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MADSEN Astera Reference Manual

1. O7Osuite BA Fie Edit View Measurement Tools Reports Help e Uu 8 FA os 5 p F Navigator E Control Panel amp ay A zg amp SJ Ls Tone Speech Aided Speech I Aided Speech II SISI ABLB MLD DLI QuickSIN LIPread B k sy AMTAS Oldenburg Channel Settings x 20 1000 20 a Continuous ON dB Hz dB SS ee O TRANSDUCER Inet O O Ch1 Tone Phone Right NBN Phone Left Ch2 Phone O HL 1235 25 125 250 500 750 ik 15k 2k 3k 4k 6k sk Hz High Frequency O O HL 125 250 500 ik 2k 4k 8k 16k 10 ROUTING w ogg 2 2 Right O 10 20 A 30 P gt 20 dB 0 40 50 O n 70 Test Options 20 a v Switch ears automatically 30 30 100 FREQUENCY 110 O Sweep Up 40 a O Sweep Down 50 HL 9k 10k 1142k 125k 14k 16k 18k 20k Hz Fixed Frequency 20 60 10 SIGNAL TYPE 0 10 oO Pulsed 70 a O steady 80 30 40 90 5 60 70 100 a 30 110 100 110 120 P Ready No User Test loaded 11 09 2012 Se otometrics Otometrics MADSEN Astera 83 3 14 8 84 Sweep Frequency results OTOsuite DERK Fie Edit View Measurement Tools Reports Help SBHe gt R x Ss p F Navigator E Control Panel Ny Sy A LH amp J Ls Tone Speech Aided Speech I Aided Speech II SISI ABLB MLD DLI QuickSIN LIPread B k sy AMTAS Oldenburg Channel Settings x 12h 20 20 ae a8 1000 n ae O Chi Tone Phone Right W
2. BOL Selecting OCA MON tessa etl eae Cys tn A outed trea nae ere ER AAE 3 8 2 Channel specific Storing 3 8 3 Automatic frequency level shift when storing e eee 3 8 4 Stimulus duration 3 8 5 Ear shift frequency and level setting 3 8 6 Saving non stimulus channel as masking Otometrics MADSEN Astera 13 15 15 15 16 16 17 18 20 20 20 23 23 26 27 29 31 31 32 33 34 34 35 35 37 37 38 38 39 41 42 42 42 42 43 43 43 3 9 3 10 3 11 3 12 3 13 3 14 Me SPEC LESUSClOCW ooze obec ak Oe Bi eee an ee a le ie ee eee 43 3 9 1 Selecting word or phoneme scoring __ eee eee eee ee eee eee eee ee eee eee 44 3 9 2 Selecting speech material 2 22 5 3265 25 ed nel doe whe ldbeiwedtccesveountl aalies 48 3 9 3 Scoring words using integrated OTOsuite Speech Material _ 50 3 9 4 Scoring words using external sound source eee cece eee ec cc cece ecceees 52 3 9 5 Scoring phonemes using integrated OTOsuite speech material 53 3 9 6 Scoring phonemes using external sound source _ eee cece ee ec eee eeeeeee 54 3 9 7 Saving source levels for speech material _ 22 002 eee eee eee eee ee eee eee 55 Speech testing tabular view _ 2 lc eee eee eee ccc cee cece cece ence cece ceeeeeeeee 56 3 10 1 Speech editing opti
3. o _ Tone Pecatrx Speech Sts ane MO 0U QISIN Bebesy Trius 20 SS Chi Prerecorded Phone Left 0 0 0 60 S T r0d28 way oq 40 Trad29 wey 301 20 a Trad 30 wav a 10 T radai we T radad wav T radas wav BUA gt wh l0 1208 rw al Loudness Sling 20 l O SWN Phone Right 2 10 5 32 20 amp Selected for Play Tested Lists Audogam P c Users abojesen Desktop tmp MyWavys 5 xj eI j tmp MyWavs sera Ble Edk Toos Help Organize Inde in library 3 fi x E O o speechieve D TrackO7 wav E Trackis we Z gt TrSerOT we E TrackOS wav E TrackiS we 4 E TrackO02 wav E Track09 wav E Tracki6 we 2 E Track03 wav E TrackiO wav E Trackl7 w TrackO4 wav Tracki l wav EJ Tracki8 we E ES Track0S wav E Tracki2 wav BD Tracki9 we a EP Track06 wav Ep Tracki3 wav m Track20 we apa Kt 2 136 tems f 7 In the Speech test screen of the OTOsuite Audiometry module you can use either tabular view or graphical view 1 To select the view you wish to use select Tools gt Options gt Audiometry gt Speech gt Speech View Mode gt Tabular View or Graphical View General description The tabular speech view consists of a table showing the measurement conditions for testing and displaying the speech data The rows are color coded according to their respective routing The table adapts to the tests and adds a row for ea
4. 10 Troubleshooting 156 Otometrics MADSEN Astera 11 Standards and safety This manual contains information and warnings which must be followed to ensure the safe performance of the devices and software covered by this manual Local government rules and regulations if applicable should also be followed at all times See Symbols used 157 and Connector warning notes 157 11 1 Symbols used MADSEN Astera complies with the standards listed below Electronic equipment covered by the Directive 2002 96 EC on waste electrical and electronic equipment WEEE All electrical and electronic products batteries and accumulators must be taken to separate collection at the end of their working life This requirement applies in the European Union Do not dispose of these products as unsorted municipal waste You can return your device and accessories to Otometrics or to any Otometrics supplier You can also con tact your local authorities for advice on disposal Consult user manual for warnings and cautions Consult user manual for warnings and cautions Consult instructions for use Complies with Type B requirements of IEC60601 1 Complies with Medical Devices Directive 93 42 EEC and RoHS Directive 2011 65 EC MEDICAL General Medical Equipment as to electrical shock fire and mechanical hazards only in accord ance with UL 60601 1 first edition 2003 CAN CSA 22 2 No 601 1 M90 MEDICAL General Medical Equipment as
5. 4 Connect the ACP to the PC See Connecting the ACP to the PC gt 139 eee Cto seece Cee eecece eee seece eoo eeeee eee eeecee eeeceeece o o eecee 5 Connect accessories to the ACP See Connecting accessories to the ACP 141 Otometrics MADSEN Astera 137 6 Unpacking and installing 6 4 4 Connecting the ACP to MADSEN Astera 8 o 5 8 0 6 6 o 0 O 6 0 6 0 0 e 6 6 o 8 l b 6 0 0 6 6 6 amp o o 6 6 a o o o Cabling Caution Make sure that each jack as depicted on each end of the cable connects with the specific sockets on the ACP and MADSEN Astera All four cables for connecting accessories are joined in a bundle and color coded for easy connection e Yellow Operator desktop microphone e Green Operator monitor headset headphones e Pink Operator monitor headset boom microphone e Gray Operator monitor speaker Connecting 1 Remove the cable cover from MADSEN Astera 2 Connect the ACP to MADSEN Astera SeG888 LELTE CELIE CELLIE 508 CELTE The connections are located at f f the back of the ACP O O eae From Main Unit To Operator 138 Otometrics MADSEN Astera 6 4 5 6 Unpacking and installing Operator desktop microphone e Ifyou are using a desktop microphone connect the yellow cable in the cable bundle
6. Presents filtered ISTS International Speech Test Signal asthe stimulus type To configure the bandwidth of the stimulus click the ISTS button in the toolbar or select Tools gt ISTS Bandwidth You can set the width for each test frequency TRANSDUCER Otometrics MADSEN Astera 95 a sioesone reae OOOO Test Options METHOD Adaptive Non Adaptive Manual Familianization MANUAL dB STEP 5 STIMULUS Shuffle Frequency Order DdB v UCL Offset Unaided v Condition Test Options METHOD e Adaptive Selects the adaptive mode where the patient is tested in two phases e Inthe first phase the dynamic range is roughly estimated e Inthe second phase the dynamic max level is calculated based on the presentation of stimulus as the max level presented in the first phase plus 5 dB e Non Adaptive Selects the non adaptive mode where the patient is tested in two phases e Inthe first phase the patient is instructed to respond to the softest sound the threshold which the patient can hear The level is then increased and the patient is instructed to respond when the stimulus reaches the UCL In the second phase the threshold and the UCL from phase one are used as reference points for the rest of the test Selects manual mode where you use the regular audiometer controls to perform Loudness Scaling testing Otometrics MADSEN Astera 3 14 11 2 Test Options e Familiarization You can run a predefined n
7. sss ee Right The stimulus masker will be presented to the right transducer Binaural The stimulus masker will be presented to both the left and right transducers 3 15 2 5 Test type controls Aided Displays the aided symbols on the graph in the OTOsuite Audiometry Module when data E points are stored Aided can be selected in combination with any other test type TONE THR Threshold Displays the typical audiometric symbols for air conduction bone conduction masked or unmasked on the graph when data points are stored MCL Displays the Most Comfortable Loudness symbol on the graph when data points are stored UCL Displays the UnComfortable Loudness symbol on the graph when data points are stored SPEECH SDT The data will be stored asa Speech Detection Threshold 112 Otometrics MADSEN Astera 3 15 2 6 Speech test controls B eee e00eee0 T D eoo sol 9 eeo g T eee Otometrics MADSEN Astera F eee eee0ee0 E 6 eee ee0e0ee0 SRT The data will be stored asa Speech Reception Threshold MCL The data will be stored as a Most Comfortable Loudness level UCL The data will be stored asan UnComfortable Loudness level WRS SRS The data will be stored as a Word Recognition Score or Sentence Recognition Score Speech material controls Play pause The button toggles between Play and Pause e Play ai Press the play button
8. 17 3 Navigating in the OTOsuite Audiometry Module mension em oes TE Standard All High frequencies Frequency resolution 3 2 4 Measurement menu Monitoring Desktop Headset Microphone Talk to Assistant 18 The graph shows up to 20 000 Hz MADSEN Astera presents stimulus up to 12 500 Hz e Click to choose between viewing Standard Frequencies Displays the audiogram from 125 to 8000 Hz All Frequencies Displaysthe audiogram from 125 to 20 000 Hz High Frequencies Displays the audiogram from 8000 to 20 000 Hz The options for frequency resolutions are 1 6 1 12 1 24 and 1 48 octave as well as 1 Hz Select the different tone stimulus resolutions from the toolbar or from Tools gt Options gt Audiometry gt General You can store up to 24 points for each audiometry curve You will be prompted if you try to store more than the maximum number of points Enables or disables the monitor speaker for monitoring stimuli presented to the patient from the Stimulus or Masking channel l e Channel 1 or Channel 2 Toggle microphone types Click to toggle between the operator headset boom microphones and desktop microphone used to communicate with the patient and or the assistant The one displayed isthe one currently active Click to enable or disable talking to another party usually a second tester in the booth Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module
9. 5 Examples of audiometric testing 5 1 Testing the older child or adult patient 5 1 1 Assessing pure tone threshold using the Hughson Westlake procedure Threshold This isthe lowest level at which the patient responds to the stimulus at least 50 of the time 1 Talk tothe patient while you walk him her to the booth This will give you some idea of how well he she is hearing Ask him her which ear is his her better hearing ear 2 Perform otoscopic inspection of the ear canals to make sure that the ears are free from occluding cerumen earwax or debris 3 Optional Perform tympanometry and reflexes prior to audiometric test 4 Properly place the earphones Begin the test with the air conduction transducer Ifyou are planning to test high frequencies use the HDA 200 earphones for all frequencies if they have been cal ibrated for all frequencies 5 Give the patient the responder s 6 Instruct the patient so that he she knows what to expect You will hear various sounds from low pitches to high pitches Push the button when you hear a sound even if it is very soft 7 Ifthe patient reports having tinnitus consider using a pulsed tone for testing 8 Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing sound level and frequency Make sure that threshold test THR is selected 9 Begin the test inthe ear reported as the better hearing ear Tell the patient in which ear th
10. 6 3 2 ACP Front view MADSEN Astera is operated from either the software or the ACP front panel The ACP front panel controls are described in detail in ACP front panel controls 106 132 Otometrics MADSEN Astera 6 Unpacking and installing Se otometrics Rear view The rear panel contains the sockets for connecting various accessories the sockets for connecting the ACP to MADSEN Astera and the USB socket for connecting to the PC See also Assembling the ACP 137 L O From Main Unit To Operator Otometrics MADSEN Astera 133 6 Unpacking and installing 6 3 3 Total system view MADSEN Astera ACP PC connection setup 60 M Tt pppop 8 F008 8m PTT oe LL LL ee me BPD PTE eo oeeed T i 6 4 Installing MADSEN Astera and the ACP This section provides you with instructions on how to assemble and install MADSEN Astera and the ACP Caution Install the OTOsuite Audiometry Module on the PC before you connect MADSEN Astera and the ACP to the PC e Before you start using MADSEN Astera it is recommended that you leave it at room temperature for 30 minutes par ticularly if it has been stored at very cold or warm temperatures e g if it has been in acar e Choose between placing MADSEN Astera on the desktop or mounting it on the wall using the wall mounting plate Safety aspects To ensure safe performance MADSEN Astera and the ACP must be correctly installed and
11. 8 dB of the SDT for each ear if the data are reliable Click in the Reliability box to report the reliability of the patient s responses during testing Good Fair or Poor 5 3 Special Tests 5 3 1 Performing Tone Decay using the Modified Carhart Method 1 Properly place the earphones Begin the test with the air conduction transducer 2 Give the patient a responder 3 Instruct the patient so that he she knows what to expect You will hear a continuous tone Press the button on the responder as long as the tone stays the same If the pitch changes or you can no longer hear the tone release the responder button 4 Select tone decay in the Test Selector Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing sound level and frequency Any frequency can be used 5 Make sure that the tone decay box and the timer box have appeared in the display 6 Start the test at 5 dB above the patient s threshold for that frequency in that ear 7 Assoon as the subject responds start the timer You will be presenting a tone for at least one minute 8 Ifthe patient indicates that the tone was audible at the same pitch for one minute then the test is complete Store the test result in the Tone Decay Box 9 Ifthe patient indicates that the tone is no longer audible or changes pitch before one minute passes increase the level of the tone by 5 dB Reset the timer w
12. 9 1 9 1 1 9 2 Maintenance and calibration MADSEN Astera requires no preventive maintenance except for regular calibration of the transducers See Calibration 154 Service and repair It is recommended that you keep the packing material in which MADSEN Astera was delivered If you need to send it in for service the original packing material will ensure protection against damage during transport etc Warninge For the sake of safety and in order not to void the warranty service and repair of electro medical equipment should be carried out only by the equipment manufacturer or by service personnel at authorized work shops In case of any defects make a detailed description of the defect s and contact your supplier Do not use a defective device Note There are no user serviceable parts inside the MADSEN Astera cabinet Fuses MADSEN Astera has no user accessible fuses Cleaning There are no specific requirements to sterilization or disinfection of the test device Cleaning the device Make sure that the instrument is kept clean and free of dust e Remove dust using a soft brush e Toclean the cabinet use a soft slightly damp cloth with a small amount of mild detergent on it Cautions Do not allow any moisture inside the instrument Cleaning accessories Headphones The headphones are in constant contact with the patient and should therefore be kept clean Clean the headphones between patients e g
13. Entire level range AC 125 to 5000 Hz 3 dB 5000 to 20000 Hz 5 dB Entire level range BC 250 to 5000 Hz 4 dB 5000 to 8000 Hz 5 dB Level resolution 1 2 or 5 dB step resolution over the entire range HL Range Maximum output will be limited by the transducer AC 10 to 120 dB HL 500 to 4000 Hz supra aural earphones BC 10 to 80 dB HL 1500 to 3000 Hz mastoid placement SF 103 dB HL Note with external amplifier Total harmonic distortion Air lt 2 5 Bone lt lt 5 Selectable transducers AC TDH39 HDA 200 HDA 300 and Insert Earphones BC Bone vibrator Mastoid Forehead SF e Passive sound field speaker using the built in amplifier inMADSEN Astera or e Sound field speaker with built in amplifier or external amplifier with both types using the line output from MADSEN Astera Transducer options depend on how MADSEN Astera is ordered and calibrated 162 Otometrics MADSEN Astera Outputs AC BC SF power output SF line output External inputs CD Analog line in Talk Back microphone Stimulus presentation Normal Continuous ON Pulse Pulse duration Operator accessories Operator monitor speaker Operator monitor headset head phones Operator monitor headset boom microphone Operator desktop microphone Assistant monitor headset Static force of transducer headbands TDH 39 Otometrics MADSEN Astera 12 Technical specifications 3 x 2
14. 3 14 3 2 3 14 4 3 14 4 1 The test process The audiometer produces an intensity increment every 5 seconds Each increment has a rise time of 50 msec a duration at full strength of 200 msec and a decay time of 50 msec The size of the increment can be varied from Oto 5 dB in 1 dB steps selected on screen from the Increment box although the test is scored only on the percentage of 1 dB increments correctly identified by the patient Twenty 1 dB increments are presented during the test If the subject responds 10 times out of the 20 1 dB increments the sensitivity index is 50 Before starting the test Before starting the test present five 5 dB increments to give the patient a noticeably intense increment to respond to ABLB Alternate Binaural Loudness Balance This test was first described by Fowler 1928 Hearing levels at which a pure tone sounds equally loud to both ears of a subject are compared The test is applicable when there is a difference in hearing loss of at least 20 dB between the two ears at the pure tone test frequency Navigating in ABLB The Control Panel Continuous ON When checked the stimulus will be continuously on and will turn off when you press the stimulus button Insert Presents the stimulus through the insert earphones Presents the stimulus through the headphones High Frequency Presents the stimulus through the high frequency headphones Left transducer is considered the ABLB test ear R
15. 43 Saving source levels for speech material Note This feature applies to sound files on the PC hard drive except for the integrated OTOsuite Speech Mater ial If you have a folder on the PC containing WAVE wav files eg from a CD you can calibrate these files by adjusting the Source A and Source B levels in the Monitor and Level section of the control panel The next time you browse to this folder or create a user test the Source A and Source B level settings will automatically be set to the saved level Otometrics MADSEN Astera 55 3 Navigating in the OTOsuite Audiometry Module Procedure 1 Browse to the folder containing AET the WAVE wav file or files you wish to adjust to a specific aus CHANNEL Continuous ON STIMULUS level 2 Play the file from the Speech MASKING TRANSDUCER player 3 Use the dials in the Monitor and Level section of the con trol panel to adjust the levels to zero as seen on the VU meter 4 Open the Play list in the Speech player and click Save Source A amp B level in this folder 5 Afile called O speechlevel is created in this folder The next time you play any file from this folder it will be cal ibrated to the level set in the O speechlevel file 3 10 Speech testing tabular view Selecting tabular or graphical view E n Ele fdt Yiew Measurement Jools Reports Help De a7 iy S F Navigator Control Panel gt a A RI
16. Begin the test with the air conduction transducer Instruct the patient that you are trying to find the level at which he she is most comfortable listening to the sounds Make sure that the control panel of the OTOsuite software is set to the correct transducer desired routing and sound level Make sure that most comfortable level test MCL is selected Start at a moderate level Present the stimulus and ask the patient if the current level is comfortable or if he she would prefer it louder or softer Increase and decrease the sound level until the patient s preferred level is determined This is the MCL Once MCL is obtained store the response Repeat steps 3 and 4 for each frequency if performing MCL testing for pure tones Switch to the other ear and tell the patient to listen for the sounds in that ear Repeat steps 3 and 4 for the opposite ear Assessing pure tone or speech uncomfortable loudness level UCL 1 Properly place the earphones Begin the test with the air conduction transducer Instruct the patient that you are trying to find the level at which the sound is uncomfortably loud It should be tol erable and not painful Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing and sound level Make sure that uncomfortable loudness testing UCL is selected Otometrics MADSEN Astera 5 Examples of audiometric testing 4 Start ata
17. Changing an assigned transducer for a pinned test 1 Select the transducer in the Control Panel 2 Right click on the Apply Settings button in the pinned test row and select Assign Selected Transducer Note When you use Click n Get to apply settings the AC transducer as well as the speech stimulus are loaded as your preferred starting point You can always adjust them in the Control Panel or in the Speech Player panel Example 1 You typically use insert phones but you have a patient with an ear infection and you wish to use supra aural head phones Use Click n Get to load the desired test and simply switch to Phone in the Control Panel before you start the test Example 2 You typically wish to start the Speech test by familiarizing the patient with a specific word list before starting the actual test with a different word list Use Click n Get to load the desired starting point and simply switch to any word list you wish to use after the familiarization Storing data ina row To store data in a row click the dB field in the relevant row or press S on your keyboard The Info field The Info field provides additional information such asa stimulus source e g CD Live File or specific soeech material as well as noise condition and your own comments if desired To add your own comments right click the Info field Editing a row Click on the data you wish to edit and use the right click menu to change the value
18. Intensity Indicated by the dB level above the channel status bars e The green wave symbol above the level indicates with two waves that the stimulus carrier tone is currently being presented and with three waves that the increment is applied Stimulus bar color Indicates the routing for the channel e Blue left ear e Red right ear Stimulus transducer and routing indicators Indicates the stimulus type the transducer and the routing for each channel Test Controls Test controls provide ameans of operating the audiometer if you use the mouse and on screen options to perform tests e Toenable test controls select Tools gt Options gt Audiometry gt General gt On screen controls Controlling intensity and frequency and storing data The Up arrow increases the base line intensity The Down arrow decreases the base line intensity e The Up arrow increases the DeltaL modulation size e The Down arrow decreases the DeltaL modulation size Player Timer box e The timer is used for keeping track of when to change the Deltal Play button Starts the test and the timing Otometrics MADSEN Astera Stop button Stops the test and the timing Reset button Resets the timer DLI data EVALUATION ONLY File Edit View Measurement Tools Reports Help SDD Dee DED PF Novoner E omoran BY BOW F E Tone Speech sist ass mp ou 500 gt Chi Tone Phone Left Fre
19. MADSEN Astera 3 5 2 3 Monitor and Level 3 Navigating in the OTOsuite Audiometry Module The signal level changes in 3 dB steps with each click of the arrow up or arrow down buttons To change the signal level by more than one click at a time use the mouse scroll wheel The check boxes are used for enabling disabling of mon itoring You can also define this in Tools gt Options gt Audiometry gt General gt Measurement gt Monitor Chi Ch2 Talk back Click to enable monitoring of Channel 1 or Channel 2 The indicator dis plays the level of the signal Talkback can be monitored if this option is enabled The indicator displays the level of the signal The signal level changes in 1 dB steps with each click of the arrow up or arrow down buttons e Tochange the signal level by more than one click at a time use the mouse scroll wheel Source A Source B 3 6 The stimulus bar Stimulus Tone Insert be Intensity Stimulus indicator Transducer indicator Stimulus being presented Sopp Otometrics MADSEN Astera For adjusting the sensitivity ofthe test microphone reflected on the VU meter only used for Speech testing For adjusting the sensitivity of the signal coming from Source A or Source B reflected on the VU meter only used for Speech testing 1000 20 al NBN Insert Right Masking Frequency Stimulus bar color Routing indicator Masking on ITOmNmnm 31 3 Naviga
20. Options gt Tone or Tools gt Options gt Speech Speech Presents a Speech Weighted Noise as the masking type SWN is the default Transducer Presents the stimulus or masker through the insert earphones Phone Presents the stimulus or masker through the supra aural headphones High Fre Presents the stimulus or masker through the high frequency headphones quency Presents the stimulus or masker through the bone oscillator Speaker Presents the stimulus or masker through the soundfield speakers e Ifyou are using only 2 speakers the routing is determined by the routing controls Left Right Bin aural If you are using only 2 speakers you can set up a channel to provide stimulus masking via a dif ferent transducer i e when providing masking to one ear and stimulating the other ear using the soundfield speakers 28 Otometrics MADSEN Astera Transducer Multiple SPEAKERS Multiple Front Left Front Right Undefined Undefined Save As Test Options Routing 3 5 2 2 Test Options Talk Forward Test options dB Step Defines the intensity of the stimulus and masker used to record the audiogram Threshold Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Enables multiple speaker routing options This routing setup is only available if you have purchased multiple speaker package If 4 speakers are used you can determine which stimulus will be presented from
21. Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Enable or disable the Masking Assistant The Masking Assistant causes an unmasked threshold to flash repeatedly if masking is recommended e See The Masking Assistant 20 Enables or disables the overlays Overlays display pictures severity speech banana speech letters unusable area on the audiogram Overlays can also be displayed by selecting them from the overlays box below or next to the audiogram To view hide the overlays box select Tools gt Options gt General e See Tone feature boxes 39 Click to toggle between viewing both ears in a single audiogram com bined audiogram or both a left and aright audiogram on your screen Combined View e Click to view both ears in a single audiogram Split View e Click to view separate audiograms for each ear Click to display the left ear audiogram on the left side of the window and the right ear audiogram on the right side of the window when Dual Graph View is enabled in Options gt Audiometry gt Tone gt Misc Click to display the right ear audiogram on the left side of the win dow and the left ear audiogram on the right side of the window when Dual Graph View is enabled in Options gt Audiometry gt Tone gt Misc Click to enable or disable the display of the audiogram legend The legend contains the most commonly used symbols for the audiogram It is not configurable
22. View gt Score Presentation e Click onthe relevant phoneme score counter button to record the response of the client Otometrics MADSEN Astera 53 3 Navigating in the OTOsuite Audiometry Module The Word List The Word List is shown automatically when you select an integrated word list You can view the currently selected integrated OTOsuite Speech Material in the Word List and use it to review and edit scoring during the test You can also see the word currently being played back for monitoring purposes The number of correct phonemes repeated is marked with the corresponding number to the left of the word in the list The word currently playing is indicated by a musical note and highlighted in blue inthe list You can right click on a word to change the score or control the play back of the word list You can either play back a single item or select a place in the list where you want Th oe to start the play back Ignore Play From Here Play Item Cancel Using word lists with monitored live voice testing When you have loaded an integrated OTOsuite Speech Material you can use the word list to read from using Mic stim ulus for live voice testing Store the phoneme score results See Selecting the work area inthe Speech screen gt 43 3 9 6 Scoring phonemes using external sound source Note Using an external sound source includes the use of all types of sound sources such as CDs MP3 players casse
23. duction This test is used to confirm a conductive hearing loss 2 Instruct the patient that two tones will be presented to him her Ask the patient to tell you when the tone can no longer be heard 3 Make sure that the Rinne box is present 4 Strike the tuning fork against the knee or the elbow not the table otherwise the vibrations will be excessive and cause the patient discomfort 5 Hold the fork for 2 3 seconds and then place it on the patient s mastoid Note The time interval from initial stimulus perception to inability to hear the tone 6 Strike the fork again 7 Hold the fork for 2 3 seconds and then place it in front of the patient s ear Note The time interval from initial stimulus perception to inability to hear the tone 8 Ifair conduction perception is better than bone conduction this isa positive Rinne and agrees with normal hearing 9 Ifbone conduction perception is better than air conduction this isa negative Rinne and indicative of a conductive hearing loss 10 If air conduction and bone conduction are equal this is a positive Rinne and indicative of a sensorineural hearing loss 11 Store the test result inthe Rinne Box 5 3 6 Performing Alternate Binaural Loudness Balancing ABLB test If you have measured thresholds prior to performing ABLB then these will appear already plotted in the ABLB graph 1 2 Properly place the earphones Give the patient the responder s Otometrics MADSEN Astera
24. from the Operator desktop microphone socket in the MADSEN Astera rear panel to the Operator desktop microphone socket in the ACP Operator monitor headset with boom microphone e Connectthe green cable in the cable bundle from the Operator monitor headset head phones socket in the MADSEN Astera rear panel to the Operator monitor headset headphones socket in the ACP e Connectthe pink cable in the cable bundle from the Operator monitor headset boom microphone socket in the MADSEN Astera rear panel to the Operator monitor headset boom microphone socket in the ACP Speaker built into the ACP e Connectthe gray cable in the cable bundle from the Operator monitor speaker socket in the MADSEN Astera rear panel to the Operator monitor speaker socket in the ACP 3 When you have connected the accessories slide the cable cover onto MADSEN Astera and click it into place Connecting the ACP to the PC The ACP is powered from the PC through a USB connection Caution Install the OTOsuite Audiometry Module on the PC before you connect the ACP to the PC Caution To connect the ACP to the PC use the supplied USB cable The cable length must not exceed 3 m approx 10 feet Cautione Do not connect the ACP to the PC by using a bus powered hub USB hub without external power supply It cannot provide sufficient power to the ACP The Power on LED on the ACP will flash to indicate an error Use instead a USB hub with external
25. with a non alcohol based antibacterial wipe such as Audiowipes Eartips for Insert Earphones Warninge To prevent cross infection use new eartips when you test the next client Otometrics MADSEN Astera 153 9 Maintenance and calibration The eartips are disposable and therefore should not be cleaned or re used There are no special requirements for the dis posal of the eartips Bone oscillator Clean the bone oscillator between patients e g with a non alcohol based antibacterial wipe such as Audiowipes 9 3 Calibration Annual calibration The audiometer headphones bone oscillators and sound field speakers must be calibrated once a year by your authorized service department The audiometer is dispatched from the factory together with a Test Report Calibration Certificate The Test Report spe cifies the transducers that have been calibrated i e those which have been supplied together with the instrument according to which standards and the equipment used for calibration Results are listed for each transducer at all standard frequencies In general the instrument is calibrated in dB HL and dB masking level using the stated reference equivalent thresholds dB HL is related to sound pressure levels dB SPL dB re 20 UPa and force levels dB re 1 uN Cautione Note that calibration has been performed only on the transducers supplied If you wish to use any other transducer for testing with the device please contact you
26. 2 4 3 4 4 4 5 5 Examples of audiometric testing 2 22 2 eee eee eee ee eee ee ee eee eee eee eeee Testing the older child or adult patient _ 20 02 eee ee cee eee eee eee cece eeeeeee 5 1 1 Assessing pure tone threshold using the Hughson Westlake procedure __ 5 1 2 Assessing pure tone or speech most comfortable loudness level MCL 5 1 3 Assessing pure tone or speech uncomfortable loudness level UCL _ 5 1 4 Assessing speech reception threshold SRT using the Hughson Westlake procedure 5 1 5 Assessing word recognition score _ 2 2c eee eee ee eee eee ee eee eee testine the pediatric patient 2226 scccowales et es en be dedcadonsicedcaned usudsis Geers oeceaceens 5 2 1 Assessing speech detection threshold SDT using the Hughson Westlake procedure 5 2 2 Assessing pure tone threshold using the Hughson Westlake procedure _ Special TESTS 5 phi sed Ae h hs aan ee eee aa e eaa a etl edi atta geet Aalst cae det 5 1 5 2 5 3 5 3 1 S302 5 3 3 5 3 4 5 3 5 5 3 6 5 3 7 Performing Tone Decay using the Modified Carhart Method Performing a pure tone Stenger _ 022 eel eee eee eee eee eee ee eee eee Performing speech Stenger 22 6 oc ies edd cesdedeeesddden cieeeceetbdaddddcdeuciancisax Performing Weber ioe toes thc sot cab once tins ou ate chill ages See aoe eee PERM OnMING RIONE 2 l
27. 2 3 dB List Info 80 1 Mute video pr ya 17 09 2012 Se otometrics Select the desired test list in the player Present the test with earphones or in a sound field Instruct the patient in how to respond to the presented material Score the key words highlighted in each sentence by clicking the words on the screen You can also enter a full sen tence score by clicking the All Correct button You can store results inthe Results Table by clicking the Store button Click the table to review scoring data Otometrics MADSEN Astera 3 14 9 3 14 9 1 Otometrics MADSEN Astera 89 Tinnitus Navigating in Tinnitus The Control Panel Continuous ON The stimulus is continuously on and turns off when you present the stimulus SIGNAL Presents a pure tone as the stimulus type e 125 Hzto 12 500 Hz is standard e 12 500 to 20 000 Hz is optional Presents a warbled pure tone as the stimulus type This stimulus type should be used for sound field testing to avoid any standing waves Presents the customized FRESH noise as the stimulus type FRESH stands for FREquency Specific Hearing assessment noise Presents Narrow Band Noise asthe stimulus type Presents White Noise as the stimulus type TRANSDUCER a msioesone norae OOOO This determines the dB step size for the intensity of the stimulus when presenting the tone manually fs Pulsed Presents the sti
28. 200 HDA 300 earphones Insert earphones BC SF Tone accuracy FRESH noise stimulus Narrow Band Noise masking Frequency resolution Stimulus types e Tone e Warble e Pulsed tone e Pulsed warble e FRESH noise e Pulsed FRESH noise Masking types e Narrow Band Noise ACand BC SF e Speech Weighted Noise ACand BC SF Otometrics MADSEN Astera Standard frequencies 125 12500 Hz Standard frequencies 125 20000 Hz Standard frequencies 125 8000 Hz Standard frequencies 250 8000 Hz Standard frequencies 125 20000 Hz gt 0 03 Available in entire frequency range within the transducer specified range for SF 125 12500 Hz Accuracy 0 3 Available in entire frequency range 1 48 1 24 1 12 and 1 6 oct 1 Hz step Frequency specific hearing assessment noise Consists of noise bands with frequency specific filter width The FRESH noise is filtered to obtain very steep slopes outside the passband Correlated Non correlated Correlated Non correlated 161 12 Technical specifications e White Noise Wide band noise ACand BC Correlated SF Non correlated A Amaximum of 3 non correlated simultaneous masking signals Stimulus modulation FM Warble Adjustable modulation rate and depth e Modulation rate 1 20 Hz default 5 Hz e Modulation depth 1 25 of center frequency default 5 SISI 5 2 1 dB increments Accuracy of sound level
29. B 1996 Development of the Tinnitus Handicap Inventory Archives of Otolaryngology 122 143 148 Newman C W Sandridge S A Jacobson G P 1998 Psychometric adequacy of the Tinnitus Handicap Inventory THI for evaluating treatment outcome Journal of the American Academy of Audiology 9 153 160 e TFI Tinnitus Functional Index The Tinnitus Functional Index TFI has documented validity both for scaling the severity and negative impact of tin nitus for use in intake assessment and for measuring treatment related changes in tinnitus responsiveness It provides comprehensive coverage of multiple tinnitus severity domains References TFI Meikle MB Henry JA Griest SE Stewart BJ Abrams HB McArdle R Myers PJ Newman CW Sandridge S Turk DC Folmer RL Frederick EJ House JW Jacobson GP Kinney SE Martin WH Nagler SM Reich GE Searchfield G Swee tow R Vernon JA 2012 The tinnitus functional index development of a new clinical measure for chronic intrus ive tinnitus Ear Hear Mar Apr 33 2 153 76 http www ohsu edu xd health services ent services tinnitus clinic tinnitus functional index cfm Otometrics MADSEN Astera e THS Tinnitus and Hearing Survey The Tinnitus and Hearing Survey is a brief questionnaire designed specifically to assist patients and clinicians in determ ining how much ofa patient s reported problem is due to tinnitus and how much is due to hearing problems The sur vey also contai
30. Click ona test record in the Oldenburg Measurements main window 2 Click the button Delete Measurement 3 14 13 Ambient Noise Assessor Note The Ambient Noise Assessor feature is based on ANSI standard 3 1 and is available by special request only If you are interested in this feature please contact your local OTOsuite sales representative 100 Otometrics MADSEN Astera 3 14 13 1 3 14 13 2 With Ambient Noise Assessor you can use AURICAL FreeFit to measure ambient noise levels during audiometric tests in the Tone screen and in the Speech screen in tabular view The permissible noise level is calculated according to ANSI 3 1 The Ambient Noise Assessor dialog indicates whether the current noise level is permissible for the current measurement according to ANSI 3 1 The permissible noise level depends on the frequency and level of the stimulus that is being tested as well as other factors such as the transducer type Selecting the FreeFit device in OTOsuite You must select your FreeFit device in the configuration wizard before you can use FreeFit for the first time 1 In OTOsuite click Tools gt Configuration wizard and then click the Configure button for PMM 2 Onthe Select Your FreeFit page select your device Ifthe device is not listed turn on FreeFit by pressing the power button on the device Check the My device is turned on and ready to be found check box and then click Search 3 Click Finish twic
31. F MOOD Setting up for Scoring and Playing To set up for scoring and playing see Selecting word or phoneme scoring gt 44 The Stimulus bar word score 50 amp 50 7 14 20 l RSS hte Chi Pre recorded Insert Right SWN Insert Left Ch2 20 10 5 32 0 ii 2 3 20 10 5 32 0 1 2 38 Scoring Panel The score percentage and the Correct or Incorrect scores relating to the number of words played are shown at the top of the screen When you use integrated word lists the Scoring Panel is either initialized to 0 0 0 or to 100 0 0 depending on the setting in Tools gt Options gt Audiometry gt Speech gt View gt Score Presentation e Click on the relevant Word score counter button to record the response of the client Otometrics MADSEN Astera The Word List box Selected for Play Tested Lists es Nag Limb Shout Sub Dime P Tough Puff E Change Score JJ Play From Here JJ Play Item Cancel Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module The Word List box consists of a tab showing the list Selected for Play and Tested Lists Selected for Play The Word List is shown automatically in the Selected for Play tab when you select an integrated word list You can view the selected OTOsuite Speech Material in the Word List and use it to review and edit scoring during the test Scoring You can always click on any word to cha
32. Hall Ill H Gustav Mueller Ill Singular Publishing Group 1997 and Munro K J Agnew N A comparison of inter aural attenuation with the Ety motic ER 3A insert earphone and the Telephonics TDH 39 supra aural earphone Br J Audiol 1999 33 259 262 Otometrics MADSEN Astera 21 3 Navigating in the OTOsuite Audiometry Module denotes configurable Air Bone gap criterion Tools gt Configuration Wizard gt Configure Audiometry gt Masking Assist ant Min IA is frequency specific These are the Min IA tables for TDH 39 and Otometrics Inserts used in the Masking Assistant Min IA supraaural phone TDH 39 frequency specific ce fel o e mnonapew anim o u mewn mo o uun ow e mewn soo o uane mo u mewn w a asin eileen neaapew anton Min IA insert phone Co o mwe isto o se 22 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module 3000 Munro amp Agnew BJA 1999 4000 Munro amp Agnew BJA 1999 6000 Munro amp Agnew BJA 1999 8000 Munro amp Agnew BJA 1999 3 5 The Control Panels l Click the Control Panel icon in the toolbar to activate the Control Panel Note If you are using the MADSEN Astera ACP you may choose not to display the Control Panel Select Tools gt Configuration Wizard gt and click Next until the Preferences screen is displayed The checkbox Activate control panel must be disabled Click the Sunshine icon to select
33. MADSEN Astera the ACP and the OTOsuite Audiometry Module Warninge Local government rules and regulations if applicable should be followed at all times Safety information is stated where it is relevant and general safety aspects are described in Standards and safety 157 e Standards and safety 157 gives you an overview of device labeling and standards e General warning notes 158 contains relevant warning notes e Connector warning notes 157 contains connector warning notes Typographical conventions The use of Warning Caution and Note To draw your attention to information regarding safe and appropriate use of the device or software the manual uses pre cautionary statements as follows Warning Indicates that there is a risk of death or serious injury to the user or patient Otometrics MADSEN Astera 1 Introduction to MADSEN Astera Cautione Indicates that there is a risk of injury to the user or patient or risk of damage to data or the device Note Indicates that you should take special notice 1 6 1 Navigation Menus icons and functions to select are shown in bold type as for instance in a e Click the Set options icon on the toolbar or select Tools gt Options 25 lt Otometrics MADSEN Astera 11 1 Introduction to MADSEN Astera 12 Otometrics MADSEN Astera Getting started Training We recommend that you read this manual and make yourself familiar with the MADSEN Aster
34. You can measure and store the results for one ear by using Ch 1 and for the other ear by using Ch 2 1 Select Dual Graph View 2 Assign Ch 1 and Ch 2 routings to match the view order of the graphs To do so assign a stimulus to each channel No Masking one test ear to Ch 1 and the other to Ch 2 Note Frequency Shift on Store is disabled when you use this feature ACP Use the dials and the control buttonsto control the frequency levels and stimulus To store Ch 1 results press the Store button on the left hand side To store Ch 2 results press the Store button on the right hand side 3 8 3 Automatic frequency level shift when storing When you use the Wrap or Butterfly method for testing this feature enables you to speed up the test process by auto matically shifting frequency and level when you store a point in the audiogram To do so select Tools gt Options gt Tone gt Measurement gt Auto Freq Level Shift Note Masking is always switched off when the frequency is changed automatically 42 Otometrics MADSEN Astera 3 8 4 3 8 5 3 8 6 3 9 3 Navigating in the OTOsuite Audiometry Module You can set up the definitions for each of the test types THR MCL and UCL individually Included AC BC SF Defines which frequencies to exclude from the automatic frequency shift The actual available Frequencies frequency range is defined by the selected transducer Note You can always select any frequency man
35. active audiogram You can switch the position ofthe right and left graphs to cor respond to your viewing preference 1 Select Tools gt Options gt Tone gt Misc gt Dual Graph View orin the menu bar under View 15k 3k OK A Stimulus marker ear color B Masking level indicator Viewing masking levels Below the audiogram the intensity levels used for masking can be displayed It isan option to display the masking levels Select Tools gt Options gt Tone gt View gt Misc gt Masking Levels e In combined view the non test ear masking levels are shown below the graph 110 i ia 750 15k 3k 6k 125k Hz Masking AC dB EML R L 125 250 500 750 1k 15k 2k 3k 4k 6k 8k 125k 36 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Masking levels e In Dual Graph View the masking level used for masking the non test ear will be displayed under the graph for the test ear The masking level can be set to be displayed either under the test ear or under the non test ear select Tools gt Options gt Tone gt View gt Misc gt Masking Table Placement 11u 11u 120 i 120 SF a a 750 15k 3k Masking AC dB EML Masking 4C dB EML 125 250 500 750 tk 15k 2k 3k 4 6k 8k 12 5k 125 250 500 750 ik 15k 2k 3k 4k 6k 8k 12 5k 3 7 3 Curves and symbols selection You can select a symbol and or a curve style for a specific measurement and you can create new symbols 3 7
36. an individual speaker or from a combination of speakers You can determine which speaker s will be used for talk forward When 2 speakers and a masking noise are selected in a channel the noise can be non cor related between the speakers if non correlated noise is enabled in Tools gt Options gt Gen eral Alternate transducers cannot be used in combination with a multiple speaker setup Stores the left symbol on the left audiogram Right Stores the right symbol on the right audiogram Binaural Stores the binaural symbol on both audiograms or once on the combined audiogram Stimulus is routed to the left transducer Right Stimulus is routed to the right transducer Stimulus is routed to both the left and right transducer The stimulus masker from both channels will be presented simultaneously if this option is enabled When the intensity of the stimulus masker for a channel is increased decreased by x dB the intensity of the stimulus masker for the other channel will also increase decrease by the same x GB if this option is enabled Tone The audiometric symbols for air conduction or bone conduction thresholds masked or unmasked will display on the graph when data points are stored 29 3 Navigating in the OTOsuite Audiometry Module Test options Speech The data will be stored as a Speech Detection Threshold This is the lowest level at which the patient responds to speech at least 50 of the time a
37. and horizontal and vertical offsets that will apply when you use the new symbol Compare audiograms Make sure the feature box for Compare Audiograms is visible in the OTO Compare suite main view area if not set Tools gt Options gt Tone gt View gt Show Current z004 03 26 Compare Audiograms to On M 2008 04 07 Unaided e LJ 2006 09 08 Difference OTOsuite under NOAH All sessions relating to the selected client and containing audiometry data are automatically loaded into the Compare Audiograms feature box Otometrics MADSEN Astera Compare current and historical audiograms In the Compare Audiograms feature box single click to select the audiograms you wish to view from the list of historical audi ograms Any selected historical audiogram will appear with grey curves in the audiogram graph All curves of the selected audiograms are viewed and compared simultaneously unless you explicitly select acurve type from the feature box drop down lists The lists let you define the test type and aided condition that you wish to view and compare You can enhance the compare view by enabling the Difference view This is done by checking the Difference option in the fea ture box The Difference view highlights any difference between the most recent and any older audiogram curves selec ted in the list 3 Navigating in the OTOsuite Audiometry Module HL125 250 500 1k 2k 4k Bk 750 1 5k 3k Bk Hz If y
38. been scored for a word the next word is presen ted External speech material Does not apply to external sound source speech material Otometrics MADSEN Astera 47 3 Navigating in the OTOsuite Audiometry Module Playing e Number of items to play back Word scoring Defines the number of words to be presented from the integrated external word list Integrated speech material The player pauses after presenting the defined number of words Press Play to continue play ing the rest of the list External speech material This isthe total number on which the percentage should be based when counting Corrects only or Incorrects only Phoneme Sentence scoring Defines the number of words to be presented from the integrated word list The player pauses after presenting the defined number of words Press Play to continue playing the rest of the list External speech material Does not apply to external sound source speech material Autoscore Autoscore Word scoring When you score words Autoscore is defined by the combinations of the settings in the columns Counting and Playing Ifa word is not manually scored before Time out or before the next word is presented by Continuous Play back the scoring is set automatically External speech material Does not apply to external sound source speech material Phoneme Sentence scoring When you score phonemes you can define Autoscore manually to either ignore the entire
39. button actually a stop icon will pause playing this is different when using word lists 3 Aclick on Reset stops the playback and resets the score How to score e Use the score buttons or shortcut keys When to reset score Notice the field Reset Score Counter in the Options dialog e Reset Score Counter True The Scoring panel is reset if you change Channel Settings except Continuous On the Intensity or if the Reset but ton is clicked e Reset Score Counter False Does not change the score even if Reset is clicked Playing sound files with word lists Prepare playing 1 Use either Int CD or Int File as Sound Source 2 If Int CD is chosen select a CD drive in CD Drive Selection in the Options dialog or in the Player Panel It is import ant that an XML file extension wordlistdefinition describing the word lists exist on your PC in the installation folder If not the tracks on the CD will be listed and not the actual words 3 Ifint File is chosen select a wav file in the Sound File Selection which is located in the same folder as a word listdefinition file You can also browse for a folder in the Player Panel that contains a wordlistdefinition How to play stop files 1 Use either the Play or Pause button 2 A double click ona word in the Word list control plays the selected word 3 A Play button click will start to play back the word list from the current index to the end 4 If you like to chang
40. graph during testing See Curves and symbols selection 37 3 3 The Patient Responder indicator When the patient presses the Patient Responder this is shown on the Stimulus bar and a sound signal from the PC is heard through the Monitor Speaker or Operator Headset The sound signal is optional Tools gt Options gt Audiometry gt General gt Monitoring and Levels gt Audible patient response Use the Configuration Wizard to select Single Responder or Dual Responder setup See Configuring the Audiometry Mod ule gt 147 Single Responder setup e Green Indicates that the patient is pressing the Patient Responder Dual Responder setup Red Indicates that the patient is pressing the right response button Blue Indicates that the patient is pressing the left Hz 30 al response button can chal Red and blue Indicates that the patient is pressing both response 30 I Sere Lait Mii buttons a p nor Le HE beats ayn Ch2 3 4 The Masking Assistant Ifthe Masking Assistant is enabled it will at all times check for frequencies that may require testing with masking This also applies to old audiograms imported from NOAH or XML as long as a supported transducer was stored with the data 20 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module The Masking Assistant is a tool provided to help you with an indication that there may be frequencies where testing with mask
41. gt Options gt Audiometry You can select whether to play the video instantly or whether to briefly display specific screens in order to prepare the patient for the next presentation or present a topic cue for the next presentation Prepare Yourself Otometrics MADSEN Astera 87 3 14 8 7 88 You can disable sound in order to assess the patient s ability to lipread Select the speech list The list can be presented either through earphones or sound field loudspeakers you wish to include in the test Test monaurally or binaurally Insert earphones are recom mended for monaural testing Their high interaural atten uation typically makes masking of the non test ear unnecessary Preparing the patient You can use a practice lists to familiarize the patient with the test protocol 1 Instruct the patient to repeat the sentences that are presented during the test The test process Click the List Selection button to expand and select the list a List 1 Ready No User Test loaded File Edit View Measurement Tools SHe gt Channel Settings CHANNEL Continuous ON TRANSDUCER Inset Phone High Frequency Muttiple Speaker ROUTING Right Binaural V Display Video Monitor Level MONITOR T CHI O m S CH2 Oj Source A gt l 2 Source B amp O Reports Help De oF O 5 2 4F Navigator 5 Control Pane
42. in 3 dB steps 109 Talkback You can monitor the talkback 1 Press and hold the Talkback Monitor button and turn one of the Attenuator knobs to determine the intensity of the signal When you press and hold the Talkback button the level is displayed on the PC screen inthe control panel The level will be adjusted in 3 dB steps Operator microphones monitoring transducer Mic Level To set the microphone level press and hold the Mic Level button and turn one of the Attenuator knobs E When you press and hold the Mic Level button the level is displayed on the PC screen in the control panel The level will be adjusted in 1 dB steps Headset Press to enable the operator headset boom microphone When you enable the headset microphone you disable the desktop microphone Desktop Press to enable the desktop microphone When you enable the desktop microphone you disable the headset boom microphone zs Talk forward Press to enable and speak directly to the patient Press again to disable when done To set the microphone level press the Talk forward button in the Operator Mic column The Talk Forward window will appear on the screen While keeping the Talk forward but ton in the Operator Mic column pressed turn one of the Attenuator knobs to adjust the intensity of the signal 3 15 2 4 CH1 and CH2 controls The buttons in the Channel 1 and Channel 2 columns are identical making it easy for you to activate
43. material as well as noise condition and your own comments if desired To add your own comments right click the Info field Editing a row Click on the data you wish to edit and use the right click menu to change the value Deleting a row Right click on the field you wish to delete and select Delete Measurement Speech editing options graph view When you right click on a measurement in the graph the following options appear Selected Point e g WRS Left If more than one symbol is at the same intensity select the data point of interest Live AC from the drop down Delete Point Deletes a selected data point Delete Curve Deletes a selected data curve Insert No Response This will overwrite the current symbol with aNo Response symbol All Correct score Is shown if Calculate All Correct score is enabled in the Scoring and Playing dia log Otometrics MADSEN Astera 3 12 3 13 3 Navigating in the OTOsuite Audiometry Module Masking Level2 Displays the effective masking level of the measurement point dB EML Curve SNR Displays the Signal to Noise ratio used for the entire curve SNR When you right click on a row in the graph legend the following options appear Selected Point e g WRS Left Live AC Identifies the curve in the graph that you wish to edit If needed enter information of your choice Speech feature boxes You can access anumber of speech display options directly from
44. mouse and on screen options to perform tests e Toenable test controls select Tools gt Options gt Audiometry gt General gt On screen controls Otometrics MADSEN Astera 77 3 14 5 2 3 14 6 78 Controlling intensity and frequency and presenting and storing data e Arrow up increases the intensity e Arrow down decreases the intensity e Arrow left decreases the stimulus frequency e Arrow right increases the stimulus frequency The MLD graph dB HL 500 Hz 10 110 120 SONO SMNO SONM MLD db 12 MLD editing options e Deletes the selected data point e Deletes all data for the currently selected frequency e Closes the window The test process 1 Establish and store the hearing threshold with the SONO condition 2 Maintain the noise level and re establish the threshold using either the STNO or SONT condition 3 The MLD is calculated automatically DLI Difference Limen Intensity This DLI test was developed by Zwislocki and L scher 1949 and was introduced as a procedure for establishing the test subject s capability of detecting small variations of intensity in atone signal The test consists of superimposing brief bursts of 0 2 to 5 dB intensity increments DeltaL on asustained tone presented monaurally through earphones at a sensation level of 20 dB at each tested frequency Otometrics MADSEN Astera 3 14 6 1 The patient is instructed to report any variations in loudness
45. or deselect the Sunshine Panel in either Tone or Speech testing The Sun shine Panel is also available in a range of special tests meal The Sunshine Panel Use the Sunshine Panel to quickly select the main settings for testing See The Sunshine Panel 23 The Classic Control Panel Use the Classic Control Panel to select more advanced settings for testing See The Classic Control Panel 26 3 5 1 The Sunshine Panel Use the Sunshine Panel to quickly select the main settings for testing kl Click the Control Panel icon in the toolbar to activate the Control Panel LJ Click the Sunshine icon in the toolbar to select the Sunshine Panel in Tone or Speech testing or in some of fen the special tests Otometrics MADSEN Astera 23 3 Navigating in the OTOsuite Audiometry Module 24 In the Sunshine Panel you can quickly select test ear transducer masking and test type You can control the monitor level activate the Talk Forward dialog and select the Test Selector for quickly selecting the relevant user test Your selections are shown in the Stimulus bar and as symbols in the audiogram Customizing the Sunshine Panel You can customize the Sunshine Panel to display one or several buttons for some of the functions For instance you can dis play one or more of the Curve Selection buttons on the panel When the right click menu for a button includes the selection Add Remove B
46. out a manual test 1 When you use the manual test method stimuli are presented the same way as in Tone audiometry 2 Start the test by clicking Play This will open the Patient Responder window 3 The manual test can supplement an automatic test whereas an automatic test cannot supplement a manual test Carrying out several tests You can make one or more tests They are displayed in dedicated view tabs at the bottom of the screen A new tab is cre ated whenever anew test setting is selected 3 14 11 3 The test result Equal loudness contours and level loudness function at 1000 Hz for the right ear HL 125 250 500 ik 2k 4k 8k R 7 5 ee PN 15 15 Pint 23 95 25 35 35 _ as 45 49 45 45 750 1 5k 3k 6k Hz Here you can enter something smart 1000Hz 98 Otometrics MADSEN Astera 3 14 12 Otometrics MADSEN Astera The test view tab If you make one or more tests they are displayed in dedicated view tabs at the bottom of the screen A new tab is created whenever a new test setting is selected Any historic Loudness Scaling tests will appear when you load the patient data in OTOsuite Historical data cannot be deletedin OTOsuite but must be done in the source file e g NOAH session The name of the test view tabs contain the measurement settings and test date Editing test results Right click options in the function graph Include selected point If you have exclud
47. playback and scoring the Scoring Counter at the top of the screen shows e the number of words in the list scored correctly of the total number of words in the list e the percentage of correctly scored words e the list currently being presented 3 14 8 3 The LIPread Player Panel Otometrics MADSEN Astera Store The Player Panel is a group of buttons enabling you to control the test You can Reset select the speech list for the test and you can play pause resume and stop the test Play During the test the List View shows only the speech list that has been selected for the current test you can click on any sentence to jump freely in the selected speech list click the Play button to play back the selected sentence Stop Stops play back of the current sentence Store Terminates the test and stores the result Reset Terminates the test without storing any results List selection drop down list Click the drop down to select which speech list to use in the test 85 3 14 8 4 86 The LIPread List View Are Jour Sisters still Single oF are they fmarried List 1 Would Are Do you think the secretary can make the arrangements for the business meeting Get your trousers cleaned or you won t be able to wear them on Saturday We went to the children s zoo and saw the animals The central heating needs repairing The crowds in the stadium cheered when the team
48. product for managing clients launching hearing test applications and fitting software and storing audiological test results OTOsuite stores test results using NOAH Note Whenever reference in this manual is made to NOAH this reference should also apply to NOAH com patible systems Otometrics MADSEN Astera 9 1 Introduction to MADSEN Astera 1 4 1 5 1 5 1 1 6 10 Intended use MADSEN Astera and the Audiometry module Users audiologists ENTs and other health care professionals in testing the hearing of their patients Use diagnostic and clinical audiometric testing The MADSEN Astera Audiometer Control Panel ACP The ACP is intended as a supplementary user interface connected to MADSEN Astera About this manual This is your guide to installing calibrating and using MADSEN Astera and the MADSEN Astera ACP and to using the OTO suite Audiometry Module It also introduces you to the key features of the device and the software as well as to working scenarios for performing tests and viewing and printing test results We strongly recommend that you read this manual carefully before using MADSEN Astera and the OTOsuite Audiometry Module for the first time Note If you are using the Audiometry Module with NOAH we recommend that you are familiar with the screens and functions provided in NOAH Safety This manual contains information and warnings which must be followed to ensure the safe performance of
49. special tests Operation The ACP provides the controls for operating MADSEN Astera with the OTOsuite Audiometry Module acting as the display showing the current settings as well as intensity frequency and other information on the PC monitor Input and output options The ACP connects both to MADSEN Astera and the PC From MADSEN Astera to the ACP e Desktop microphone socket e Operator headset socket e Operator boom microphone socket e Built in monitor speaker From the ACP to accessories e Desktop microphone socket e Headset socket e Boom microphone socket From the PC to the ACP e USB socket if needed through externally powered USB hub The OTOsuite Audiometry Module OTOsuite OTOsuite OTOsuite is a software tool that integrates asuite of audiological tests with result review and reporting capabilities into a single powerful PC application Se otometrics OTOsuite integrates closely with the latest generation of Otometrics test devices by offering real time presentation of test results and full test control directly from aPC with a comprehensive user interface and NOAH compatibility The OTOsuite Audiometry Module is designed to operate with MADSEN Astera as the test device Otometrics MADSEN Astera 1 Introduction to MADSEN Astera The OTOsuite Audiometry Module The OTOsuite Audiometry Module provides you with comprehensive control and overview of the current stimulus and masking choices both numeri
50. stimulus Speech From the right click menu of the Stimulus selection button you can also select e Int CD internal CD ROM built into the PC Speech e File stored on hard drive Speech Line In external medium connected to the PC Speech Pulsed stimulus Tone Stim Lock presents stimulus and masker simultaneously Tracking increases stimulus and masker intensity by the same number of dB 1 2 or 5 dB step Otometrics MADSEN Astera 25 3 Navigating in the OTOsuite Audiometry Module w CR E Curve selection Click to select the curve type THR Threshold level Tone MCL Most Comfortable Loudness level UCL Uncomfortable Loudness level SDT Speech Detection Threshold Speech SRT Speech Recognition Threshold Speech WRS SRS Word Recognition Score Sentence Recognition Score Speech Opens the Monitor and Level dialog For a description of the Monitor and Level dialog see Monitor and Level a1 Opens the Talk For ward dialog For a description of the Talk Forward dialog see Measurement menu gt 18 Opens the Test The Test Selector dialog is described in the OTOsuite User Guide Selector dialog 3 5 2 The Classic Control Panel ad Click the Control Panel icon in the toolbar to activate the Control Panel Note If you are using the MADSEN Astera ACP you may choose not to display the Control Panel Select Tools gt Configuration Wizard gt and click Next until the P
51. stimulus frequency e Stores the data point Otometrics MADSEN Astera Otometrics MADSEN Astera ABLB data PA OTOsuite FOR EVALUATION ONLY File Edit View Measurement Tools Reports Help GS W S D De v ee E D F Navigator 23 control panet S Task Wizard A amp og d pmm Tone Speech Aided Speech I Aided Speech II SISI ABLB Channel Settings a a a l ee ga 90 g Ww gt 4000 WwW 80 dB Continuous ON Hz Sts _ M TRANSDUCER Insert Chi Tone Insert Right Tone Insert Left Ch2 Phone O High Frequency O dB HL 1000Hz 2000Hz 4000Hz ROUTING Left ii ABLB test ear Right O 0 10 Test Options dB Step ABLB dB Step 20 On O 1 02 02 30 5 40 Monitor Level 50 MONITOR 0 CH1 A Mic A vw 70 CH2 Source A A S a vV V 80 Talk Source B back A 30 100 110 120 Ref Test Ref Test Ref Test Ready 10 14 2008 Se otometrics i Data display in ABLB screen Frequency column e Each frequency displays low to high intensity from top to bottom e The ear that is considered to be the reference ear A steady tone at a par ticular intensity is presented to this ear Test e The ear that is considered the test ear A steady tone with adjustable intens ity is presented to this ear until equal loudness with the reference ear is determined ABLB editing options Editing options Selected point e e g 1000 Hz 90 75 dB Delete Selected measurement e Deletesthe data for the frequency
52. stimulus type 89 Otometrics MADSEN Astera 175
53. t A z 90a gt Tone Speech Aided Speech I Aided Speech II sisi ABLB MLD ou QuickSIN Bekesy LiPread The central heating needs repairing Did you hear the wind howl Go to the doctor and get some advice Lend me that paperback Pay the bill What time do you finish work today The cows are grazing in the big field The house is for sale Take your medicine Bring me a needle and thread I like that song f Do you think the secretary can make the arrangements for the business meeting Get your trousers cleaned or you won t be able to wear them on Saturday We went to the children s zoo and saw the animals The crowds in the stadium cheered when the team won the game They always buy tickets to both the opera and the ballet Do you want to have a barbecue this evening When was the last time that you went to visit your parents Please don t put too much powder in the machine when you do the washing The football pitch is right next to the tennis court Can you remember the last time we had a heat wave Don t use your credit card if you can t pay the bill on time o 5 8022S 8132 80 Listi Ch1 Pre recorded Insert Left 10 5 32 10 1 2 3 20 fho m store Reset List Results All Correct mane List 1 9 17 2012 Here you can enter your own comment SI 762 Pre recorded Insert Right Ch2 i0 5 32 10 1
54. the Pediatric test Setting up for Pediatric testing You can enable disable a range of features including VRA tools for use in Pediatric testing To do so select Tools gt Con figuration Wizard gt Configure Audiometry and click next until the Pediatric configuration screen is shown See Con figuring the Audiometry Module 147 The main screen ________ e A The control panel where you adjust the set ma i o r a tings required for testing The Pediatric test 4 1000 ae screen has two main types of panels The Con L ama os trol Panel and the Test Panel See The Control kg and Test Panels 66 B The audiogram area See The audiogram area gt 68 C Curve Selection box with Graph Control but tons See The Curve Selection box gt 69 D SDT results Speech Detection Thresholds See The audiogram area gt 68 E The Pediatric Test Panel where you control the actual test See The Control and Test Panels 66 HL 250 500 ik 0 Otometrics MADSEN Astera 65 3 14 2 2 The Control and Test Panels The Control Panel The Sunshine Panel without VRA The Classic Control Panel without VRA Use the Sunshine Panel to quickly Channel Settings Use the Classic Control Panel to CHANNEL select the main settings for test STIMULUS select more advanced settings for ing testing FRESH Noise See also The Sunshine Panel ee lt See also The Classic Co
55. the Speech main screen The display options can be turned on off To do so select Tools gt Options gt Speech Feature boxes Pure Tone data Displaysthe pure tone average for air conduction and bone conduction as well as the articulation index The Al is calculated according to the Count the dot method Stenger Displays the results of a speech Stenger test e Scoring options are positive or negative Terms and abbreviations used in Speech testing Score Percentage of correct incorrect words Level dB level at which the words were presented Msk Effective masking level dB EML used for contralateral masking SNR Signal to Noise Ratio Otometrics MADSEN Astera 63 3 Navigating in the OTOsuite Audiometry Module 64 Pure Tone Average PTA AC Pure Tone Average for Air Conduction thresholds PTA BC Pure Tone Average for Bone Conduction thresholds AL Articulation Index based on the Count the dot method Otometrics MADSEN Astera 3 14 3 14 1 3 14 2 3 14 2 1 Special tests Locally available special tests Some special tests such as the QuickSIN and HorTech tests may be specific to language or local test protocols and are not included in OTOsuite but are available for adding to the OTOsuite Audiometry module Contact your local supplier for fur ther information Pediatric testing The Pediatric test in the OTOsuite Audiometry Module is a tool that complements t
56. the data to the selected stimulus ear Otometrics MADSEN Astera 149 7 Configuring the Audiometry Module 150 Otometrics MADSEN Astera 8 1 8 2 Otometrics MADSEN Astera 151 Communicating with the device Connecting to the device OTOsuite is designed to communicate with and display test data generated by Otometrics test devices e When you start up OTOsuite click on the Control Panel icon OTOsuite will automatically connect to the test device e See also the section Activating the Control Panel in the OTOsuite User Guide Firmware update If a Firmware Update message appears see e Updating device firmware 151 Information about the test device To see information relating to the test device select Help gt About Device Reconnecting to the device Ifthe control panel for a test type is shown and communication with the selected test device isinterrupted a message appears stating that there is no longer connection to the device e Click the Connect button on the Control Panel to reconnect to the selected test device Updating device firmware Ifthe OTOsuite software version contains a more recent firmware for the device a message will appear when next you switch on the device It is recommended that you update the device firmware to make sure that the device and OTOsuite perform correctly e Follow the on screen instructions 8 Communicating with the device 152 Otometrics MADSEN Astera
57. the required functions for each channel mm l Stimulus types p aa Tone Presents apure tone as the stimulus type Warble Presents awarbled pure tone as the stimulus type This stimulus type should be used for soundfield testing to avoid any standing waves 110 Otometrics MADSEN Astera FRESH Noise Presents the customized FRESH noise as the stimulus type 2 FRESH stands for FREquency Specific Hearing assessment noise When FRESH Noise is selected under the stimulus parameters it should only be used as a stimulus not a masker because it is calibrated as a stimulus Mic Present live voice as the stimulus type Source A Delivers the speech material from Source A The options are e Int CD internal CD ROM built into the PC e Int File stored on hard drive or e Line In external medium connected to the PC Source B Delivers the speech material from Source B The options are e Int CD internal CD ROM built into the PC e Int File stored on hard drive or e Line In external medium connected to the PC 37 8 Masking type o oe e o NBN B 8 g Presents a narrowband noise as the masking type When narrowband noise is selected under the masking parameters it should only be used as a masker not a stimulus because it is cal ibrated as an effective masker NBN is only available during tone testing SWN Presents a Speech Weighted Noise Speech Noise Speech weighted noise is
58. the requirements listed in Standards and safety 157 and Technical specifications 161 must be complied with Cooling requirements There are no specific cooling requirements However wall mounting the MADSEN Astera with the cable connections pointing upwards is the best position for ensuring optimal cooling of the audiometer Cautione Do not place anything on top of MADSEN Astera 134 Otometrics MADSEN Astera 6 4 1 Cautione Make sure that MADSEN Astera is placed ina well ventilated location Place MADSEN Astera and the ACP in locations away from sources of heat and direct sunlight MADSEN Astera and the ACP must not come into contact with liquids Installation sequence 1 2 Install the OTOsuite Audiometry Module on your PC Assemble and set up MADSEN Astera Assembling MADSEN Astera gt 135 Wall mounting MADSEN Astera gt 136 if needed MADSEN Astera connection panel gt 142 Assemble and set up the ACP Assembling the ACP 137 Connecting the ACP to MADSEN Astera gt 138 Connecting accessories to the ACP 141 Switch on MADSEN Astera 6 Unpacking and installing Run the Configuration Wizard in OTOsuite to connect to and set up communication with MADSEN Astera See see Configuring the Audiometry Module 147 Assembling MADSEN Astera Removing the cable cover 1 To remove the cable cover from MADSEN Astera press the releases e on both sides of the cable c
59. to wear the earphones 122 Otometrics MADSEN Astera 5 2 2 10 11 12 13 5 Examples of audiometric testing For infants less than 6 months old use monitored live voice to present stimuli like the patient s name and observe the patient for behavioral responses Forinfants older than 6 months use the head orienting reflex for Visual Reinforcement Audiometry VRA For toddlers use social reinforcement for Conditioned Play Audiometry CPA Ifthe child is old enough use a picture board depicting SRT words and ask the child point to the picture cor responding with the word heard Use words with which the child is likely to be familiar All of the above are examples of Speech Detection Threshold SDT If using play audiometry or a picture board condition the patient to respond as desired before beginning the testing Make sure that the control panel of the OTOsuite software or the MADSEN Astera ACP is set to the correct trans ducer and desired routing and sound level Make sure that speech detection threshold SDT is selected Begin the test in the ear suspected to be the better hearing ear It is recommended that children be tested using an ascending approach Start at 10 dB and increase the level of the speech stimulus until the child responds This will ensure that you are not conditioning the child at alevel that he she cannot hear Once you identify a level that is clearly audibl
60. won the game Did you hear the wind howl Go to the doctor and get some advice Lend me that paperback Pay the bill They always buy tickets to both the opera and the ballet Do you want to have a barbecue this evening When was the last time that you went to visit your parents What time do you finish work today Please don t put too much powder in the machine when you do the washing The cows are grazing in the big field The house is for sale The football pitch is right next to the tennis court Can you remember the last time we had a heat wave Take your medicine Bring me a needle and thread Don t use your credit card if you can t pay the bill on time I like that song During play back When you start play back of the selected speech list the List View shows the selected lists Each sentence ina list has a number of highlighted key words that can be scored as Correct or Incorrect Words that can be scored are displayed in bold type The sentence being presented is shown at the top of the list This is where you score correctly repeated words by clicking on them e When you score aword as Correct it is highlighted in green e When you score a word as Incorrect it is high lighted in grey Practice List For practicing the test flow so that the client is familiar with the procedure before the actual test starts Results from a practice list cannot be stored An icon to the left ofthe sentence that is being pres
61. you can deliver the recor ded words one ata time by double clicking on the word in the word list You can also present the speech material using monitored live voice 7 Ifthe patient responds to the initial sound level presented proceed with the test by decreasing the level in 10 dB steps until no response is obtained Increase the level in 5 dB steps until a response is obtained again Continue decreasing in 10 dB steps and increasing in 5 dB steps until you determine the lowest level at which the patient responds correctly to two of three trials This is the SRT Once the SRT is obtained store the response 8 Ifthe SRT of the test ear and the SRT or PTA of the nontest ear differ by 45 dB or more masking is needed Ifthe SRT of the test ear and the bone conduction PTA of the nontest ear differ by 45 dB or more masking is needed 9 Switch tothe other ear and tell the patient to listen for the words in that ear 10 Repeat steps 3 to 7 11 The SRT will be 8 dB of the PTA for each ear if the data are reliable 5 1 5 Assessing word recognition score 1 Properly place the earphones Begin the test with the air conduction transducer Instruct the patient so that he she will know what to expect You will hear various words like bird dog etc When you hear a word repeat it back to me This time the words will all be loud enough to hear It is okay to guess if you are unsure of the word Otometrics MAD
62. 127 5 Examples of audiometric testing 3 Instruct the patient so that he she knows what to expect You will hear a continuous tone The level of this tone will be changed periodically Press the button on the responder immediately each time you hear achange will ask you if the test tone is softer than louder than or equal to the reference tone in the opposite ear 4 Choose the ABLB tab or select ABLB in the Test Selector Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing Ifleft ear is selected as the test ear in the Control Panel Routing section then the right ear will be the reference ear 5 Set the reference level Ch 1 6 Set the test level Ch 2 to 10 dB above the patient s threshold for that ear 7 Adjust the level of the test signal Ch 2 until the patient reports that the two signals sound equally loud 8 Store the data points 9 Repeat steps 5 to 8 for additional frequencies 10 If desired switch routing to test the opposite ear and repeat steps 5 to 8 5 3 7 Performing Short Increment Sensitivity Index SISI test 1 Properly place the earphones 2 Give the patient the responder s 3 Instruct the patient so that he she knows what to expect You will hear a continuous tone The level of this tone will be changed periodically Press the button on the responder immediately each time you hear achange 4 Choose the SISI tab or select SI
63. 16 1 x 11 4 x 1 4 inches Weight Approx 2 1 kg 4 6 Ib Power supply No external power supply Supplied by the USB 5 V Note If you are using a USB hub use a powered USB hub Otometrics MADSEN Astera 12 3 12 4 Power consumption Normal operation lt 360 mA 5 V Suspend mode lt 500 uA 5 V Standards Patient Safety EMC Accessories IEC 60601 1 2 12 Technical specifications Complies with IEC 60601 1 Class 1 Type B UL 60601 1 CAN CSA C22 2 NO 601 1 90 Standard accessories and optional accessories may vary from country to country please consult your local distributor MADSEN Astera Audiometer Control Panel ACP TDH 39 headphones HDA 200 headphones for high frequency audiometry HDA 300 headphones for high frequency audiometry Otometrics insert phones Bone oscillators NB 71 B 71 Sound field loudspeakers Monitor headphones with boom microphone Assistant headphones Desktop microphone Talkback microphone Monitor speaker Patient Responder one or two Power supply and mains cable Wall mounting plate Connection cables AURICAL FreeFit MADSEN Astera Reference Manual MADSEN Astera User Guide ACP Notes on EMC Electromagnetic Compatibility USB cables Wrist support MADSEN Astera is part of a medical electrical system and is thus subject to special safety precautions For this reason the installation and operating instructions provided in this document should
64. 25 5 heed eo AS Ooooh ores cadh Bi eee toed test Aa sie 155 IOT HPOWONING 2x28 S20 ceetorceicts Sele nde cost etn tte esis ee oeec et ches Me lun see Doe ot eee 155 10 2 Software device communication 2 cee eee eee eee eee cece eee eeeeeeeee 155 11 Standards and safety ie ec esis atic Ge ee ci i ee di A ES 157 1d lt SViMDOIS USEC utes Gite Si bee eee dwt E A SAE oe ebocera ee seme SA cob bemi eee oes 157 TIZ Connector warnine NOUS suo 6c Son eit ot Sense ete ioe t acd ede Laces eens hee 157 TL3 General warming NOLES 4 2 adc bee dee aaNet au cies edly hel enh Dele et Cuttin earn ois otek 158 11 4 The OTOsuite Audiometry Module _ 22 2 0 eee ee eee ee eee ee eee eee 160 TES Manufaciurer 25 26 Scho Kes eed id pees dees tout des ganas ana dtate ees ieeegebale eae 160 11 5 1 Responsibility of the manufacturer _ 2 eee eee eee ee eee eee eee ee eee 160 12 Technical specifications _ 2 2 ee eee eee ccc eee ee cece cece eee cece ceeccceneces 161 12 1 MADSEN Astera l aalala oe cc cece eee eee eee ee eee 161 Ta SCR 6 oii oe ead cen sashaG nna de a oie ba ets oe Cea enous oh ah eouc esac A E RETOS 165 MDE NGC OSS OM E ade se ide tap pa et caste NE EE E A hie neta he nets eels nt eee et ed tegen eats 167 12 4 Notes on EMC Electromagnetic Compatibility 2 022 ee eee ee eee ee ee eee 167 Index 171 Otometrics MADSEN Astera 1 1 Introduction to MADSEN Astera T
65. 3 1 Selecting a symbol or curve You can select a symbol and or a curve style for a specific measurement 1 2 a Select Tools gt Curves and Symbols Click on the selections that apply to your measurement under Test Transducer and Aided Condition The current symbols and line style are shown Double click on the symbol you wish to change The Symbols selection dialog box is shown Double click on the symbol you wish to use To change the line style of the curve select from the Line Style drop down list To change the color double click on the current Color square Select a new color or click on Define custom colors gt gt to select a color not shown Click OK To optimize viewing of the audiogram you can offset the symbols in relation to the audiogram grid in the fields Hori zontal Offset and Vertical Offset You can superimpose symbols on the audiogram where two different points share the same value i e air and bone threshold In order to see both superimposed symbols you can define an offset direction for each individual symbol Curves and Symbols Options File Tone Graphical Speech Aided Condition Test Transducer Threshold Air Conduction Unaided MCL Bone Conduction Aided 1 UCL Sound Field Aided 2 Symbols i 7 LYMEFrnRYw awe UmMommnoEeEBEeEXY MMDD gt DeTEO TX Se nS cai eee Unmasked x O No Response x fo 7 Resp at Limit Eg
66. Activate deactivate center VRA 67 3 14 2 3 The audiogram area HL 250 500 1k 2k 4k SDT The audiogram is tailored to acco 10 10 modate tracking of responses with respect to the dB range and the fre 20 20 quency range shown 30 The gray and yellow highlights serve to distinguish between the dif 40 ferent 5 dB steps 50 60 70 80 90 100 100 110 110 750 1 5k 3k Hz Editing and managing curves Right click on the symbols in the graph to edit responses and curves You can manage your curves in the curve selection box Configuring the audiogram area You can configure the audiogram area e toincrease the audiogram area to 6 kHz e toinclude the Speech Detection Thresholds See Configuring the Audiometry Module 147to set up these features 3 14 2 4 Controlling and using VRA The MADSEN Astera supports specific VRA systems so that you can control them from the Audiometry Module For fur ther information please contact your supplier To enable using VRA select Tools gt Configuration Wizard gt Configure Audiometry and click next until the Pediatric configuration screen is shown See also Configuring the Audiometry Module 147 You can control the VRA functions from OTOsuite from the keyboard or from the ACP 1 Ifneeded select the VRA reinforcement types in the Control Panel 2 Use the on screen VRA buttons in the Test Panel to activate deactivate visual reinforcement 68 Otometrics MAD
67. Deleting a row Right click on the field you wish to delete and select Delete Measurement Sorting the tabular speech data You can sort your data either by ear or by its sequential number depending on your needs Usually the sequential sorting is preferred during data collection when you perform one test type at a time Sorting by ear is sometimes preferred when you compare the ears when analyzing the complete results e To sort data by their sequential number click the number field in the table header marked with the symbol e To sort data by ear click the ear field in the table header Otometrics MADSEN Astera 3 10 1 3 10 2 3 Navigating in the OTOsuite Audiometry Module Pure Tone Data These fields contain the tone test results They display the pure tone average PTA for air conduction AC bone con duction BC and the calculated Articulation Index Al for that ear The PTA and Al are automatically calculated from the tone audiogram e Toconfigure pure tone average PTA calculation select Tools gt Options gt Audiometry gt General gt Misc gt PTA Frequency AC BC Speech editing options tabular view When you right click any of the rows in tabular view the following options appear Stores the dB level s currently displayed to the field that is highlighted Insert No Response NR will replace the stimulus level for the selected speech test Insert Did Not Test DNT will replace the stimulus level fo
68. EN Astera 3 Navigating in the OTOsuite Audiometry Module 3 7 1 The work area in the Tone screen The Tone test work area consists of arange of elements for viewing and selecting various features e The audiogram amp 35 With a description of audiogram elements how to view single or dual graphs and how to view the intensity levels used for masking e Tone feature boxes 39 With a description of result boxes for special tests utilities such as a timer and an overlays selector and instructions for how to view hide the feature boxes 3 7 2 The audiogram Audiogram elements Cross hatch Indicates your current stimulus level and frequency The color indicates the rout ing e Blue left e Red right Black binaural Indicates where you place the mouse The color indicates the routing e Blue left e Red right e _ Black binaural Audiogram Intensity is shown to the left of the audiogram in dB HL Octave frequencies are shown below the audiogram in Hz Interoctave frequencies are shown above the audiogram in Hz Viewing the audiogram You can choose between Otometrics MADSEN Astera 35 3 Navigating in the OTOsuite Audiometry Module A Stimulus marker ear color B Masking level indicator C Mouse cursor ear color When you use the dual graph viewing option the graph that are ii corresponds with the stimulus ear will have a gray outline to denote the
69. HTL per transducer type _ 2 eee eee ee ee eee eee ee eeeee 3 15 Test controls ACP keyboard mouse ___ 02 22 eee ee eee ee ee ee eee noraa 3 15 1 ACP front panel layout 2 2 2 elec cee cece cc ee cece eee ee ceeeeeceees 3 15 2 ACP front panel controls _ 2 02 cle eee ee ee ee eee cece neces 5 152 A POSL COMPOS 24 cic e em PE A EE EEEE Ee eed o EE 3 1532 3 Montone CONLIOIS oki cctv er tact oo ema aa eek atededes ds eunee ese 3 15 2 4 CH1 and CH2 Controls 2ce4vne eee eee ee ee ee be SVS S Mest Iye CONTOS Sacto tite bikes Sule Oba a eae Sek ce eat eat 3 15 26 Speech test controls corcra ot a aa oune e A uterde eet edad 3 153 PC Keyboard COnUGIS soaa Gone enata eaaa he ian tude aureet dese ceteseuseck 4 Preparing for testing ___ 2 ell eee ee eee eee eee eee eee eee eee Preparing the test environment _ 2 2 0 eee eee cece ccc ec cee cece ccc eeeeceeeees Preparing the test equipment ___ lee eee eee eee eee eee eee eee cee eeeees DISTSNING CHECK e scuke ee ean re tat cae Solent Sister ernest Sash east Roeder asd Preparine the Chent 2045s dees fs Pee ee ied ee a ee ee cote de ie Se Ade le TIVE IONIC PRECAUTIONS or Genk tech ate eet i UE Reds lee 8 il ah Ee a eatin Santali ial 4 4 2 Inspecting the client s Car s occ cece ecetnce soe cack sec eieeeduyeeicudoes nananana Proper transducer placement 20 6605 5 suoehooous oe ace ete ddcoee ceed ood es ehh eek 4 1 4
70. IEC60645 1 Type 1 IEC60645 2 and ANSI S3 6 Patient Safety when used with the specified power supply Delta Electronics Inc type MDS O90AAS24 e Complies with IEC 60601 1 3rd Class 1 Type B AAMI ES60601 1 CSA C22 2 NO 60601 1 08 CAN CSA e EMC IEC 60601 1 2 Patient Safety when used with the specified power supply XP Power type PCM80PS24 e Complies with IEC 60601 1 2nd Class 1 Type B UL 60601 1 CAN CSA C22 2 NO 601 1 90 IEC 60601 1 2 3 5 mm jack 32 Q 3 5 mm jack 3 5 mm jack 165 12 Technical specifications 166 Inputs Monitor headphone 3 5 mm jack 32 Q Boom microphone 3 5 mm jack Desktop microphone 3 5 mm jack Built in monitor speaker 3 5 mm jack 8 Q Operator interface e 76 buttons 61 with built in LEDs 2 rotary knobs 32 steps in each rotation USB port connector Type USB device port Compliant USB 2 0 Speed Full soeed 12 Mb s Transport and storage Temperature 30 C to 60 C 22 F to 140 F Air humidity 10 to 90 non condensing Operating environment Mode of operation Continuous Temperature 5 C to 40 C 41 F to 104 F Air humidity 30 to 90 non condensing Operation in temperatures exceeding 20 C 4 F or 60 C 140 F may cause permanent damage Warm up time lt 1 minute Disposal MADSEN Astera ACP can be disposed of as normal electronic waste according to WEEE and local regulations Dimensions Approx 410 x 290 x 36 mm
71. Left Pure Tone data 30 PTA AC PTA BC Al 100 Right dB dB Left dB dB K Overlays 120 E Pictures E Speech Banana 750 1 5k 3k Bk Hz E Severity E Speech Letters Masking AC dB EML E Unusable Area h Legend L L R Masked L R x Oo AC o 4 M M MCL 2A RBE OE U U ucl 125 250 500 750 ik 1 5k 2k 3k 4k 6k 8k S SF e a K NR 11 5 2013 e otometrics _ D Stimulus bar E Masking level indicator F Stimulus marker 15 3 Navigating in the OTOsuite Audiometry Module Sie 3 7 F i Audiometry icons and menu selections The icons and menu selections that are unique to Audiometry functionality depend on the test functions included in OTO suite and or whether atest device is connected Tone audiometry HAR 2 7 BAR 2 SB Speech audiometry AY PAR 4 T 3 2 1 File menu New Audiogram Select new audiogram You will be prompted to save or cancel current data 3 2 2 Edit menu mennen em stort pecs OSS Audiometric prop Ctrl U Click to enter Tester name Test Date and air conduction trans erties ducer for a manually entered audiogram Note The air conduction transducer is stored when you have selected it in the transducer section of the Control Panel or with device controls if applicable and data points are entered on the audiogram 16 Otometrics MADSEN Astera 3 2 3 View menu N Masking Assistant Overlays Left Right Right Left Audiogram Legend Combined Audiogram a mE mE
72. MADSEN Astera MADSEN Astera Reference Manual Doc No 7 50 0780 EN 17 Part No 7 50 07800 EN e cE otometrics Copyright notice No part of this documentation or program may be reproduced stored ina retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise without the prior written consent of GN Otometrics A S Copyright 2015 GN Otometrics A S Published in Denmark by GN Otometrics A S Denmark All information illustrations and specifications in this manual are based on the latest productinformation available atthe time of publication GN Otometrics A Sreserves the right to make changes at any time without notice Registered trademarks and Trademarks MADSEN Itera Il MADSEN OTOflex 100 OTOsuite AURICAL FreeFit AURICAL Visible Speech MADSEN Astera MADSEN Xeta ICS Chartr 200 VNG ENG ICS Chartr EP OTOcam 300 MADSEN AccuScreen MADSEN AccuLink ICS AirCal AURICAL Aud AURICAL HIT ICS Impulse OTObase and MADSEN Capella are either registered trademarks ortrademarks of GN Otometrics A S Version release date 2015 02 04 Technicalsupport Please contact your supplier Otometrics MADSEN Astera Table of Contents 1 Introduction to MADSEN Astera 1 1 MADSEN Astera _ 2e ee eee 1 2 The MADSEN Astera Audiometer Control Panel ACP 2 cece cece ee ee eee eens 1 3 The OTOsuite Audiomet
73. N Phone Left Ch2 one HL 125 250 500 1k 2k 4k 8k HL 8k 10k 12 5k 16k 20k ueny O O 20 20 ROUTING eft O i o O 10 10 P P 20 d 0 o 10 10 20 20 v Switch ears automatically 30 30 FREQUENCY 40 40 Sweep Up O Sweep Down 50 50 Fixed Frequency 60 60 SIGNAL TYPE 70 70 Pulsed 80 80 O steady 90 90 100 100 110 110 120 120 750 1 5k 3k 6k Hz 9k 11 25k 14k 18k Hz 11 09 2012 Se otometrics p Ready No User Test loaded LiPread The OTOsuite LIPread speech test is designed to integrate multi modal speech tests for playback in the OTOsuite software The purpose of the LIPread test is to test a person s ability to understand speech with and without visual cues and noise The test consists of video presentations where the patient is prompted to repeat as much as possible of the sentences presented The test can be presented with and without sound or video so that lipreading ability can be assessed for rehab ilitation purposes When OTOsuite is used asa NOAH module all historical LIPread data is always available on the screen and in reports so that the patient s progress can be followed over time Intended use The OTOsuite LIPread speech test is intended for use in connection with hearing habilitation rehabilitation performed by audiologists speech therapists and other trained personnel System overview e Testingin OTOsuite is supported by MADSEN Astera e OTOsuite with the module for performing the LIP
74. Navigating in the OTOsuite Audiometry Module 46 Always use Numerical scoring method Word scoring Does not apply to word scoring Phoneme Sentence scoring Select this if you use lists using specific phoneme sentence scoring but prefer to score the test items numerically Counting Defines how you want to score words Both Corrects only and Incorrects only Word scoring You manually score correct and incorrect words The word counter is updated accordingly Phoneme Sentence scoring Does not apply to phoneme scoring e Corrects only Word scoring Software assumes the word is incorrect unless you manually score it as correct External speech material The percentage is calculated based on the total number of words you have defined in advance Tools gt Options gt Audiometry gt Speech gt Scoring and Playing gt Number of items to play back Phoneme Sentence scoring Score the number of correct phonemes using the corresponding numbers in the Counter External speech material Always enter a score for each word This will update the counter accordingly e Incorrects only Word scoring Software assumes word is correct unless you manually score it as incorrect External speech material The percentage is calculated based on the total number of words you have defined in advance Tools gt Options gt Audiometry gt Speech gt Scoring and Playing gt Number of items to play back Phoneme Sentence scor
75. P 137 e Run the OTOsuite Configuration Wizard to connect to and set up communication with MADSEN Astera See Con figuring the Audiometry Module 147 Unpacking Unpack the device carefully When you unpack the device and accessories it is a good idea to keep the packing material in which they were delivered If you need to send the device in for service the original packing material will protect against damage during transport etc Visually inspect the equipment for possible damage If damage has occurred do not put the device into operation Contact your local distributor for assistance Check with the packing list to make sure that you have received all necessary parts and accessories If your package is incomplete contact your local distributor 1 Check the Test Report Calibration Certificate make sure that the transducers headphones and bone oscillators are the correct ones and that they comply with the ordered calibration standards Storing If you need to store MADSEN Astera before you put it into operation follow the guidelines below e Store MADSEN Astera and accessories in the boxes provided to protect the equipment from damage e Store MADSEN Astera and accessories in a dry environment See also Transport and storage gt 164 131 6 Unpacking and installing 6 3 Views of MADSEN Astera 6 3 1 MADSEN Astera 7 d i A On Off indicator A On Off indicator B On Off switch B On Off switch
76. RESH noise 27 89 95 111 Front panel 106 171 Index G Getting started OTOsuite 13 H Headphones connections 143 operator phone connection 144 Headset boom microphone selection 18 Headsets assistant monitoring connection 145 HL range specifications 162 Hygienic precautions 116 I Icons combined view Audiogram Module 17 split view Audiogram Module 17 Insert phone connections 143 Installation powering 139 Installing OTOsuite 84 Intended use Audiometry Module 10 Interrupter specifications 163 ISTS stimulus type 95 K Keys 106 L Left Right audiogram viewing 17 Legend box audiogram viewing 17 172 Level specifications 162 Line in connections 146 LIPread Player Panel 85 List View 86 M Masking assistant enabling disabling 17 Masking Assistant 20 enabling disabling 17 Masking types specifications 161 Measurement menu desktop boom microphone 18 Monitoring 18 talk forward 19 talk to assistant 18 Measurement menu Aud desktop boom microphone 18 Monitoring 18 talk forward 19 talk to assistant 18 Menu bar OTOsuite 15 Microphones desktop microphone connection 145 operator boom microphone con nection 144 talkback microphone connection 145 Monitor speaker connection 144 Monitoring 18 N Narrow Band Noise stimulus type 89 Navigating 85 LIPread player panel 85 list view 86 results table 87 scoring counter 85 scoring words 86 Otometrics MADSEN Astera Navigating in Audiom
77. SEN Astera 3 14 2 5 The Curve Selection box You can manage your curves in the Curve Selection box Response views Every measurement condition such as AC BC SF ear side etc has its own response view in the audiogram This prevents the audiogram from cluttering up and allows you to analyze the progress of the test or to plot minimum responses as an audiogram curve A new response view is created automatically when you change measurement conditions In the example you can see the right ear AC responses as well as the plotted curve HL 250 500 ik 2k 4k SDT A Response views 10 20 30 40 50 60 70 80 90 100 110 Hide Responses _ Hide Audiogram Hide Inactive Curves AC R AC L Bc Ri Bc L a Hide Responses Hide Audiogram __ Hide Inactive Curves mo B Gra ph control buttons Graph control buttons The graph control buttons beneath the graph can be used to switch between the measurement conditions that were used during testing The buttons select the view and set up the controls for the applicable measurement conditions so that you can quickly switch between the conditions used Measurements that are stored as binaural or nonar specific are represented by both right and left graph control buttons You can hide or display the different symbols and curves depending on your current needs e g during testing or post ana lysis Graph Control buttons Hide Responses Lets y
78. SEN Astera 121 5 Examples of audiometric testing 3 Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing and sound level Make sure that word recognition score WRS SRS is selected 4 Begin the test inthe ear with the lower PTA and or SRT Tell the patient in which ear the test will begin 5 Itis best to use recorded speech to reduce variability Ifthe automated presentation speed of the recorded speech is too fast for the patient you can deliver the recor ded words one at atime by double clicking on the word in the word list You can also present the speech material using monitored live voice 6 Present the words at a sound level that is 30 to 40 dB higher than the SRT score Some examiners prefer to give the patient a couple of words to make sure that the response instructions are understood These words should not be part of the test word list as familiarity can bias the test 7 Score the responses using the buttons Typically 25 or 50 words are presented in a list Once all the words on the list have been presented you have a percentage correct This is the WRS Once the WRS is obtained store the response 8 Switch tothe other ear and tell the patient to listen for the words in that ear 9 Repeat steps 6 to 7 10 Type any desired notes regarding the test for example NU 6 word list 3A in the box to the left of the scores tab ula
79. SI in the Test Selector Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing Make sure that the frequency is correct Begin the test in the ear with the lower PTA or SRT Start with 5 dB SISI dB step and set the level 20 dB above the patient s threshold for that frequency in that ear The test begins with 1000 Hz Make sure that the patient understands the response task Se ae ee oe Change the SISI dB step to 1 dB Set the level 20 dB above the patient s threshold for that frequency in that ear and press the Play button 10 Store the data points 11 Repeat steps 6 to 10 for additional frequencies 5 4 Testing with sound files 5 4 1 Playing sound files without word lists Prepare playback 1 Use either Int CD or Int File as Sound Source 2 Ifint CD is chosen select CD Drive Selection and or CD Track Selection in the Options dialog or directly in the Player Panel This will list CD tracks in the Player Panel combo box 128 Otometrics MADSEN Astera 5 4 2 5 Examples of audiometric testing 3 If Int File is chosen select Sound File Selection in the Options dialog or browse for a folder containing sound files in the Player Panel This will list all sound files contained in the same folder as the Sound File Selection file in the Player Panel combo box How to play back stop playback 1 Use either the Play or Pause button 2 Aclick on the Pause
80. The patient must release the button immediately when the tone cannot be heard any longer e The patient must press the button as soon as the tone can be heard again e The stimulus can change to the other ear Carrying out the test Start the test either by clicking the Test All Frequencies button or the Test Single Frequency button in the Control Panel Otometrics MADSEN Astera 3 14 7 2 Test functions Test All Frequencies button Runs a complete test including all the test frequencies selected in the Options dialog Test Single Frequency button Runs a limited test covering the currently selected audiometer frequency This can be used e g for retesting a certain portion of the test if needed Drop 20 dB button Use the 20 dB button to instantly drop the level This can be used if there is suspicion of malingering or psychogenic hearing loss When you drop the level by 20 dB the patient should stop responding instantly since the tone is presumably inaudible The level will then gradually increase again and the test sequence will be resumed as soon as the patient starts responding again Talk Forward icon Use the Talk Forward function to instantly stop the test Disable the Talk Forward function to con tinue the test The test result Test results are shown as plotted results Fixed Frequency results For the Fixed Frequency test the results will be stored as an HL audiogram when you save the results
81. You will find descriptions of the Audiometry test screens in The Tone test screen 34 The Speech test screen 43 Special tests are described in Special tests 65 The Audiometry Module main window The basic OTOsuite functions are described in the OTOsuite User Guide Audiometry elements OTOsuite FOR EVALUATION ONLY Menus and toolbar icons A EE Channel Settings CHANNEL Continuous ON STIMULUS Tone Warble FRESH Noise MASKING NBN TRANSDUCER Inset C Phone High Frequency Bone Multiple T Speaker C ROUTING let Right Binaural Test Options dB Step Tracking Monitor Level MONITOR CH1 EN CH2 Sours A A Talk kar Source B A Ready No User Test loaded Audiometry toolbar Control Panel Work area Generalicons See the OTOsuite User Guide Otometrics MADSEN Astera Stim Lock Unaided v File Edit View Measurement Tools Reports Help R er DE P P Newer E conira KAS A BOS O 2B Tele es Tone Pediatric Speech SISI ABLB MLD DLI QuickSIN Bekesy LIPread Tinnitus Loudness Scaling 60 Chi Tone Phone Right 40 a NBN Phone Left Ch2 1000 HL125 250 500 1k 2k 4k 8k 10 Timer Reliability 0 00 00 10 Stenger Rinne Right 20 Weber 30 Compare Audiograms 40 11 5 2013 50 60 A 70 Right 80
82. a and if needed the Audi ometer Control Panel ACP and how they operate with the OTOsuite Audiometry Module Safety For safety information see e Standards and safety 157 Installation e Toinstall the new system see Unpacking and installing gt 131 Connecting to MADSEN Astera e See Communicating with the device 151 Configuring the OTOsuite Audiometry Module e See see Configuring the Audiometry Module 147 Preparing for testing Before you receive the client and start the session of testing and explaining test results your time is well spent preparing for the session e Test preparations are described in Preparing for testing gt 115 Descriptions and testing In order for you to feel well prepared and confident before you receive clients for testing using the Audiometry Module see the test screen descriptions They provide you with examples on how to view the test results e The basic OTOsuite functions are described in the OTOsuite User Guide e The test screens are described in Navigating inthe OTOsuite Audiometry Module gt 15 e Useful information on how to test may be found in Examples of audiometric testing gt 119 Printing e See the OTOsuite User Guide Otometrics MADSEN Astera 13 2 Getting started 14 Otometrics MADSEN Astera 3 1 3 2 Navigating in the OTOsuite Audiometry Module The general functions for navigating in the main window are described in the OTOsuite manual
83. addresses possible sound tolerance problems References THS http www ncrar research va gov Education Documents TinnitusDocuments Index asp Using questionnaires 1 Click one of the Questionnaires buttons to access a questionnaire To access a different one right click on the ques tionnaire button and select from the right click menu When you select a questionnaire from one of the lists the name of that questionnaire is then shown as the new name of the button A questionnaire viewer opens and displays the questionnaire All relevant patient and tester data is entered automatically at the top of the questionnaire 2 Click the relevant selections The selections will be circled in green 3 When the selections have been made the score with a description of the severity is shown at the end of the ques tionnaire 4 To save and close the questionnaire click the red X button in the top right corner The questionnaire is now listed in the Questionnaire field Reviewing or editing a questionnaire e Ifyou wish to review or edit the questionnaire click the relevant row in the Questionnaire field to open the ques tionnaire viewer If needed you can change any values Selecting a new questionnaire e Toselect another questionnaire right click on the button and select a new one from the list Deleting a questionnaire e Todelete a questionnaire right click on the relevant row in the Questionnaire field and select Delete Otometr
84. and reflection from structures objects and people 170 Otometrics MADSEN Astera Index A ABLB 127 Accessories specifications 167 Al 64 Assistant talkto 18 Assistant monitoring headset con nection 145 Audiogram combined enabling disabling 17 show combined view Audiogram Module 17 show split view Audiogram Module 17 viewing frequency range 18 viewing left right 17 viewing legend box 17 viewing right left 17 work area in screen Audiogram Module 35 Audiometry preparing for testing 13 training 13 user interface 119 B Bone vibrator connection 143 C Calibration 154 certificate 154 CD tape connections 146 Cleaning accessories 153 device 153 Client inspecting the ear 116 Otometrics MADSEN Astera Index Combined audiogram enabling disabling 17 Configuration Wizard 147 Connections assistant monitoring headset 145 bone vibrator 143 CD tape 146 desktop microphone 145 external power supply 145 headphones 143 insert phone 143 monitorspeaker 144 operator boom microphone 144 operator headphone 144 patient responder 143 PC USB 146 SF speakers 145 talkback microphone 145 USB ACP to PC 139 Control Panel OTOsuite description 23 26 Sunshine Panel 23 Controls 106 ACP 106 Curves andsymbols 37 selecting 20 D Desktop microphone selection 18 Desktop microphone connection 145 F Firmware update test devices Aud 151 Frequency specifications 161 Frequency range audiogram viewing 18 F
85. any measurement has been deliberately left out A measurement that is not pinned to the table is added automatically below the pinned rows Click n Get loading settings The Click n Get feature allows you to perform a test from the predefined table simply by clicking the Apply Settings arrow button in the second column of the table Click n Get loads all the relevant settings including the integrated speech files Pinning a test You can pin one test per measurement condition Note You can pina test to the table if you have not already pinned an identical test To edit a pinned test make sure that User Tests are not write protected in the Configuration Wizard To pin arow simply select the row right click and select Pinned Tests gt Pin Test Here you can also rearrange pinned rows by moving them up or down in the table Otometrics MADSEN Astera 57 3 Navigating in the OTOsuite Audiometry Module 58 Modifying Click n Get for a pinned test You can assign adifferent speech stimulus and or transducer to a pinned test This will load the desired word list trans ducer etc when you use the Click n Get feature Changing assigned speech stimulus for a pinned test 1 Select the speech stimulus such as aspecific integrated word list or internal CD or line in device in the Control Panel and or speech player 2 Right click on the Apply Settings button in the pinned test row and select Assign Selected Stimulus
86. arble Enable Frequency Specific Click to enable or disable Warble Preferences Enable BSA United King e Click to enable storing Tone audiometry according to the recommendations of the dom only British Society of Audiology Use Masking Threshold e Ifthe BSA masking threshold is needed click to enable SRT Designation e You can define how SRT data is stored in NOAH by selecting the appropriate type of speech material designation This enables proper viewing in NOAH AUD Enable Portable Sound Field e Select to allow manual calibration of speaker signal for free field speech audi Audiometry ometry VRA Device Select the type of Visual Reinforcement you wish to use The applicable VRA buttons will be enabled in the Pediatric test panel on the keyboard and on the ACP Enable Center Device If you have selected OTOsuite Pediatric with VRA you can add a center VRA device to your test A center VRA button will populate the Pediatric test panel Enable 6 kHz Enable to enlarge the audiogram to show up to 6 kHz Enable SDT Enable to allow for storing Speech responses in the Pediatric audiogram Store Unmasked SF as Stores the unmasked sound field measurements as binaural data Switching on con Unspecified Ear tralateral masking enables storing the data to the selected stimulus ear Store Unmasked BC as Stores the unmasked bone conduction measurements as binaural data Switching on Unspecified Ear contralateral masking enables storing
87. aring loss in the poorer ear he she will only hear the presented word in the reportedly poorer ear As the patient is trying to appear as if he she has a hearing loss in that ear the patient will not repeat the word Thisisa positive Stenger response 9 Store the test result in the Stenger box 5 3 4 Performing Weber 1 Properly place the bone oscillator on the forehead 2 Instruct the patient so that he she knows what to expect You will hear a tone Tell me whether you hear the tone in the left right or both ears 126 Otometrics MADSEN Astera 5 Examples of audiometric testing 3 Select Weber in the Test Selector Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing sound level and frequency 4 Make sure that the Weber box has appeared in the display 5 Present a pure tone at a frequency below 1000 Hz and a sound level above the patient s bone conduction threshold 6 Ifthe patient reports hearing the tone equally in both ears this isindicative of normal hearing 7 Ifthe patient reports hearing the tone in the poorer ear this is indicative of a conductive hearing loss 8 Ifthe patient reports hearing the tone in the better ear this is indicative of asensorineural hearing loss 9 Store the test result in the Weber box 5 3 5 Performing Rinne 1 This test is performed using a256 or 512 Hz tuning fork and compares that patient s hearing to air and bone con
88. ated controls ban oO i eee e00ee00 i E 8 Gl A tan ie e i g 3 col 3 15 2 3 Monitoring controls 2 i Otometrics MADSEN Astera dB Step Determines the dB step size for the intensity of the stimulus and masker Options are 1 2 and 5 dB Pulsed Pulses the stimulus 200ms on and 200ms off The pulsing affects the Tone Warble and FRESH Noise stimulus User test To select predefined test setups 1 Press User Test The Test Selector window appears on the PC screen 2 Turn one of the Attenuator knobs to scroll through the list 3 Press User Test again to select the highlighted user test Monitoring On Off CH1 The CH 1 On Off button enables disables monitoring of Channel 1 CH 2 The CH 2 On Off button enables disables monitoring of Channel 2 Talk Back The Talk Back On Off button enables disables monitoring of the patient s speech in the operator s monitor headset Monitor Speaker The Monitor speaker button enables disables the monitor speaker built into the ACP Assistant microphone Enables disables the Assistant microphone Monitoring level CH1 CH2 You can monitor Channel 1 Channel 2 1 Press and hold the MONITOR button next to CH 1 or CH 2 and turn one of the Atten uator knobs to determine the intensity of the signal When you press and hold the CH 1 or CH 2 button the level is displayed on the PC screen in the Control Panel The level will be adjusted
89. be followed closely Otometrics MADSEN Astera 167 12 Technical specifications e Portable and mobile high frequency communication devices such as mobile phones may interfere with the func tioning of MADSEN Astera Guidanceand manufacturer s declaration electromagnetic emissions for all equipment and systems MADSEN Astera is intended for use in the electromagnetic environment specified below The user of MADSEN Astera should ensure that it is used in such an environment Emissonstet Compliance Electromagnetic environment guidance RF emissions Group 1 MADSEN Astera uses RF energy only for its internal function Therefore itsRF emissions are very low and CISPR 11 are not likely to cause any interferencein nearby electronic equipment RF emissions MADSEN Astera is suitable for use in all environments including domestic environments and those dir CISPR 11 ectly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Guidanceand manufacturer s declaration electromagnetic immunity for all equipment and systems MADSEN Astera isintended for use in the electromagnetic environment specified below The user of MADSEN Astera should ensure that itis used in such an environment Immunity test IEC 60601 Compliance Electromagnetic environment guidance test level level Electrostatic discharge 6kVcon 6kV con Floorsshould be wood concrete or ceramic
90. cally and graphically in the displayed audiogram when you test with a connected Otometrics audiometer As the module is part of OTOsuite audiograms can be used directly in other OTOsuite modules such as the PMM and Immittance modules for an optimized workflow independent of NOAH and for combined reporting The Audiometry Module provides you with a wide range of features Testing e Testing using the Audiometry Module asa handy control panel while you follow stimulus settings and test progress on your PC display e Tone testing e Speech testing e Awide range of special tests e Controlling play back of speech test material e Using the Masking Assistant to prompt when masking is recommended e Creating complete User Tests for specific audiometric tasks including selecting specific speech lists viewing pref erences activating operator monitoring peripherals etc e Entering tester details and test date entry for manually entered audiograms e Entering special test and tuning fork test results Viewing and printing e Viewing and printing test results e Viewing the progression of a range of tests online e Viewing historic audiometry results from NOAH or XML e Viewing online audiometry results during testing e Viewing masking level indicator in audiogram e Viewing audiogram overlays 1 3 1 NOAH OTOsuite integrates with e NOAH systems e NOAH for ENT e NOAH compatible Office Management systems The NOAH System is a HIMSA
91. carrying out the assembly must take into account that other connected equipment which does not comply with the same safety requirements as this product e g PC and or printer may lead to a reduction in the overall safety level of the system The equipment must comply with UL IEC 60950 The following applies only when used with the specified power supply XP Power type PCM80PS24 When selecting accessories connected to the device the following points must be considered e Use of connected equipment in apatient environment e Proof that connected equipment has been tested in accordance with IEC 60601 1 2nd and or IEC 60601 1 1 and UL 60601 1 and CAN CSA C22 2 NO 601 1 90 The following applies only when used with the specified power supply External power supply Delta Electronics Inc type MDS O90AAS24 When selecting accessories connected to the device the following points must be considered e Use of connected equipment in apatient environment e Proof that connected equipment has been tested in accordance with IEC 60601 1 3rd AAMI ES60601 1 and CAN CSA C22 2 NO 60601 1 08 CAN CSA Do not touch the output DC plug of the power supply or connectors of the device or connected devices and the patient at the same time 19 To comply with Medical Electrical Systems in IEC 60601 1 1 or IEC 60601 1 3rd computer and printer must be placed out of reach of the client i e not closer than approx 1 5 meters 5 ft 20 Do not touch
92. ch material from source A Source B Delivers recorded speech material from source B The FRESH noise is implemented according to specifications of Stimuli for Sound Field Audiometry A Response to Lippmann and Adams G Walker and H Dillon 1984 in Journal of Soeech and Hearing Disorders p 219 and H Dillon 2008 personal communication Eor more information read Narrow Band Noise Audiometry The Effect of Filter Slope Daneil J Orchik and Nancy L Mosher 1975 in The Journal of American Audiology Society Vol 1 No 2 p 50 53 Otometrics MADSEN Astera 27 3 Navigating in the OTOsuite Audiometry Module Stimulus Speech Speech material source Determines the input to Source A and Source B drop down list The options are e Int File stored on hard drive e Int CD internal CD ROM built into the PC e Line In external medium connected to the PC In Tools gt Options gt Audiometry gt Tone gt Measurement gt Switch off Masking on Store you can set up whether the masking signal should automatically switch off when you store a data point or whether it should be manually controlled Tone Presents a Narrow Band Noise asthe masking type If selected under the masking parameters it should only be used as a masker not a stimulus because it is calibrated in effective mask ing level NBN is the default Tone and Speech Presents a White Noise as the masking type Note Select WN in Tools gt
93. ch measurement you make You can also pin tests so that they are read ily available for future testing Adaptive rows The rows in the adaptive table always show the current measurement settings and the measurements you have made A new row will be added to the table every time you make a new measurement 56 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Example Test Ear Score dB SNR A A 93 Info 1 g SRT L AC File The Speech table showing the current measurement settings Data has not been stored at this point Test Ear Score dB SNR N 1 Info 1 gt SRT R 30 AC Live 2 SRT i 30 AC Live 3 gt WRS R 75 75 35 AC NU 6 List 1A WRS L AC NU 6 List 1A The Speech table showing the three first measurements followed by ablank row with the current measurement settings ready to be stored Pinned rows Test Ear Score dB SNR N 1 Info 1 SRT R AC Live 2 i SRT i AC Live 3 gt MCL R AC Rainbow Passage 4 MCL L AC Rainbow Passage 5 3 gt WRS R AC NU 6 List 1A 6 gt WRS L AC NU 6 List 2A 7 You can pin a row to make it available in advance in order to reflect the measurements usually performed in your clinic A table with pinned rows will always look the same when you start testing a new patient This customized layout provides you with a consistent work environment and makes it easy to see what to do next or if
94. characteristic of a typical location in a typ 50 60 Hz magnetic field ical commercial or hospital environment IEC 61000 4 8 Uz is the AC mains voltage prior to application of the test level Guidanceand manufacturer s declaration electromagnetic immunity for equipmentand systems that are NOT life supporting MADSEN Astera isintended for use in the electromagnetic environment specified below The user of MADSEN Astera should ensure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic environment guidance test level Radiated RF 3V m Portableand mobile RF communications equip IEC 61000 4 3 150 kHz to 80 MHz ment should be used no closer to any part of MADSEN Astera including cables than the recom 3V m mended separation distance calculated from the 80 MHz to 2 5 GHz equation applicable to the frequency of the trans mitter Recommended separation distance d 1 2VP d 1 2 VP for 80 MHz to 800 MHz d 2 3 VP for 80MHz to 2 5 GHz where Pis the maximum output power rating of thetransmitter in watts W accordingto thetrans mitter manufacturer and d is the recommended separation distance in metres m Field strengthsfrom fixed RF transmitters as determined by an electromagnetic site survey should beless than the compliance level in each frequency range gt Interference may occur in the vicinity of equip ment marked with this symbol gt Oto
95. d Operation MADSEN Astera is operated from the PC s keyboard mouse or from the the MADSEN Astera Audiometer Control Panel ACP with the OTOsuite Audiometry Module acting as the display showing the intensity frequency as well as current set tings and other information on the PC monitor Speech input signals can be taken from audio files on the PC hard drive CDROM external line in devices such as CD player or tape recorder or live voice from amicrophone Outputs MADSEN Astera supports e 3 sets of air conduction transducers TDH39 headphones HDA 200 headphones for high frequency audiometry calibration can be stored to test 125 to 20 000 Hz Insert Phones e Bone oscillator calibration can be stored for mastoid and forehead placement Otometrics MADSEN Astera 1 Introduction to MADSEN Astera 1 2 1 3 e 1set of sound field speakers 2 to 5 more than 2 is optional The speakers can use either the power amplifier built into MADSEN Astera or external power amplifiers through the balanced line outputs The MADSEN Astera Audiometer Control Panel ACP The MADSEN Astera ACP is used as a supplementary user interface connected to MADSEN Astera and via a USB connection to aPC with theOTOsuite Audiometry Mod ule When connected to MADSEN Astera and the PC with the OTOsuite Audiometry Module started the ACP can be used for performing all standard audiometric tests tone and speech audiometry and
96. d AAMI ES60601 1 and CSA C22 2 NO 60601 1 08 CAN CSA The supplementary provisions on the reli ability of electro medical systems Itis a general rule for all electrical equipment used in the proximity of the client that e The connected equipment must comply with IEC 60601 1 3rd except for the PC and equipment connected to the line in and the line out sockets of MADSEN Astera See Technical Specifications Power supply See also Connector warning notes 157 and General warning notes 158 e When you have connected the accessories configure your system setup To do so see Configuring the Audiometry Module 147 The connections are located at the back of MADSEN Astera 142 Otometrics MADSEN Astera 6 Unpacking and installing beseeeee Patient Responders 143 Insert earphones gt 143 Headphones air conduction 143 High frequency headphones air conduction 143 Bone oscillator 143 Operator monitor headset headphones 144 Operator monitor headset boom microphone 144 Operator monitor speaker 144 Operator desktop microphone 145 Talkback microphone 145 Assistant monitor headset 145 Sound field speakers power output gt 145 External power supply gt 145 PC USB connection 146 Line in 146 Sound field speakers line output 146 roamnmmonp gt VOZ2ZET AS TE Note Blue corresponds to Left and Red corresponds to Right Patient Responders e Ifyou are usi
97. d from using Mic stim ulus for live voice testing Store the word scores See Storing speech data gt 44 3 9 4 Scoring words using external sound source Note Using an external sound source includes the use of all types of sound sources such as CDs MP3 players cassette recorders and sound files on the PC hard drive except for the integrated OTOsuite Speech Material The Speech Player Panel A Word score counter buttons Soci i Incorrect LJ eet A Play Pause 4 Individual items iF Stop Reset word score Previous next list File track list selection disabled when Line Inis selected MOOD Setting up for Scoring and Playing To set up for scoring and playing see Selecting word or phoneme scoring gt 44 The Stimulus bar word score 50 3 0 0 50 words 20 al Sl Chi Pre recorded Insert Right SWN Insert Left Ch2 a A Ss Se Oo i 2 i 20 i0 5 32 101 2 3 Scoring Panel The score percentage and the Correct or Incorrect scores relating to the number of words played are shown at the top ofthe screen When you use external word lists the Scoring Panel is either initialized to 0 0 n or to 100 n n depending on the setting in Tools gt Options gt Audiometry gt Speech gt View gt Score Presentation e Click on the relevant Word score counter button to record the response of the client Store the word scores See Storing speech data 44 52 Otome
98. detected while listening to the continuous tone The intens ity increments should be changed every 3 seconds and the result of the test is the smallest dB increment that could be detected Navigating in DLI The Control Panel Channel Continuous ON When checked the stimulus will be continuously on and will turn off when you press the stimulus button the Continuous on button on the ACP the N Ch1 or M Ch2 key on the keyboard Transducer Presents the stimulus through the insert earphones Phone Presents the stimulus through the headphones High Frequency Presents the stimulus through the high frequency headphones Routing Left Stimulus is routed to the left transducer Stimulus is routed to the right transducer Test Options DLI Transducer dB Step This determines the dB step size for the intensity of the stimulus when presenting the tone manually Options are 1 2 and 5 DeltaL This determines the dB step size for the intensity of the stimulus when presenting the tone automatically using the Play button Options are 0 0 2 0 4 0 6 0 8 1 2 3 4and 5 Use the right Attenuator knob on the ACP or use Shift Arrows Up Down on the keyboard to set the DeltaL DLI Stimulus Bar G A Intensity TAI 1000 He 0 2 B Stimulus indicator cht Tone maert Let m C Transducer indicator D Routing indicator E Test level F Stimulus bar color G Frequency H DeltaL Otometrics MADSEN Astera 79 80
99. e Binaural Loudness Balance eee cece eee cece eccceeeee 73 3 14 4 1 Navigating in ABLB __ 222 ele eee ee eee eee 73 ER T PME TeSL PIOCESS E alt Ae OR A ieee E S atte Se Be 76 3 14 5 MLD Masking Level Difference _ 0 22 ee ee ee eee eee 76 3 14 5i i Navie ating INVER occ tt eee lle ease be ae hie ol ne tek te ea 76 3145 2 test Process a3 3 0 tO us 226 Be eke ou ed Slay ei ee hi Nt Pret OU aes 78 3 14 6 DLI Difference Limen Intensity 2 o cee eee nec eee eee cee eeeee 78 3 14 6 Navigauine TEOL 2552 to ls Site eld eo i be ee Se ae taice 79 3 14 0 2s1Ne Test PLOCOSS lt c56oai000555 b Sooean ucts EE obese se E 82 3 14 7 B k sy OTOsuite Bekesy audiometry _ 2 2 eee eee eee eee eee eee 82 JIA TA TNCLESUIDIOCOSS cto wd une hich wis bea et a rile leet eS cal Sots bviendun a EG 82 3AA n2 a 21 SO 211 Sa ea Oe TSE CO 83 JA LIPREAG oh onc cun cots 02 ede a cylnd ie ed eve ood hee uo eu ata eae N deadatoecnhekeaceas 84 3 14 8 1 Navigating inLIPread 2 le eee ee eee eee 85 3 14 8 2 The LIPread Scoring Counter _ 00 2 e ee ee eee eee eee cece eee cece cence 85 3 14 8 3 The LIPread Player Panel 2 ole eee eee ce cee ec c cece eee cceee 85 3 14 8 4 The LIPread List View 202 cele eee ce cee eee eee cece cece eceeeee 86 3 14 8 5 The LIPread Results Table _ 00 eel eee eee eee eee 87 3 14 8 6 Preparing for LIPread te
100. e index during playback just change index in the Word list control and it will keep on playing from that position How to score e Use the score buttons or shortcut keys or make a right click on a given word already played in the Word list con trol When to reset score Notice the field Reset Score Counter in the Options dialog e Reset Score Counter True Otometrics MADSEN Astera 129 5 Examples of audiometric testing The Scoring panel as well as the Word list control images is reset if changes are made to the Channel Settings except Continuous On the Intensity or when the Reset button is clicked e Reset Score Counter False We actually reset the score in some cases even if Reset Score Counter False This is in situations where we go from using a word list to e g Stimulus CH1 Stimulus CH2 Mic 130 Otometrics MADSEN Astera 6 1 6 2 Otometrics MADSEN Astera Unpacking and installing This section applies both to MADSEN Astera and the Audiometer Control Panel ACP If the ACP is not part of your con figuration disregard the instructions relating to the ACP To install and get started with MADSEN Astera and the OTOsuite Audiometry Module follow the sequence below e Install OTOsuite on the PC before you connect to MADSEN Astera from the PC e Unpack MADSEN Astera see Unpacking gt 131 e Assemble MADSEN Astera see Installing MADSEN Astera and the ACP gt 134 Assembling the AC
101. e test will begin 10 Start the testing at 1000 Hz 11 Start presenting the tone at asound level that should be clearly audible to the patient to confirm that instructions for responding were understood Present the tone for 1 to 2 seconds 12 Ifthe patient responds to the initial sound level presented proceed with the test by decreasing the level in 10 dB steps until no response is obtained Increase the level in 5 dB steps until a response is obtained again Continue decreasing in 10 dB steps and increasing in 5 dB steps until you determine the lowest level at which the patient responds correctly to two of three trials This is the threshold Once threshold is obtained store the response 13 Continue testing with this up down procedure in the following frequency order 2000 4000 8000 500 250 125 and reconfirm the threshold at 1000 Hz Ifthere is a 20 dB difference or greater between octaves test the interoctave frequencies Talk tothe patient occasionally Encourage the patient to concentrate on the task This will keep your patient from getting bored or becoming an unreliable responder 14 Switch to the other ear and tell the patient to listen for the sounds in that ear 15 Repeat steps 11 to 13 Otometrics MADSEN Astera 119 5 Examples of audiometric testing 5 1 2 5 1 3 120 16 17 18 19 20 21 22 23 24 If there is a difference of 40 dB or more between the test ear thres
102. e to close the configuration wizard For more information about connecting FreeFit see the Configuring PMM chapter in the AURICAL FreeFit and the Probe Microphone Measurements Module Reference Manual Measuring Ambient Noise with FreeFit To use the Ambient Noise Assessor to monitor noise levels while performing Audiometry follow this procedure 1 Fit FreeFit with counterweights For detailed instructions see the reference manual for FreeFit 2 Slide the probe cable into place so it fits snugly inthe cable holder on an Ambient Noise Assessor clip Repeat with another clip for the second probe 3 Place FreeFit on the patient s shoulders Clip the probes to the FreeFit collar Position the probes so that they are above the patient s shoulders Otometrics MADSEN Astera 101 102 4 Adjust each probe carefully 5 6 The reference microphone should face the ceiling Ensure that the probe housing does not touch the patient s clothing and that the microphone is not covered by anything such as clothing or hair A Reference microphone Open the audiometry control panel If the Ambient Noise Assessor is not already open click the button on the Audiometry toolbar Press the power button on FreeFit If FreeFit does not connect ensure that your FreeFit has been selected in the PMM configuration wizard Also check the battery status of FreeFit See Charging Powering and Connectio
103. e to the patient confirm that the response instructions are under stood by practicing the response task It is best to use recorded speech to reduce variability However younger children need constant reinforcement to keep their attention and therefore presenting the speech material using live voice is most common Ifthe patient responds to the initial stimulus level presented proceed with the test by decreasing the level in 10 dB steps until no response is obtained Increase the level in 5 dB steps until a response is obtained again Continue decreasing in 10 dB steps and increasing in 5 dB steps until you determine the lowest level at which the patient responds correctly to two out of three trials This isthe SDT Once the SDT is obtained store the response Ifthe SDT of the test ear and the SDT or PTA of the nontest ear differ by 45 dB or greater masking is needed Ifthe SDT of the test ear and the bone conduction PTA of the nontest ear differ by 45 dB or greater masking is needed It can be more challenging to use masking with children as they may become confused when masking is presented However masking should be attempted if it is warranted by the test results Switch to the other ear and repeat steps 9 to 12 Assessing pure tone threshold using the Hughson Westlake procedure 1 Depending on the child s comfort level you might decide to do testing in soundfield However ifthe child will allow it prope
104. ed a point from being calculated you can include it in the cal culations Delete selected point Exclude selected point You can exclude a data point from being included in the calculations Delete all points for this fre quency Delete all points for this ear Right click options in the test view tab New Loudness Scaling Select this item to make several Loudness Scalings using identical set tings Delete this test tab Select to delete from current view Oldenburg The OTOsuite Oldenburg module isa module designed to interface with the Oldenburg Test software From the OTOsuite Oldenburg module you can e launch the Oldenburg test software to perform tests e open view and delete Oldenburg test records e resume Oldenburg tests System overview e The MADSEN Astera audiometer e OTOsuite e The Oldenburg Test software Installation 1 Install the Oldenburg Test software not supplied by Otometrics 2 Insert the Oldenburg license dongle in the PC not supplied by Otometrics 3 Calibrate MADSEN Astera see the MADSEN Astera Service Manual 99 4 Calibrate the Oldenburg Test software if needed 3 14 12 1 Using the Oldenburg module Getting started 1 Launch OTOsuite 2 Click the Navigation Panel and select Oldenburg in the Audiometry module The Oldenburg Measurement Panel shows all installed tests The Oldenburg Measurements main window shows test records if any that relate to the selected
105. ed if MADSEN Astera has been stored ina cold environment Disposal MADSEN Astera can be disposed of as normal electronic waste according to WEEE and local regulations Dimensions Approx 325 x 255 x 60 mm 12 8 x 10 x 2 4 inches Weight Approx 1 3 kg 2 85 Ib Power supply External power supply types Delta Electronics Inc Output 24 V DC 3 75 A MDS O90AAS24 Input 100 240 VAC 50 60 Hz 1 5 A 0 75 A 164 Otometrics MADSEN Astera XP Power PCM80PS24 Power consumption lt 90 VA Mains cables 12 Technical specifications Patient Safety when used with the specified power supply Delta Electronics Inc type MDS O90AAS24 e Complies with IEC 60601 1 3rd Class 1 Type B AAMI ES60601 1 CSA C22 2 NO 60601 1 08 CAN CSA e EMC IEC 60601 1 2 Output 24 V DC 3 33 A max Input 100 240 VAC 47 63 Hz 1 1 A 0 45 A Patient Safety when used with the specified power supply XP Power type PCM80PS24 e Complies with IEC 60601 1 2nd Class 1 Type B UL 60601 1 CAN CSA C22 2 NO 601 1 90 8 71 240 POWER CABLE W SCHUKO PLUG 8 71 290 MAINS CORD HO5VV DK PLUG 8 71 80200 MAINS CORD HO5VV UK PLUG 8 71 82700 POWER CABLE AUSTRALIA 8 1 86400 POWER CABLE CHINA 7 08 027 MAINS CORD HO5VV CH PLUG 7 08 017 POWER CABLE SJ US HOSP PLUG Standards Audiometer Patient Safety EMC 12 2 ACP Outputs Monitor headphone Boom microphone Desktop microphone Otometrics MADSEN Astera
106. elec ted by user will be stored with audiogram point The selected status will be stored when you store a point in the audiogram 3 14 13 3 Noise level indicators in the audiogram Tone audiometry When you make an audiogram using the Ambient Noise Assessor the background color behind each point in the audi ogram indicates the following HL 125 250 500 1k 2k 4k 8k L A No background color The noise level was below the maximum permissible level B Yellow The measured ambient noise level was above the maximum permissible noise level for the stimulus However the level isso low that it may be noise from the FreeFit itself rather than ambient noise See Minimum HTL per transducer type gt 106 C Orange The measured ambient noise was above the maximum permissible noise level for the stimulus D Gray The status of ambient noise is unknown Either FreeFit was not activated when the point was meas ured or the frequency was stored without the signal having been presented 104 Otometrics MADSEN Astera These indicators are stored with the audiogram If the noise level was measured and was below maximum permissible levels for all points in a stored audiogram a check mark is displayed in the bottom left corner of the audiogram HL 125 250 500 1k 2k 4k 8k R 10 o o i l O O O O O 750 1 5k 3k 6k Hz Speech audiometry When you perform a test in the Speech sc
107. ented shows the status Editing E Change Score JJ Play From Here JJ Play Item word list Cancel to start the play back Scoring You can right click on a word to change the score or control the play back of the You can either play back a single item or select a place in the list where you want The key words are scored after play back of each sentence The key words to be scored are shown in BOLD type To score a word click on it You can change aprevious score by right clicking the word and selecting Change Score Otometrics MADSEN Astera 3 14 8 5 The LIPread Results Table Results Ear dB List Info 80 1 Mute Video have been included in the Results table 9 17 2012 Here you can enter your own comment During review when the Player is in idle mode the List View shows all lists that Left 100 You can add a comment of your own choice next to each test Results Table car Shows which ear was tested Indicates the correct score Shows the stimulus and masking levels used in the test Shows the number of the tested list eS Displays the test conditions for example whether sound was muted or video was included etc Date and Comments Displaysthe date of the test and any comments you may have entered 3 14 8 6 Preparing for LIPread testing Preparing OTOsuite 1 Click onthe LIPread tab in the Audiometry module 2 Setup the test to suit your purposes select Tools
108. era 22 aoao cece cece cece e cece cece eeecceeeeceeeee 135 6 4 2 Wall mounting MADSEN Astera _ 22 2220 e ee cee eee eee eee eee cece ee eee 136 64 3 ASSeMmbpling thE ACP 12 foes el oo ae ee ol ea la la eh Se li Lilac oat 137 6 4 4 Connecting the ACP to MADSEN Astera _ 2 220 eee eee eee eee eee ee eee 138 6 4 5 Connecting the ACP to the PC _ 2 2 ee cece cece cece eee cece e ee cceenee 139 6 4 6 Connecting accessories to the ACP __ aaao aoaaa ee ee ee ee ee ee eee eee 141 6 5 MADSEN Astera connection panel 0 eee ee eee cece eee eee eee cece cc eeeeeee 142 7 Configuring the Audiometry Module ___ 2 022 el ee eee eee eee 147 8 Communicating with the device 2c lee ec cee cee cece cece cece eee ceeeceenees 151 8 1 Reconnecting tothe device 2222 2 cessce ee Boe eee ie ee oe eh 151 8 2 Updating device firmware 2 2 eee cece cee cee cc eee cece eee e cece eee eeeeeceees 151 9 Maintenance and calibration ___ 2 2 eee eee eee eee eee eee eee eee 153 gT SeN eand Trepa i562 68s tem tise anceat act ace seems yeese ate cee een ee 153 MeV E NS E 8 cee cps ape Sate rca te EE E ences EAEE hoes ns fe EE A EE T 153 OD MOlCANING oun cots ecru oo aso po as gees A oes See LU Le ee EEA EE E 153 F SCAND AU ON eaten oe rere aces sped sesh bie erent ceed Saas Gis ciel bree Ot aot ie eee Soe ty 154 10 TOUDE NOOI sc 55335365
109. etry 119 O On screen controls 32 Operator boom microphone con nection 144 Operator headphone connection 144 OTOsuite menu bar 15 Overlays feature box Feature box overlays 40 viewing 17 P Patient preparation 115 Patient responder 20 connection 143 PC USB connection 146 Power supply connection 145 Powering 139 Preparing for testing 87 Audiometry 13 inspecting the client s ear 116 Pure tone data feature box Feature box pure tone data 40 Q Quick testing 88 R Reliability feature box Feature box Reliability 40 Results table 87 Right Left audiogram viewing 17 Rinne 127 feature box Feature box Rinne 40 Otometrics MADSEN Astera Index S Safety Audiometry Module 157 Scoring counter 85 Scoring words 86 Screens Speech 43 Tone Audiogram Module 34 Select orientation toolbar 19 SF speakers connection 145 Silence Mode 33 SISI 128 Speakers SF connections 145 Special tests how to 125 Specifications accessories 167 Specifications technical 161 Speech test graph view 60 scoring words 50 52 speech material 48 tabularview 56 terms and abbreviations 63 the counter player 50 52 53 55 the Speech screen 43 viewing speech list 51 54 work area in screen 43 SpeechLink 100 views 132 Stenger feature box Feature box Stenger 40 navigation speech 63 speech 126 tone 125 Stimulus modulation specifications 162 Stimulus types FRESH 27 89 95 111 173 Index 174 ISTS 95 NBN 89 specificati
110. fo E Masked jo a E MaskedNR O fa Otometrics MADSEN Astera 37 3 Navigating in the OTOsuite Audiometry Module 3 7 3 2 3 7 4 38 Creating new symbols 1 Use Microsoft Powerpoint to create graphics that can be saved in Enhanced Meta Files emf format 2 The outer size ofthe EMF file must be less than or equal to 1 x 1 inches 2 5 x 2 5 cm Note If the symbols are created larger this may severely compromise the performance of OTOsuite The standard symbols are drawn within a centered inner frame of 1 5 x 1 5 cm 0 6 x 0 6 inches The area between the inner and outer frames is used for additions to the main symbol such as arrows for No Response or Response at Limit and designators for Aided Left or Aided Right 3 Before you store the new graphic make sure that the outer and inner frames are invisible Select the frame and set the line color to No Line Repeat this for each frame 4 To save as an emf graphics file select all elements in the drawing including the invisible outer frame as well as the symbol itself centered within the frame Right click and select Save as picture 5 Name the file and select the file type emf 6 Save it in C Program Files GN Otometrics OTOsuite AudSymbols 7 Launch the OTOsuite Audiometry Module and select Tools gt Curves and Symbols The new symbol should appear on the list of symbol options In this dialog box you also have options for setting the color line type
111. g an assistant monitor headset plug it into the Assistant monitor headset socket Sound field speakers power output Connections for sound field speakers using the built in amplifiers 4 speakers are currently supported in the software e Connect the left speaker to the socket labeled 1 and the right speaker to the socket labeled 2 e Ifyou are using more than the 2 standard speakers set up the configuration in the OTOsuite Configuration Wizard See the OTOsuite Installation and User Manual External power supply Warning e Use only the power supply provided by Otometrics Warnings MADSEN Astera is not provided with a mains switch To connect MADSEN Astera to the mains supply plug the mains plug into the wall mains outlet To disconnect MADSEN Astera from the mains supply pull the mains plug out of the wall mains outlet Do not position the unit so that it is difficult to pull the mains plug out of the wall mains See Power supply for details 1 Plug the external power supply into the Power socket in the connection panel 2 Plugthe mains plug of the external power supply into an AC mains outlet with a three wire protective ground Otometrics MADSEN Astera 145 6 Unpacking and installing PC USB connection Cautione Install OTOsuite on the PC before you connect to MADSEN Astera from the PC To connect MADSEN Astera to aPC use the supplied USB cable 1 Plug one end ofthe USB cable into the PC USB socket in the co
112. h masking you can choose to store the presentation level of the non stimulus channel as a masking level To do so set Tools gt Options gt Speech gt Measurement gt Use Non Stimulus Channel as Masking to Yes The Speech test screen Selecting the work area in the Speech screen You can perform tests and view the speech test results in the work area The work area can be shown in two modes e Speech testing tabular view 56 Otometrics MADSEN Astera 43 3 Navigating in the OTOsuite Audiometry Module 3 9 1 44 e Speech testing graph view 60 Selecting word or phoneme scoring e See Selecting word or phoneme scoring gt 44 Scoring and playing speech material There are some basic differences in how the settings for Scoring and Playing are applied and relate to each other in word or phoneme scoring and in whether you use integrated OTOsuite Speech Material or speech recordings from other sources These differences are described in detail in the following sections e Set up the Control Panel and select the speech material See Selecting speech material gt 48 Word scoring e Scoring words using integrated OTOsuite Speech Material 50 e Scoring words using external sound source 52 Phoneme scoring e Scoring phonemes using integrated OTOsuite speech material gt 53 e Scoring phonemes using external sound source gt 54 Editing options e Speech editing options tabular view 59 e Speech editing optio
113. he Configuration Wizard and switch the bone oscillator default placement Operator monitor headset headphones Note This applies if you are not using the ACP e fyou are using headphones with the operator monitor headset plug the headphones into this socket K The jack is marked with this symbol Operator monitor headset boom microphone Note This applies if you are not using the ACP e Ifyou are using a boom microphone with the operator monitor headset plug the boom microphone on the monitor headset into this socket G Operator monitor speaker The jack is marked with this symbol Note This applies if you are not using the ACP Connection for the operator monitor speaker built into the ACP or asa desktop version e Plug the operator monitor speaker into the Operator monitor speaker socket Otometrics MADSEN Astera 6 Unpacking and installing Operator desktop microphone Note This applies if you are not using the ACP Connection for the operator desktop microphone e Plug the desktop microphone into the Operator desktop microphone socket G Talkback microphone Connection for the talkback microphone The jack is marked with this symbol e Ifyou are using a talkback microphone plug it into the Talkback microphone socket e Position the talkback microphone in the sound booth facing the client Assistant monitor headset Connection for the assistant monitor headset e Ifyou are usin
114. he regular Tone test in order to facil itate hearing testing on young children The Pediatric test features built in VRA control combinations of Tone and Speech stimuli as well as collecting the child s response to each stimulus presentation You can combine the unique Pediatric features with traditional MADSEN Astera functionality such as FRESH noise Talk to Assistant and flexible control options to efficiently test this difficult totest age group Pediatric testing using VRA Visual Reinforcement Audiometry is aimed at testing children from approximately 7 months to 2 years of age You can perform testing either as a Tone test a Speech test or acombination of both switching between the two types at your convenience to keep the child s attention When you present a stimulus the child will turn its eyes or entire head towards the sound source You can reward the child by activating a lighted mechanical toy placed near the sound source The purpose of the test is to estimate frequency and ear specific hearing sensitivity and hearing loss type with the result being an estimation of hearing thresholds based on minimum response levels MRSLs that are closely connected to per ceptual thresholds In order not to overly challenge the attention span ofthe child to be tested it isextremely important that you have pre pared software and equipment in advance Also it isimportant that you have a clear objective for the testing Navigating in
115. he two channel MADSEN Astera features two separate and fully independent channels true two channel circuitry This permits different stimuli to be freely routed in any combination of ears including binaural True two channel cir cuitry can be used to perform dichotic listening tests or to present two different stimuli to the same ear simultaneously With MADSEN Astera you can perform all standard audiometric tests tone and speech audiometry and special tests e You can operate MADSEN Astera from the PC s keyboard mouse or from the MADSEN Astera Audiometer Control Panel ACP with the OTOsuite Audiometry Software Module acting as the display e From the OTOsuite Audiometry Software Module which is NOAH compatible you can monitor test results create User Tests store and export data and print reports Test intensities and frequencies as well as the current test settings and other information are shown on the PC mon itor MADSEN Astera MADSEN Astera is a Type 1 2 channel PC based audiometer for testing patient hearing MADSEN Astera can be used only in connection with the OTOsuite Audi ometry Module for online operation monitoring of test results data export and storage printing and NOAH compatibility When used with the OTO suite Audiometry Module MADSEN Astera is capable of performing all standard audiometric tests tone and speech audiometry and special tests MADSEN Astera can be desktop or wall mounte
116. hen you increase the level and begin timing again 10 Continue increasing the tone by 5 dB until a level is reached at which the patient indicates that the tone is audible at the same pitch for one minute 11 Ifdesired test additional frequencies or the opposite ear 12 Store the test result in the Tone Decay box 5 3 2 Performing a pure tone Stenger 1 To perform this test the pure tone thresholds for the chosen stimulus frequency should be at least 20 dB different in each ear You must suspect that the patient is malingering 2 Properly place the earphones Begin the test with the air conduction transducer 3 Instruct the patient to push the button in response to the tone even if the sound is very soft 4 Select Puretone Stenger in the Test Selector Otometrics MADSEN Astera 125 5 Examples of audiometric testing Make sure that the control panel of the OTOsuite software isset to the correct transducer and desired routing frequency and sound level Choose any frequency Set the level for the better ear at 10 dB above recorded threshold and set the level in the poorer ear at 10 dB below recorded threshold 5 Make sure that the Stenger box has appeared in the display 6 Make sure that Stim Lock is enabled and present the tone to both ears simultaneously 7 Ifthe patient truly has a hearing loss in the poorer ear he she will only hear the presented tone in the better ear and will respond that the t
117. hold and nontest ear threshold the better ear must be masked to test the poorer ear The Masking Assistant can assist you in determining which thresholds need to be masked To use masking noise in combination with the pure tone either check Stim Lock to coordinate the presentation of two channels or check Continuous On to keep the masking channel presenting continuously After the air conduction thresholds are determined bone conduction audiometry can be performed Properly place the bone oscillator Instruct the patient again to push the button in response to the tone even ifthe stimulusis very soft Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing sound level and frequency Repeat steps 9 to 13 Ifthere is a difference of 10 dB or greater between the bone conduction threshold and the air conduction threshold of the same ear masking isneeded The Masking Assistant can assist you in determining which thresholds need to be masked When all air and bone conduction thresholds are determined the pure tone average PTA for each will appear in the PTA AI box The Articulation Index Al and the overlay options can be used for counseling the patient Click in the Reliability box to report the reliability of the patient s responses during testing Good Fair or Poor Assessing pure tone or speech most comfortable loudness level MCL 1 Properly place the earphones
118. ics MADSEN Astera 93 3 14 10 3 14 11 94 Printing a questionnaire e To print a questionnaire click the Print icon in the top left corner of the questionnaire viewer TEN Threshold Equalizing Noise Purpose of the test The TEN test is a tool for identifying dead regions regions with no functioning inner hair cells and or neurones in the cochlea Dead regions can be difficult to determine with standard pure tone audiometry Persons with dead regions may not benefit from hearing instrument amplification in those regions and amplification may even reduce speech intel ligibility However people with high frequency dead regions may have some benefit from amplification for frequencies up to approximately 70 higher than the edge frequency of a dead region When the pure tone signal frequency falls in adead region the signal will only be detected when it produces sufficient basilar membrane vibration at aremote region in the cochlea where there are surviving inner hair cells and neurons The amount of vibration produced by the tone at this remote region will be less than in the dead region and so the noise will be very effective in masking it Thus the signal threshold is expected to be markedly higher than normal Procedure 1 Select Tone in the Audiometry Module 2 Performa pure tone test to register a pure tone audiogram 3 In Tone select TEN as masking noise and route it ipsi laterally so that both the tone and noise are
119. ify a level that is clearly audible to the patient confirm that the response instructions are under stood by practicing the response task Present the tone for 1 to 2 seconds 7 Ifthe patient responds to the initial stimulus level presented proceed with the test by decreasing the level in 10 dB steps until no response is obtained Increase the level in 5 dB steps until a response is obtained again Because you want to obtain the most inform ation as quickly as possible you may prefer to decrease the level in 20 dB steps and increase in 10 dB steps until you get close to threshold Continue decreasing in 10 dB steps and increasing in 5 dB steps until you determine the lowest level at which the patient responds correctly to two out of three trials This is the threshold Once the threshold is obtained store the response 8 Continue testing with this up down procedure in the following order 4000 500 2000 250 8000 and if possible reconfirm the threshold at 1000 Hz Ifthere is a 20 dB difference or greater between octaves test the interoctave frequencies if possible Remember children need constant reinforcement to keep their attention 9 Switch tothe other ear and repeat steps 5 to 8 10 Ifthere is 40 dB or greater difference between the test ear threshold and nontest ear threshold the better ear must be masked to test the poorer ear The Masking Assistant can assist you in determining which thresholds
120. ight button increases the stimulus frequency e Stores the data point Scoring Level Intensity Change Recognition e Click the button each time the patient acknowledges that a change in 0 0 0 0 intensity was heard gt e Play button Starts the test Otometrics MADSEN Astera 71 Stop button Stops the test Reset button Resets the score to 0 and 0 0 The score box tracks the number of 1 dB intensity changes presented and the number of 1 dB intensity changes the patient heard The percentage isa ratio of the number of intensity changes heard compared to the number of intensity changes presented SISI data OTOsuite FOR EVALUATION ONLY babak File Edit View Measurement Tools Reports Help gt U amp 9 g SE 9 SF Navigator E Control Panel ay A Z amp gt nm Tone Pediatric Speech SISI asp mud Dit QuicksIN Bekesy Tinnitus 40 500 40 l O Stimulus Tone Insert Right NBN Insert Left Masking eeen dB mere dB 0 0 0 i gt m Hu2 250500 1k 2k 4k 8k 10 20 m O OS 50K Ha 70 Do9 80 2 ifs 120 7501 5k 3k 6k Hz Info Threshold Right 25 dB Left Ready No User Test loaded 2015 01 15 Se otometrics e Deletesthe data for a particular frequency for a particular ear e Deletesthe data for all the frequencies for a particular ear 72 Otometrics MADSEN Astera
121. ight transducer is considered the ABLB test ear Test Options ABLB Transducer dB Step This determines the dB step size for the intensity of the reference stimulustone Options are 1 2 and 5 ABLB dB Step This determines the dB step size for the intensity of the ABLB test stimulus Options are 1 should be used for testing 2 and 5 Otometrics MADSEN Astera 73 74 ABLB Stimulus Bar A Intensity ae 6 lt lt gt 1 500 Hz gt 50 fe B Stimulus indicator ae Tore Inmsertet 2 C Transducer indicator oe RA Ne a D Routing indicator E Stimulus bar color F Frequency Intensity Indicated by the dB level above the channel status bars e The green triple wave symbol above the level indicates that the stimulus is currently being presented Stimulus bar color Indicates the routing for the channel e Blue left ear e Red right ear Stimulus transducer and routing indicators Indicates the stimulus type the transducer and the routing for each channel Test controls Test controls provide ameans of operating the audiometer if you use the mouse and on screen options to perform tests e Toenable test controls select Tools gt Options gt Audiometry gt General gt On screen controls Controlling intensity and frequency and storing data e Arrow up increases the intensity e Arrow down decreases the intensity e Arrow left decreases the stimulus frequency e Arrow right increases the
122. ill automatically be disabled ACP front panel controls The ACP buttons and controls are grouped according to their function and how frequently they are used The buttons in the Channel 1 and Channel 2 columns reflect the Control Panel in the OTOsuite Audiometry Module Otometrics MADSEN Astera 3 15 2 1 MADSEN Astera Audiometer Control Panel Test controls gt 107 A Channel 1 Level and on off controls B Common level and frequency controls C Channel 2 Level and on off controls Test related controls 109 D Common level step size pulsed on off E User Test selection Monitoring controls gt 109 F Monitoring Selection and level Operator monitoring and level G Talk forward Test controls STIMULUS TRANSDUCER TRANSDUCER STIMULUS OPERATOR MIC r 1 j kir le ai b Hamctemt Mie i Dewkbug Mie Talc Formac ai CH1 and CH2 controls gt 110 H Channel 1 stimulus I Channel 2 stimulus Test type controls gt 112 J Test types Speech test controls gt 113 K Speech and Pediatric test controls These test controls include the HL attenuator controls Frequency controls the Continuous on Stim Lock Tracking and Talk forward buttons and VRA activation buttons The Store buttons are located just above these controls Otometrics MADSEN Astera 107 HL attenuat
123. ing Does not apply to phoneme scoring Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Playing Playin TAE Note This feature applies to the playback of integrated word lists from the OTO suite Speech Material It contains the following options e Time out Play on Word scoring Count Next word is presented every x seconds based on the value set in the Autoscore in sec box ifthe word is scored the next word will be presented without pausing If the current word times out the Autoscore is applied External speech material Does not apply to external sound source speech material Phoneme Sentence scoring Does not apply to phoneme scoring e Continuous Play Word scoring back The word list is presented exactly as the original recording without pausing External speech material Does not apply to external sound source speech material Phoneme Sentence scoring The word list is presented exactly as the original recording without pausing If a word is presented without any phonemes being counted the Autoscore is applied External speech material Does not apply to external sound source speech material e Play on Count Word scoring Next word plays after previous word is scored To enable this option select the value Both under Counting External speech material Does not apply to external sound source speech material Phoneme Sentence scoring When the number of correct phonemes has
124. ing is recommended e The audiogram symbol will flash at the specific frequencies where contralateral masking may be recommended e The masking criteria are configurable so that you can set them up to match your local recommendations for Masking Assistant masking You can for instance choose either frequency specific criteria which increases the efficacy of your Masking Criteria work or the traditional one level fits all criteria TES CO 970 feo feo 955 fico P55 fos 70 fso feo feo EG Select the Tools gt Configuration Wizard gt Con dai a a ddiaa o feo P40 feo Peo feo feo Jao Pao feo feo Jo pi 125 250 500 750 tk 15k 2 k 4k fk amp k gt 8k Hz Air Bone Gap criterion dB figure Audiometry gt Masking Assistant to set up the masking criteria How does the Masking Assistant work Minimum inter aural attenuation eo p poeeme eC C BC lt AC x dB Only stored thresholds measured without masking are checked Levels which did not evoke a response are excluded from the check This means that as soon as a masked threshold has been stored the flashing stops for that frequency Katz J Lezynski J 2002 Clinical Masking In J Katz ed Handbook of Clinical Audiology Williams and Wilkins Bal timore Based on criteria described in Clinical Masking Essentials of Audiology StanleyA Gelfand Thieme 1997 and Meas urement of Pure Tone Hearing Thresholds Audiologists Desk Reference Vol 1 James W
125. ize for the intensity of the stimulus when presenting the tone manually Options are 1 2 and 5 SISI dB Step This determines the dB step size for the intensity of the stimulus when presenting the tone automatically using the play button Options are 1 should be used for testing 2 and 5 70 Otometrics MADSEN Astera SISI Stimulus Bar a8 be SEJA 1000 Hz tts Chi Tone Insert Left Neg Intensity Intensity Stimulus indicator Transducer indicator Routing indicator Stimulus bar color Frequency mon gt Indicated by the dB level above the channel status bars e The green wave symbol above the level indicates with two waves that the stimulus carrier tone is currently being presented and with three waves that the increment is applied Stimulus bar color Indicates the routing for the channel e Blue left ear e Red right ear Stimulus transducer and routing indicators Indicates the stimulus type the transducer and the routing for each channel Test controls Test controls provide ameans of operating the audiometer if you use the mouse and on screen options to perform tests e Toenable test controls select Tools gt Options gt Audiometry gt General gt On screen controls Controlling intensity and frequency and storing data The Arrow Up button increases the intensity The Arrow Down button decreases the intensity The Arrow Left button decreases the stimulus frequency The Arrow R
126. l Panel and or speech player 2 Right click on the Apply Settings button in the pinned test row and select Assign Selected Stimulus Changing an assigned transducer for a pinned test 1 Select the transducer in the Control Panel 2 Right click on the Apply Settings button in the pinned test row and select Assign Selected Transducer Otometrics MADSEN Astera 61 3 Navigating in the OTOsuite Audiometry Module 3 11 1 62 Note When you use Click n Get to apply settings the AC transducer as well as the speech stimulus are loaded as your preferred starting point You can always adjust them in the Control Panel or in the Speech Player panel Example 1 You typically use insert phones but you have a patient with an ear infection and you wish to use supra aural head phones Use Click n Get to load the desired test and simply switch to Phone in the Control Panel before you start the test Example 2 You typically wish to start the Soeech test by familiarizing the patient with a specific word list before starting the actual test with a different word list Use Click n Get to load the desired starting point and simply switch to any word list you wish to use after the familiarization Storing data ina row To store data in a row click the dB field in the relevant row or press S on your keyboard The Info field The Info field provides additional information such as a stimulus source e g CD Live File or specific soeech
127. le used for connecting the ACP to the PC does not exceed 3 meters 10 feet 1 Unfold the feet of the ACP 2 Place the ACP in front of the PC monitor 2 3 Plugone end ofthe USB cable into the USB socket located in the ACP rear panel and the other end of the cable into a USB socket on the PC Connection to PC using externally powered USB hub Caution If the PC the externally powered USB hub and the ACP are connected make sure that you switch on power to the hub before or right when you switch on the PC This is to ensure that the USB connection between the PC and the hub is established correctly This connection is established when the PC is switched on 140 Otometrics MADSEN Astera 6 Unpacking and installing Cautione If you are using an externally powered hub no individual USB cable must exceed 3 meters 10 feet a Power up sequence with externally powered USB hub 1 Connect the externally powered USB hub to the mains socket and switch it on 2 2 Plugthe single USB cable from the externally powered USB hub directly into a USB socket on the PC 3 Connect the USB cable from the externally powered USB hub to the USB socket located in the ACP rear panel 6 4 6 Connecting accessories to the ACP e Connect the operator monitor headset the boom microphone and the desktop microphone if needed to the ACP fi Jogo 6 o From Main Unit To Operator a ca oe q To Operator Operator monitor head
128. lso known as SAT Speech Aware ness Threshold SRT Speech The data will be stored as a Speech Reception Threshold This is the lowest level at which the patient repeats at least 50 of spondaic words correctly MCL Tone and Speech The Most Comfortable Loudness level symbols will display on the graph when data points are stored UCL Tone and Speech The UnComfortable Loudness level symbols will display on the graph when data points are stored Unaided Aided 1 Tone only Aided 2 Select to display unaided or aided symbols on the graph To change the symbol sets for Unaided Aided 1 Aided 2 select Tools gt Curves and Symbols Tone only The stimulus pulses 200ms on and 200ms off if this option is enabled The pulse duration is configurable Select Tools gt Options gt Audiometry gt Tone gt Measurement gt Pulsed WRS SRS Speech The data will be stored as a Word Recognition Score or Sentence Recognition Score This test requires monosyllabic words to be presented at the patient s MCL level or above The patient is instructed to repeat the words he or she hears Speech Check SNR to report a Signal to Noise Ratio in the SNR column in the Speech test table e Manual Uses the fixed predefined SNR level Automatic Calculates the SNR based on the channel level SNR in dB Set the difference in dB between the signal and the noise If noise is louder in intensity than the signal use a negative number 30 Otometrics
129. m Masking Level 10 dB Inhibition Characteristic Descriptor of perceived residual inhibition Note Enter you comments or notes such as hyper acusis fluctuating etc Tinnitus editing options Right click values in the Tinnitus Evaluation table for measurement information Here you can also delete the data Tinnitus Questionnaires See Tinnitus questionnaires 92 Otometrics MADSEN Astera Data display in Tinnitus screen Evaluation date and time Click to see a list of historical Tinnitus evaluations for the selected patient New Clears the Tinnitus Evaluation table and creates a new table The patient compares the pitch of the tinnitus with the pitch of a presented signal The The patient compares the loudness of the tinnitus with the loudness of the presented Tinnitus matched to non audiometric frequency does not have corresponding hearing The amount of time the tinnitus is absent after 60 seconds of noise stimulation at Min 91 3 14 9 2 92 Tinnitus questionnaires Standardized tinnitus questionnaires are used to obtain a global index score of a patient s perceived tinnitus severity and many questionnaires are available for this purpose C W Newman amp Sandridge 2004 A tinnitus severity index score from a tinnitus questionnaire however should not be relied on asthe sole indicator ofthe degree to which tinnitus affects a patient s life A tinnitus questionnaire provides a standardized baseline of the patie
130. metrics MADSEN Astera 169 12 Technical specifications Note 1 At 80 MHzand 800 MHz the separation distancefor the higher frequency range applies Note 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people The ISM industrial scientific and medical bands between 150 kHz and 80 MHzare 6 765 MHzto 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHzto 27 283 MHz and 40 66 MHz to 40 70 MHz The compliance levels in the ISM frequency bands between 150 kHz and 80 MHzand in the frequency range 80 MHz to 2 5 GHzare intended to decrease the likelihood that mobile portable communications equipment could cause interference if it isinadvertently broughtinto patient areas For this reason an additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in these frequency ranges Field strengthsfrom fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FMradio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment dueto fixed RF transmitters an elec tromagnetic site survey should be considered If the measured field strength in thelocation in which MADSEN Astera is used exceeds the applicable RF com pliancelevel above the MADSEN Astera should be observed to verify normal operati
131. moderate level Present the stimulus and then ask the patient ifthe current level is okay or uncomfortable Increase the presentation level in 5 to 10 dB steps until the patient s uncomfortable loudness level is determined 5 Repeat steps 3 and 4 for each frequency if performing UCL testing for pure tones 6 Switch to the other ear and tell the patient to listen for the sounds in that ear 7 Repeat steps 3 and 4 for the opposite ear 5 1 4 Assessing speech reception threshold SRT using the Hughson Westlake procedure 1 Properly place the earphones Begin the test with the air conduction transducer 2 Instruct the patient so that he she will know what to expect You will hear various words like hotdog ice cream ect When you hear a word repeat it back to me even if the word is very soft It is okay to guess if you are unsure of the word 3 Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing and sound level Make sure that speech reception threshold SRT is selected 4 Begin the test inthe ear that has the lower PTA Inform the patient in which ear the test will begin 5 Start presenting words at a level that should be clearly audible to the patient to confirm that the instructions for responding were understood 6 Itis best to use recorded speech to reduce variability Ifthe automated presentation speed of the recorded speech is too fast for the patient
132. mono jacks 1 4 2 x mono jacks 1 4 5 x terminals 5 x 40 W peak 8Q load 3x mini XLR 6 pin 5 x 6 dBu balanced 0 2 to 2 0 Vrms 10 kQ 2 x RCA phone Electret microphone Input voltage 0 002 to 0 02 Vrms Input resistance 2 21 kQ 3 5 mm jack The signal is presented when the Stimulate button is pressed The signal is interrupted when the Stimulate button is pressed The signal is pulsed 225 ms on and 225 ms off default 1 5W 802 connected between tip and ring sleeve floating 3 5 mm jack 40 mW 162 3 5 mm jack Electret microphone Input voltage 0 002 to 0 02 Vrms Input resistance 2 21 kQ 3 5 mm jack Electret microphone Input voltage 0 002 to 0 02 Vrms Input resistance 2 21 kQ 3 5 mm jack 40 mW 162 3 5 mm jack 4 5 N 0 5 N 163 12 Technical specifications Bone vibrator 5 4 N 0 5 N HDA 200 10 N HDA 300 10 N USB port connector Type USB device port Interface USB 2 0 Speed Full speed 12 Mb s Transport and storage Temperature 30 C to 60 C 22 F to 140 F Air humidity 10 to 90 non condensing Air pressure 500 hPa to 1060 hPa Operating environment Mode of operation Continuous Temperature 15 C to 35 C 59 F to 95 F Air humidity 30 to 90 non condensing Air pressure 980 hPa to 1040 hPa Operation in temperatures exceeding 20 C 4 F or 60 C 140 F may cause permanent damage Warm up time lt 5 min Note Should be extend
133. mulus asa pulsed tone Test Options This determines the dB step size for the intensity of the stimulus when presenting the tone automatically using the Play button Residual Inhibition Player The amount of time the tinnitus is absent after 60 seconds of noise stimulation at Min Noise 1m imum Masking Level 10 dB Tinnitus Stimulus Bar 40 1000 SS ete Chi Tone Phone Right N9 Intensity Stimulus indicator Transducer indicator Routing indicator Stimulus bar color Frequency 1 octave buttons Function beseription A Intensity Indicated by the dB level above the channel status bars e The green wave symbol above the level indicates with two waves that the stimulus QOam moO DW p gt carrier tone is currently being presented and with three waves that the increment is applied B Stimulus indicator Indicates the stimulus type for the channel C Transducer indicator Indicates the transducer for the channel D Routing indicator Indicates the routing for the channel E Stimulus bar color Indicates the routing for the channel e Blue left ear e Red right ear F Frequency Indicates the current frequency G 1 octave buttons Allows octave confusion testing without having to manually find the frequency The audiogram The audiogram shows the patient s most current audiogram at the time of the evaluation Pitch and loudness data is plotted with a T symbol at the a
134. n Status in the reference manual for FreeFit The Ambient Noise Assessor dialog indicates the status of the noise level Ambient Noise Status The measured ambient noise level is below the maximum permissible level for the stim ulus that is currently selected The ambient noise level is above the maximum permissible level calculated by the stand ard Reduce noise if possible The measured ambient noise level is above the maximum permissible noise level However the level is so low that it may be noise from FreeFit itself rather than ambient noise A Connect button is displayed if FreeFit is not connected If you view the Ambient Noise Assessor dialog in an Audiometry test screen other than Tone or Speech you can view the ambient noise bar graph but no maximum permissible level iscalculated and therefore no status can be displayed A question mark is also dis played ifno audiometer is connected Otometrics MADSEN Astera 7 Ifyou are using TDH39 headphones with Peltor noise reduction enclosure select the With Peltor option Note The ANSI standard used to calculate the maximum permissible noise level is based on use of the TDH39 with Peltor noise reduction 8 Tosee alive graphical display of ambient noise click the Show Details button wW Ambient Notse Assessor Pa The curve shows the maximum permissible ambient noise level for the selected stimulus The columns show the current measured noi
135. nana Displays the speech banana of a listener with normal hearing Speech Letters Displays speech sounds at their approximate dB level Unusable area Shades the area which is outside the patient s dynamic range of hearing 3 7 6 Tone editing options When you right click on the main screen in Tone mode the following options appear Tone editing options Selected Point e g Left AC threshold 1kHz If more than one symbol is at the same intensity frequency select the data point of interest from the drop down list Delete Point e Deletes a selected data point Delete Curve e Deletes a selected data curve Insert No Response e Inserts a no response symbol default symbol with arrow down ward on the audiogram You can also access the no response symbol by holding down the S key on the keyboard Insert Response at Limit e Inserts a response at limit symbol default symbol with arrow upward on the audiogram Otometrics MADSEN Astera 41 3 Navigating in the OTOsuite Audiometry Module 3 8 Work flow related features 3 8 1 Selecting orientation Select graph table and control layout Bs Click Select Orientation on the toolbar to see the following dialog Es Graphs and Tables Click to select the way you view the patient in relation to your monitor Control Click to select the position of the stimulus channel on the screen 3 8 2 Channel specific Storing
136. need to be masked It can be more challenging to use masking with children as they may become confused when masking is presented However masking should be attempted if it is warranted by the test results 11 To use masking noise in combination with the pure tone either check Stim Lock to coordinate the presentation of two channels or check Continuous On to keep the masking channel presenting continuously 12 After the air conduction thresholds are determined bone conduction audiometry can be performed 13 Properly place the bone oscillator See Proper transducer placement gt 117 for more detail 14 Instruct the patient and reinforce their participation for example Good Job 15 Make sure that the control panel of the OTOsuite software or the MADSEN Astera ACP is set to the correct trans ducer and desired routing sound level and frequency 16 Repeat steps 5 to 8 124 Otometrics MADSEN Astera 17 18 19 5 Examples of audiometric testing Ifthere is a difference of 10 dB or greater between the bone conduction threshold and the air conduction threshold of the same ear masking isneeded The Masking Assistant can assist you in determining which thresholds need to be masked Once all air and bone conduction thresholds are determined the PTA for each will appear in the PTA AI box The Articulation Index Al and the overlay options can be used for counseling the person accompanying the child The PTA will be
137. ng only one Patient Responder plug it into either of these sockets e Ifyou are using two Patient Responders you can set up the specific Left and Right separation of the Patient Respon ders in see Configuring the Audiometry Module 147 Insert earphones e Plug the insert earphones into the Right and Left Insert sockets If you are using a mono insert earphone plug it into the Left Insert socket the lower socket Headphones air conduction e Plug standard headphone cables red and blue jacks into the Right and Left Headphone sockets High frequency headphones air conduction e Plug the high frequency HDA 200 headphone cables red and blue jacks into the Right and Left High frequency head phone sockets Bone oscillator Mastoid e fyou are using a standard bone oscillator for Mastoid placement plug it into the Mast oid socket the socket pointing to the Mastoid location on the client Otometrics MADSEN Astera 143 6 Unpacking and installing 144 Forehead e Ifyou are using a bone oscillator for Forehead placement plug it into the Forehead socket the socket pointing to the Forehead location on the client Two bone oscillators e Ifyou are using two bone oscillators plug the mastoid bone oscillator into the Mastoid Bone socket and the forehead bone oscillator into the Forehead Bone socket Note If you switch between mastoid and forehead bone vibrator placement for calibration to be correct you must select t
138. nge the score The word that has just been played is also shown above the list so that you can easily score it e Specific scoring Click on the word to toggle between Correct Incorrect or Not Scored or Numerical scoring Use the traditional score controls for word scoring or 0 1 2 3 for phoneme and sentence scoring in the Player Panel Tested Lists After you have scored the integrated word lists they will appear in the Tested Lists tab The Tested Lists tab will show the list belonging to the test currently selected in the Speech Results table tabular or Speech legend graphical The tested lists are also avail able for printing When you mouse over an item in the speech list a Play button appears to the left of the item Click the Play button to present the item to the patient The word currently playing is indicated by a musical note and highlighted in blue inthe list A word that was correctly repeated is highlighted in green in the list A word that was incorrectly repeated is highlighted in gray in the list You can right click on a word to change the score or control the play back of the word list You can either play back a single item or select a place in the list where you want to start the play back 51 3 Navigating in the OTOsuite Audiometry Module Using word lists with monitored live voice testing When you have loaded an integrated OTOsuite Speech Material you can use the word list to rea
139. nnection panel and the other into a USB socket on the PC 2 Switch on MADSEN Astera The driver installation will be initiated 3 Ifthe Found New Hardware Wizard appears on the screen click the radio button No not this time and click Next 4 Follow the on screen instructions Line in Connection for any line in device e g CD player or tape recorder Cautione When you connect other electrical equipment to MADSEN Astera2 remember that equipment that does not comply with the same safety standards as MADSEN Astera can lead to a general reduction in the system s safety level Sound field speakers line output Connections for sound field speakers using external amplifiers 5 speakers are currently supported in the software e Blue connection for speakers 1 and 4 e Red connection for speakers 2 and 5 e Black connection for speaker 3 146 Otometrics MADSEN Astera 7 Configuring the Audiometry Module You must run the Configuration Wizard before you can use the Audiometry Module and the audiometer for the first time You can also use the wizard later to change specific settings or for example to repair the connection between the Audi ometry Module and the audiometer 1 Select Tools gt Configuration Wizard 2 Click on Configure next to Audiometry 3 Enter your selections and click on Next to continue the configuration or Finish to return to the Applications page of the configuration wizard Audiometers C
140. non medical parts such as the laptop computer or printer and the patient at the same time Otometrics MADSEN Astera 159 11 Standards and safety 11 4 The OTOsuite Audiometry Module Complies with Medical Devices Directive 93 42 EEC and RoHS Directive 2011 65 EC Used in error message dialogs if software program fails See the detailed information in the dialog box 11 5 Manufacturer GN Otometrics A S Hoerskaetten 9 2630 Taastrup Denmark T 45 45 75 55 55 45 45 75 55 59 www otometrics com Ju 11 5 1 Responsibility of the manufacturer The manufacturer is to be considered responsible for effects on safety reliability and performance of the equipment only if e All assembly operations extensions re adjustments modifications or repairs are carried out by the equipment man ufacturer or personnel authorized by the manufacturer e The electrical installation to which the equipment is connected complies with EN IEC requirements e The equipment is used in accordance with the instructions for use The manufacturer reserves the right to disclaim all responsibility for the operating safety reliability and performance of equipment serviced or repaired by other parties 160 Otometrics MADSEN Astera 12 Technical specifications 12 1 MADSEN Astera MADSEN Astera is type 1066 from GN Otometrics A S Channels Two separate and identical channels Frequency range TDH39 earphones HDA
141. nowledge about the user s loudness perception of auditory stimuli for dif ferent presentation levels and frequencies This information can be used for diagnostic and rehabilitative purposes par ticularly with regard to hearing instrument selection fitting and verification The Loudness Scaling test in the OTOsuite Audiometry module offers an interactive and self explanatory user interface for e asimple and time efficient procedure to ensure general use in clinical environments e high reliability and straightforward interpretation of test results Description of the test The patient uses a mouse or a touch screen as the patient responder connected to the PC running OTOsuite The test uses asingle step loudness scaling procedure using either a 7 category or 11 category scale not audible very soft very loud uncomfortably loud The results are registered on the PC screen either as level loudness functions loud ness growth curves or as equal loudness contours Navigating in Loudness Scaling The Control Panel Channel Settings SIGNAL Warble FRESH Noise ISTS TRANSDUCER Insert Phone High Frequency Speaker Left Right ROUTING Channel Settings SIGNAL Presents a warbled pure tone as the stimulus type This stimulus type should be used for sound field testing to avoid any standing waves Presents the customized FRESH noise as the stimulus type FRESH stands for FREquency Specific Hearing assessment noise
142. ns graph view gt 62 Storing speech data You can store the current data as the result either by clicking with the mouse on the highlighted field or by pressing the Store shortcut key on the keyboard S See also e Storing SNR for Speech testing gt 59 Selecting word or phoneme scoring Scoring and Playing is a control where you can configure how to play back recordings and score the results The control contains four different columns as listed and described below These columns present various controls which you can com bine to define how to run the test To set up word or phoneme scoring p e click n or e select Tools gt Options gt Speech gt Scoring and Playing and click the pop up button The Scoring and Playing dialog is shown Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Scoring and Playing Scoring Counting Playing Word Scoring Both Time out Play on Count Autoscore in sec Phoneme Sentence Scoring Corrects only Continuous Play back Number of phonemes or Incorects only Play on Count words in sentences 3 Number of items to play back 2 Calculate All Corect Score Always use Numerical scoring method OK Cancel The Scoring and Playing dialog Word scoring In word scoring you score either correct or incorrect responses using or in the Speech Player Panel Numerical phoneme sentence scoring In numerical scoring you click the numbe
143. ns two items that screen for sound tolerance problems The THS is not avalidated outcome instrument and therefore should not be used asa primary measure of outcome of intervention The THS was designed to differentiate tinnitusspecific versus hearing specific problems The THS contains three sections SectionA includes four statements that address tinnitus specific problems unrelated to hearing problems Section B contains four statements that focus on common hearing problems The Section B statements are phrased to minimize any perceived effects of tinnitus on hearing function Higher scores for Section A indicate a tinnitus specific problem whereas higher scores for Section B indicate a hearing problem Results of this survey along with results of the hearing evaluation provide the clinician with the information needed to differentiate tin nitus specific problems from hearing problems Section C asks patients if they have sound tolerance problems Affirmative responses to Section C should be dis cussed with patients to determine the potential need to focus on treating the sound tolerance problem before continuing with Tinnitus management counceling After completing the THS patients should understand that the problems listed in Section A are problems that can be addressed with tinnitus management Section B problems can be addressed with intervention specific to hearing regardless of the cause of the hearing problem Section C
144. nt s perceived problem due to tinnitus and it is essential to acquire this baseline prior to any testing or counseling Types of questionnaires The Tinnitus questionnaires are available in anumber of languages e THI Tinnitus Handicap Inventory The purpose of the THI questionnaire is to establish the severity of the patient s Tinnitus problems The Tinnitus Handicap Inventory C W Newman et al 1996 is one of the most widely used and best documented of the tinnitus questionnaires that currently are available The THI can serve as the primary outcome instrument Patients should complete the THI to assess outcomes at inter vals e g every 3 months during ongoing intervention and prior to terminating intervention The THI contains 25 statements and response choicesare no 0 points sometimes 2 points and yes 4 points The index score ranges from O to 100 Handicap severity can be categorized based on the THI index score as follows Handscomb 2006 Severe 58 100 Moderate 38 56 Mild 18 36 No handicap 0 16 A change in the total index score of at least 20 points has been reported to indicate a statistically and clinically sig nificant change in self perceived tinnitus handicap C W Newman amp Sandridge 2004 The THI would be helpful in selecting those patients with tinnitus most in need of intervention References THI Newman C W Jacobson G P amp Spitzer J
145. ntrol 23 TRANSDUCER Inset Panel gt 26 Phone High Frequency O O Multiple ROUTING Binaural gt a ES C Pulsed The Sunshine Panel with VRA The Classic Control Panel with VRA s x al Click the buttons to toggle Channel Settings Select from the VRA drop down ty ate ade between selections ila mc amp listsin the Test Options panel Tone Note e This example does FRESH Noise 0 b MASKING NBN Q not apply if you are using 0 TRANSDUCER Inset bam a VRA with video rein Phone forcement High Frequency C e Bone Multiple Speaker 5 L an giii it Oc m Right Binaural LA JLo a The Test Panel This iswhere you control the Pediatric test 66 Otometrics MADSEN Astera Without VRA 20 A LI Tone Phone Left Chi Air AY Z 20 2 With VRA Otometrics MADSEN Astera Stimulus control A Stimulus indicator shows the stimulus being presented B Stimulus bar shows stimulus type transducer routing test ear color C Decrease or increase frequency D Enable or disable stimulus Tracking response E Buttons for tracking responses Response Questionable Response and No Response Masking F Masking indicator G Masking ear indicator H Decrease or increase masking level I Enable or disable masking VRA controls See Controlling and using VRA amp 68 A Activate deactivate left or right VRA B
146. on If abnormal performance is observed additional measures might be necessary such as reorienting or relocating MADSEN Astera Over the frequency range 150 kHzto 80 MHz field strengths should beless than 3 V m Recommended separation distances between portable and mobile RF communications equipment and MADSEN Astera The MADSEN Astera is intended for usein an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the MADSEN Astera can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equip ment transmitters and the MADSEN Astera2as recommended below according to the maximum output power of the communications equipment Rated maximum output Separation distance according to frequency of transmitter power of transmitter m W 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz d 1 2 P d 23 P For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equa tion applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer Note 1 At 80 MHzand 800 MHz the separation distancefor the higher frequency range applies Note 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption
147. one is present Thisisa negative Stenger response 8 Ifthe patient does not truly have a hearing loss in the poorer ear he she will only hear the presented tone in the reportedly poorer ear As the patient is trying to appear as if he she has a hearing loss in that ear the patient will not respond to the tone Thisisa positive Stenger response 9 Store the test result in the Stenger box 5 3 3 Performing speech Stenger 1 To perform this test the SRT should be at least 20 dB different in each ear You must suspect that the patient is malingering 2 Properly place the earphones Begin the test with the air conduction transducer 3 Instruct the patient to repeat the word back to the examiner even if the word is very soft 4 Select Speech Stenger in the Test Selector Make sure that the control panel of the OTOsuite software is set to the correct transducer and desired routing and sound level Setthe level for the better ear at 10 dB above recorded SRT and set the level in the poorer ear at 10 dB below recorded SRT 5 Make sure that the Stenger box has appeared in the display 6 Make sure that Stim Lock is enabled and present the word to both ears simultaneously 7 Ifthe patient truly has a hearing loss in the poorer ear he she will only hear the presented word in the better ear and will respond by repeating the word Thisisa negative Stenger response 8 Ifthe patient does not truly have a he
148. only available during speech testing WN Presents a white noise asthe masking type White noise is available for both tone and speech testing Transducer Insert Presents the stimulus or masker through the insert earphones Phone Presents the stimulus or masker through the supra aural headphones The FRESH noise is implemented according to specifications of Stimuli for Sound Field Audiometry A Response to Lippmann and Adams G Walker and H Dillon 1984 in Journal of Speech and Hearing Disorders p 219 and H Dillon 2008 personal communication bE or more information read Narrow Band Noise Audiometry The Effect of Filter Slope Daneil J Orchik and Nancy L Mosher 1975 in The Journal of American Audiology Society Vol 1 No 2 p 50 53 Otometrics MADSEN Astera 111 High Frequency Presents the stimulus or masker through the high frequency headphones Bone Presents the stimulus or masker through the bone oscillator Speaker Presents the stimulus or masker through the soundfield speakers e Ifyou are using only 2 speakers the routing is selected with the routing controls left right binaural e Ifyou are using only 2 speakers you can set up a channel to provide stimulus masking via a different transducer e g when providing masking to one ear and stimulating the other ear using the soundfield speakers Routing Left The stimulus masker will be presented to the left transducer tae i
149. onnect to the device you Click on the device you wish to use wish to use for testing Ifthe device isnot listed check the check box My device is turned on and ready to be found and click on Search If you are having problems connecting to a device that is included in the list click on Repair License Keys Enter your License Keys to e fyou have purchased additional OTOsuite functions you will be prompted to unlock OTOsuite functions enter the relevant license keys Audiometer Configuration Responders Single e For use with one patient responder The response will be shown in single color on the screen Connect the single responder to either of the patient responder sock ets on the MADSEN Astera rear panel Dual ear specific e For use with two patient responders one for each ear The response will be shown in dual color on the screen Connect the corresponding responder to the relevant patient responder socket on the MADSEN Astera rear panel Otometrics MADSEN Astera 147 7 Configuring the Audiometry Module Audiometer Configuration Insert phone selection Mono insert e Ifyou only wish to use a single insert for masking select the mono insert Note If you use only one insert make sure that it is connected to the Left insert socket onthe MADSEN Astera rear panel Dual insert e Ifyou wish to use insert phones as a standard transducer select the dual insert Connect the corresponding transduce
150. ons tabular view __ 0 2 02 eee ee eee eee eee eee 59 3 10 2 Storing SNR for Speech testing 2 cl eee eee ee cece ccc eee e cece ceeeeeeee 59 Speech testing graph view _ 00 eee eee cee eee eee eee eee eee 60 3 11 1 Speech editing options graph View 2 2 ee eee eee eee ee cece cece eee eeeee 62 SMe CCH ed LUG DOES wines ao ea na utes eee een nnd nets Sareea ees oe ewe 63 Terms and abbreviations used in Speech testing 2 cele eee ee eee eee eee eeee 63 SIC CAI CGSES Faas Bt ayn e Aare tee ahs aes te E See 65 3 14 1 Locally available special tests co tw ota ck cde eee wie ec eioe boned aa 65 3 14 2 Pediatrie LOS UMS asic one teen a tien aoa einai heen eatin ee deas caldeciars 65 3 14 2 1 Navigating inthe Pediatric test _ 002 ee eee eee eee eee eee ee cece 65 3 14 2 2 The Control and Test Panels _ 2 2 0 lee eee eee eee eee eee 66 3 14 2 3 The audiogram area acicco5 ac dad cddaSedeeddcakweot ned cukendeadesevseaneesd 68 3 14 2 4 Controlling and using VRA __ 2 2 0 lee ee eee eee eee ee eee eee 68 3142S BNE CURVE SELECTION DOK fers on dion tt oo cect onus a tenia ec eos te dag aun E 69 3 14 3 SISI Short Increment Sensitivity Index 22 0022 2 eee eee eee eee eee eee 70 514 54 Navigating Wall wcusceteledreciesteus dons E ded detent AE EA tues 70 BAA 3 2 The test PIOCOSS Chetan tet ok eee Nd ate Mel neg hd ol ead a aie 73 3 14 4 ABLB Alternat
151. ons 161 Tone 27 89 Warble 27 89 95 WN 89 Storing 131 Sunshine Panel 23 Symbols and curves selecting 20 T Talk forward selecting 19 Talk to assistant 18 Talkback microphone connection 145 Technical specifications 161 Test devices connecting 151 information about 151 views 132 Test devices Audiometry firmware update 151 Test report 154 Testing preparing 87 scoring words 86 Tests Speech screen 43 Tone screen Audiogram Mod ule 34 Timer feature box Feature box Timer 40 Tone decay feature box Feature box tone decay 40 Tone test the Tone screen Audiogram Module 34 Tone stimulus type 27 89 Toolbar select orientation 19 Tools menu Curves andsymbols 20 Tools menu Aud Curves andsymbols 20 Training Audiometry 13 Transducers calibration 154 headphone connections 143 insert phone connections 143 specifications 162 U Unpacking the test device 131 USB PC USB connection 146 USB connection ACP to PC 139 User interface 119 V View menu audiogram legend 17 combined audiogram 17 frequency range 18 left right audiogram 17 Masking Assistant 17 Overlays 17 right left audiogram 17 View menu Aud audiogram legend 17 combined audiogram 17 frequency range 18 masking assistant 17 Overlays 17 W Warble stimulus type 27 89 95 Warning notes Astera 157 158 Weber 126 feature box Feature box Weber 39 multi frequency 40 single frequency 39 Otometrics MADSEN Astera Index White Noise
152. or controls For adjusting e the test signal intensity level e the masking intensity level e operator microphone level e monitoring levels e the talk forward level Stimulus buttons Presents the selected stimulus To reverse this function press the Continuous On button and press the Stimulus button to stop presentation of the selected stimulus Continuous On When activated the stimulus will be continuously on the button is lit To disable continuous presentation press the Continuous On button the button is not lit When the Continuous On but ton is disabled the stimulus is only presented when you press the Stimulus button Frequency buttons Press to select the frequency at which the stimulus is presen ted e The left Frequency button i decreases the fre quency e The right Frequency button ke increases the fre quency Stim Lock Presents the stimuli from both channels simultaneously when you press one of the Stimulus buttons Activate VRA Activates the Visual Reinforcement on your left hand side dur ing Pediatric testing Tracking Changes the level of the stimulus in each channel by the same amount Activate VRA Activates the Visual Reinforcement on your right hand side during Pediatric testing Store Press to store data points in the OTOsuite Audiometry Mod ule E i z TY gt i to 0 ro 108 Otometrics MADSEN Astera 3 15 2 2 Test rel
153. ore button Tone and Speech e Stores the data point on the audiogram s or in the Speech screen Silence Mode Silence Mode allows you to control tone levels and presentation by hovering the mouse cursor over the respective on screen controls This is particularly useful when the operator of the audiometer and the person being tested are in the same room e Toenable silence mode select Tools gt Options gt Audiometry gt General gt On screen controls gt Silence Mode gt On e Tochange the level and frequency by more than one click at atime use the mouse scroll wheel The Tone stimulus bar 20 1000 30a Chi Warbk Insert Left NB Noise insert Binaural Ch A Symbol B Frequency During online testing the stimulus bar shows e Indicatesthe symbol that will be displayed on the audiogram s when a data point is stored The symbol shown reflects the current audiometer measurement settings See also Curves and symbols selection 37 Frequency e Indicated by the Hz value in the center of the stimulus bar Otometrics MADSEN Astera 33 3 Navigating in the OTOsuite Audiometry Module 3 6 3 3 7 34 The Speech stimulus bar J A 502 0 0 25 402 E Chi Live speech Phone Right SPN Phone Left Ch 2 10 S5 32 E 12 3 20 0 6 S2101 2 3 A VU meter B Speech score C Wordcount During online testing the stimulus bar shows Displays the percentage correct inco
154. ou and the client if the environment the client the test device and the software are ready for the test Preparing the test environment Before you start testing make sure that the test environment is conducive to testing e The test environment should be quiet preferably in a sound proof booth for accurate threshold results e The test room or sound booth should have a minimum of furniture and hard surfaced articles i e filing cabinets tables etc asthese can cause reverberation during sound field testing Live voice examinations are best carried out when using asound booth so that the client patient cannot hear the tester s voice directly With tester and client patient in the same room especially of clients with normal or almost normal hearing false results could be obtained Furniture The test environment should include e acomfortable chair for the client e achild sized chair if testing pediatrics e acomfortable chair for the assistant The examiner should be able to see the client patient The client patient should be seated so that it is not possible to see what the examiner is doing or how the equipment is being operated This reduces the likelihood that the client patient can anticipate when the stimulus will be presented For pediatric testing consider using a highchair which is a familiar environment for most children and will place them closer to eye level with the visual reinforcement toys Make sure if performing vis
155. ou decide to make anew audiogram then anew Current audiogram is generated in the Compare Audiograms fea ture box list and what was previously the current audiogram consequently becomes ahistorical one displayed with measurement date If you deselect the viewing of a Current audiogram so that it is no longer shown then it will instantly be reselected if you try to edit a curve You can keep any previously collected audiogram visible in the graph while collecting the current audiogram simply by keeping it selected in the Compare Audiograms feature box while measuring 3 7 5 Tone feature boxes You can access anumber of Tone view options directly from the Tone main screen The view options can be turned on off To do so select Tools gt Options gt Tone Feature boxes Single Frequency Weber Displays the results of a single frequency 500 Hz Weber test e Lateralization options are Uncertain patient response question mark Left L Right R Center arrow up Blank no result Otometrics MADSEN Astera 39 3 Navigating in the OTOsuite Audiometry Module Multi Frequency Weber Displays the results of the Weber test when performed at the standard audiometric frequencies 250 to 4000 Hz e _Lateralization options are Uncertain patient response question mark Left L Right R Center arrow up Blank no result Stenger Displays the results of a pure tone Stenger test e Scoring option
156. ou view the audiogram curves more clearly without showing the responses Lets you view the responses more clearly This is particularly useful during post analysis of the test progress Hide Audiogram Otometrics MADSEN Astera 69 Graph Control buttons Hide Inactive Curves This is particularly useful when you want to focus on one test condition at a time 3 14 3 SISI Short Increment Sensitivity Index The SISI Test was developed by Jerger and co workers Jerger Shedd and Harford 1959 and was introduced as a pro cedure that was reliable and reasonably objective The test consists of superimposing brief bursts of 1 dB intensity increments on a sustained tone presented monaurally through earphones at asensation level of 20 dB at each tested frequency The patient is instructed to report any jumps in loudness detected while listening to the sustained tone for a period of about two minutes 3 14 3 1 Navigating in SISI The Control Panel Continuous ON When checked the stimulus will be continuously on and will turn off when you press the stim ulus button Insert Presents the stimulus through the insert earphones Presents the stimulus through the headphones High Frequency Presents the stimulus through the high frequency headphones Routing Left Stimulus is routed to the left transducer Stimulusis routed to the right transducer Test Options SISI Transducer dB Step This determines the dB step s
157. over swing the cover up into vertical position and lift it off MADSEN Astera Lift off the cable cover Otometrics MADSEN Astera 135 6 Unpacking and installing MADSEN Astera without cable cover Securing cables to MADSEN Astera 1 Secure the cables to the back of MADSEN Astera with the rubber bands provided Mounting the cable cover 1 Remountthe cable cover by inserting the blue tags of the cable cover into the grooves of MADSEN Astera and swinging the cover into place until you hear a click 6 4 2 Wall mounting MADSEN Astera You can hang MADSEN Astera on the wall orienting it in one of three positions 136 Otometrics MADSEN Astera 6 Unpacking and installing j i While tools are needed to attach the wall mount plate to the wall no tools are needed for mounting or dismounting MADSEN Astera on the wall mount plate Note Make sure that you use screws specifically suited for the type of wall on which you will be hanging the MADSEN Astera r 4 1 Mount the wall mount plate securely on the wall J gt 2 Fit the screws through the slots marked by the red arrows 3 Hang MADSEN Astera on the wall mount plate 6 4 3 Assembling the ACP MADSEN Astera ACP PC connection setup If you are using the ACP 1 Unfold the feet of the ACP 2 Place the ACP in front of the PC monitor 3 Connect the ACP to MADSEN Astera2 See Con necting the ACP to MADSEN Astera gt 138
158. patient Testing from the Oldenburg Test software 1 Ifneeded click on Settings in the Oldenburg Measurement Panel and adjust test settings 2 Click onthe test you wish to perform in the Oldenburg Measurement Panel A message indicates that OTOsuite becomes inactive and the Oldenburg Test software is launched 3 Performthe test and save the results 4 Exit the Oldenburg Test software OTOsuite becomes active and the Oldenburg Measurements main window shows the new test record The test record lists the test name and a range of test specific data for easy identification Viewing Oldenburg test records 1 Double click on a test record in the Oldenburg Measurements main window A message indicates that OTOsuite becomes inactive and the Oldenburg Test software is launched 2 Youcan now view the test record Resuming Oldenburg tests If needed you can resume testing from the Oldenburg Test software as long as the test record is from the current working day 1 Double click on atest record inthe Oldenburg Measurements main window A message indicates that OTOsuite becomes inactive and the Oldenburg Test software is launched 2 Youcan now resume the test 3 When you exit the Oldenburg Test software a new test record is shown in the Oldenburg Measurements main win dow in OTOsuite Deleting Oldenburg tests You can delete obsolete or incomplete test records as needed as long as the test record is from the current working day 1
159. pom ee OOOO Talk Forward Select Orientation Sunshine Panel Scoring and Playing Ambient Noise Assessor Otometrics MADSEN Astera Enables communicating with the patient in the sound booth This will display the Talk Forward dialog box where you can control the talk for ward microphone sensitivity and the output level in dB HL to the patient Talk Forward 20 10 Output level dB HL Mic Level e C Allow stimulation v When enabled the monitor speaker will be disabled When the Allow stimulation checkbox is checked you can present stim uli while leaving Talk Forward on This is useful when you wish to present stimuli and verbally reinforce the patient quickly as for instance during pediatric testing Note Be aware that background noise must not be present if Allow stimulation is checked Click to select the perspective of the patient s ears as presented on the screen for graph and table views Click to select the Sunshine Panel in Tone or Speech testing or in some ofthe special tests See The Sunshine Panel See Selecting word or phoneme scoring gt 44 See Ambient Noise Assessor 100 19 3 Navigating in the OTOsuite Audiometry Module 3 2 5 Tools menu Menten em omc Curves and Symbols Click to select the Curves and Symbols dialog box This dialog box and its related function are specific to configuring the curves and symbols to be displayed on the audiogram or speech
160. power supply Otometrics MADSEN Astera 139 6 Unpacking and installing SI d O00 O From Main Unit To Operator 2 The following applies only when used with the specified power supply External power supply Delta Elec tronics Inc type MDS O90AAS24 The installation must be carried out in accordance with Medical Electrical Systems clause 16 in IEC 60601 1 2 3rd AAMI ES60601 1 and CSA C22 2 NO 60601 1 08 CAN CSA The supplementary provisions on the reli ability of electro medical systems It is ageneral rule for all electrical equipment used in the proximity of the client that e The connected equipment must comply with IEC 60601 1 3rd The following applies only when used with the specified power supply XP Power type PCM80PS24 The installation must be carried out in accordance with IEC 60601 1 1 UL 60601 1 and CAN CSA C22 2 NO 2 601 1 90 The supplementary provisions on the reliability of electro medical systems It is ageneral rule for all electrical equipment used in the proximity of the client that e The connected equipment must comply with IEC 60601 1 2nd and or IEC 60601 1 1 Any PC connected to the ACP must comply with the requirements of UL IEC 60950 Safety of information technology equipment including electrical business equipment Only the supplied cable must be used for the connection Direct connection to PC using single USB cable Cautions Make sure that the total length of the USB cab
161. pplicable level and frequency This symbol also shows in the Tone test audiogram and is included in Tone audiogram reports Tinnitus Evaluation table The Tinnitus Evaluation table always shows the most recent data as default You can also click the button showing eval uation date and time to review historical data Otometrics MADSEN Astera Tinnitus Evaluation 2 27 2013 2 11 AM New Pe Right Binaural Pitch Matching Loudness Matching Hearing Threshold Masking Noise Threshold Minimum Masking Level MML Maskability Residual Inhibition Inhibition Characteristic Note Pitch Matching signal is adjusted up or down in frequency until the patient reports a match between them The signal frequency Hz is reported as the result Loudness Matching signal The signal is adjusted up or down in level until the patient reports a match between them The signal level dB is reported as the result Hearing Threshold threshold in the audiogram Here you can measure and enter the patient s perceived hearing threshold for the tinnitus frequency This threshold allows for displaying the tin nitus loudness in dB SL sensation level Masking Noise Threshold The minimum level at which the patient can detect the masking noise signal Min Masking Level MML The mimimum level where the masking noise masks the tinnitus Maskability Descriptor of the perceived degree of masking Residual Inhibition imu
162. presented in the test ear The stimulus for each frequency of the pure tone signal is presented at a level 10 dB above the established threshold For frequencies where the hearing loss is less than or equal to 60 dBHL set the TEN level to 70 dBHL This is not unpleasantly loud for most people and it leads to adefinitive result When the hearing loss is 70 dBHL or more at a given frequency set the TEN level 10 dB above the audiometric threshold at that frequency For example if the audiometric threshold is 75 dBHL set the TEN level to 85 dBHL 4 Ifthe TEN is found to be unpleasantly loud or if the maximum TEN level of 90 dBHL is reached you can set the TEN level equal to the audiometric threshold This should still produce a definitive result It typically takes about 4 minutes per ear to perform the TEN HL test for all test frequencies Interpretation of the test result The criteria for diagnosing a dead region at aspecific frequency are e The threshold of the test tone in the TEN is 10 dB or more above the TEN level e The threshold ofthe test tone in the TEN is 10 dB or more above the audiometric absolute threshold Sources Web site hearing psychol cam ac uk Loudness Scaling Purpose of the test The OTOsuite Loudness Scaling test complies with the ISO 16832 standard for Acoustics Loudness scaling by means of cat egories Otometrics MADSEN Astera 3 14 11 1 Loudness Scaling is a tool for acquiring reliable k
163. quency dB AL Frequency dB L L 2w Info Right Left 4 gt 2000 i 00 NBN Phone Right Ch2 Timer 00 00 ie 250500 1k 2k 4k amp k x OONA 0o ai in N 00 N0oANSAwWN DODOGQOGOGQOGOCO 7501 5k3k 6k Hz Threshold 30 dB Ready No User Test loaded 2015 01 15 e otometrics Data display in DLI screen a pame O O o o y O Threshold e Displays puretone average DLI editing options Editing options e Deletesthe data for a particular frequency for a particular ear Delete all e Deletesthe data for all the frequencies for a particular ear Otometrics MADSEN Astera 81 3 14 6 2 3 14 7 3 14 7 1 82 The test process The audiometer produces four intensity increments per second Each increment has arise time of 50 msec aduration of 75 msec and a decay time of 50 msec The size of the increment DeltaL can be varied from 0 to 5 dB in steps selected e g on screen from the DeltaL dB selection list in the Test Options box During the test the DeltaL is decreased every 3 seconds until the patient no longer hears any changes in the signal and the last registered DeltaL is stored as the result The procedure should be repeated in order to verify the result B k sy OTOsuite Bekesy audiometry Purpose of the test Bekesy audiometry is atype of self recording audiometry The patient is presented with a stimulus which decreases while the patient keep
164. r local distributor first 154 Otometrics MADSEN Astera 10 Troubleshooting 10 1 Powering Problem The On Off light indicator is not lit 10 2 Problem During installation the install ation process may be inter rupted Various error messages may occur When OTOsuite is launched one or more error messages may appear regarding XML errors There is no connection to the device Otometrics MADSEN Astera 155 There is no power supply to the device The PC s virus scan is active and prevents the install ation process from pro gressing An earlier version of OTO suite was installed An extended version of data sets has been installed with the new version of OTOsuite The USB cable connecting the device to the PC was connected prior to installing OTOsuite This results in a Windows default driver being alloc ated Check that the cables of the power supply are firmly connected to the device and the mains outlet socket Check that the mains supply is switched on Deactivate the PC virus scan until the install ation process is completed Accept the error message This message only appears the first time the new version of OTO suite is launched Select the Windows Device Manager followed by Universal Serial Bus controllers The faulty connection will be marked by a yel low question mark in the list Uninstall the driver Make sure OTOsuite is installed and relaunch OTOsuite
165. r the selected speech test Insert Could Not Test CNT will replace the stimulus level for the selected speech test Delete Measurement Deletesan existing measurement Entry fields Enables you to enter results in the selected field e When you have typed inthe desired data confirm by pressing Enter or cancel by pressing Esc Select to define a row as pinned See also Speech testing tabular view 56 Storing SNR for Speech testing Word and Sentence Recognition tests can be performed in noise The Signal to Noise Ratio can be stored with the data regardless of whether the noise comes from the recording or is generated in the audiometer You can enter an SNR manually or set it to be calculated automatically based on the difference between the Stimulus and the noise channel levels e Manudl is useful when signal and noise are mixed together in the speech recording Automatic is useful when you mix speech and noise from the two audiometer channels Otometrics MADSEN Astera 59 3 Navigating in the OTOsuite Audiometry Module 3 11 Speech testing graph view General description 100 90 80 70 60 50 40 30 20 10 0 10 0 10 20 30 40 50 110 120dB The Speech Graph screen displays the speech graph which includes SDT MCL UCL noted by a line blue left red right at the corresponding dB level For SRT and WRS SRS or WRS SRS with noise symbols will be shown based on the location corresponding to
166. r to the relevant insert sockets on the MADSEN Astera rear panel Bone oscillator placement Mastoid e Ifyou wish to use mastoid placement ofthe bone oscillator select Mastoid This selection will enable the calibration data entered for mastoid placement Connect the mastoid bone oscillator into the Mastoid socket on the MADSEN Astera rear panel Forehead e Ifyou wish to use forehead placement of the bone oscillator select Forehead This selection will enable the calibration data entered for forehead placement Con nect the mastoid bone oscillator into the Forehead socket on the MADSEN Astera rear panel Test Type Show xxxx test type e Click to enable viewing any of these test types as a test tab selection on the Audi ometry test screens If aUser Test is set up to include either of these tests and they have been disabled in this screen you will be prompted to enable them here Bone Oscillator Level Limitation Mastoid F orehead Place Define the output level limitations for Bone Conduction testing in order to avoid vibro ment Max Level tactile stimulation Masking Assistant Masking Criteria Define the masking criteria for Insert phone s earphones and high frequency earphones Air Bone Gap Criterion Set the dB level for the Air Bone gap criterion 148 Otometrics MADSEN Astera 7 Configuring the Audiometry Module Frequency Specific Warble Depth Rate Define the depth and rate for using frequency specific w
167. r view or symbols graphical view 5 2 Testing the pediatric patient 5 2 1 Assessing speech detection threshold SDT using the Hughson Westlake procedure Threshold This isthe lowest level at which the patient responds to the stimulus at least 50 of the time For very young children often the responses obtained are above threshold It may take several visits to obtain a complete audiogram 1 Talk tothe patient while you walk him her to the booth This will give you some idea of how well he she is hearing Make the test sound exciting and fun Tell the patient about the toys you have in the booth so that the patient is more comfortable with the testing Use the person accompanying the child as a resource for information about the patient s hearing including which ear might be the better hearing ear 2 Perform otoscopic inspection of the ear canals to make sure that the ears are free from occluding cerumen earwax or debris 3 Optional Perform tympanometry and reflexes prior to audiometric test 4 Depending on the child s comfort level you might decide to do testing in soundfield However ifthe child will allow it properly place the earphones Younger children will usually tolerate insert earphones better than supra aural earphones See Proper transducer placement 117 for more detail Itis helpful to have an extra set of earphones for the person accompanying the child to wear to show the child that it is okay
168. read test is supplied on the OTOsuite Installation disk e The LIPread speech material is supplied on a separate disk Installation For instructions on installing OTOsuite see the OTOsuite Installation Guide which is inserted in the OTOsuite Installation box and the OTOsuite Reference Manual Whether you install OTOsuite or the LIPread speech material first is of no consequence 1 When you have installed OTOsuite and the LIPread speech material enter the LIPread license key in the OTOsuite Configuration Wizard Select Tools gt Configuration Wizard and click the Configure button next to Audiometry 2 Click Next until you reach the screen for entering license keys and enter the license key 3 Ifthe LIPread tab is not shown in OTOsuite enable viewing the tab in the Configuration Wizard Otometrics MADSEN Astera 3 14 8 1 Navigating in LIPread For general information about navigating in the test screen see also the OTOsuite User Guide The main screen consists of e aScoring Counter at the top of the screen See The LIPread Scoring Counter gt 85 e aPlayer Panel for selecting speech lists and controlling the test See The LIPread Player Panel gt 85 e aList View for viewing and scoring in the selected list during presentation See The LIPread List View 86 e aResults Table for viewing and comparing the results See The LIPread Results Table 87 3 14 8 2 The LIPread Scoring Counter 8 132 80 List 1 During
169. red buttons in the Speech Player Panel to score the number of correct phonemes in phoneme scoring or words in sentence scoring The maximum score ina single presentation is either determined as a fixed value 1 to 9 inthe Scoring and Playing dialog or automatically as determined by the integrated word list Specific phoneme sentence scoring Some speech materials support specific scoring This means that you can click the scorable items directly in the speech list Scorable items can be either individual phonemes in phoneme scoring or individual words in sentence scoring You can use the All Correct button when the patient responds correctly to a presentation When you use specific phoneme scoring you can keep your focus on the speech list by using the Play button next to the item in the speech list Word scoring Enable Word Scoring Phoneme Sentence scoring Enable Phoneme Sentence Scoring Number of phonemes or words in sentence Word scoring Does not apply to word scoring Phoneme Sentence scoring Defines the total number of phonemes in the word The default is 3 phonemes intended for monosyllabic words The corresponding number of buttons is enabled in the Speech Player Panel and on the Numerical pad of the PC keyboard Calculate All Correct Score Word scoring Does not apply to word scoring Phoneme Sentence scoring Calculates all correctly scored phonemes or items based on Otometrics MADSEN Astera 45 3
170. reen using tabular view you manually select the status in the Ambient Noise Assessor dialog and the selection appears as a background color behind each measurement in the table The colors have the following meaning A Orange The measured ambient noise was above the Ear Test dB SNR gt 2 i Dm E ji a alee eee h ee eek 2 L soT AC He B Gray the status of ambient noise is unknown Meas 3 R gt SRT AC File x m i urements stored with this status appear the same as 4 L SRT AC File 5 R Mc AC Fie measurements made without the Ambient Noise 6 L 2 ma AC File Assessor activated 7 R uCL AC File 8 tL kelua AC i C Yellow The measured ambient noise level was 9 L p wrRs 65 o AC Maryland CNC List 1 above the maximum permissible noise level for the 10 R WRS 65 Hne z i 2 sah nih BE E stimulus However the level isso low that it may be 11 L gt WRS AC Maryland CNC List 6 f 12L wrs 100 AC MARTER noise from the FreeFit itself rather than ambient 13 R WRS AC Fie noise See Minimum HTL per transducer type 106 D Green The noise level was below the maximum per missible level 3 14 13 4 Activating the Ambient Noise Assessor automatically You can use the toolbar button to open the Ambient Noise Assessor when you need it or you can set the feature to open automatically In Options gt Audiometry gt General gt Measurement Misc you can set Show Ambient Noise Asses
171. references screen is displayed The checkbox Activate control panel must be disabled The Classic Control Panel is divided into the following main sections where you can view and change various settings depending on the selected test type 26 Otometrics MADSEN Astera File Edit View Measurement Tools Reports Help FS C a E FF nonor E coaie HUI 8 8 AF BOS Pediatric Speech sist ass mud DLI Quicksin Bekesy LiPread Tinnitus Loudness Scaling 3 Navigating in the OTOsuite Audiometry Module A Channel Settings 27 B Test Options 29 60 as 1000 Ch1 Tone Phone Right O OO HL125 250 500 1k 2k 10 m EN 000 Oo 0 5 3 5 2 1 Channel Settings Presents a pure tone asthe stimulus type e 125 Hzto 12 500 Hz is standard e 12 500 to 20 000 Hz is optional 40 4 cC Monitor and Level gt 31 NBN Phone Left Ch2 11 5 2013 otometrics Presents a warbled pure tone asthe stimulus type This stimulus type should be used for sound field testing to avoid any standing waves Presents the customized FRESH noise as the stimulus type b FRESH stands for FREquency Specific Hearing assessment noise The microphone operator headset boom microphone or desktop microphone delivers the speech stimulus using live voice Delivers recorded spee
172. rements usually performed in your clinic A legend with pinned rows will always look the same when you start testing a new patient This customized layout provides you with a consistent work environment and makes it easy to see what to do next or if any test has been deliberately left out A test that is not pinned to the legend is added automatically below the pinned rows Click n Get The Click n Get feature allows you to perform a test from the predefined legend simply by clicking the Apply Settings arrow button in the second column of the legend Click n Get loads all the relevant settings including the integrated speech files Pinninga test You can pin one test per measurement condition Note You can pina test to the legend if you have not already pinned an identical test To edit a pinned test make sure that User Tests are not write protected in the Configuration Wizard To pin arow simply select the row right click and select Pinned Tests gt Pin Test Here you can also rearrange pinned rows by moving them up or down in the legend Modifying Click n Get for a pinned test You can assign adifferent speech stimulus and or transducer to a pinned test This will load the desired word list trans ducer etc when you use the Click n Get feature Changing assigned speech stimulus for a pinned test 1 Select the speech stimulus such as aspecific integrated word list or internal CD or line in device in the Contro
173. ries connected to the equipment s outlet fittings must be identical to the type supplied with the system It is recommended that an annual calibration be performed on accessories containing transducers Furthermore it is recommended that calibration be performed if the equipment has suffered any potential damage e g headphones dropped on the floor Note that calibration has been performed only on the transducers supplied Ifyou wish to use any other transducer for testing with the device please contact your local distributor first Disposable accessories such as eartips should not be reused and must be replaced between patients to prevent cross infection Unwanted noise may occur if the device is exposed to a strong radio field Such noise may interfere with the per formance of the device Many types of electrical devices e g mobile telephones may generate radio fields We recommend that the use of such devices in the vicinity of MADSEN Astera be restricted Likewise we recommend that the instrument is not used in the vicinity of devices sensitive to electromagnetic fields Changesor modifications not expressly approved by the manufacturer could void the user s authority to operate the equipment The device can be disposed of as normal electronic waste according to local regulations 18 Use only the specified power supply See Technical Specifications Power supply When assembling an electro medical system the person
174. rly place the earphones Younger children will usually tolerate insert earphones better than supra aural earphones See Proper transducer placement 117 for more detail Itis helpful to have an extra set of earphones for the person accompanying the child to wear to show the child that it is okay to wear the earphones For infants under 6 months it is difficult to get reliable behavioral pure tone responses Forinfants older than 6 months use the head orienting reflex for Visual Reinforcement Audiometry VRA For toddlers use social reinforcement for Conditioned Play Audiometry CPA Otometrics MADSEN Astera 123 5 Examples of audiometric testing 3 Make sure that the control panel of the OTOsuite software or the MADSEN Astera ACP is set to the correct trans ducer and desired routing sound level and frequency Make sure that threshold THR is selected If presenting in soundfield select Warble for the stimulus type Iftesting with earphones switching between tone pulsed tone warble and FRESH noise will keep the patient s attention longer 4 Begin the test inthe ear that has the lower SDT 5 Start the testing at 1000 Hz 6 It is recommended that children be tested using an ascending approach Start at 10 dB and increase the level of the speech stimulus until the child responds This will ensure that you are not conditioning the child at alevel that he she cannot hear Once you ident
175. rrect and the amount of words correct incorrect out of a given number of words You can display speech score and word count either as Correct or as Incorrect To set your pref erence select Tools gt Options gt Speech gt Misc gt Score Presentation Correct is the default setting Displays the level in volume units of the test microphone or speech material from Source A or Source B Speech should always be delivered at O dB on the VU meter so that the dB level on the stimulus intensity bar represents the level actually being delivered to the patient The Tone test screen During online testing the screen reflects the test done by the audiometer asit progresses p OTOsuite FOR EVALUATION ONLY File Edit View Measurement Tools Reports Help A Stimulus bar OF A SI C e ES P nioo E conctrnng HB 8 BOM amp SIE Pediatric Speech sist_ ass mo ou eatin bens in ams meee T B Work area 60 1000 A0 al C Feature boxes Timer ter Compare Audiograms A 11 5 2013 All z Tone Decay 2 kHz z Right Left Pure Tone data PTA AC PTA BC AI dB dB Left d8 d ba la E Overlays F Pictures E Speech Banana 750 1 5k 3k 6k Hz Severity E Unusable Area Legend L R L R M M MCL Ea uvu ua 125 250 500 750 ik 1 5k 2k 3k 4k 6k 8k P NR 11 5 2013 e otometrics Ready No User Test loaded Otometrics MADS
176. rum Insert earphones have greater attenuation between ears especially at the low frequencies this reduces the need for masking 2 Itis best to clip the insert earphone transducers behind the child or on the back of their clothing and then fit the foam eartip into the child s ears Ifthe foam eartip is alittle too large consider cutting it down to make ita little smaller Bone Oscillator Note For unmasked bone thresholds you can store binaural data by selecting Binaural bone in the routing sec tion of the control panel Mastoid placement 1 Move any hair covering the mastoid out of the way and place the flat round part of the bone oscillator securely on the boniest portion of the mastoid without any part of the transducer touching the external ear 2 Make sure the bone oscillator is tight on the mastoid but still comfortable 3 Ifyou are going to perform masking with earphones position the other end ofthe bone oscillator headband over the patient s temple on the opposite side of the head so that the headband of the earphones and bone oscillator fit on the patient s head Otometrics MADSEN Astera 117 4 Preparing for testing Frontal bone placement 1 For frontal bone placement place the flat round part of the bone oscillator securely on the middle of the forehead about an inch 2 5 cm below the hairline 2 Make sure the bone oscillator is tight on the forehead but still comfortable 118 Otometrics MADSEN Astera
177. ry Module DS INOQAM sets cave tdeuu bie eee ee tot TA intended 1 iu coe hie Geet che 1 5 About this manual 1S A Salt SoS eSab cute EA EEE EE 1 6 Typographical conventions 1 6 1 Navigation 2225 ssceedescisedeeincteuy 2 Getting started soe so5 See eee eee 3 Navigating in the OTOsuite Audiometry Module __ 3 1 The Audiometry Module main window 3 2 Menus andtoolbaricons __ 3 2 1 FIG MON 2055 ovevovdsoasescadesieaues 3 2 2 Editmenu ___ 5 270 TOOS MENU 2 tence towel sle fad cto 3 3 The Patient Responder indicator 3 4 The Masking Assistant 3 5 The Control Panels __ 3 5 2 1 Channel Settings 3 5 2 2 Test Options _ 3 5 2 3 Monitor and Level 3 6 The stimulus bar 3 6 3 The Speech stimulus bar 3 7 The Tone test screen 3 7 1 The work area inthe Tone screen 3 7 2 The audiogram 3 7 3 Curves and symbols selection s 0 0 2 2s se edadth ee eee Soe een eke oe ee 3 7 3 1 Selecting a symbol or curve _ 3 7 3 2 Creating new symbols _ 3 7 4 Compare audiograms _ 3 7 5 Tone feature boxes 3 7 6 Tone editing options 3 8 Work flow related features _
178. ry Module on the PC see the OTOsuite User Manual e Make sure MADSEN Astera is switched on e Make sure the connection between the Audiometry Module and MADSEN Astera is enabled See Configuring the Audiometry Module 147 Listening check Perform listening checks routinely to make sure that the equipment is functioning properly e Use a person who has auditory thresholds below 10 dB and make sure that he or she can hear a very faint sound for each stimulus type frequency and for each transducer at 0 to 5 dB e ifthe person cannot hear the stimulus contact the manufacturer or local representative to troubleshoot the system e It is recommended that the system be calibrated annually or according to the local requirements Preparing the client Hygienic precautions It is important that hygienic precautions are taken to protect the client from cross infection Be sure to follow any estab lished infection control procedures for the setting in which you are working e Headphones Clean the headphones between patients e g with a non alcohol based antibacterial wipe such as Audiowipes e Insert earphones Warninge To prevent cross infection use new eartips when you test the next client Inspecting the client s ear s 1 Position the client so that you can easily access the client s ear s 2 Grasp the pinna and gently pull it back and slightly up and away from the client s head 3 Inspect the ear canal and make sure that
179. ry responder easier to use This can be set in Tools gt Options gt Number of Cat egories Preparing the patient Instruct the patient in how the test progresses e The patient will hear stimulus signals e When the signal is presented the patient must select the category bar on the responder corresponding to the patient s perception of loudness Otometrics MADSEN Astera 97 e Explain the loudness categories The rating scale consisting of the response alternatives will be presented to the patient during the test The patient responder contains category bars Minimum and Maximum stimulus levels The effective maximum level is the lowest level of Tone UCL Offset and maximum level as set in Options The effective minimum level is the highest level of Tone THR and minimum level as set in Options The effective test range is shown as the light area between the shaded areas of the Loudness Contour graph Carrying out an automatic test 1 Start the test by clicking the Play button 2 Monitor the patient during the automated test You can pause and resume the test if necessary and Talk Forward can be used at any time The automatic test always repeats the last stimulus when resuming testing after a pause 3 Some stimuli will be perceived as extremely loud 4 The test automatically closes the Patient Responder window when the test is completed 5 Anautomatic test can be supplemented with manual testing if necessary Carrying
180. s are positive or negative Displays the results of a Rinne tuning fork test e Scoring options are positive or negative Reliability Displays the reliability of the patient s responses good fair poor Timer Allows you to time the length ofa tone presentation e g during Tone Decay test ing e The arrow starts the timer The square stops the timer e The Reset button resets the timer to 00 00 Pure Tone Data Displays the pure tone average PTA for air conduction and bone conduction as well as the articulation index Al e The Al iscalculated according to the Count the dot method e Toconfigure PTA calculation select Tools gt Options gt General gt Misc gt PTA Fre quency Multipliers AC BC Tone Decay Displays the results of the tone decay test Scoring options are e Rosenberg Method Normal Mild Moderate Marked or e Jerger STAT Method Negative Positive Select the overlay to be displayed on the audiogram These overlays assist in the counseling process e Select Tools gt Options gt Audiometry gt Tone gt Overlay Selection Box The overlay options are Pictures Displays pictures representing common environmental sounds at their approximate dB level e g bird plane 40 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Severity Displays the audiometric severity levels normal mild mod erate moderate to severe severe profound Speech Ba
181. s the button pressed and increases when the patient releases the button The patient s threshold will be established as located between the points where the patient presses and releases the button The test uses both pulsed and steady tones Results may suggest middle ear cochlear or eighth nerve lesions Description of the test In OTOsuite you can carry out Bekesy testing in two different modes Each mode has its own test screen and you can use the toolbar button to switch screens The applicable screen is automatically selected when you start a test e Sweep frequency This isthe traditional method where the response tracings resulting from a pulsed and a steady stimulus can be com pared for differential diagnostics The Jerger Method e Fixed frequency The level is increased and decreased without changing the frequency until the predefined number of level cycles is reached An average threshold level is calculated and plotted in an HL audiogram and can be stored asa regular audiogram References B k sy Gv 1947 A new audiometer Acta Otolaryngol Stockholm 35 p 411 422 Jerger J 1960 B k sy audiometry in analysis of auditory disorders J Soeech Hear Res 3 p 275 287 The test process Preparing the patient Instruct the patient in how the test progresses e The patient will hear asoft tone that is either pulsed or steady e The patient must keep the responder button pressed for as long as the tone can be heard e
182. se for each 1 3 octave band between 125 Hzand 8 kHz Each column is green orange or yellow corresponding to the color symbols described above Ifthe measured noise exceeds the maximum permissible level 2 seconds before or 0 5 seconds after the stimulus is presented a warning marker is displayed at the corresponding frequency The warning marker will disappear if a new measurement is made when the ambient noise level is OK The warning marker also disappears if you switch to a new test frequency 9 When the noise level is acceptable to you you can store a point in the audiogram as you would normally Inthe Tone screen when a point is stored the noise level status from the last presentation of the stimulus is stored wW Ambient Noise Assessor A Current noise status Too High Current statu Noise status at last stimulus auto matically selected by OTOsuite will be stored with audiogram point Inthe Speech screen the noise level status is not assigned automatically because OTOsuite cannot judge if noise registered after the stimulus is ambient noise or the patient s answer You can use the Ambient Noise Assessor dialog to keep an eye on the current noise level and then present the stimulus when the status is OK Green Then you can select the status in the dialog box before storing Otometrics MADSEN Astera 103 Ambient Noise Assessor A Current noise status With Peltor Noise status at last stimulus s
183. set with boom microphone e Connectthe operator monitor headset to the Operator monitor headset socket The jack is marked with this symbol e Connect the boom microphone onthe monitor headset to the Operator boom micro phone socket The jack is marked with this symbol Otometrics MADSEN Astera 141 6 Unpacking and installing Operator desktop microphone e Ifyou are using a desktop microphone connect it to the Operator desktop micro phone socket q The jack is marked with this symbol iC 6 5 MADSEN Astera connection panel Caution Install OTOsuite on the PC before you connect to MADSEN Astera from the PC The following applies only when used with the specified power supply XP Power type PCM80PS24 The installation must be carried out in accordance with IEC 60601 1 1 UL 60601 1 and CAN CSA C22 2 NO I 601 1 90 The supplementary provisions on the reliability of electro medical systems Itis a general rule for all electrical equipment used in the proximity of the client that e The connected equipment must comply with IEC 60601 1 2nd and or IEC 60601 1 1 except for the PC and equipment connected to the line in and the line out sockets of MADSEN Astera The following applies only when used with the specified power supply External power supply Delta Elec tronics Inc type MDS O90AAS24 The installation must be carried out in accordance with Medical Electrical Systems clause 16 in IEC 60601 1 I 3r
184. sor to Yes Then the Ambient Noise Assessor dialog will open automatically when you open the Tone or Speech tab in Audiometry Otometrics MADSEN Astera 105 3 14 13 5 Minimum HTL per transducer type 3 15 3 15 1 3 15 2 106 The following table describes the minimum HTLs for which the Ambient Noise Assessor can measure ambient noise for various transducers For stimuli below the given level the Ambient Noise Assessor cannot distinguish between noise pro duced by the transducer and ambient noise For stimuli below the minimum level the ambient noise status indicator will be yellow Test controls ACP keyboard mouse The following sections describe ACP controls PC keyboard controls and PC keyboard shortcuts for accessing all basic func tions ACP front panel layout When you use the ACP you can show hide the OTOsuite Control Panel press F12 on the keyboard a You can access all basic functions directly by using the buttons and knobs on the MADSEN Astera ACP front panel The button light indicators Each button has its own function Some buttons have alight to indicate e ee e00000 eee 0000080 i whether the function is currently active For the buttons to light up launch the OTOsuite Audiometry Module Se otometrics Enable disable buttons e Press the button to enable e Press the button again to disable Radio buttons e Toggle function Press the button to enable Any corresponding button w
185. sting 2 2 eee eee eee eee eee eee cece eee eeees 87 31487 he test PIOCOSS nec poe es Sc aa Sodtecciw sameness Seo Du ean amuse seeks 88 SLEIN ks gg av tee Eg md EMSC a SR PRT TP He BO IRR Te e TE 89 3 14 9 1 Navigating inTinnitus _ 0 0 2 2 2 eee eee eee eee 89 3 14 9 2 Tinnitus questionnaires 22 02 5 6 0 00 0c ea tences eles cee ta decesvesdesiesetheies 92 3 14 10 TEN Threshold Equalizing Noise 22 2 eee eee eee eee ee eee eee 94 31A P LOUdMESS S Ca INE oer u ath eeoetits se ceit cor tke nals Sete Hot eee ase os Sen ealad 94 3 14 11 1 Navigating in Loudness Scaling 2 2 0 2 eee ee eee eee eee eee 95 3 14 11 2 The test DlOCESS 4 25 ocn has tn oe oe i eet eid a a ee da ea daccete le 97 Otometrics MADSEN Astera KIA S hetest COST a aac ahh cae eae aerate rate Gck eres eNA D2 s o Bp lt a ee OAR nT EO Re re enn ene PSOE wee SEO SOT en Oem eT Ree EI 3 14 12 1 Using the Oldenburg module 2 eee eee eee eee eee eee eeeee 3 14 13 Ambient Noise Assessor _ 2 2 0 eee ee ee eee eee eee eee nonna 3 14 13 1 Selecting the FreeFit device in OTOsuite 2 2222 2 eee eee eee eee 3 14 13 2 Measuring Ambient Noise with FreeFit _ 3 14 13 3 Noise level indicators inthe audiogram e ee eee eee eeeeeee 3 14 13 4 Activating the Ambient Noise Assessor automatically 3 14 13 5 Minimum
186. t ceo o2c co teedtnt 28 tcou tee osteo tee dt oeseca eee sausecesess ces Performing Alternate Binaural Loudness Balancing ABLB test __ Performing Short Increment Sensitivity Index SISI test 2 0 5 4 Testing with sound files 002 elle ee eee eee eee eee eee 5 4 1 Playing sound files without word lists 2 00 l ee eee eee eee cece eee e cece eeecees 5 4 2 Playing sound files with word lists 02 2 0 l lee eee ee eee eee eee eee 6 Unpacking and installing 24200 4 nt chords chee cece vetted bie ce uli wo buy bene deben ddddae en 6 1 Otometrics MADSEN Astera Unpacking 100 100 101 101 104 105 106 106 106 106 107 109 109 110 112 113 114 115 115 115 116 116 116 116 117 119 119 119 120 120 121 121 122 122 123 125 125 125 126 126 127 127 128 128 128 129 131 131 Oi2 SOLOS aster heim stern ei ciate tas oe oan NE ecclesia 131 6 3 Views of MADSEN Astera 22 20 cee ee eee eee eect eee ee 132 6 3 1 MADSEN Astera 2 210 ccc cc ee ccc cee cece eee cece eee cece eee eccceeeeee 132 Oe OP ce ih een Donets tote Sree eee eee a tee Me Be os ee il eth eee as ae es 132 6 3 3 Total system View 2b osetia Sei bea acta dla a Sach dyer Suu boa lies a thelandestueusleaewts 134 6 4 Installing MADSEN Astera and the ACP __ _ 0 22220 eee eee eee ee cee cece cece ees 134 6 4 1 Assembling MADSEN Ast
187. that is currently displayed Delete all at x e g 1000 Hz e Deletesthe data for that particular column when the frequency is currently set differently from that column 75 3 14 4 2 The test process BHL 1000Hz Tones are presented alternately to both ears and the patient is asked to make an equal loud aa ness judgment 70 80 90 100 110 120 Ref Test 3 14 5 MLD Masking Level Difference The MLD test isa measure of the masking needed to completely mask the test tone when the tone and the masking noise isin phase between both ears SONO compared with a condition when either the tone is 180 degrees out of phase between the ears STNO or the masking noise is SONT The difference in MLD threshold is automatically calculated when the necessary data for the different conditions are stored 3 14 5 1 Navigating in MLD In the MLD Control Panel you can start and stop the stimulus with Continuously On select air conduction transducer with the Insert Phone or High Frequency selections set the stimulus increment size with dB Step and Pulse lets you choose whether to pulse the tone signal You can also select the MLD test conditions SONO STNO or SONT The section for Monitor Level is common for all the audiometer test types The Control Panel Channel Continuous ON When checked the stimulus will be continuously on and will turn off when you press the stimulus button the Continuous on buttons on
188. the ACP the N Ch1 and M Ch2 keys on the keyboard 76 Otometrics MADSEN Astera Insert Presents the stimulus through the insert earphones Phone Presents the stimulus through the headphones High Frequency Presents the stimulus through the high frequency headphones Test Options MLD Test Options MLD Signal Ch1 dB Step This determines the dB step size for the intensity of the tone signal Options are 1 2 and 5 Noise Ch2 dB Step This determines the dB step size for the intensity of the noise signal Options are 1 2 and 5 Presentation This determines the MLD test condition SONO STNO or SONT Togglesto the next con dition when you store data Pulsed This determines whether you pulse the tone signal MLD Stimulus Bar m 543 500 n 402 o Chi Tone Pulsed Insert Binaural NBN Insert Binaural Ch2 Indicated by the dB level above the channel status bars Intensity Stimulus indicator Transducer indicator Routing indicator Stimulus bar color Frequency mOO BD gt Intensity e The green triple wave symbol above the level indicates that the signal is currently being presented Stimulus bar color Indicates the routing for the channel e Blue Red Binaural Stimulus transducer and routing indicators Indicates the stimulus type the transducer and the routing for each channel Test Controls Test controls provide ameans of operating the audiometer if you use the
189. the dB level of presentation and the percentage of correct responses The graphical speech legend The graphical speech legend shows the measurement conditions for testing and displays the corresponding symbols from the graph The legend rows are color coded according to their respective routing The legend adapts to the tests and adds a row for each measurement you make You can also pin tests so that they are readily available for future testing Adaptive rows The rows in the adaptive legend always show the current measurement settings and the measurements you have made A new row will be added to the legend every time you make a new test Example Curve Ear SNR SN 1 Info 1 SRT X OL AC File The adaptive Speech legend showing the current measurement settings Data has not been stored at this point Curve Ear SR A 1 Info 1 gt SRT x OL AC File 2 gt SRT O AR AC File 3 gt WRS O AR AC File WRS x O L AC File The adaptive Speech legend showing the three first measurements followed by a blank row with the current measurement settings ready to be stored 60 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Pinned rows Curve Ear SR SN 1 Info 1 gt SRT O AR AC File 2 gt SRT X OL AC File 3 gt MCL R AC File 4 MCL L AC File 5 gt WRS O AR AC File 6 gt WRS x OL AC File You can pin a row to make it available in advance in order to reflect the measu
190. tile If floors are covered with synthetic material ESD tact tact the relative humidity should be at least 30 IEC 61000 4 2 8 kV air 8 kV air Electrical fast transient burst 2 kVfor 2 kV for Mains power quality should bethat of a typical commercial or hospital environment IEC 61000 4 4 power supply power supply lines lines 1kVfor 1 kV for input output input output lines lines Surge IEC 61000 4 5 1kVline 1kV line Mains power quality should bethat of a typical commercial or hospital environment s to line s s to line s 2 kVline 2 kV line s to earth s to earth 168 Otometrics MADSEN Astera 12 Technical specifications Voltagedips short inter lt 5 U_ gt 95 lt 5 U_ gt 95 Mains power quality should bethat of a typical commercial or hospital environment If the user ruptionsand voltage variations dip in U dip in U of the MADSEN Astera requires continued operation during power mains interruptions it is on power supply input lines forO 5cycle forO5cycle recommended that the MADSEN Astera be powered from an uninterruptible power supply or IEC 61000 4 11 40 UT 60 40 UT 60 a battery dip in U for dipin U for 5 cycles 5 cycles 70 U_ 30 70 U_ 30 dip in U for dipin U for 25 cycles 25 cycles lt 5 U_ gt 95 lt 5 U_ gt 95 dip in U dip in U for5s for5s Power frequency Power frequency magnetic fields should be at levels
191. ting in the OTOsuite Audiometry Module Intensity Indicated by the dB level above the channel status bars e Maskingis denoted by square brackets around the level calibrated in effective masking level e The green triple wave symbol above the level indicates that the stimulus is currently being presented Stimulus bar color Indicates the routing for each channel Blue left ear Red right ear Blue Red binaural Gray unspecified Stimulus transducer and routing indicators The stimulus masking type the transducer and the routing for each channel 3 6 1 Test controls Test controls provide ameans of operating the audiometer if you use the mouse and on screen options to perform tests e Toenable test controls select Tools gt Options gt Audiometry gt General gt On screen controls gt Show gt On Up and down arrows Tone and Speech Stimulus and Masking e The Arrow Up and the Arrow Down buttons change the stimulus level depending on the set ting in Tools gt Options gt Audiometry gt Tone gt Misc gt Level Direction of Arrow Keys Left and right arrows Tone Stimulus and Masking e Arrow left decreases the stimulus frequency e Arrow right increases the stimulus frequency Stimulate button Tone e Presents stimulus e if Continuous ON is enabled activating the button interrupts the stimulus 32 Otometrics MADSEN Astera 3 6 2 3 Navigating in the OTOsuite Audiometry Module St
192. to electrical shock fire and mechanical hazards only in accord ance with medical general medical equipment ANSI AAMI ES60601 1 2005 CAN CSA C22 2 No 60601 1 2008 90 EA 11 2 Connector warning notes Warning Never mix connections between the two types of connectors shown below Direct connectors e All connectors within the red frame are connected directly to patient transducers Otometrics MADSEN Astera 157 11 Standards and safety 11 3 158 Fig 1 Sockets with direct connections to patient transducers MADSEN Astera connection panel Isolated connectors e All connectors within the red frame are isolated from patient transducers Note The safety standards listed in Standards and safety 157 do not apply to the isolated connectors used in the MADSEN Astera audiometer General warning notes 1 This class of equipment is allowed in domestic establishments when used under the jurisdiction of a health care pro fessional 2 MADSEN Astera is intended for diagnostic and clinical use by audiologists and other trained health care professionals in testing the hearing of their patients 3 To prevent cross infection use new eartips when you test the next client 4 Accidental damage and incorrect handling can have a negative effect on the functionality of the device Contact your supplier for advice 5 Forthe sake of safety and in order not to void the warranty service and repair of elec
193. to start the presentation of the word list e Pause During presentation of the word list press the play button gt to pause the present ation The button flashes when the test is paused e Continue play Press the play button gt to continue presentation of the word list Stop e Stop Press the stop button to stop the presentation of the word list Speech counter controls Incorrect Correct e Word Counters Press Correct to count correct responses and Incorrect to count incorrect responses Reset will return the counter to 0 0 The next word will proceed when you have scored the word as correct or incorrect See also Scoring words using integrated OTOsuite Speech Material 50 for more information 113 Pediatric VRA c Press to activate the central Visual Reinforcement during Pediatric testing a e Score as uncertain Press to score the word as uncertain peg e Score as incorrect Press to score the word as incorrect e Score as correct Press to score the word as correct 3 15 3 PC keyboard controls ATA O ORR e Eo oe For PC keyboard controls see the Documentation folder on the OTOsuite install ation medium disk or memory stick CEQtCEEIEeE H H EELESEREEEE 114 Otometrics MADSEN Astera 4 1 4 2 Preparing for testing It is important to prepare properly before making measurements with MADSEN Astera and the OTOsuite software It is time saving for both y
194. trics MADSEN Astera 3 9 5 3 Navigating in the OTOsuite Audiometry Module Scoring phonemes using integrated OTOsuite speech material The Speech Player Panel A Phoneme score counter buttons No correct phonemes 0 1 phoneme correct 1 2 phonemes correct 2 jonfoh m oReset I All 3 phonemes correct 3 S Individual items Play Pause Stop Reset Counter scoring and Player Previous next list File track list selection mMOO DW In the Speech Player Panel example shown above the Number of phonemes setting in the Scoring and Playing dialog box is set to 3 Configurable number of phonemes The integrated speech materials dictate the number of phonemes and provide the appropriate number of scoring buttons automatically This can be configured specifically for each item in the integrated Speech material Please contact your sup plier for further information Setting up for Scoring and Playing To set up for scoring and playing see Selecting word or phoneme scoring 44 The Stimulus bar phoneme score 652 76 15 words 40 al Chi Pre recorded Insert Left SWN Phone Right Ch2 2 10 5 32101 2 3 2 10 5 32 101 2 3 Scoring Panel The score percentage and the number of words played are shown at the top ofthe screen The Scoring Panel is either initialized to 0 0 words or to 100 0 words depending on the setting in Tools gt Options gt Audiometry gt Speech gt
195. tro medical equipment should be carried out only by the equipment manufacturer or by service personnel at authorized workshops In case of any defects make adetailed description of the defect s and contact your supplier Do not use a defective device 6 Itis recommended to install the unit in an environment that minimizes the amount of static electricity For example anti static carpeting is recommended 7 Do not store or operate the device at temperatures and humidity exceeding those stated in the Technical Spe cifications Transport and storage 8 Keep the unit away from liquids Do not allow moisture inside the unit Moisture inside the unit can damage the instrument and it may result ina risk of electrical shock to the user or patient 9 Donot use the instrument in the presence of flammable agents gases or in an oxygen rich environment 10 No parts may be eaten burnt or in any way used for purposes other than the applications defined in the Intended Use section of this manual Otometrics MADSEN Astera 11 12 13 14 15 16 17 11 Standards and safety The device and any device to be connected which has its own power supply should be turned off before any con nectionsare established To disconnect the device from the mains supply pull the mains plug out of the wall mains outlet Do not position the unit so that it is difficult to pull the mains plug out of the wall mains For safety reasons accesso
196. tte recorders and sound files on the PC hard drive except for the integrated OTOsuite Speech Material 54 Otometrics MADSEN Astera 3 9 7 3 Navigating in the OTOsuite Audiometry Module The Speech Player Panel A Phoneme score counter buttons No correct phonemes 0 1 phoneme correct 1 2 phonemes correct 2 Lo fa 2 3 m Reset id mL All 3 phonemes correct 3 S Individual items X Play Pause Stop Reset Counter scoring and Player Previous next list File track list selection disabled when Line Inis selected moO DW In the Speech Player Panel example shown above the Number of phonemes setting in the Scoring and Playing dialog box is set to 3 Setting up for Scoring and Playing To set up for scoring and playing see Selecting word or phoneme scoring gt 44 The Stimulus bar phoneme score 653 76 15 words 40 l Chi Pre recorded Insert Left SWN Phone Right Ch2 2 10 5 32 101 2 3 2 10 5 32 101 2 3 Scoring Panel The score percentage and the number of words played are shown at the top ofthe screen The Scoring Panel is either initialized to 0 0 words or to 100 0 words depending on the setting in Tools gt Options gt Audiometry gt Speech gt View gt Score Presentation e Click onthe relevant phoneme score counter button to record the response of the client Store the phoneme score results See Selecting the work area inthe Speech screen gt
197. ual reinforcement audiometry that the reinforcing toys can be seen by the child A child cannot look over and up at a toy until approximately 9 months of age Lighting The lighting in the booth should be bright enough for the examiner to adequately see the client Toys If testing pediatrics several interesting toys are needed to center the child obtain the child s attention toward the assist ant or tester prior to stimulus presentation It is best ifthese toys do not produce sounds The child should be conditioned to respond to the sound of the stimulus only Competing sounds from toys can confuse the child and reduce the reliability of the test Soft toys are needed to keep ayoung child s attention during behavioral observation or visual reinforcement audiometry Younger children like to tap the toy on the highchair tray and therefore a toy that does not create much sound would be more appropriate during testing Blocks buckets puzzles are needed to keep achild s attention during play audiometry Preparing the test equipment Accessories Make sure that you have connected the required accessories to the audiometer e headphones Otometrics MADSEN Astera 115 4 Preparing for testing 4 3 4 4 4 4 1 4 4 2 116 e insert phone s e bone oscillator e patient responder MADSEN Astera and the Audiometry Module e Make sure the cables of the test equipment are connected correctly e Launch OTOsuite and the Audiomet
198. ually Level Shift when You can choose whether the new level should be referenced to the previous data point or be set Storing to a fixed level If adata point already exists at the new frequency this will be used asa ref erence point Note The automatically selected level never exceeds 80 dB HL for reasons of safety Frequency Shift Wrap when Storing Automatically selects the next higher frequency When it reaches the highest available fre None Wrap But quency it wraps around to the lowest frequency terfly Butterfly Automatically selects the next higher frequency When it reaches the highest available fre quency it goes to 1000 Hz and automatically selects the next lower frequency When it reaches the lowest frequency it automatically goes to 1000 Hz The direction depends on whether the previous data point was stored at a higher or lower frequency Stimulus duration You can set a fixed duration of the presentation of the tone stimulus To do so select Tools gt Options gt Tone gt Meas urement gt Stimulus Duration Ear shift frequency and level setting When you change test ear you can define that the frequency and level should be set to 1000 Hz at 20 dB HL To doso select Tools gt Options gt Tone gt Measurement gt Ear Shift Frequency and Level Check Ear Shift Frequency and Level Saving non stimulus channel as masking If you use an external masking signal non audiometer masking noise for soeec
199. umber of presentations in the test in order to famil iarize the patient with the test process The patient s responses will not be col lected The number of presentations used to familiarize the patient can be set in Tools gt Options gt Familiarization Presentation Count You can click the Skip button to interrupt the familiarization phase and start the actual test where the patient s responses will be collected MANUAL dB STEP ays Definesthe intensity of the stimulus used STIMULUS e Shuffle Frequency Order Jumps between frequencies during the test instead of completing an entire fre quency before going to the next frequency UCL Offset Definesthe max level of the Loudness Scaling testing in relation to the UCL level from the Tone audiogram The Player Panel A Play Pause and Stop buttons Play opens the Patient Responder B Select the frequencies at which you wish to perform the test for one or both ears 250 v 500 v 750 J ik W 1 5k 125 F x E J 4k Vv The test process The Patient Responder The patient s response is entered using the Patient Responder window Entering the response can be done either by the patient or by the operator by selecting the category bar corresponding best to the patient s perception of loudness Even bars with no text can be clicked The Patient Responder window opens up on the screen where it was last used when the test is started Some patients may find the 7 catego
200. ut 3 You can find the speech material files in the File track list Goke le a E selection drop down list beoi j4 Speech list files provided by Otometrics When you use integrated OTOsuite Speech Material you can choose between speech lists in the File track list selection drop down list Select Int File in the Control Panel and browse to the folder where your speech material is installed default location c Program Files GN Otometrics OTOsuite Wordlists Regular sound files files not supplied on the OTOsuite Speech Material CD You can use any sound file stored on your PC hard drive Select Int File in the Control Panel and browse to the folder where your recordings are stored CD material You can use any type of CD sound recordings of your choice e Select Int CD in the Control Panel and browse to the drive you wish to use These files are shown as CD track numbers in the File track list selection drop down list Line In When Line In is selected only the Counter of the Player Panel is activated Otometrics MADSEN Astera 49 3 Navigating in the OTOsuite Audiometry Module 3 9 3 50 Scoring words using integrated OTOsuite Speech Material A Word score counter buttons Correct Incorrect a gt The Speech Player Panel PPPA gt Reset _ Play Pause Stop Reset word score Previous next list File track list selection 5 Individual items
201. uttons you can customize the setup 1 Enable disable the button s you wish to display 2 Click to disable the selection Use Single Button The enabled buttons are displayed immediately in the panel Unusual settings Non default settings that you can select only in the right click menus are shown as shortcut links in the Sunshine Panel Click the link to deselect or change the setting Panel description Click on the buttons to toggle the selection or right click on a button to select acombination of functions e e Test ear selection Click to select test ear e Right e Left e Binaural Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module rmm O fo oee Transducer selection Click to select the transducer used for the test ear for test ear Phones standard headphones Bone oscillator Insert earphones High Frequency headphones SF Unaided Sound Field speaker unaided SF Aided 1 and SF Aided 2 Sound field speaker Aided 1 and 2 Transducer selection Click to select the transducer used for the masked ear for masked ear Phones standard headphones Bone oscillator Insert earphones High Frequency headphones SF Sound Field speaker SF Aided 1 and SF Aided 2 Sound field speaker Aided 1 and 2 Click to select stimulus type Tone Tone testing Warble Tone testing FRESH noise Tone testing Pre recorded stimulus Speech Microphone to present live speech
202. word or count it as fully correct or incorrect If phonemes are not manually scored before Time out or before the next word is presented by Continuous Play back the scoring is set automatically External speech material Does not apply to external sound source speech material 3 9 2 Selecting speech material Caution Only speech material supplied on the OTOsuite Speech material CD is precalibrated according to the description supplied with the original speech material If you use any other speech material make sure that it is calibrated correctly 48 Otometrics MADSEN Astera 3 Navigating in the OTOsuite Audiometry Module Classic Panel Sunshine Panel 1 Activate Source A or Source B in the STIMULUS section of Sg Mask Channel Settings a CHANNEL 1 2 A t h e Cont rol Pa ne l Continuous ON a z STIMULUS Mi O O ail int Fie Ot Source 4 O i Sy a SouceB O O N MASKING swn O 2 Select speech input from pre recorded input sources for xg Mask Channel Settings Source A or Source B from the list in the STIMULUS section CAUNET Continuous ON 4 2 ofthe Control Panel STIMULUS Mi O O a mra meee EO _ Int CD CD material in CD DVD drive CD Saxd 0 Q gt ee swn O Int File integrated OTOsuite Speech Material or reg ular sound files Line In analog input from external sound players eg CD MD MP3 or cassette recorders connected to the audiometer via the Line in inp
203. you can see the ear drum If you can see apparent narrowing of the ear canal it may be blocked by vernix or debris or it may not be straight 4 Ifthe ear canal is blocked for instance by vernix or debris the outcome of the procedures may be affected Clean the ear canal if required Otometrics MADSEN Astera 4 5 4 Preparing for testing Proper transducer placement Headphones 1 Loosen the headband and place both the left and right side of the headphones simultaneously 2 Make sure that the blue indicator is on the left ear and the red indicator is on the right ear The center of the head phone diaphragm should be directly opposite the opening of the ear canal for the left and right side Note If the headphones are not placed properly there is risk of causing the ear canal to collapse which will res ult in elevated thresholds 3 Askthe patient if the headphones are comfortable 4 Tightenthe headband while holding the headphones in place with your thumbs 5 Examine the placement of the headphones to make sure they are level and properly positioned Insert Earphones Young children tolerate insert earphones better than headphones The insert earphones are color coded e the blue indicator for the left ear e the red indicator for the right ear 1 Select the largest foam eartip that will fit into the patient s ear Ifthe eartip istoo small the sound will leak out and the dB level will not be accurate at the eard

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