Prod Ls sd DO 2000 290 mu ep 4d 0 Rep en 6000 en UO en o e r ER BID F T cmn Ti m TT e PTT sn HO E LI Enn i a Procedure The attenuation value of a frequency band can be changed by moving the brush with the mouse and clicking on the desired level or by using the arrow keys e Change frequency bands left and right arrows e Change the attenuation value up and down arrows b Suggestions for use The default setting corresponds to OdB of attenuation for the whole spectrum This parameter can be managed based on standard criteria used for conventional hearing aid therapy The gains function is often changed to take into account the patient s feedback New preset functions f
76. n Goer eo fee ip vel patient patient MS ZSA About the dynamic range The dynamic range is expressed in dB and calculated as the logarithm of the ratio of the Max to Min thresholds It is useful to assess the patients ability to discriminate between different intensity levels Electrical dynamic ranges vary depending on the patient In general the dynamic ranges of the basal electrodes electrodes ithrough5 are narrower And the shape created by the dynamic ranges of all of the electrodes shows the widest dynamic ranges in the middle of the electrode array Dynamic range generally increases during the first few months after implantation a Procedure Enabling disabling electrodes At the start of the first fitting all electrodes are disabled and greyed out Some electrodes must be enabled to proceed Only the intracochlear electrodes should be enabled so please consult the surgical report to determine which electrodes to enable To enable or disable a single electrode double click on its number or select the number and press the Ins key to enable the electrode Del to disable it To enable all electrodes at once press the CTRL E keys An electrode may be disabled in the following circumstances e No sound sensation e Sensation that is not sound stimulation of the face or vestibular effects e Unpleasant sound sensation patients who have suffer
77. nection scenarios see the section in this manual entitled Connection page 54 e Place the processor on the patient s ear Noze If an update is necessary you will be prompted once you make the connection Simply follow the instructions Once the processor is connected the Digimap SP software opens program P by default 2 Fitting parameters Z I Main Window a Impedances See the method for the Saphyr SP b Thresholds See the method for the Saphyr SP 2 2 Supplementary window The following parameters are adjusted using a talk over test in order to fine tune the fittings based on the patient s feedback a Stimulation The default value for the number of significant peaks extracted from the signals spectrum in each stimulation frame Is but the value can be adjusted from to 20 Generally this parameter changes rapialy for children who receive an implant early on e For the first fitting keep or if necessary increase the default value e For the following fitting sessions increase the number of peaks based on the child s performance speech therapy parents feedback increased babbling etc See the method for the Saphyr SP b Volume See the method for the Saphyr SP 0 Gains See the method for the Saphyr SP d Denoising The denoising level and analog gain cannot be adjusted for the Digi SP K processor like they can for the Saphyr SP processor However the Denoising parameter may be set in th
78. ng message appears 22 KEE careful Be careful this action will modify the length of the stimulations of several electrodes Do you really want to interpolate Confirm the interpolation by clicking OK The new interpolated Map will then appear d Estimate Min thresholds In Keeping with the goal to simplify the fitting method it is now possible to estimate thresholds Once the Max thresholds have been determined by the user clicking on the Estimate Min thresholds function shortcut CTRL M will set the Min thresholds to IO of the Max threshold levels Cxample e Determine the Max thresholds with the patient The following Map is obtained RIS m ES e Click on the Estimate Min thresholds function or the shortcut CTRL M e Awarning message appears Accept the changes by clicking OK 23 M careful Be careful this action will modify the durations of the stimulations of several electrodes Do you want to modify automatically the Min thresholds from the Max thresholds Cancel eu _ TA Been hee caen eus ep er n mag 270 End fitting session This function starts the procedure to end the fitting session The following steps must be carried out before disconnecting the processor e Save fittings in the computer s local database e Program the processor e Adjust the selector wheel Programming HEA al the en dof the
79. nt using the potentiometer Denoising fitting This function is fairly similar to the method used to adjust the Sensitivity parameter on the previous generation of processors Digi SP Digisonic BIE e When the processors selector wheel is in position 3 the denoising level corresponds to the value defined in the Denoising window default value of OdB e When the processors selector wheel is near the O position before the off position the denoising level is IO less than the value defined in the Denoising window more denoising requiring more sound to begin stimulation Potentiometer O Deactivate Ce Activated Feature IDR Control w Analog gain fitting The Digimap SP software now makes it possible to adjust the amplification gain of the audio input The default value of the analog amplification gain is 2458 The gain in this configuration can therefore vary between 79 and 3058 which corresponds to 6dB of attenuation amplification relative to the default value of 2408 e When the patient puts the potentiometer in position 3 the level of amplification gain corresponds to the Max value 3058 in this example of the available range defined in the Controls window The sound heard by the patient is therefore louder than it was during the fitting session talk over test with the value defined in the Controls Microphones window e When the patient puts the potentiometer in position O bef
80. o the high frequencies in order to get as close as possible to how the cochlea normally functions Bark Scale This is the type of distribution that should be applied in the vast majority of cases The Redistribute in Cust Freq button allows you to change advanced parameters see the section below a Procedure Standard distribution A default distribution is automatically given for all activations This representation is both linear and logarithmic and falls within a wide bandwidth This bandwidth may vary slightly depending on the processor type see the table below The and buttons on either side of the screen enable you to use the mouse to adjust the Min and Max values for a selected electrode These values can also be changed using the left and right arrow keys Each electrode can receive a range of frequencies that is within the total bandwidth of the microphone The lt and gt arrows at the bottom of the screen shift the entire frequency distribution by intervals of 422Hz or 20Hz depending on the processor generation Customized distribution The window displayed allows you to set additional parameters for the frequency distribution namely the Min and Max values of the total bandwidth the boundaries of the linear range and the width of the bands in the linear range 45 46 Personalised Automatic Frequency Distribution Frequency Range E E Hz Linear Bands Up to Linea
81. od to ensure the electrode array is completely inserted in the cochlea This measurement which was previously only available in the Digistim SP software is now possible for the Saphyr SP generation of processors with Digimap SP version 3 4 3 available for Digi SP K processors using version 3 2 or higher Simply click on the Impedances parameter in the main window then start the measurement by selecting Measure During the measurement the patient must wear the processor with the antenna in place in order to make sure that itis communicating with the internal part If the impedance measurement fails follow these instructions I Make sure that the external component is positioned correctly particularly the antenna which should face the implant After checking the positioning try the measurement again 2 Carry out the test with spare external components processor antenna coil 3 Perform the test with the Digistim SP USB system and its Digistim SP software 4 f after all of these steps the impedance measurement still cannot be carried out it is recommended to contact your Neurelec clinical support contact or Neurelec s Customer service Department Bases Eres hansr Tats Les auus tb Mt m e ep eg il ir i i i D b i a rw Eu MG Eun rw ox FA TES I SEM You can compare Impedances
82. oes not change the patients program when the processor is connected to the fitting software The program being used during the fitting is always displayed in the information bar Click on the drop down list to switch from one program to another During a talk over test the patient receives information from the program that is selected in the information bar not the program that corresponds to the physical position of the selector e The processors off position is now on the selector wheel instead of the selector like it is for the Digi SP by This indicator light can be configured according to the needs of the patient and his her family and other support Simply check the boxes if necessary as shown below e Indicate stimulation when turning on the indicator shines green for a few seconds then flashes when the microphone is picking up sound For this setting check On during stimulation e Low battery detected when turning on the indicator shines green for a few seconds then turns off When the batteries are too low the indicator slowly flashes red once per second For this setting check Flashing when the batteries are low C Auditory feedback It is possible to choose an electrode and sound level as a of the dynamic range to indicate when a program is changed and or when the batteries are almost spent d Potentiometer oeveral functions can now be configured in the Functionality menu and can thus be adjusted by the patie
83. or adjusting the gains are now available in this Digimap SP software version Here are a few usage examples e The patient complains of echoes or resonance Attenuate the low frequencies by 3 AdB Click on the button next e The patient complains of crackling or unpleasant sot Attenuate the high frequencies by 3 4dB Click on the button next The attenuation applied is rarely less than 6dB though it may in some cases be a way to detect a problematic electrode during the talk over test It is recommended to use the Digiscope sensor if the fitting changes do not improve the patients hearing comfort enough The Digiscope enables you to view any abnormal saturation of one or more electrodes and to therefore change the corresponding attenuation level 2 2 Volume This parameter adjusts the overall level of loudness It compresses the dynamic range of the active electrodes Nofe Certain parameters other than the volume also enable you to adjust the loudness level loudness equalization analog gain Volume is expressed in decibels dB and can be modified by intervals of 0 5dB between 3dB and 3dB a Procedure The default value OdB is automatically given for all activations Any change to this parameter can be made by moving the cursor with the mouse or by using the right and left arrow keys b Suggestions for use The volume is adjusted primarily during the talk over test with the patient s participation e D
84. ore turning off the level of amplification gain corresponds to the Min value i8dB in this example of the available range defined in the Controls window The sound heard by the patient is therefore quieter than it was during the fitting session talk over test with the value defined in the Controls Microphones window 9 Activated Feature Gain adjustment v Input Front Mic w Available range Min i8 Ms dB Max 30 dB It is possible to adjust the range in which the analog gain is applied by changing the Min and Max values Available D range Min 8 K dB Max It is also possible to choose the input that the gain is applied to front or rear microphone Telecoil Auxiliary input This can be used if there is a special program for an accessory for which the microphone s volume is not of importance Note e When setting a Zebra processor the analog gain function does not exist but is instead replaced by the acoustic gain fitting e t is recommended to make sure that the input selected for the potentiometer is being used in the patient fitting If not the following message will be displayed pz careful Th potentiometer is set t act to disabled input Please medy tha parameters of the petantiomater Depending on the audio input selected the recommendations for adjusting the range of the analog amplification gain are the following e Rear m
85. ow view the MAPs one by one or else load the entire fitting session ix P Olzatznz L626 ZEBRA JLLL3 Maps 45 46 A Expand all ed Hl Map 45 Performed by SAY Say i ia Ee ap 46 Ts Perrormed Dy Shy edv Reduce all ES oitaanziezn ZEBRA SI LI3 PGR Maps 45 46 P bed Pi Map 45 Performed by ROOT NEURELEC d P2 Map 46 Performed by ROOT NELIRELEC c nonzatzoiz ez ZEBRA ZIL II3 Maps 45 46 Pi Map 45 Performed by ROOT NEURELEC Im P2 Map 46 Performed by ROOT NELIRELEC Sf otzataoiz Letz ZEBRA SII I3 PGR Maps 45 46 PO Je Fi Map 45 Performed by ROOT NEURELEC Pz Map 46 rari Performed by ROOT MELIRELEC c Eg orzasiz0i2 pg ZEBRA A II3 Maps 45 46 Sum up aT Pi Map 45 Performed by ROOT NEURELEC Open the adjustment c Eg oife3ieoi2 pd ZEBRA I LI3 PGR Maps 45 46 Se ven Pi Map 45 Performed by ROOT NWEURELEC bee P2 Map 46 rar Performed by SAY SAW Print Quit B DLE POLS Iie ZEBRA GI Maps 45 46 Sat Pi Map 45 Performed by ROOT HEURELEC Pz Map 46 rar Performed by SAY SAV If the users loads MAP 4 existing in program HI only MAP 4 is displayed in Px mode TERP D sch shed Renee Tei Tak Mag ze Therefore only MAP 4 appears on the screen and the fittings for P2 P3 or P4 are not visible To view these you need to switch to s
86. play to be greyed out and inactive while the selected parameters appear at the bottom of the window and are active Any change to a displayed parameter that is followed by a talk over test or a Digiscope test is automatically applied This change is only shown in the summary section of the left hand column after it has been accepted via the dialog box Accept modifications clicking anywhere on the inactive section of the fitting area or on any other parameter or menu make this dialog box appear C Description of menus Il Patients Menu The Patients menu provides access to options for managing patient files e The options listed below are available in this menu The most frequently Patients Adjustments Processor Tests Tools Setting used options will be presented further on in this document E T DEEN ZEE patient Ctrl M e New patient creates a new patient identity card e Open opens an existing patient file from the local database Open e Identity card opens or exports the patient s identity card Identity card e Import imports a fitting from removable storage media MM USB key floppy disk etc Import b e Export export a fitting to removable storage media USB key floppy disk etc e Email sends a patients fitting by email Export a patient File t DJ File Send bv email a patient File AC File
87. pment defect flash red when a stimulus in launched The STIM light Defect detected constantly glows red during self diagnosis of the DIGISTIM SP USB unit The Stimulation button Mo patient file is not available selected in the software department Load a patient fila or creat Possible cause Please unplug the DIGISTIM SP USB unit reinstall the correct version of the software If the software refuses to connect wit h the DIGISTIM SP USB unit reinstall the software and try again If the problem persists contact Neurelac s after sales department Unplug the DIGISTIM SP USB unit wait a few seconds then plug it back in If the problem persists contact Neurelec s after sales one to be able to launch stimulation page 27
88. py disk key USB es Ma e he USB key which should not have yet been connected to the computer must now be connected to a USB port Then click OK e Unplug and click OK e Plugin again and click OK O The key is now identified and works properly This synchronization operation only needs to be carried out once During each fitting session with the patient it will be necessary to merge the USB key s data with the data saved locally because the patient files could potentially be different example the patient went for a follow up visit in another implantation center To do so just click NO when the window above appears see the section entitled Merge files page 45 6 4 Internet s Langage Asien Fors Fina pugno ere The Internet tab allows you to set email settings by choosing either a local email software program or Neurelec s remote mail server eler a LATI equali rog dei Css Mad Serm MI mibreurer iym ET If the Neurelec mail server is used the default parameters do not need to be changed However it is necessary to make sure that port 5877 is not blocked by the firewall of the E px une h och dos cond ass sath Dulicak spas begi network being used Hamer Ul il erum 7 Help Menu The Help menu and more specifically the About option provides the user with information about the Digimap SP software version being used This informat
89. r Bands Width Cancel b Suggestions for use Disabling electrodes The audiologist may have to disable electrodes during the fitting e When disabling a single electrode and or when disabling an electrode less than 6 months after surgery it is recommended to keep to the standard proposed frequenoy distribution e fthe implanted patient is stable disabling one or several electrodes requires careful attention in order to limit any possible discomfort that the patient might experience The system will offer to automatically readjust the frequency distribution according to the number and location of the electrodes to be disabled If automatic distribution is not possible then the software will recommend that the distribution be carried out manually To do so it is necessary to fill the gap in the frequencies created by disabling electrode N by changing the distribution of the frequency bands of the neighboring electrodes N ang When disabling multiple electrodes it is strongly recommended to contact Neurelec clinical support In some special cases for example with the Digisonic SP ABI for brainstem implantations it may be necessary to change the frequency distribution of the electrodes or even to reverse the order of the frequency bands To reverse the order of the electrodes it is necessary to use the Advanced Stimulation function shortcut in the column in order to establish a frequency distribution that coincides with the p
90. r use Cl Programming strategies a Procedure b Suggestions for use 2 Supplementary window TJ Gains a Procedure b Suggestions for use 2 2 Volume a Procedure b Suggestions for use 2 3 Denoising a Procedure b Suggestions for use 2 4 Stimulation a Procedure b Suggestions for use 3 Controls 3 7 Button control a Program selector b LED c Auditory feedback d Potentiometer 3 2 Microphones a Procedure b Suggestions for use 3 3 Auxiliary input a FM system and Auxiliary input b Telecoil D Other program E End fitting session Il Save in the patient file 2 Save to the storage media 3 Programming the processor Ill APPENDICES B Setting the DIGI SP K processor except Digi SP K cx Il Connection 2 Fitting parameters 2 7 Main Window a Impedances b Thresholds 2 2 Supplementary window a Stimulation b Volume c Gains d Denoising 2 3 Controls 3 Other program 4 End fitting session 56 56 56 56 58 I INFORMATION ABOUT THE DIGIMAP SP 3 4 3 SOFTWARE Important This section of the document presents the various menus and tools that are available when using a latest generation Saphyr SP processor Differences specific to the other types of processors Saphyr CX Zebra Digi 57 Digi SP Digisonic BTE and Digisonic BW will be highlighted when necessary You can access user guidance for all processors via the Help section in the software A Logging
91. rammer le r glage courant dans le processeur Si vous choisissez e Non le r glage initial sera r tabli a Oui Non Hon Annuler Click on Yes if you want to get the fitting written into the processor BERN Programmation du r glage courant dans le processeur Les num ros de map suivants sont actuellement affect s PT Map 2 souhaitez vous effectuer une impression maintenant o ww Click on Yes if you want to print the maps Potentiometre R glage de la Sensibilit MMM sensibilit o b Ajustez le potentiom tre puis validez Potentiom tre Pasition actuelle 8 0 dB Adjust the potentiometer to the patient needs Validate D e igiMap Ke eurelec I Table of Contents INFORMATION ABOUT THE DIGIMAP SP 3 4 3 SOFTWARE A Logging in as a user B Description of the fittings window Il Menu information bars 2 Functions A Il System identification 2 2 Comments 2 3 Management of parameters 2 4 Shortcuts 3 Fittings C Description of menus Il Patients Menu 7 7 New patient a Required b Complementary C Medical 7 2 Open a Local patient file b Local patient file for the opposite side c Saphyr demo file 7 3 Identity card 7 4 Importing a fitting Al Export a patient file 7 6 Email a patient file 2 Fittings menu Zil Cancel the change 2 2 Patient sessions Map numbering 2 3 Fittings recap 2 4 Save fitting
92. rd impedance values Per operative Post operative 200 Q to2kQ 2k iopkO NB The system is designed for a distance of 2 mm to tZ mm between the antenna and the implant thickness of skin Interpreting impedance readings e Value below standard value Possibility of liquid seepage short circuit in electrode circuit e Value above standard value Possibility of Electrode partially damaged or outside cochlea High of infinite Inf impedance level Electrode damaged electrode circuit broken Action to take if the DIGISTIM SP software indicates an error e Coil Cable not connected or faulty message Check that the antenna cable is connected to the DIGISTIM SP USB unit properly If it is it may be damaged Implant not detected message Check that the distance separating the antenna from the implant is not too great 72 mm Alternatively the patient s implant may by faulty e Other message Check the distance separating the antenna from the implant To take a reliable reading in cases of very thin skin young children etc it may be necessary to insert a compress between the antenna and the skin Integrity test This test is designed to check that the implant is working properly It is carried out using an external data gathering device Decrodei bo bess Troe cf tent Ii Digne 47 EN bp A a igi A uw LiDE cu Cu E ET Integrity test Parameters that can be modified e The range of electrode
93. revious next electrode Up and down arrows Click the electrode number Select several electrodes consecutive or Hold down the SHIFT key and select the Hold down the SHIFT or CTRL key and non consecutive electrodes using the up or down arrow select the electrodes by clicking on the desired electrode s number Increase decrease the threshold value Use the right and left arrows Click the and buttons on the right and left side of the electrode Switch between the Min Max thresholds Press the Enter key Click the and buttons corresponding to the threshold that is being tested Start stop stimulation Use the F2 shortcut or the space bar Click the stimulation shortcut 42 7 3 Intensity Intensity corresponds to the global amplitude shared by all electrodes and may be adapted to each patient during a fitting session Any change to this parameter may have an impact on the threshold values It is therefore important to adjust the intensity before proceeding to adjust the Min and Max thresholds The intensity value is expressed in Machine Units MU and can be changed by intervals of MU between 30 and 20 MU e l 50 Stimulation with constant voltage an 40 Fl ED 70 an gn oo III Im PEE CO Stimulation with constant current The window also allows you to select the stimulation mode e Current mode default the current is constant and the voltage varies
94. rogram and turning off each time the push button is briefly pressed the blue indicator flashes one or several times to indicate the selected program flash P selected 2 flashes P2 selected etc Holding down the push button causes the blue light to stay lit indicating that the device is in standby mode e Green Indicates stimulation the indicator flashes green when the microphone is picking up sound This setting can be deactivated during the fitting session e hed Low battery or other errors Low battery detected the red indicator light flashes 3 times in a row followed by steady constant rapid red flashing if the sound and light alert functions are activated If the sound alert function is inactive the red flashing will be constant The setting for detecting low battery charge can be activated or deactivated in the Button control window Defective connection lead detected the lights flash steadily alternating between red and green Any other error detected If there are 4 consecutive red flashes followed by 4 consecutive green flashes it is recommended to turn off the device then turn it on again If the problem persists contact your local distributor or Neurelec 3 Other program See the method for the Saphyr SP 4 End fitting session Once fittings are complete and the programs have been validated in the talk over test you can then proceed to close the fitting session Go to the Fittings End fitting session menu
95. s 2 5 Print the fitting 2 6 Fitting management 2 7 Enable all electrodes 2 8 Presets fast fittings 2 9 Duration of stimulation a Increase Decrease all thresholds b Tilt function for all thresholds 0 Interpolate d Estimate Min thresholds 270 End fitting session 3 Processor Menu 3 7 Reinitialize the processor 3 2 Update the processor 4 Tests Menu 4 Il Stimulation a Stimul ation b Advanced stimulation C Stimulate a group of electrodes 4 2 Talk over test Advanced talk over 4 3 Measurements a Digiscope b Vu meter 5 Tools Menu 5 Il Files Tools a Merge files b Automatically rename files 0 Find duplicated files 6 Settings Menu 6 Il Stimulation 6 2 Ports 6 3 Files 6 4 Internet 7 Help Menu Il FITTING PROCEDURE A Connection Il Unprogrammed processor III The patient file not already saved in the computer first fitting 32 The patient file is saved in the computer maintenance or pre fitting 2 Processor that is already programmed 2 Il Patient file not saved in the computer new PC or change of center 2 2 Patient file saved in the computer standard fitting B Reprogramming C Fitting parameters TI Main window 7 7 Impedances 7 2 Thresholds a Procedure b Suggestions for use 7 3 Intensity a Procedure b Suggestions for use 7 4 Transmission power a Procedure b Suggestions for use 7 5 Frequency distribution a Procedure b Suggestions fo
96. s Configuration Aide oo N TN TT TE EET FDO CC I KE He DT FOR CCC Te 7 lt i EC x CC O T EE HT LL TE 35 YEA 4 CCC IE Ke Ts Ts i lt i ER WI dl Tat Ua n AEN 4 BJ HAT T DI 20 3 Ka 50 amp 80 IO no L Figure 3 MAP defined with 4 levels of T and C Select the following electrodes with the help of click on Ctrl click on the left hand shown electrodes e E20 e El3 e E7 e El Use the funtion of interpolation with click on Ctrl O Papentt B glage Brocesseur etais Gertie Cenfiqursti hid j r J Focesour SEET Me Hp De at E LE Ki 4 Es Taw AES CL Y Au mee 5 asf COO O O fea CORRE 4740 Tv Het lola gt aise T 5 H in in A 40 Si E m BE Si Da nae tg Figure 4 MAP after interpolation Check the thresholds of the C with advanced stimulatin Perform an audiogramm and verify the thresholds Note If it is not possible to define the thresholds it is possible to use the function Estimate the minimum of the patient It is found under Adjustments and Duration of stimulation followed by Estimate the Min or by using the short cut with Ctrl M e Voice test o Test the voice o Inthe case of a to high stimulation and uncomfortable loud voice for the patient Lower the C levels one step o Inthe case of a too
97. s been assigned to the currently used program 23 Management of parameters This area is for managing fitting parameters These parameters are grouped into several windows that correspond to the different stages of the fitting Main Supplementary Controls Each window and parameter selected is identified by a green dot and blue band The currently value of each parameter is displayed on the right Any change to a parameter is only shown after it has been accepted e Main window designates the primary parameters to be adjusted and checked during a fitting Impedances Thresholds Intensity Transmission power Frequency distribution Strategies Main Window The Thresholds parameter sub window is the default window displayed under the Main window It is sent to the background whenever another parameter from the Main Window is selected Click on the Thresholds window to re activate it e Supplementary window contains the parameters used for improving patient comfort Acoustic specific to the Zebra processor TF _ TH E HF nn al We WU ETE E Gains Ma Stimulation Supplementary Window Volume Controls Denoising TS e lotepad The Stimulation parameters are automatically displayed in the fittings section while the Gains parameters are in the background The parameters from the Supplementary Window are usually adjusted during the talk over test Stimulation e Controls config
98. s the natural shape of the ear e design already approved by patients e Abio compatible material especially developped for medical devices ISO 70002 BUT ROBUST AS A SAPPHIRE Simplicity of the system for a reliability improved e Solder Bump Technology assembly for optimized resistance to shocks e Protection against humidity increased by the tropicalisation process M ajor actions to enhance reliability solid strengthened connections robust electronic boards micro screws integration new microphone encapsulation modular conception EF ES ALPSESNeureec ii neurelec Multilingual packaging IA languages New accessories that matches better the patients needs New manuals to provide all the necessary information ALPSmZzxNeurelec gt EAR Livi neurelec ALPS ESI Neurelec Thank You e s neurelec Neurelec ALPS Hearing Research Saphyr L _ e I23
99. s to be tested for example from Toi or from 8 to 5 and the direction in which they are scanned Type of test High speed or Complete Stimulation frequency from Hz toi0o0Hz Stimulation amplitude from 30 to 720 Pulse width from 2 us to 250 us Stimulation number to average from to 7000 Stapedius reflex This test determines an electrode s maximum threshold in an objective manner by measuring the activity of the stapedius muscle One or more electrodes are stimulated simultaneously either continuously or intermittently A synchronisation pulse is sent before each stimulation burst bg dree 00 eas p Pw i il Caper ur B dr ech 5 5 E 5 Lys 5 5 5 5 5 amp 4 te e lt cat otapedius reflex test Parameters that can be modified Electrode s to be tested ticked on a list Stimulation Type Continuous or Intermittent Frequency of stimulation from Hz to 2000 Hz Amplitude of stimulation from 30 to 220 Pulse width for each electrode from 2 us to 250 us Stimulation mode in the case of Digisonic SP implants U voltage or electric current Transmission power Three further parameters can be defined for the intermittent stimulation mode e Bursts Number e Duration of each burst e Delay between bursts PROBLEM SOLVING Il Problems and solutions This device is highly dependent upon the proper working order of the computer to which it is linked It is hig
100. saved in the computer maintenance or pre fitting In order to make the Digimap SP software easier to work with and to standardize the connection procedures the most difficult case to deal with loading a patient file to a processor that is already programmed with another patient file during maintenance is done easily by following these steps e Connect the processor and clear it of its contents go to the Processor Reinitialize the processor menu After re initialization is complete the processor is automatically disconnected e Reconnect the processor now empty and click on Choose a patient from the list of local files to select the desired patient file from the list and load the desired fitting session from the history When managing patient files and particularly for routine tracking of the various systems used by the patient implant or processor the message shown on the right appears to provide information about the status of the patient s usual processor Ea Processor ca connected is not usual patient processor In case of voluntary exchange please indicate status of new processor This window enables you to enter information about the status of the new processor that has been connected e g a spare or a permanent exchange as well as the status of the patient s usual processor sent in for repairs or temporarily or permanently declassified This information is then automatically copied in the p
101. splays the identity card of the patient whose file is currently in use e Export The identity card can be exported in csv format once the corresponding patient file has been selected and opened 7 4 Importing a fitting If the patient s fitting is not stored in the computer it is possible to read the fitting stored on the patient s floppy disk or the Neurelec USB key To do so simply click on Patient file stored on Neurelec disk or Patient file stored on Neurelec USB key depending on the storage media used If the storage media Neurelec USB key or disk has not been selected in the Settings menu the associated fields appear shaded and cannot be accessed In this case it is possible to manually search for the desired patient file by clicking on Patient file LIS LLY COI Import patient File From a Neurelec Disk patient File From a Meurelec USE key Export a patient File ADJ File 4 patient File Send by email a patient File AC file a A window appears that allows you to browse the computer s folders and select the folder containing the patient file that you are looking for Select the location then click OK Then simply select the patients name in the list that is displayed E Contact EE ee This is Ube Bet of Une Fourrd patients Which palient du you want bo import FEES Links PATENT Pint ew mu Nofe When importing data if there is already a file for the
102. ssais Outils Configuration Aide NOM Prenom 9 Processeur EK Dyn dB 95 Hz 326 Hz 27 44 4 Fen tre principale gt M EI EUR Ski Lol Kos X Fen tre compl mentaire O m I EE c cc 35 53 4 me ORALE 20 5 usn 39 50 59 3 SAPH Num ro de s rie 773 DSP 3 9 Rev 0 49 Implant SP EI 7 Commentaire 20403 2070 46 l ET o Example with only IS active electrodes in total select the following electrodes o E20 o EIS o E9 o ES o Always test with advanced stimulation from 50 to UO before going on life mode o To perform this use the short cut t or F3 or in Test menu select stimulation and advanced stimulation o The advanced stimulation window appears ll Stimulation Avanc e p Min i0 30 Electrodes 20 29 L i7 90 70 90 Max LU Periode is 25 35 Fermer o With the Saphyr it is possible to define the duration of the stimulation for each electrode between 2 or 3 seconds List of short cuts and manupulation for checking the T and C levels Action ion Select several electrodes Seperat from each other or next to each other and stimulate these electrodes Increase decrease the thresholds Manipulation on keyboard Click SHIFT or CTRL and continue to select the electrodes to highlight them followed by stimu
103. stem is divided into three separate sections in order to simplify everyday use e Menu bar and information bar e Function management Vertical left hand column e Available fitting Information Right hand side J see j m EGNI R A disks Hume Memes as Tom Zeiten o Heb patient patient Ben Wado O EXERE PTT Hr TT E a T Hle TET p H Aes e O cr e u s lui Il Menu information bars The upper section of the software provides access to all menu options Patients Processor Fittings Tests Tools Settings Help which will be explained in detail further on The information bar identifies the current patient file and processor and shows the current status of the system connection status stimulation status selected ear talk over test activated etc Patent Acpeiments Drees Teste Tost pima Piaf PATIENT Patient emm T Information bar e Patient name e Type of processor Connection status e Selected ear e Stimulation e Selected program e Talk over test 2 Functions The vertical column is the reference section of the software and includes the following information oystem identif
104. tcut F2 stimulates at the Min or Max threshold of the selected electrode b Advanced stimulation Advanced stimulation makes it possible to check whether the loudness of each electrode is balanced correctly with other electrodes thus enabling you to check the threshold fittings that were previously made C usd FN l i e Use the SHIFT and CTRL keys to select a group of electrodes Dn ZP fe Gia n US Mems TE e Using the cursor define the stimulation level expressed as a percent of the Max threshold level nita Stimulation e Click on Stimulate to start a sweep of the selected electrodes The patient should indicate if the perceived loudness of any one of these electrodes is 6 different from the others The goal is to obtain consistent loudness across all Is 25 Gs electrodes e f one electrode does stand out as having a level that is too low or too high return to the Thresholds window and readjust its threshold e Click on the arrow to switch the order of stimulation low to high pitched electrodes or the reverse Note It is possible to change the amount of time between two stimulations so that the patient can easily compare the selected electrodes M w R OT DJ co ux C Stimulate a group of electrodes The new version of Digimap SP makes it possible to stimulate groups of electrodes in order to quickly determine the patient s Min and Max thresholds P roce dure Select the group of electrodes
105. ters intensity Max thresholds number of active electrodes per frame The combination of this set of parameters may in some cases lead the system to automatically readjust the stimulation frequency value A notification will indicate this change and the button for accessing the Strategies parameter will stay red until this window is opened as seen in the example below eh dissem Pee ts ps eg priz Les 3 Les Ki gt In the given example the major change number of active electrodes per frame from 6 to 6 to the Stimulation parameter causes the stimulation frequency to be automatically readjusted In this extreme example the slight decrease in the stimulation rate will have little or no effect on the patient s perception As noted above automatically readjusting the stimulation rate depends on the following parameters intensity Max thresholds and number of active electrodes For reference a fairly high setting Max thresholds at 6085 would entail 44 active electrodes at GOOHZ IU at 7OOHZ or 8 at 800Hz 47 48 2 Supplementary Window 2 Il Gains The Gains parameter enables you to balance the levels of all of the electrodes It is possible to attenuate a specific electrode or frequency band This setting does not change the electrical parameters or the frequency distribution It only changes the amplification in order to optimize the patients hearing co
106. ther to adapt it to the patient s specific needs outdoor environment music etc 2 7 Enable all electrodes For the first fitting all of the electrodes are disabled This function enables all of the electrodes at once The shortcut is CTRL E 2 6 Presets fast fittings In order to speed up the fitting procedure according to the needs of each patient new pre established fitting modes presets are now available in this version of the Digimap SP software except for the Digi SP and Digisonic BTE without LED processors Each mode has parameters gains volume loudness equalization etc that were chosen to correspond to a specific sound environment e Noise Mode e elecoil Mode e Phone Mode Important These modes offer suggested parameters for these given situations Once the parameters have been applied it is always possible to change their values later on It is also possible to restore the default parameters by clicking the respective button The shortcut for this function is CTRL T 20 2 9 Duration of stimulation a Increase decrease all thresholds This function increases decreases the detection thresholds and comfort thresholds simultaneously It shifts the dynamic range of all of the electrodes The shortcuts for this function are the following e Increase all thresholds CTRL e Decrease all thresholds CTRL U b Tilt function for all thresholds This function balances the dynamic ranges of the low and
107. thod described below P roce dure Go to the Tools Files Tools Search the redundant patient files menu If the Digimap SP software indicates that duplicated files have been identified the files merge window will automatically open Otherwise the procedure is finished e Inthe files merge window the software automatically fills in the left hand column with the files to be merged that were found while searching for duplicates It is necessary to manually oversee the process one patient at a time to avoid errors e Select all of the files belonging to the same patient in the left hand column using the Add button purple circle in the picture below e The files to be merged will appear in the right hand column Note It is possible to delete a file from the right hand column by clicking on Remove the selected file Tait e Gi T E B Ust of Found patients List of Files For Fusion ms Name address Fle Narre Patent Mme Fle Heng end plir PATIENT PATEENT Madj patient patient MY PATIENT sA e A reliability index blue circle in the following picture will appear in order to prevent the user from merging files that should not be merged for example two different patients or files from the left Cl and right Cl of the same patient f the reliability index is greater than or equal to 7726 the files may be merged f the index is less than this value the files are probably different from different
108. tients Adjustments Processor Tests Tools Settings Help TEST Test 4 p J Lett ear Processor NOM Mir Max Den dB Processor 20 ee 5 5 0 I9 5 5 0 9 5 5 0 Implant II ss L 5 5 0 Digisonic SP 0 37 8 Ip 5 5 0 RE 20 Electrodes E _ 5 5 0 EI LA es LA d 5 0 Comments 39 8 0 8 I3 es Ia ss 5 5 0 E e IA 5 5 0 es 5 5 0 I0 5 5 0 Main Window 9 aa 5 5 0 Supplementary Window eo D 5 5 0 Controls ta 5 usis ed E 5 9 F 6 TES 5 5 9 Notepad 5 5 5 0 3 era i 5 5 0 3 mi pns 5 5 0 NR E 5 5 0 ss 5 5 0 Measure Print Compare measurements measurements You can manually adjust the transmission power to define the amount of energy that is required to transmit the energy through the skin This test is possible as soon as all electrodes are activated Click auto In case of switching from a Saphyr 2 turn antenna to a Saphyr 3 turn antenna it is required to re test one time the transmission power Puissance d mission 5 of transmission power is a standard value St represents a higher power consumption and should be avoid Parameter set
109. ting at the activation fitting e Select the frame supplementary window Stimulation The standard default setting of stimulating electrodes is LO It can be increased toi tot Nombre maximal d lectrodes actives en m me temps P U LI LL LL LL LL IZ 3 4 5 amp 7 8 9 0 d L J JI III Im AD O la O Verify that the gain is flat at 0 amp CHA SP 3 Patents R glages Processeur Esra Out Configuration Aide NOM Prenom Oreille Gauche Processeur r i Implant uemerers Lair er 28 92 20 TE Fem principale Loggt cmgplementaimn Hir nr lier aid mw e m arises maximal dee hodez aclives en meee lenga i F J LL VU 3 4 5 amp 7 EE EEE CEFN m Denoising should be at the highest level of the window screen Patents A gleges Processeur Essen Cutts Configuration aide NOM Prenom ULL id Ku M Je 3 d 35 J d RK uo GES SG tox S E Form 4 in in The fitting Go to the main window IO AUD Fi 3000 3500 4000 Zu S0 3900 6000 ES A00 T500 BU Oreille Gauche el e Test the T and C levels and benefit from the interpolation function o Interpolation of the electrical threshold levels o Test the C levels and the T levels of 4 Electrodes DIGIMAP SP OI Patients R glages Proc esseur Essais Outils Configuration Aide NOM Prenom Processeur SAPHYR Num ro
110. to be tested using the SHIFT blue circle and or CONTROL keys Select the desired stimulation level depending on whether you are testing detection thresholds or comfort thresholds by double clicking on the heading Min or Max at the top of the column for the chosen electrodes The boxes that correspond to these values the Max values in this example appear in green purple circle oe rT Er LL LLL ii Poets Fm bareme m Dus Lag gens Je be ESSA Essa Orato Draitr eer Este palco s Du TT QM delt fu fa 26 e Start stimulation using the shortcut F2 in this example all of the electrodes are stimulated at the patient s comfort threshold and flash at the same time black circle anme HEIN NN Papx Maa Ferae uk Duk Omm dede ESSAI Em Orem 5 Oras S SE ged J E 4 2 Talk over test Advanced talk over During a talk over test the processors microphone is activated and the patient hears the surrounding sound environment Any change in the position of the processor s control buttons sensitivity selector wheel or program selector has no impact on the patient s perception during the talk over while he she is connected to the interface Rather the level of the parameter being configured gain denoising for a Saphyr SP processor is defined in the corresponding fittings window and the program being used is selected from the
111. ttings window of the Denoising parameter For Digi SP and Digisonic BTE processors the microphones sensitivity level corresponds to the value that has been defined in the fittings window of the Sensitivity parameter When the potentiometer s selector wheel is in its highest position this level corresponds to the value defined in the fittings window of the Denoising Sensitivity parameter The selector wheel s range of variation offers IO of attenuation between the highest and lowest positions Thus f the Denoising parameter is set at OdB in the software the patient will be able to adjust the minimum sound level between OdB selector wheel position 3 and 0dB position O before turning off depending on the environment f the Sensitivity parameter is set at 35dB in the software the patient will be able to adjust the sensitivity level between 35dB selector wheel position 3 and 4558 position O before turning off depending on the environment 2f e During an advanced talk over test menu Fittings Advanced Talk Over the denoising sensitivity level can be modified in order to define with the patient the most appropriate setting for his her comfort and lifestyle This function is particularly used in cases where it is necessary to lock the selector wheel the elderly very young children etc at a predefined level of denoising sensitivity Let Ehe patient Feelt change the potentiometer
112. ures the external processor controls and input microphone choices available to the patient Button control Microphones Auxiliary input Controls A i r e J L J LE Dali External Button Control 24 Shortcuts The Digimap SP software offers direct access to certain functions using shortcuts icons found at the bottom and left of the screen Some functions will be grayed out and not available when a processor is not connected The shortcuts have the following functions Stimulation management File management TL Start stop calibrated stimulation testing hearing comfort thresholds JL Advanced stimulation electrode sweep S Start stop talk over test Lal Digiscope ec Vu meter Patient sessions Ex Save fitting Fitting management 3 Fittings The largest section of the Digimap SP software screen is for adjusting parameters Depending on the choice of Main Supplementary Controls or Notepad a predefined default parameter is displayed For example the Thresholds parameter is displayed when the Main Window is selected as in the example below and the Gains parameter is displayed for the Supplementary Window LL 7 A i Selecting a different parameter from the sub menu causes the default dis
113. using patient files particularly in cases of bilateral implantation it is essential to specify the side that the cochlear implant system was implanted on whenever a new identity card is created Thus any new patient file saved in the computer s local database appears as follows Last name first name_R adj R stands for Right for implantation on the right side or Last name_first name_L adj L stands for Left for implantation on the left side However for patients who received their implant system before May st 2070 the implant side is not specified in the name of the patient file It is therefore necessary to update the existing database of patient files using the Automatically rename patient files function No e In some cases the implant side was not filled in by the user when creating the identity card In this case the Ear field in the is blank and is marked with an exclamation point The Automatically rename patient files function cannot therefore update this type of patient file Al 32 Kier Ear Proc ser File Mame Right Ji828 am me wd Right 828 db Right 57057 AFP FT Right Jane aum reibaa rad Right 57057 qur rtis ach ne Afoa m ee Tr adj Side not specified toes adi deeg gend adj nre FT T ind orth cet Spare Left HE Aren cl iiwan od mitre Spare Left Kid Srel es Lach 4 n Left DUU anm Fa Open Patient Sessions ALL dapes Bi Left 4209 dr rs a
114. ws you to change a number of parameters that are defined as user preferences in the Digimap SP software fandia L ets Fi Dij Ton ka tg gp ac tele Heel af Sauce MP coord ls less riese Chess Bus Server The options listed below are available in this menu The most frequently used options will be presented further on in this document SF arip anpe cam P t EI e Language select the language to use in the software e Stimulation define the characteristics of the sound stimuli e Ports configure the ports according to the equipment that is being used for the fitting interface Digiscope e Files configure the path for the removable storage media and patient files e Digiscope display parameters for the Digiscope sensor e Internet configure email settings fue Dutbok jor confuse r tsch Kee eiert bessie Had See Cen nc Le 6 Il Stimulation It is possible to change the stimulation type sound stimulus used when testing thresholds or during advanced stimulation By default the software proposes intermittent stimulation It is possible to define the duration of the pulse burst Ton as well as the duration of silence Toff between two pulse bursts It is recommended to keep the default values proposed by Digimap SP However slower stimulation may be indicated in specific cases auditory nerve that fatigues easily etc sirar Me Lastly it is possible to enable sound f
115. y date K CH Implanted ear te e Se ee LE Serial number Electrode array The status of the implant is automatically displayed ncaa are Serial Humber Broches x e Processor Information about the processor is automatically detected by the software and displayed in the identity card notably the type and serial number The following types of processors may be detected Saphyr SP Saphyr CX Zebra Digi SP Digi SP2 with LED Digisonic BTE Digisonic BTE2 with LED Digi SPK 2 Digisonic BW etc Nozes During an actual fitting it is best to first connect the patient s processor while the processor is not on the head then fill out the identity card Moreover it is possible to list several processors per patient Whenever the patient s fittings are loaded into a processor other than his her usual processor it will be detected and the nature spare permanent exchange etc of the new processor will need to be specified when it is connected The new processor is then automatically included in the list of processors used by the patient T3 _ New Processor c connected is not usual patient processor In case of voluntary exchange please indicate status of new processor Spare processor Pracessor s Permanent exchange ESI amp Serial Number Microphone Status DIGI SP2 6483 Spare DIGI SP 585 Repair Processor of the patient is DISI SP 2362 Former spare DIGI S

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