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TM262 User`s Manual

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1. or frequency modulated FM tone by depressing the appropriate button The display reflects the change with the appropri ate symbol These alternative tone formats remain selected during that particular audiometric test Once any new test or test ear is initiated the tone type returns to steady The audiometry test defaults to testing the right ear first To start with the left ear itis necessary to select the LEFT button upon entering the audiometry mode To change frequencies select the Hz gt button to advance to higher frequencies or the Hz lt 4 button to advance to lower frequencies Push once to advance one frequency or hold the button down to scroll through the frequencies Once the end of the frequency range is reach ed the scroll will wrap around to the opposite end of the range and continue advancing The value of the currently selected frequency is always displayed on the LCD screen To change the intensity level of the test tone use the dB HL knob Rotating this knob in the clockwise direction causes the intensity level to increase in 5 dB steps rotating it in the counter clockwise direction causes the intensity level to decrease in 5 dB steps Note that the cur sor moves up and down accordingly and that the corresponding level appears on the screen above the frequency value For each frequency there is a fixed intensity range normally available 125 Hz 10 to 50 dB HL 250 Hz 10 to 70 dB HL 500 to
2. Audiometry Normal Box Pressure Peak Probe Tone Tympanogram Tympanometry reflex arc elicited in the presence of very loud sounds which causes a decrease in middle ear compliance as a protective mechanism for the cochlea the point of maximum mobility in a tympanogram which indicates the degree of mobility within the middle ear system volume measured between the tip of the probe and the tympanic membrane at the starting pres sure for a tympanogram the acoustic reflex elicited when the stimulus is presented to the same ear where the response is measured a hearing test performed with a variety of fre quencies and intensities without the use of mask ing to determine if an individual can hear range of pressure peak and compliance peak val ues associated with normal middle ear function 150 daPa to 100 daPa 0 2 cm to 1 4 cm per ASHA 32 Supl 2 1990 17 24 pressure value where maximum mobility occurs in a tympanogram This pressure value approxi mates the pressure within the middle ear space low frequency 226 Hz tone used to measure middle ear mobility the tracing which depicts the results of tympano metry an objective measurement of middle ear mobility and middle ear pressure through the use of a low frequency sound probe tone and air pressure changes Bibliography American Speech Language Hearing Association 1990 Guidelines for Screening for Hearing Impairment and Middle Ear
3. If there is a perforation due to trauma or due to the presence of a pressure equalization P E tube the measured ear canal volume will be much larger than normal since the TM 262 Auto Tymp is measuring the combined volume of the ear canal and the middle ear space 4 2 COMPLIANCE PEAK NORMAL The range of normal compliance admittance is 0 2 cm to approxi mately 1 4 cm Some groups site a larger range of normal up to 1 8 cm A measured compliance peak within this range indicates normal mobility within the middle ear system ABNORMAL A compliance admittance value of less than 0 2 cm indicates a pathological condition as the middle ear system is stiffer than normal To distinguish the probable cause of the stiffening the pressure value where this stiffened compliance peak occurs needs to be considered For example normal pressure along with a stiff middle ear system is indicative of a glue ear otosclerosis a severely scarred tympanic membrane or a layer of plaque across the tympanic membrane On the other hand abnormal pressure along with a stiffened middle ear system is consistent with a poorly functioning eustachian tube with possible effusion serous otitis media NOTE If the measured compliance value is less than 0 1 cm3 the TM 262 Auto Tymp will print the letters NP next to the heading cm on the screen and printout The letters NP indicate a poorly defined or flat tympanogram The tympanogram
4. 25 dB HL These normal values assume a sufficiently quiet environment during testing ABNORMAL In children a failure to respond to a 20 dB HL or lower stimulus pre sentation during a retest performed four to six weeks after the initial test would indicate the need for more extensive diagnostic testing to determine the cause In adults a failure to respond at or below 25 dB HL when the room noise levels are low indicates the need for more evaluation How ever the age and employment history of the individual must also be considered 4 7 SPECIAL MESSAGES AND ERROR CODES Special messages and error code numbers may be displayed on the screen or on the printout Special messages appear to apprise the op erator of certain situations For example if there is no test result on the screen and the PRINT SCREEN button is pressed the printer will indicate No Test To Print An error code appears as a two digit number prefixed by the letter E If an error code appears repeat the operation that caused the error code to appear If the error code appears for the second time contact Welch Allyn with the exact error code number 4 8 SAMPLE TEST RESULTS NAME Range of Normals DATE Ear Canal Volume 0 2 2 0 s 3 A a eo a Compliance Peak 0 2 1 4 15cm Pressure Peak 150 100 Gradient 60 150 Child 50 110 Adult Acoustic Reflex Yes or No T T T T T 1 400 daPa 0 200 F
5. 3 RD SIGNAL 7 7 SIGNAL SIGNAL 7 5 SIGNAL GROUND GROUND GROUND GROUND 5 6 3 Communications Flow Control Software XON XOFF flow control is available to allow software com mands from the external computer to start and stop the flow of data from the TM 262 No hardware flow control is provided Sending XOFF ASCII control character DC 3 to the TM 262 pauses its transmission Sending XON ASCII control character DC1 to the TM 262 resumes the transmission Once XOFF is received by the TM 262 XON must be received within six seconds If not received within this time then the message NO RESPONSE is displayed for about three seconds transmission is aborted and normal operation resumes After an XOFF timeout the next transmission waits for XON to be re ceived within six seconds as described above These commands are valid only during data transmission and when enabled in the Data Transfer Program Mode Service and Warranty Information SERVICE AND REPAIR Repair must be performed by authorized personnel Failure to do so invalidates the TM 262 Auto Tymp warranty For customers in North America or Canada please contact Welch Allyn for information regarding where to return your TM 262 Auto Tymp for service Technical Service Department Technical Service Department Welch Allyn Inc Welch Allyn Canada Limited 1 Westchester Drive 160 Matheson Boulevard East Milford NH 03055 3056 Mississauga Ontario Canada L4Z 1
6. 6000 Hz 10 to 90 dB HL 8000 HZ 10 to 70 dB HL To extend the intensity range by 10 dB push the 10 dB button This 10 dB button may only be selected when the intensity level is set to the highest value in the normal range For example with the test tone of 1000 Hz the normal intensity limit is 90 dB HL When the inten sity knob is rotated clockwise beyond the 90 dB HL maximum the in tensity value on the LCD flashes This indicates that the normal intensity limit has been reached To go beyond 90 dB HL push the 10 dB button A large sign appears on the screen below the 1000 Hz value Now the dB HL knob can be rotated through two additional positions 95 and 100 dB HL If the dB HL knob is turned to the next position be yond 100 dB the intensity value 100 flashes on the screen This indi cates that the maximum dB HL for the extended range has been reach ed If the dB HL knob is rotated one more position beyond the flashing 100 dB position the letters NR appear next to the letters dB This per mits the selection of the no response symbol NR or X on the au diogram during testing The extended range remains selected until the intensity level for that particular frequency is brought down 5 positions below the maximum dB HL value e g 65 dB HL for 1000 Hz or the frequency is changed To present a test tone to the selected test ear press the present bar A speaker symbol lt j appears on the screen for as long as the pre
7. Disorders ASHA 32 Suppl 2 17 24 American National Standards Institute 1977 Criteria for Permissible Ambient Noise During Audiometric Testing ANSI 3 1 American National Standards Institute 1978 Methods for Manual Pure Tone Threshold Audiometry ANSI 3 21 de J onge R R 1986 Normal Tympanometric Gradient A Comparison of Three Methods Audiology 26 299 308 Koebsell K A amp Margolis R H 1986 Tympanometric Gradient Mea sured from Normal Pre School Children Audiology 25 149 157 Margolis R H amp Heller J W 1987 Screening Tympanometry Criteria for Medical Referral Audiology 26 197 208 Margolis R H Shanks J E 1991 Tympanometry Basic Principles and Clinical Applications In Wm Rintelmann ed Hearing Assessment 2nd ed Austin TX Pro ed Inc Michael P L and Bienvenue G R 1981 Noise Attenuation Charac teristics of Supra Aural Audiometric Headsets using the Models MX41 AR and 51 Earphone Cushions J Acoust Soc Am 70 5 Nov 1235 1238 Newby H A AUDIOLOGY 4th Ed 1979 New J ersey Prentice Hall Inc Paradise J L Smith C G Bluestone C D 1976 Tympanometric Detection of Middle Ear Effusion in Infants and Young Children Pediatrics 58 2 198 210 Stool SE Berg AO Berman S Carney CJ Cooley R Culpepper L Eavey RD Feagans LV Finitzo T Friedman E et al Managing Otitis Media with Effusion in Yo
8. and or printed is properly identified used to select right earphone for audiometry LEFT Used to identify left ear under test so that data stored in memory and or printed is properly identified used to select left earphone for audiometry 500 Hz Selects 500 Hz as a stimulus during reflex testing 1000 Hz Selects 1000 Hz as a stimulus during reflex testing 2000 Hz Selects 2000 Hz as a stimulus during reflex testing 4000 Hz Selects 4000 Hz as a stimulus during reflex testing PAGE Used to scroll through test results stored in memory ERASE Used to erase currently displayed page of data from memory ERASE ALL Used to erase all pages of data from memory DATA TRANSFER Used to transfer test results to an attached computer 2 4 PRINTER AND LIQUID CRYSTAL DISPLAY LCD The printer cover can be removed to reload paper see Figure 2 3 Section 2 6 1 page 12 provides paper loading instructions Printer Cover FIGURE 2 3 PRINTER COVER LOCATION 2 4 1 Liquid Crystal Display LC D The display indicates test mode parameters for test and test results Figures 2 4 through 2 8 show the individual display format for each test mode FIGURE 2 4 Display format for Ttympanometry FIGURE 2 5 Display format for Reflex test results reported as Yes or No See MI I 1888 HE FIGURE 2 6 Display format f
9. change in pressure introduced during the tympanogram in the same way that it would if the middle ear were properly aerated The contin ued presence of effusion leading eventually to a completely fluid filled middle ear cavity will reduce the magnitude of the tympanogram to the point where no change in compliance is detectable across the pressure range Under this condition no gradient measurement is possible 1 3 SCREENING ACOUSTIC REFLEX An acoustic reflex occurs when a very loud sound stimulus is present ed to the auditory pathway During ipsilateral acoustic reflex testing the stimulus is presented to the ear canal through the probe This stimulus then travels through the middle ear to the cochlea From the cochlea frequency and intensity information are transmitted via the 8th nerve to the brain stem If the intensity of the stimulus is high enough to elicit the reflex response a bilateral response occurs i e the right and left 7th nerves innervate their respective middle ear muscles stapedial mus cles causing them to contract As these muscles contract they stiffen their respective ossicular chains This stiffening of the ossicular chain reduces the compliance of each middle ear system As in tympano metry a probe tone is used to measure this decrease in compliance During ipsilateral acoustic reflex testing both the stimulus and the probe tone are presented via the hand held probe Acoustic reflex measurements are useful
10. if storage temperature is different from room temperature Humidity 5 to 90 MECHANICAL Dimensions 13 15 W x 14 5 D x 4 3 H 33 66 cm W x 35 56 cm D x 9 53 cmH Weight 10 Ibs 4 5 kg net 14 lbs 6 4 kg shipping CATALOG SUPPLIED ACCESSORIES NUMBERS Instruction Manual 1738 0101 TDH 39 Headset Models 26230 26235 Only 23223 Test Cavity 26241 Eartips 6 sizes 2 each 26100 Paper 3 rolls thermal 4 10 16 cm wide CATALOG OPTIONAL ACCESSORIES NUMBERS Carrying Case 05260 Dust Cover 26240 Earphone Sound Enclosures 23222 Eartips 8mm 1 box of 25 26008 11mm 1 box of 25 26011 13mm 1 box of 25 26013 15mm 1 box of 25 26015 17mm 1 box of 25 26017 19mm 1 box of 25 26019 Replacement Paper 5 rolls box 52600 Patch Cord 1 23221 Response Handswitch 23220 RS 232 Cable Adaptor 26244 DB 25 M DB 09 F RS 232 Cable 26243 10 DB 25 M F straight through WITHOUT WITH CATALOG LISTING RS 232 PORT RS 232 PORT TM 262 Auto Tymp with Ipsi Reflex 26200 26200 RS North America TM 262 Auto Tymp with Ipsi Reflex 26205 26205 RS export specify country and voltage TM 262 Auto Tymp with Ipsi Reflex 26230 26230 RS and Manual Audiometer North America TM 262 Auto Tymp with Ipsi Reflex 26235 26235 RS and Manual Audiometer export specify country and voltage GLOSSARY OF TERMS Acoustic Reflex Compliance Peak Ear Canal Volume Ipsilateral Acoustic Reflex Manual Threshold
11. in determining the integrity of the neuronal pathway involving the 8th nerve brainstem and the 7th nerve Since the acoustic reflex test is performed at high intensity levels and since it involves a measurement of middle ear mobility acoustic reflex testing is not a test of hearing The acoustic reflex test also serves as a good validation of tympano metric results since an acoustic reflex cannot be measured in the absence of a compliance peak In other words if the tympanometric results indicate no mobility over the pressure range available with the TM 262 no reflex can be measured If the test results indicate a reflex response in the absence of a compliance peak one has cause to question the validity of the tympanometric test results This indi cates that the tympanogram should be repeated Clinical middle ear instruments allow the measurement of the acoustic reflex threshold since they provide the ability to manually change the intensity of the stimulus to a level where a reflex response is just barely detectable for each patient tested However the TM 262 Auto Tymp automatically presents the stimulus in a very definite stimulus intensity sequence This preset intensity sequence may Start at a level above an individual s acoustic reflex threshold level Since the TM 262 uses a hand held probe noise from hand motion can be detected by the in struments circuitry The magnitude of a detectable response must be somewhat hig
12. indicates that no pressure peak was detected over this pressure range 4 4 GRADIENT NORMAL When testing a child the normal range for the gradient is between 60 and 150 daPa infants may show higher gradient values due to the mo bility of their ear canals The range of normal is somewhat narrower for adults i e 50 to 110 daPa ABNORMAL A high gradient value greater than the high end of the normal range per age group is indicative of middle ear effusion The reduced compliance values and negative middle ear pressure characteristic of developing or resolving Otitis Media with Effusion OME will be manifested in a broad tympanogram with a large gradient value However abnormal gradient values may also be found in the absence of abnormal param eters This could indicate a transient OME so a retest after several weeks may be recommended When the middle ear s mobility is reduced to near 0 cm3 due to vis cous effusion or a glue ear condition no gradient value can be mea sured In this case the TM 262 Auto Tymp will display dashes next to the letters GR Very low gradient values are associated with a flaccid middle ear sys tem These low values should be taken into consideration with the ear canal volume and compliance peak values to determine the probable cause of the flaccid condition 4 5 ACOUSTIC REFLEX NORMAL For screening purposes a reflex measured at any one of the three levels availabl
13. may depict a very shallow peak A compliance value greater than 1 4 cm or 1 8 cm indicates a hyperflaccid tympanic membrane or a possible disarticulation de pending upon how far above the normal range the value is Generally speaking a compliance value of greater than 3 0 cm is indicative of a disarticulated ossicular chain Further testing is necessary to confirm this suspicion NOTE If a compliance value is measured to be greater than 1 5 cm3 the TM 262 automatically changes the range assigned to the graph and the tympanogram is traced to 3 0 cm The validity of tympanometry and acoustic reflex testing is dependent upon a healthy tympanic membrane A pathological condition at this membrane can mask the true condition of the middle ear 4 3 PRESSURE PEAK NORMAL Strict rules for middle ear pressure indicate a normal range of 50 daPa However for most applications a normal range of 150 daPa to 100 daPa is used ABNORMAL An extreme positive pressure condition is rare Some researchers have reported high positive pressures at the onset of acute otitis media Pressure values more negative than 150 daPa are indicative of a poorly functioning eustachian tube The severity of this condition is determined by the degree of negative pressure and its impact on the compliance peak If no pressure peak is measured over the pressure range of 200 daPa to 400 daPa the letters NP will appear on the screen and the printout This
14. missions are aborted and normal operation resumes The NAK responses and timeouts are treated independently Thus when a combination of errors is happening the NAKs and timeouts are being counted separately If the transfer is not successful the error message displayed corresponds to the failure condition which occurs first The only expected response from the external device to the TM 262 is an ACK ora NAK character When a series of records are transmitted the external device must ACK or NAK after each response 5 5 DATA TRANSFER PROGRAM MODE The Data Transfer Program mode is used to modify the RS 232 interface configuration parameters to match the computer s RS 232 parameters To enter the Data Transfer program mode first enter the User Selection Program Mode by selecting the PROGRAM button Then select the DATA TRANSFER button The following screen appears the first time the Data Transfer Program mode is entered showing the default settings set at the factory Program Mode Data Transfer 19 2 kBAUD NO PARITY 8 BIT DATA 9600 BAUD ODD PARITY 7 BIT DATA 4800 BAUD EVEN PARITY 7 BIT DATA 2400 BAUD SPACE PARITY 7 BIT DATA 1200 BAUD XON XOFF FLOW DISABLED 600 BAUD XON XOFF FLOW ENABLED These selections fall into three different groups of control Baud rate Parity and data bits Flow control The default setting for each group has an asterisk before it so that it is easy to scan the settings for each group Se
15. this step Practice is preliminary to threshold measurement determination and is to be completed at each new frequency setting 5 The level of the first presentation shall be 10 dB below the level at which the subject responded during the familiarization procedure Present the tone for a period of one or two seconds Time between tones can be varied but not shorter than the duration of the test tone itself After each failure to respond to a signal the level is increased by 5 dB until the first response occurs After the response the inten sity is decreased 10 dB and another ascending series is begun NOTE Descend in 10 dB steps and ascend in 5 dB steps 6 The threshold is considered to be the minimum dial setting at which a response has occurred two times on an ascending scale 7 Press the SAVE button to store the threshold level for a par ticular frequency Note that the appropriate symbol O right X left appears at the correct intensity level where the threshold was determined 8 Repeat this test sequence for each frequency to be tested typi cally 1000 2000 3000 4000 6000 8000 Retest 1000 followed by 500 and 250 If there is a difference of 20 dB or more between two successive octaves test the inter octave responses i e 750 1500 9 Once thresholds have been obtained for all the desired frequencies select the other ear and repeat the sequence Note that the dis play changes to a new screen for storing t
16. to ensure that the sub ject understands how the test is to be conducted and what he she will hear For sake of uniformity an unvarying explanation is advisable something close to the following lam going to place these earphones over your ears You will hear a variety of tones some high some low some loud and some very soft Whenever you hear or think you hear one of these sounds raise your hand Lower your hand when you no longer hear the sound Remember that although some of the tones will be easy to hear others will be very faint Therefore you should listen very carefully and raise your hand whenever you think you hear the tone Modify the instructions accordingly if the optional handswitch is to be used 3 6 2 Placement of Earphones The most important thing to remember is that a good seal is required between the earphone cushion and the subject s head and ears To increase the likelihood of a good seal a Eliminate all obstruction between the earphones and the ears e g hair eyeglasses earrings hearing aids etc b Adjust the headband so that it rests solidly on the crown of the subject s head and exerts firm pressure on both ears c Center the earphones carefully over both ears The earphone with the RED connector goes on the RIGHT ear Take care to eliminate any visible gaps between the earphone cushions and portions of the individual s head and the ear on which the cushion rests 3 6 3 R
17. GURE 4 5 ABNORMAL TYMPANOMETRIC RESULT NAME DATE ECV 0 9 cm PEAK 0 2 cm R GR 110 daPa 20 daPa 3 1 5m djs 2000 HZ HL C Q 1 cm 0 07 SEC 200 Normal Ear Canal Volume Normal Middle Ear Mobility Normal Middle Ear Pressure Borderline or Wide Gradient Slightly Elevated Reflex POSSIBLE CAUSE Glue Ear Otosclerosis Severely scarred tympanic membrane Plaque over tympanic membrane FIGURE 4 6 ABNORMAL TYMPANOMETRIC RESULT NAME DATE ECV 1 2 cm PEAK 1 8 cm L GR 50 daPa 30 daPa 3 0 cm 500 HZ L 01 cm 07 SEC daPa 0 200 Normal Ear Canal Volume Hyperflaccid Middle Ear System Normal Middle Ear Pressure Normal or Borderline Narrow Gradient Normal Reflex POSSIBLE CAUSE Minor scar tissue in tympanic membrane FIGURE 4 7 ABNORMAL TYMPANOMETRIC RESULT NAME Normal Ear Canal Volume DATE Restricted Mobility ECV 0 7 cm PEAK 0 3 cm R Negative Middle Ear Pressure Abnormally Wide Gradient Elevated or No Reflex GR 205 daPa 245 daPa 3 1 5 em na 500 Hz E 0 1 ci POSSIBLE CAUSE Serous otitis media Small air pockets present FIGURE 4 8 ABNORMAL TYMPANOMETRIC RESULT NAME Normal Ear Canal Volume DATE Normal Middle Ear Mobility ECV 0 8 cm PEAK 0 8 cm R Slightly Negative Middle Ear GR 105 daPa 145 daPa Pressure tear L 1000 Hz Normal Gradient Normal to Slightly Elevated Reflex POSSIBLE CAUSE Partially blo
18. IGURE 4 1 RANGE OF NORMALS NAME Normal Ear Canal Volume DATE Restricted Mobility ECV Pe PEAK Daem R Abnormal Middle Ear Pressure 135 daPa ara i i i isem I Borderline Wide Gradient Slightly Elevated Reflex POSSIBLE CAUSE Poorly functioning eustachian tube 0 0 7 SEC 200 FIGURE 4 2 ABNORMAL TYMPANOMETRIC RESULT NAME Normal Ear Canal Volume parE No Mobility ECV 1 0 cm PEAK NP cm R GR daPa NP daPa No Middle Ear Pressure 15cm l is NR 500 Hz No Gradient 0 1 emei No Reflex POSSIBLE CAUSE Fluid filled middle ear Serous Otitis Compliance peak may be present rot TTF at a more negative pressure than 400 daPa 0 200 400 daPa 6 07 SEC FIGURE 4 3 ABNORMAL TYMPANOMETRIC RESULT NAME Abnormal Ear Canal Volume DATE No Mobility 3 PEAK NP cm L ae S a NP daPa No Middle Ear Pressure 3 15cm ny 500Hz No Gradient 1 O40 No Reflex POSSIBLE CAUSE Perforation Patent Pressure Equalization P E tube 0 07 SEC T T T T T 400 daPa 0 200 FIGURE 4 4 ABNORMAL TYMPANOMETRIC RESULT NAME DATE ECV 1 6 cm PEAK 4 5 cm L GR 35 daPa 0 daPa 3 0 cm I NR 500 Hz oa E cm Normal Ear Canal Volume Extremely Hyperflaccid Middle Ear Normal Middle Ear Pressure Narrow Gradient No Reflex POSSIBLE CAUSE Ossicular disarticulation more detailed testing indicated FI
19. L values The instrument is programmed to default to the right ear at 0 dB and 1000 Hz upon selection of a new audio metric test To erase all tests from memory press the ERASE ALL M button Be certain that you wish to remove all tests from memory before pressing the ERASE ALL w button because the erasure occurs immediately upon pressing the ERASE ALL iw button 3 13 PRINTING TEST RESULTS The printout will begin with the header of your choice see Program Mode Section 3 7 The next two lines contain space for entering the individual s name and the test date This is followed by the test results in the order that they were obtained selected Either a single test can be printed from memory or the entire group of tests in memory can be printed To print a single test from memory use the PAGE button to arrive at the desired test result and press the PRINT SCREEN button To print all tests in memory press the PRINT ALL 55 button When PRINT ALL is selected and two audiogram tests are stored in memory they will combine under the following conditions 1 There must be one left test and one right test sequentially stored in memory and 2 A left and right audiometric pair of tests will not be combined if they are separated in the memory by a tympanometry test Therefore when tests are erased the resorting could cause a change in the Left Right sequence with audiometric tests The resu
20. Newborn 8mm 11mm Pre school 11 mm 13 mm School age 11 mm 13 mm 15 mm Adult 15 mm 17 mm 19 mm Before attempting to seal the entrance of the ear canal visually inspect the opening to make sure that the canal is free of any obstruction If the canal is completely plugged at the entrance or if fluid is running from the ear canal tympanometry should not be attempted until the condi tion is cleared NOTE Damage to the probe can result if fluid is pulled up into the probe with nega tive pressure Slip the appropriate size eartip onto the nose cone of the probe mak ing sure that eartip is flush against the surface of the nose cone see Figure 3 5 Flush tip to nose cone FIGURE 3 5 Positioning the Eartip Before testing clear any hair away from the ear and pull upward and back on the pinna For a young child pull downward and back on the pinna This tends to straighten out the ear canal and ensure better results Keep the pinna in this position throughout the test sequence Make sure that the green lamp on the probe is blinking Position the probe up against the entrance of the ear canal applying a gentle pres sure to maintain a tight seal see figure 3 6 Watch the probe lamp As soon as a good Seal is obtained the green lamp will change from its blinking status to a continual status This green light will remain on and steady while the test is in progress Once the test sequence is over all lamps on the probe will be t
21. TRANSFER button will transfer only the currently displayed stored test re sults There is one exception to this rule If the last most recent test result is displayed the instrument assumes normal testing operation and transfers all test results OTHER LCD SCREEN MESSAGES The message INVALID SELECTION appears if the DATA TRANSFER button is pushed during any of the following circumstances e During presentation of an audiometric tone e During a tympanometry test e During a reflex test e During printing The message NO DATA AVAILABLE appears if the DATA TRANSFER button is pushed and no results are stored The message NOT AVAILABLE appears if the DATA TRANSFER button is pushed and the RS 232 interface is not installed 5 3 RECORD FORMATS 5 3 1 General Record Format All output records are transmitted in a predefined fixed length format The generic format for all records is Record Record Record Total Data Fields Checksum CR LF Type Sequence Index Record Number Number Number Each record contains only printed ASCII characters other than the terminating CR LF characters Each record consists of fixed length data fields with any unused data fields filled with a value of 0 The Record Sequence Number is a value from 0 to 9 which is incremented by 1 for each new record which is transmitted This value will wrap around from 9 to 0 A record will be retransmitted with the same sequence nu
22. V4 North America Tel 1 800 561 8797 Tel 1 800 535 6663 In Canada only In North America only WARRANTY Welch Allyn Inc warrants the TM 262 Auto Tymp to be free of original defects in material and workmanship and to perform in accordance with manufacturer s specifications for a period of one year from the date of purchase If this instrument or any component thereof is found to be defective or at variance from the manufacturer s specifications during the warranty period Welch Allyn will repair replace or recalibrate the instrument or component s at no cost to the purchaser This warranty only applies to instruments purchased new from Welch Allyn or its authorized distributors or representatives The purchaser must return the instrument directly to Welch Allyn or an authorized TM 262 distributor or representative and bear the costs of shipping This warranty does not cover breakage or failure due to tampering misuse neglect accidents modification or shipping and is void if the instrument is not used in accordance with manufacturer s recommen dations or if repaired or serviced by other than Welch Allyn or a Welch Allyn authorized representative No other express or implied warranty is given Return of the instrument registration card is required for proof of purchase and warranty validation Specifications STANDARDS IEC 601 1 Medical Electrical Equipment Requirements for Safety CSA C22 2 No 601 1 M90 Electromed
23. WA TM 262 Auto Tymp Operating Instructions Contents Section 1 Introduction 1 1 Instrument DeSCIIPtiON cccccesecssessseceseeseseeseeeeesserees 1 1 2 Tympanometry and Gradient ccccccsecsssssesseteeseeees 1 1 2 1 Tympan mety ccs leccsiccdedeedeeeidetraceceecteesetaesssortnaesays 1 L22 Gradient sosi eoni cdrimsecierameccagss iei E fala a 2 1 3 Screening Acoustic Reflex eesssscsccsrsrrrr 3 1 4 Manual Audiometry ss sssssssrssesrrrnrrrnenrrrenrnrnnnnnnnenrrrnnn 4 Section 2 Installation 2 1 Unpacking and Inspection cccceccesssessseseeeeteeenes 5 2 2 Probe ndicatoiS ii cieistiiescriacsitessssedscsivessseetitveseaereiieeds 5 2 3 Front Panel Controls and Indicators 1 cece 6 2 4 Printer and DisSplay cccccccccccccsssssrseecessecsseeeeeseessrsnees 8 2 4 1 Liquid Crystal Display LCD cee eee teens 8 2 5 Rear and Bottom Panel Labels C onnectors 10 210 PNAS QUOD srecx sec cr vaste cea ce a ees tae 11 2 6 1 Loading the Papel ccccccccscccsssssessssecesssstsesseseeeeees 12 2 6 2 Paper Storage oo eet tee etieteteeee 12 2 7 Pretest Tympanometry Checks sssr 13 21 Calibration 0 eee anarian 13 2 7 2 Altitude Adjustment srcem 14 2 8 Pretest Audiometric Checks Models with Audiometer Only 2 8 1 Noise Recovery Period esscr 2 8 2 Elimination of Ambient Noise 0 eee 2 9 Biological GNOGCK csucs iise Section 3 Operation Sel Earntip C are nerue
24. anogram compliance peak is possible The pressure sweep begins at the starting pressure of 200 daPa and proceeds in a negative direction at a rate of 600 daPa second Mea surements of compliance are made continuously as the pressure sweep continues in a negative direction The slope of the tympanogram increases as the measurement approaches the compliance peak This signals the TM 262 to slow the rate of pressure sweep to 200 daPa second to ensure a more accurate reading of the compliance peak After the peak compliance and pressure values are detected and stored the tympanogram dips downward toward the baseline and the pressure sweep rate returns to 600 daPa second The tympan ometric sweep ends automatically when the compliance value returns to baseline and the pressure is at least 100 daPa Only when the middle ear pressure is very negative is it necessary for the pressure sweep to continue all the way down to 400 daPa This automatic stop feature eliminates unnecessary pressurization of the ear and shortens the test time When the test is completed the solid green lamp turns off and the tympanogram results are displayed on the LCD In addition to the tympanogram tracing the screen displays the test summary data Ear Canal Volume ECV the compliance peak in cm the pressure at the peak of the tympanogram in daPa and the gradient GR as a pressure width value The test results are automatically stored in a page of memory The actua
25. aper will begin to ap pear out of the printer mechanism Continue to advance the paper so that a section of paper is long enough to pass through the printer cover once it is repositioned over the printer 2 6 2 Paper Storage The TM 262 Auto Tymp utilizes a thermal printer which requires a heat sensitive paper to create an image For maximum paper life any Spare rolls of paper should be stored as follows 1 Store in the dark i e in a drawer or cabinet 2 Do not store above 77 F 25 C 3 Store at less than 65 relative humidity The above recommendations are for the maximum paper life greater than five years Storing your TM 262 thermal paper at high temperatures or high humidity levels will only shorten the total paper life 2 7 PRETEST TYMPANOMETRY CHECKS For your convenience a test cavity is provided with your TM 262 Auto Tymp This test cavity enables you to quickly verify the proper calibration of your unit Welch Allyn Inc strongly recommends that you make this quick check a part of your daily routine 2 7 1 Calibration To initiate the quick check select the Tymp only mode and insert the probe without a tip on it into the 0 5 cm opening on the test cavity See Figure 2 12 NOTE Since the TM 262 is designed to start automatically it is important that the probe is inserted as quickly and as smoothly as possible During the calibra tion check the probe must be held carefully and without move
26. by at least 0 05 cm this reflex intensity level is stored in memory and the test is completed If no response is measured i e a compliance decrease of at least 0 05 cm was not detected at this lowest intensity level the intensity level of the stimulus is automatically increased by 10 dB and a measurement of compliance change is again made If a response is detected the test sequence for this frequency ends If once again no response is detect able the intensity level is increased by 10 dB e g 1000 Hz Ipsi 105 dB HL and the stimulus is presented After the compliance measure ment is made and a response is detected this highest intensity level is stored as the reflex test result and displayed on the screen If no response is detectable at this third and highest intensity level either a NO oran NR depending upon Program Mode setting is indicated on the screen next to the frequency tested label If during any of the three stimulus presentations a large pressure leak develops NT appears on the screen next to the tested frequency and the test sequence is aborted If no other frequencies were selected for the test the Tymp Reflex sequence ends here The display will indicate the reflex test re sult as described in Section 3 7 Note that the green lamp is no longer illuminated indicating that it is time to remove the probe from the ear The same sequence is followed for each test stimulus selected a maxi mum of three different
27. caled by 2 in the sequence of 125 Hz 250 500 750 1000 1500 2000 3000 4000 6000 and 8000 Hz Example HL Threshold 125 Hz 0 0 9 6 0x96 150 decimal scaled x 2 150 2 75 dB HL 6 The pressure at which a Tympanometry compliance value was meas ured atis not contained in the data record but may be calculated At the start of each pressure sweep the pressure sweep rate is 600 daPa sec If the compliance begins to rapidly increase the pressure sweep rate changes to 200 daPa sec and remains at that rate until the compliance rate of change has sufficiently slowed down to allow the pressure sweep rate to return to 600 daPa sec While the pressure sweep rate is 600 daPa sec a compliance data point is stored at every 12 daPa drop in pressure and at 200 daPa sec a compliance data point is stored at every 3 daPa drop in pressure The Slow Index and Fast Index values in the data record indicate where the pressure sweep rate changes if any occurred 7 Reflex compliance values are stored in three groups 1 Reflex Baseline Average value which is the reference measurement per formed before the stimulus is presented 4 Reflex compliance data points which are measured while the stimulus is presented and stored as the relative compliance change from the Baseline Average value and 4 to 6 Reflex recovery compliance data points which are measured after the stimulus is turned off and stored as the relative complian
28. ce change from the Baseline Average value 5 4 DATA TRANSMISSION PROTOCOL The TM 262 RS 232 Interface uses an Auto Repeat Request ARQ communications protocol to insure the reliable transfer of data With this protocol the TM 262 will transmit a data record and then wait for a response from the external device If the external device receives the record correctly it should respond with an acknowledge ACK char acter ASCII control character ACK If the record is not received cor rectly the external device should respond with a not acknowledge NAK character ASCII control character NAK If an ACK is received by the TM 262 within 3 seconds of the completion of the transmission the transmission has been successfully completed The DATA TRANSFER message disappears and normal operation resumes If after the transmission of a record there is no response within three seconds the record is retransmitted with the same Record Sequence Number If such a timeout occurs after the second attempt then the message NO RESPONSE is displayed any pending transmissions are aborted and normal operation resumes Ifa NAK response is received during a transmission or within three sec onds after the transmission is completed the record is retransmitted with the same Record Sequence Number If the transmission is not acknowledged within three attempts the message TRANSFER NOT COMPLETE is displayed for about three seconds any pending trans
29. cked eustachian tube 0 07 SEC faa d nib a 1 T 400 daPa 0 200 FIGURE 4 9 ABNORMAL TYMPANOMETRIC RESULT NAME Normal Ear Canal Volume DATE Normal Middle Ear Pressure ECV 11cm PEAK 04cm L Positive Middle Ear Pressure GR 95 dapa 85 daPa j 1 5 cm Normal Gradient 7 I 500 Hz At Elevated Reflex 0 15 POSSIBLE CAUSE Patient has a cold 0 07 SEC T T T T T 400 daPa 0 200 FIGURE 4 10 ABNORMAL TYMPANOMETRIC RESULT Section 5 RS 232 Interface 5 1 INTRODUCTION The TM 262 RS 232 Interface option provides the capability of trans ferring stored test results from the TM 262 to an external computer or data collection device via an optically isolated serial interface 5 2 OPERATION Press the DATA TRANSFER button located on the front panel see figure 2 2 page 6 of the instrument to transfer test results stored in memory During data transfer the message DATA TRANS FER will appear on the LCD screen TRANSFERRING DURING NORMAL OPERATION During normal test operation the DATA TRANSFER button will sequentially transfer all stored test results The test results are trans ferred with one record for each memory location in the order in which they are stored Any test results which have been erased will not be transferred TRANSFERRING FROM MEMORY PAGES If the PAGE button is used to review individual test results stored in any of the eight memory locations the DATA
30. cm 9 99 Standard E71 is displayed in the bottom right corner of the display until the probe is in the 2 0 cm cavity STEP 2 Place the probe into the 2 0 cm cavity provided with the instrument and check cm value against the altitude correction table for accuracy STEP 3 If the measured volume is not within the published table value 0 1cc then the operator should exit the altitude mode by pressing the PROGRAM button and contact field service Providing the measured volume agrees with the published table 0 1cc the operator may proceed with the altitude adjustment STEP 4 With the probe still in the 2 0 cm cavity select the PAGE button to enter the custom calibration mode Custom will appear on the fourth line of the display STEP 5 The value now displayed in the cm display area is the volume measured and adjusted to the current altitude If the value displayed is 2 0 cc then the volume is adjusted to the current site If the value is not 2 0 cc 0 1 then press the SAVE button to customize the volume measurement to the current altitude The measured volume should now read 2 0 cc STEP 6 To exit the altitude mode press the PROGRAM FF S button to return to normal mode 2 8 PRETEST AUDIOMETRIC CHECKS Models with Audiometer Only 2 8 1 Noise Recovery Period Exposure to high levels of sound e g unmuffled lawn mowers loud music gunfire tends to create a Temporary Threshold Shift TTS which diminishes with time a
31. column for reflex results Fre quencies which follow will be ranked ordered lowest to highest To change the default frequencies for the Tymp Reflex mode select the desired frequencies as described above then press the SAVE button Note that the word SAVED appears on the display screen Now every time that you re enter the Tymp Reflex mode these revised default parameters will automatically be selected It is still possible to temporarily alter the frequencies selected by choosing the desired fre quencies However each time that the Tymp and Reflex test mode is exited and re entered the default parameters will reappear There is no limit to the number of times that the default frequencies can be modified 3 9 2 Exit Tympanometry Reflex Mode To exit Tymp Reflex Mode select the Tymp Only or Audiometry Mode Note that the appropriate screen appears on the display 3 10 AUDIOMETRY TEST SEQUENCE Models with Audiometer Only To enter the audiometry mode push the AUD button Note that the display changes to an audiogram format The default settings for the frequencies available during audiometry are 125 through 8000 Hz normal but can be changed to 500 through 6000 Hz narrow in the Program Mode see Section 3 7 Upon entering the audiometry mode the starting signal is automatically a 1000 Hz 0 dB HL continuous or steady tone It is possible to tempo rarily change the signal format from this steady tone to a pulsed tone
32. d even if they are not sure whether they hear a tone Select the ear to be tested with the RIGHT CR Jor LEFT button Next select the desired screening intensity by rotating the dB HL knob to the appropriate position The American Speech Language and Hearing Asso ciation recommends 20 dB HL as the screening level for school aged children Select the desired frequency at which to start the test by pressing the Hz Jor Hz button Present the selected tone via the present bar If the individual fails to respond increase the intensity by 10 dB and try again Press the SAVE m jbutton at the intensity level where the individual responded Continue the procedure for all the desired frequencies These results can be printed in an audiogram or tabular format Check the Program mode to determine which setting has been selected 3 10 2 Threshold Audiometry 1 Carefully position the earphones as described above and select the ear to be tested first 2 Familiarize the individual with the test protocol by presenting a tone of 40 dB HL at 1000 Hz 3 Set HL control to 10 dB 4 Practice Beginning with the tone continuously on Present Bar held down gradually increase the intensity by turning the HL con trol until a response occurs Switch the tone off for at least two seconds and present the tone again at the same level If there is a second positive response proceed to threshold measurement If a second response does not occur repeat
33. d for cleaning purposes Carefully remove this wire from the metal tube see Figure 3 3 This will pull any cerumen out of the metal tube Examine the wire for cerumen Clean the wire with a lint free tissue if necessary Reinsert the wire into the metal tube and push it in as far as it can go The wire must be inserted into the metal tube for the TM 262 Auto Tymp to function properly Probe Metal wire tube O ring Probe FIGURE 3 3 Probe Wire Removal 3 2 4 Probe Reassembly Take care to align the threads on both the probe body and the nose cone before screwing the pieces together Gently squeezing the two sides of the probe case together screw the cone back onto the probe using a clockwise rotation Only screw the nose cone on until it is finger tight The probe nose cone must be screwed firmly in place to prevent any air leaks 3 3 EARPHONE CARE Models with Audiometer Only The earphone and cords provided with the TM 262 Auto Tymp should last a long time with proper care To clean the earphones and cords use only a dry cloth or tissue Moisture should not be allowed anywhere near an earphone itself this can damage the diaphragm and grill cloth requiring their replacement With extended use earphone cords tend to fray internally at the con nectors This fraying will ultimately either decrease the signal level or cause the signal to be intermittent To check for this problem position the test headset
34. e Tympanometry compliance axis scale 15 1 5 cm3 30 3 0 cm3 Character Number of Data Field Name Field Description Number Characters Type uChar Number of The number of reflex tests performed Reflex Tests Range 0 to 4 uChar Reflex Test Reflex test selection parameters Parameters it O Ipsi status O Not selected 1 Selected it 1 Contra status O Not selected 1 Selected it2 500 Hz status O Not selected 1 Selected it 3 1000 Hz status 0 Not Selected 1 Selected it 4 2000 Hz status 0 Not Selected 1 Selected it5 4000 Hz status 0 Not selected 1 Selected Bits 6 amp 7 Not used uChar Reflex 1 Results of Reflex test 1 its 1 amp O dB level tested 00 Low dB level 01 Middle dB level 10 High dB level 11 Invalid Bits 3 amp 2 Reflex tests status 00 NT Not tested 01 YES Yes a reflex was detected 10 NRE No reflex detected 11 NT_CAL Not tested due to a calibration data error Bits 5 amp 4 Test frequency 00 500 Hz 01 1000 Hz 10 2000 Hz 11 4000 Hz Bit 6 Test type O IP S 1 CONTRA Bit 7 Not used Reflex 1Base Average baseline compliance line Average in cm3 X 256 Reflex 1 Re Average reflex compliance flex Average incm3 X 256 Reflex 1 Reflex compliance data point Reflex 0 1 of 4 incm3 X 256 Bit 15 Noise indicator 0 Quiet data measurement 1 Noisy data measurement potentially unreliable Reflex 1 Reflex compliance data point R
35. e per frequency can be considered normal Obviously the lowest values are desired However without knowing the hear ing threshold level of the individual for that frequency it is difficult to make a more definite statement Generally speaking the reflex is reported to occur at between 70 and 90 dB HL above the hearing threshold in normal ears Remember that these values apply to reflex threshold measurements and that the TM 262 does not permit reflex threshold measurements due to the use of a hand held probe The presence of a reflex in the absence of a compliance peak suggests that the tympanometric results should be considered invalid and the test repeated This is true because if there is no compliance measured during tympanometry it is not possible to measure any stiffening affect during the reflex stimulus presentation ABNORMAL If a pressure leak occurs during the reflex testing and the pressure system is unable to correct for this leak the reflex test sequence is aborted When this occurs the test results are assigned the letters NT not tested If no response is obtained at the third and final stimulus level the TM 262 will indicate this with the letters NR or No More detailed testing at the frequency where this occurred is required to determine the reason for the no response 4 6 AUDIOMETRY NORMAL A normal response from a child should be at or below 20 dB HL A normal response from an adult may be higher at or below
36. e physical sign when the test signal is heard Section 2 Installation 2 1 UNPACKING AND INSPECTION Examine the outside of the shipping container for any signs of damage Notify your carrier immediately if any damage is observed Carefully remove your TM 262 from its shipping container If the TM 262 Auto Tymp appears to have suffered mechanical damage notify the carrier immediately so that a proper claim can be made Save all packing material so the claim adjuster can inspect it as well When the carrier has completed the inspection notify your Welch Allyn Inc distributor TABLE 2 1 Accessories Supplied Probe Assembly Test Cavity Power Module or Internal Supply Instruction Manual Eartips 6 sizes 2 each Test Headset Models with audiometer only Paper 3 rolls NOTE Keep the original packing material and shipping container so the instrument can be well packaged if it needs to be returned for repair or calibration Inventory the accessories in Table 2 1 If any accessories are missing or damaged notify your Welch Allyn Inc distributor or the factory im mediately See page 60 for a listing of optional accessories 2 2 PROBE INDICATORS The probe indicators are shown in Figure 2 1 and a description follows FIGURE 2 1 PROBE INDICATORS P1 Yellow lamp The probe is occluded remove the probe and inspect for cause of occlusion P2 Greenlamp Blinking TM 262 Auto Tymp is ready to begin a te
37. eflex 3 4 of 4 in cm3 X 256 Bit 15 Noise indicator 0 Quiet data measurement 1 Noisy data measurement potentially unreliable Character Number of Data Field Name Field Description Number Characters Type Reflex 1 Reflex recovery compliance data Recovery 0 point 1 of 6 measured after the stimulus is turned off in cm3 X 256 Bit 15 Noise indicator 0 Quiet data measurement 1 Noisy data measurement potentially unreliable Reflex 1 Reflex recovery compliance data Recovery 5 point 5 of 6 measured after the stimulus is turned off in cc X 256 Bit 15 Noise indicator 0 Quiet data measurement 1 Noisy data measurement potentially unreliable The recovery points 5 and 6 are only included when the recovery is slow and there was no recovery according to the first four recovery data points If not included their values will be 0 Reflex 2 See Reflex 1 format Reflex 3 See Reflex 1 format Reflex 4 See Reflex 1 format Checksum The hexadecimal sum of characters 1 to 416 Package CR LF Terminator Start of record Record Type y Record O to 9 Sequence Number Record Index 1 to 8 Number Total Record 1 to 8 Number Reserved Reserved for future use Defaulted Character Number of Data Field Name Field Description Number Characters Type 11 2 uChar Ear Ear under test Bit O 1 Left ea
38. el only 2 6 INITIAL SETUP Place the TM 262 Auto Tymp on a stable counter or table where it will subsequently be used and near a properly grounded wall outlet Attach accessories to their appropriately labled connectors on the rear panel of the TM 262 see Figure 2 9 Locate the POWER switch on the rear panel of the TM 262 and move the switch to the ON position Note that the lamp F1 on the front panel is illuminated indicating the TM 262 is receiving power The TM 262 symbol will then appear on the display along with a listing of the revision number for the Tymp Reflex and Audiometry if purchased software Next the display will default to the Tymp Reflex mode and the probe s green lamp will begin to blink indicating that the TM 262 is ready to begin a test If both the green and yellow lamps are illumi nated at the same time either the probe is occluded or the tymp reflex software did not properly initialize Simply move the power switch to the OFF position inspect the probe tip for any signs of an occlusion and reposition the power switch to ON If both green and yellow lamps are still illuminated and you are certain that the probe is not occluded contact the Welch Allyn Technical Service Department see page 55 In the meantime it is still possible to select the Audiometry mode if purchased Allow the instrument to warm up for about five minutes before conduct ing a test Th
39. equency depressing the Hz gt _ button causes the fre quency to change to a higher frequency e Each frequency or tone is pure i e there is no distortion or crackling sound present e Rotating the dB HL knob in a clockwise direction increases in intensity of the tone e Rotating the dB HL knob in a counter clockwise direction de creases the intensity of the tone Section 3 Operation 3 1 EARTIP CARE After the eartip is removed from the probe it can be washed with warm soapy water to remove cerumen Use an alcohol swab to disinfect the eartips Be sure that the eartips are completely dry before reuse NOTE Eartips may crack or otherwise deteriorate if left submerged in alcohol for a long period of time Eartips should not be placed in an autoclave as they will melt and lose their shape 3 2 PROBE CARE With use cerumen can work its way up inside the probe nose cone probe tip During the warm up period each day and throughout the day inspect the probe tip to make sure it is clean and free of cerumen If any cerumen is detected refer to the following instructions for clean ing and maintaining the TM 262 Auto Tymp probe 3 2 1 Probe Nose Cone Cleaning Nose cone l FIGURE 3 1 Probe Nose Cone Removal Refer to Figure 3 1 and remove the nose cone portion of the probe as follows e Hold the body of the probe in one hand and grasp the nose cone of the probe in the other hand e Rotate the nose cone p
40. esponse Handswitch Optional Accessory If the optional handswitch is to be used be sure that the handswitch connector is properly inserted into the jack on the rear panel The TM 262 Auto Tymp will display an appropriate symbol 0 whenever the handswitch is operated 3 7 PROGRAM MODE To enter the program mode depress the PROGRAM button located on the front panel The following screen appears the first time you enter the Program Mode the asterisks indicate the default settings Program Mode User Selections Reflex HL Curve Print Audiogram Reflex HL only Print Aud Table Reflex Yes No Normal Box ASHA Prn Header Welch Allyn Normal Box Off Prn Header Off Aud Range Normal Prn Header Custom Aud Range Narrow Note that these selections fall into five different groups of controls Reflex format for printer Print header format Audiometric test result format Status of normal box Audiogram frequency range The default setting for each group of controls has an asterisk before it so that it is easy to scan the settings selected for each group 3 7 1 Reflex Format Reflex test results can be displayed and printed in these three ways Reflex HL Curve Reflex HL Only or Reflex Yes No Reflex HL Curve default Reflex Yes No Ipsi Frequency Intensity level Ipsi Frequency YES response Frequency intensity ions me levels or NO no response detected To select a different s
41. etting for reflex format note that a square cursor 3 is located next to the reflex HL curve option Use the Hz lt 4 but ton to cursor down to the setting that you wish to select for your own default criterion When the square cursor is positioned in front of your desired setting press the SAVE button Note that the word SAVED appears in the lower right margin of the screen Also this will cause the asterisk to be deleted from in front of the prior default setting Re flex HL curve and to be repositioned in front of the new setting 3 7 2 Print Header Format Three different selections are available with respect to a print header Print Header TM 262 Print Header Off or Print Header Custom Print Header TM 262 is the default setting for this feature Prn Header TM 262 Prn Header Off Prn Header Custom PEDIATRIC ASSOCIATES Each time the PRINT SCREEN or PRINT ALL 2 button is chosen the printout will begin with the label Welch Allyn TM 262 To deselect the Welch Allyn header and select No Header or a Custom Header use a similar procedure to that described above With the Hz Cor Hz button position the square cursor in front of the desired new setting and press SAVE to select it as the new default setting The word SAVED appears in the lower right margin If the custom header is selected a line cursor will begin to flash at the left hand margin below the words Prn Header Custom To type
42. fter exposure Any subject tested soon after such exposure may exhibit a hearing loss that does not reflect his her normal hearing threshold This test procedure therefore generally prescribes a 16 hour interval between the last exposure to high level sounds and the administration of any hearing test 2 8 2 Elimination of Ambient Noise Excessive noise in the test environment during audiometric testing such as that produced by conversation computers and public address systems reduces test validity because it tends to mask the test signals particularly at the lower frequencies where earphone cushions provide less effective attenuation An acoustically treated room may be required if ambient noise reaches objectionable levels i e sufficient to cause apparent hearing loss at the low frequencies Also earphone sound enclosures are available from Welch Allyn as an optional accessory If the person being tested is in the same room as the audiometer it is recommended that he she be seated about three feet one meter away from the TM 262 Auto Tymp Maximum permissible noise levels are specified by the American Na tional Standards Institute Criteria for Permissible Background Noise during Audiometric Testing ears covered with earphones S3 1 1991 revised Table 2 3 shows the maximum background levels that can be present inside the room while a valid hearing test is being conducted For more comprehensive information about hearing te
43. he second ear s results 3 10 3 Exit Audiometry Mode To exit the audiometry mode select the Tymp mode or the Tymp Reflex mode Note that the appropriate screen appears on the display 3 11 TESTS INMEMORY The Tymp and Tymp Reflex test results are automatically stored in mem ory once the test sequence ends Audiometric test results are stored in memory once the SAVE M button is pressed A total of eight memory locations or pages are available with the TM 262 Auto Tymp Each test result is assigned a memory location number M1 through M8 in the order the test was obtained To sequence through test results press the PAGE button repeat edly The memory location number for each page is located in the up per right hand corner of each screen If only five tests were stored in memory only five memory locations can be scanned 3 12 MEMORY ERASE To erase a particular test result before printing PAGE to the test result and press the ERASE w button The LCD displays a blank screen for erased memories with the memory location number located at the top right corner Upon exiting the erase mode the stored memories re shuffle and replace the empty memory with the remaining tests in the order in which they were run To exit the erase mode press the PRINT ALL or ERASE ALL w buttons or initiate a new test NOTE When the erase mode is entered a current audiogram is no longer acces sible to change or to store new H
44. her than the criterion generally used during clinical acoustic reflex threshold testing in order to avoid artifact caused by hand motion Thus the acoustic reflex measurements made with the TM 262 are referred to as screening acoustic reflex testing The pur pose of these screening reflex tests is to determine if a reflex is detect able or not rather than to determine the lowest intensity at which the reflex occurs i e threshold testing 1 4 MANUAL AUDIOMETRY While tympanometry and acoustic reflex measurements check the integrity of the middle ear system audiometry provides a means for checking the integrity of the entire auditory pathway Manual audiometry provides a method to check an individual s ability to hear a test signal at a particular intensity level or at the lowest possible intensity level without the use of masking During threshold audiometry the test signal is generally presented through an earphone to the ear under test Different test protocols define the frequencies and intensity sequence to be used to obtain a response Audiometric testing requires a behavioral response This consists of having the individual raise a finger hand or press a hand switch optional whenever the test signal is heard The finger hand is lowered or the handswitch is released when the test signal is no longer audible Thus the individual being tested must be able to understand a set of simple instructions and have the ability to provide som
45. ical Equipment Warnock Hersey Listed ANSI 3 39 1987 Aural Acoustic Impedance Admittance Type 3 IEC 1027 1991 Aural Acoustic Impedance Admittance Type 3 ANSI S3 6 1989 Audiometers Type 4 IEC 645 1 Pure Tone Audiometers Type 4 TYMPANOMETRY REFLEX MODES Probe Tone 226 Hz 3 Sound Pressure Level 85 5 dB SPL 2 0 dB measured in a 2 0 cm coupler Harmonic Distortion lt 5 Admittance Compliance Range 0 to 1 5 cm 0 to 3 0 cm NOTE 1 The range is automatically selected based upon the amplitude of the compensated tymp only tympanogram 2 The maximum uncompensated ECV tympanogram peak admittance compliance range is 0 to 5 0 cm 3 ECV cavity limits for initiating pressurization is 0 2 to 6 0 cm Compliance Accuracy 0 1 cm or 5 whichever is greater PNEUMATIC SYSTEM Pressure Range 200 to 400 daPa NOTE 1 1 daPa 1 02 mm H 0 2 Pressure sweeps to at least 100 daPa To save test time pressure sweep stops once tympanogram returns to baseline after 100 daPa 3 Full pressure sweep for 6 cm from sea level to 7000 ft altitude with no leak Pressure Accuracy 10 daPa or 15 whichever is greater Rate of Sweep 600 daPa sec except near tympanogram peak where sweep rate slows to 200 daPa sec to provide better definition of peak compliance Direction of Sweep Positive to negative Tympanometric Test Time approximately one second NOTE High compliance tympanograms will take somewhat lo
46. ies 0 33 3 9 2 Exit Tympanometry Reflex Mode nsss 34 3 10 Audiometry Test Sequence Models with Audiometer Only cc ccccceresseesereeees 34 3 10 1 Screening Audiomety cece eceectteeeteeecteeeeees 35 3 10 2 Threshold Audiometry neccen 36 3 10 3 Exit Audiometry Mode nsere 37 3 11 Tests IMNMEMON seriene iieii 37 3 12 Memory Erase ssisecisioiiisaiinesi iirin iaienni eiie 37 3 13 Printing Test RESUItS cceescssssssrseeeeseeseserstseeeeseeees 37 Section 4 Test Results 4 1 Ear Camall VOM messis 39 4 2 Compliance P ak ecceccscssecssecceeceessessressees 39 4 3 Pressure Peak cantasi na aieri 40 AA Gradient seeni ia veces 40 4 5 ACOUSTIC REMOX orescence isisisi ienien 41 4 6 AUGIOMOIY eisrean aE 42 4 7 Special Messages and Error Codes cccessecssteeeenees 42 4 8 Sample Test Resuts 0 0 cccccsesssecseeeseeesseesneeens 42 Section 5 RS 232 Interface 51 WMO GUCTIOMN sssri sirara EE 46 5 2 OPSTAUO Mt cccicsdigesiee cheshaiestavesssiasthsdsntechdescecadenene aR 46 53 Record Formats mirasdan cine 47 5 3 1 General Record Format ccccccccsssssceesessssstseeeeeseeees 47 5 3 2 Tympanometry and Reflex Test Results Record 47 5 3 3 Audiometry Test Results Record ccccsccsessseeseereeees 50 LA NOES iriiria RSTO 51 5 4 Data Transmission Protocol ccccsccsccsssssesssreesssserees 52 5 5 Data Transfer Program Mode sassssssssrssressere 53 9 0 R9232 INTEMACG sassis 54 5 6 1 Interface Configu
47. ight hand margin 3 7 5 Audiogram Range All eleven frequencies are available during audiometry however the range can be abbreviated to eight frequencies The default setting is Aud Range Normal Aud Range Normal Aud Range Narrow 125 Hz thru 8000 Hz 500 Hz thru 6000 Hz To select the abbreviated frequency range position the square cursor in front of the feature Aud Range Narrow Press the SAVE button to save this narrow range for audiometric testing Note that the word SAVED will appear in the lower right hand margin and the asterisk now appears in front of the narrow range selection If the narrow range is selected the Hz C4 Jand Hz gt J buttons will allow you to scroll through this abbreviated frequency range only however the screen and printout will still be labelled with the full range of frequencies 3 7 6 Exit Program Mode Exit the program mode by selecting the PROGRAM button Note that you return to the test mode which was operational prior to entering the program mode 3 8 TYMPANOMETRY ONLY MODE To do only Tympanometry press the TYMP button The display will immediately show the format for the tympanogram along with the sum mary information headers ECV cm daPa and GR The default scale for compliance is 1 5 cm If a compliance peak greater than 1 5 cm is measured the TM 262 Auto Tymp automatically scales the compliance axis to 3 0 cm so that more of the tympanogram data can be seen Determ
48. in the desired header use the dB HL knob To sequence forward through the character set rotate the knob in a clockwise direction To sequence in reverse rotate the knob in a counter clockwise direction The available character set is A Z 0 9 and a blank space The blank space can be used to erase an unwanted letter or number A total of 35 character spaces are available Please note if you wish the header to be cen tered it will be necessary to consider the length of the name to be in serted and calculate from the left margin where you want the header to begin Otherwise if you begin to enter the characters for the header from the left margin the header will be printed from the left margin on the printout To move the cursor from the left hand margin without inserting a letter or a number select the character which represents a space i e rotate the knob one position to left of the letter A Use the Hz button to move over to the next character position Repeat this sequence until the cursor is moved over to the desired start position for the first char acter to appear in your header Rotate the dB HL knob to select the appropriate characters to spell out the desired header After selecting each character use the Hz gt button to move over to the next char acter position Once all of the header characters have been added press the SAVE button to save your header in memory The word SAVED will appea
49. ine which ear is to be tested and select the appropriate ear but ton RIGHT Rk Jor LEFT so that the test results will be properly labeled Examine the ear canal to determine the appropriate size eartip Push the eartip as far down on the probe as possible so that it is flush against the probe Position yourself at eye level with the test ear The blinking green lamp indicates that the TM 262 is ready to begin the test Place the probe against the entrance of the ear canal so that its opening is completely covered so that no visible leaks are apparent Once the TM 262 determines that a volume between 0 2 cm and 6 0 cm is present the test sequence begins and the green lamp changes from a blinking to a steady state From this point on hold the probe securely in this same position without any hand motion Keep your eyes on the probe and the individual s ear At the start of the test the pressure system establishes a pressure of 200 daPa within the ear canal When this pressure is achieved the TM 262 Auto Tymp makes a measurement of Ear Canal Volume ECV This information is valuable since it indicates if a good seal has been established and it helps differentiate between two similar tympan ograms i e a fluid filled middle ear system and a perforated tympanic membrane After the Ear Canal Volume ECV is obtained this compliance value is subtracted from the remaining compliance measurements so that a direct reading of the tymp
50. ing tympanometry a low frequency tone 226 Hz is presented to the ear canal via the probe The probe tone is used to measure the compliance admittance changes within the middle ear system while air pressure within the hermetically sealed ear canal is changed from positive to negative In the normal ear positive pressure introduced into the ear canal space causes the middle ear system to stiffen up or become less mobile Because the pressure difference between the sealed ear canal space and the middle ear space forces the tympanic membrane to stretch inward this stiffened middle ear system displays little or no compliance As the pressure within the ear canal is brought back toward atmospheric ambient or 0 daPa pressure the pressure difference between the ear canal space and the middle ear space is reduced in normal ears At or near atmospheric pressure 0 daPa the greatest amount of sound probe tone enters the middle ear system In other words this is the air pressure value where the middle ear system displays the maximum amount of compliance admittance As negative pressure is introduced a pressure difference is once again established and the middle ear system becomes less compliant Thus by varying the pressure within the ear canal it is possible to make a series of compliance measurements by means of the probe tone The tracing which depicts these compliance changes is referred to as a tympanogram The point on the ty
51. is allows the electronic circuits to stabilize prior to use If the storage temperature is lower than the room temperature allow some additional time for the instrument to reach room temperature Warning The TM 262 is designed to be used with a hospital grade outlet Injury to per sonnel or damage to equipment can result when a three prong to two prong adapter is connected between the TM 262 power plug and an AC outlet or extension cord Additionally those TM 262 Auto Tymps that are equipped with power transformers use a specific transformer 8000 0260 8000 0261 or 8000 0262 which should not be interchanged with any other transformer or supply The TM 262 is a specifically calibrated device and the periodic service and adjustments which the instrument may require should be done only by an authorized Welch Allyn service technician 2 6 1 Loading The Paper Remove the printer cover see Fig 2 3 for location by placing your fin gers along the back edge of the printer and pulling upward on the cover Cut the printer paper so that the leading edge of paper is straight across Place the roll of paper inside the paper well so that the paper will unroll from the lower surface See paper loading label for additional help Figure 2 11 a Paper exit Paper loading label entrance FIGURE 2 11 Paper Loading Position the leading edge of the paper roll into the paper entrance while pressing the PAPER ADVANCE 4 button The p
52. itional 10 dB is available per frequency via the 10 dB button Accuracy 125 to 4000 Hz 3 dB 6000 and 8000 Hz 5 dB Step Size 5 dB Signal to Noise Ratio gt 70 dB in 1 3 octave less than 10 dB HL for levels less than 60 dB HL Rise Fall Time 20 to 50 msec Tone Format tone is normally off until present bar is depressed Continuous steady when present bar is depressed Pulsed 2 5 sec i e 200 msec ON 200 msec OFF FM frequency modulated 5 Hz 5 TRANSDUCERS IPSI Welch Allyn design Audiometric Headset Pair TDH 39 earphones with MX41AR cushions 60 ohms impedance Models No 26230 No 26230 RS No 26235 and No 26235 RS only marked Version 4 PRINTER Paper Roll Length approximately 80 feet 960 Tests Roll Tymp and Reflex 420 tests or 210 people Tymp and Reflex plus one audiogram 230 tests or 115 people Speed approximately 1 5 minutes to print three screens including audiogram POWER Line Voltage 120 V 410 or 220 V 410 or 240 V 410 NOTE Wall mount power supply or internal power supply depending upon country Frequency Range 50 to 60 Hz 5 Line Voltage Current 0 2 amps at 120 V or 0 1 amps at 240 V AC Power Consumption 15 watts maximum while printing Low voltage input for wall mount power supplies 10 to 11 VDC 970 mA ENVIRONMENTAL Temperature Operating 60 F to 105 F Storage 40 F to 140 F 15 C to 40 C 40 C to 60 C NOTE Warm up time is required
53. l memory location number is deter mined by the number of tests which preceded this current test For ex ample if this is the first test to be stored in memory it will be assigned the number M1 If it is the third test to be stored in memory it will be numbered M3 and so on This test result can be printed out immediately as a single test by selecting PRINT SCREEN ONLY button Other tests can be run and saved before all tests in memory are printed via the PRINT ALL button 3 8 1 Exit Ttympanometry Only Mode To exit Tymp Only Mode select Tymp Reflex or Audiometry Mode To enter the Tymp Reflex Mode press 8 3 9 TYMPANOMETRY AND IPSILATERAL REFLEX MODE The default parameters for this test are tympanometry followed by an ipsilateral acoustic reflex test at 1000 Hz To change this default setting select the frequencies for the reflex test as described in Section 3 9 1 Following the tympanometry sequence see Section 3 8 for details the test automatically sequences to the reflex portion of the test as follows The pressure from the tympanogram peak compliance is re established within the ear canal and is offset by 20 daPa to avoid problems with extremely sharp tympanogram slopes With the air pressure held con stant throughout the reflex test sequence the lowest intensity level for the starting frequency is presented and a measurement of compliance change is made If the compliance decreases
54. lecting different default settings for any of the groups is done in the same manner as the Program mode Use the lt Hz lt _ or gt Hz buttons to move the solid square cursor down or up to the setting that you wish to select and press the SAVE button The word SAVED will appear in the lower right margin of the screen and the asterisk will be repositioned in front of the new setting Exit the Data Transfer Program mode by selecting either the DATA TRANSFER or PROGRAM buttons This will return to the User Selection Program mode which can be exited by selecting PROGRAM a second time 5 6 RS 232 INTERFACE 5 6 1 Interface Configuration The configuration of the TM 262 RS 232 interface must be set to match the interface configuration of the computer The TM 262 defaults to 9600 baud no parity 8 data bits 2 stop bits and no communications flow control The default settings for the baud rate parity number of data bits and flow control may be modified using the Data Transfer P ro gram mode explained in Section 5 5 5 6 2 Cable Connections The TM 262 RS 232 interface provides a serial interface consisting of RxD Received Data and TxD Transmitted Data using a standard DB 25 female connector A straight through cable can be used to connect to either a 25 pin or 9 pin using appropriate adapter connector on the external device GSI 38 Computer GSI 38 Computer 25 Pin 25 Pin 25 Pin 9 P in TD 2 2 TD TD 2 2 TD RD 3 3 RD RD 3
55. lt would be that the wrong audiometric tests could be combined when PRINT ALL is selected Prior to selecting PRINT ALL the operator should scroll through the tests in memory noting where the audiometric tests are lo cated to avoid combining tests from different patients Section 4 Test Results 4 1 EAR CANAL VOLUME NORMAL As a general rule values for ear canal volume should be between 0 2 and 2 0 cm However the normal values will vary with age and bone structure With use you will develop a feel for the appropriate values ABNORMAL An ear canal value of less than 0 2 cm indicates an abnormal condition If the probe is partially plugged with cerumen or if the probe is position ed against the ear canal wall a smaller than expected value will be measured If an individual has a relatively large bone structure for his her age and a smaller than expected value is measured the probe could be partially occluded or up against the canal wall It is also pos sible to collapse the canal if the probe is held too firmly against it Exam ine the tympanogram and the reflex results to confirm your suspicions If they are abnormal it is good practice to repeat the test An ear canal volume greater than 2 0 cm also may indicate an abnor mal condition An important application of the ear canal volume mea surement is to determine if there is a perforation of the tympanic mem brane
56. mber if retransmission is necessary due to a communications error The Record Index Number is a value from 0 to 8 which indicates the record number within a group of records when all test results are transmitted For example this value will identify a record as Record 1 of 5 or Record 7 of 8 when used in conjunction with the Total Record Number If only the currently displayed record is being trans ferred this value will be 1 The Total Record Number is a value from 1 to 8 which indicates the total number of records to be transmitted in a group when all test results are transmitted The Checksum is calculated as the mod 256 sum of all preceding characters in the record including the prefix with the most sig nificant bit 0 and stored as two Hex ASCII characters 5 3 2 Tympanometry and Reflex Test Results Record Character Number of Data Field Name Field Description Number Characters Type 1 fAscii startofrecord o i al al al ASCII Record Type X ASCII Record Sequence 0 to 9 Number ASCII Record Index 1 to 8 Number ASCII Total Record 1 to 8 Number 5 ASCII Reserved Reserved for future use Defaulted to a 4 5 6 Character Number of Data Field Name Field Description Number Characters Type 11 2 uChar Ear Ear under test Bit 0 1 Left ear under test 0 Left ear not under test Bit 1 1 Right ear under test 0 Right ear
57. ment Do not place the probe on the same counter as the instrument or any moving object during this check as mechanical noise will be picked up by the probe and interfere with the calibration check 0 5 cm3 FIGURE 2 12 Test Cavity The calibration check will start automatically if the probe has been in serted into the cavity properly This is confirmed by the green lamp changing from blinking to a steady condition If the orange lamp is illu minated the probe is not properly positioned within the cavity so that a large pressure leak exists If the yellow lamp is illuminated the probe tip has been occluded In either case remove the probe and wait for the blinking green lamp Insert the probe once again Clean the probe tip if necessary see Section 3 2 When the test sequence is completed the green lamp on the probe is no longer illuminated Remove the probe from the test cavity and note that the green lamp is blinking once again The display will indicate a flat line on the tympanogram along with the value of the test cavity next to the letters ECV ear canal volume i e 0 5 The letters NP will ap pear next to the labels cm and daPa and three dashed lines will ap pear next to the letters GR gradient Since the test cavity is a hard walled cavity the tympanogram should be a flat line indicating that there is no mobility in the system The TM 262 Auto Tymp places the letters NP next to the cm and daPa headers to i
58. metry mode Counter clockwise rotation decreases the intensity Clock wise rotation increases the intensity E F9 F10 lt p gt F11 F12 F13 au F14 tyme F15 EE F16 R F17 J F18 500Hz F19 1000Hz F20 2000Hz F21 4000Hz F22 F23 CM F24 M F25 ie F26 10 dB Used to temporarily extend the audiometry intensity range by 10 dB When selected a large plus sign appears on the display Save During Audiometry mode saves the threshold informa tion per frequency on the display during Program mode selects a particular option during Tymp Reflex mode stores a frequency as a default parameter lt and gt Hz Selecting Hz C4 button causes the cursor to move to the next lower frequency selecting Hz gt Jbutton causes the cursor to move to the next higher frequency Present Bar Depress to present test signal to appropriate earphone release to turn test tone off PROGRAM Depress to select Program mode screen which lists settings available for Reflex presentation format printout header format audiogram vs tabular format display normal box and identify frequency range for Audiometry mode AUD Press to select Audiometry mode available in models with audiometer only TYMP Press to select Tympanometry only mode TYMP REFLEX Press to select Tympanometry and Reflex mode RIGHT Used to identify right ear under test so that data stored in memory
59. mpanogram which represents the point of maximum compliance admittance is the compliance peak of the tympanogram The air pressure pressure at the peak where this compliance peak occurs approximates the pressure within the middle ear system since maximum mobility is only possible when there is little or no pressure difference between the ear canal and the middle ear space Compliance is measured with respect to the ability of an equivalent volume of air to conduct sound and the scientific quantity used is cm Air pressure is measured in decapascals daP a NOTE 1 0 daPa 1 02 mm H O The presence of a pathological condition which interferes with the mo bility of the tympanic membrane the ossicular chain or the air pressure within the middle ear space can be detected during tympanometry For example e Ifthe air pressure within the middle ear space becomes negative due to a blocked Eustachian tube tympanometry permits the measurement of this negative pressure and its effect on middle ear compliance e If fluid builds up within the middle ear space this fluid will restrict the ability of the ossicular chain to conduct sound to the cochlea If small air pockets exist within the fluid the tympanogram will in dicate the negative pressure where the restricted mobility occurs With a totally fluid filled middle ear space no mobility will be mea sured during tympanometry at any pressure value e Inthe case of a glue ear the os
60. nctioning properly See Section 2 9 for details 3 5 1 Helpful Hints Tympanometry and acoustic reflex testing can be performed at any age However the technique used will vary with age From three years through adult tympanometry can be performed with little difficulty due to the cooperative nature of this age group With the under three year population a bit of ingenuity is required to keep the patient relatively quiet during the seconds required for the test In all cases distraction is the key to success Anything which provides a sound and or visual distraction should work Examples are only limited by your imagination Sucking on a pacifier or a bottle will help with the younger population However the tympanogram tracing will not appear as smooth due to the movement artifact Having a parent hold an infant during testing will also help The key to success in all cases is to make sure that you are at eye level with the ear canal Keep your hand steady and your eyes on the ear canal and probe lights until the test is over When first using your TM 262 Auto Tymp practice on a cooperative patient to gain confidence in its use Once you feel comfortable with the probe you are ready to handle any situation Remain calm and suc cess will follow 3 5 2 Obtaining a Seal Six different size eartips are provided with your TM 262 Auto Tymp Generally speaking the following guidelines apply Age Tip Size Preemie 8mm
61. ndicate that there is no peak compliance and therefore no peak pressure can be determined during the quick check Also since there is no compliance peak de tected it is not possible to calculate a gradient Therefore the TM 262 displays the dashed lines when a gradient calculation isn t possible Using the same sequence place the probe in the test cavity opening la belled 2 0 cm Note that the display looks the same as with the 0 5 cm measurement except for the value placed next to the letters ECV 2 0 If you wish the same sequence can be followed with the 5 0 cm open ing on the test cavity To keep a record of this test cavity calibration check simply press the PRINT ALL lt button on the front panel of the TM 262 2 7 2 Altitude Adjustment Since sound pressure will vary with altitude and barometric pressure some variation from the 0 5 2 0 and 5 0 cm readings may be observed Your TM 262 is carefully calibrated at our factory which is at approxi mately 250 feet above sea level If you are located at an elevation of 1000 feet or higher your instrument may need to be recalibrated to account for your elevation It is not necessary to recalibrate for baro metric pressure changes on a daily basis J ust keep in mind that a change in barometric pressure i e from low to high or high to low will slightly affect the test cavity readings The altitude calibration adjustment allows for corrections to the Ear Canal V
62. nger Gradient Tympanogram pressure width at 50 of peak compliance ACOUSTIC REFLEX STIMULI Frequencies 500 1000 2000 and 4000 Hz Accuracy 3 Total Harmonic Distortion lt 5 Rise Fall Time 5 to 10 msec Output Levels IPSI 500 and 4000 Hz 80 90 100 dB HL 1000 and 2000 Hz 85 95 105 dB HL NOTE 1 Ipsi stimuli are time multiplexed with probe tone 106 msec ON 53 msec OFF 2 Stimuli are presented at lowest level first If there is no response the intensity is increased by 10 dB untila response is detected or the maximum dB HL is reached Pressure Automatically set to pressure at peak compliance with an offset of 20 daPa Reflex Determination Compliance change of 0 05 cm or greater Reflex Test Time 1 to 12 seconds depending upon the number of ipsi test frequencies selected four maximum and intensity required Probe LED Indicators Steady yellow occlusion Blinking green ready to start testing Steady green test in progress Steady orange leak AUDIOMETRY MODE Model No 26230 No 26230 RS No 26235 and No 26235 RS only marked Version 4 Frequencies 125 250 500 750 1000 1500 2000 3000 4000 6000 8000 Hz Accuracy 3 Total Harmonic Distortion lt 3 125 to 3000 Hz measured acous tically at maximum dB HL 4000 amp 6000 Hz measured electrically Intensity Levels 125 Hz 10 to 50 dB HL 500 to 6000 Hz 10 to 90 dB HL 250 and 8000 Hz 10 to 70 dB HL NOTE An add
63. nian nonnen aenea aiaa 18 32 PODE Care eian a AEE aS EEEE i 18 3 2 1 Probe Nose Cone Cleaning scssi 18 3 2 2 The O RING wo eseeececscecsceseecceeecessenseesseeeeesersesesseeeeenees 19 3 2 3 The Probe Wire o oo eceeeeeeeesceeeeseneeeeeeaeetenneeeeniaes 20 3 2 4 Probe Reassembly ccceeeceeseeeeseneeeeeseeetenees 20 3 3 Earphone Care Models with Audiometer Only c ccccccessseesereeees 20 3 4 Paper Supply wissa sedsasniitniitn enue Gad einiiiniie 21 3 5 Tympanometry Testing Information seser 22 3 5 1 Helpful HINES scicca 22 3 5 2 ODtAINING a Seal or iisecinesseni aijaa 22 3 6 Audiometry Testing Information ccccccessseeeeeeeeees 24 3 6 1 Instructing the Subject ssssessssreseerrrrrirrererrrrrnr 24 3 6 2 Placement of Earphones scssi 25 3 6 3 Response Handswitch Optional Accessory 25 342 Program Modessa sinen iad sid hadiecies 25 3b IRETMOXIF OFM secs renns naan aa e as 26 3 1 2 Print Header Format ccccccsseceeesseeeeeeteeeeeneaees 27 3 7 3 Audiometric Format During Printing eee 28 3 7 4 Normal Box Format eect eee etree 29 3 7 5 Audiogram RANGE eeeeeececcsceccteetsteetteentteeteeenatens 30 3 7 6 EXit Program MOd sieci sieisen 30 3 8 Tympanometry Only Mode sasscssccsccerrrecrees 31 3 8 1 Exit Tympanometry Only Mode cccscseesestseeeseeees 32 3 9 Tympanometry and Ipsilateral Reflex Mode 04 32 3 9 1 Programming Ipsilateral Acoustic Reflex Test Frequenc
64. not under test Bits 2 7 Not used Either the RIGHT ear is selected OR the LEFT ear is selected Both ears selected or no ear selected is invalid 13 4 ulnt ECV Ear canal volume in cm3 measured at 200 daPa stored as ECV X 64 Range 0 00 to 6 00 cm3 Peak Peak compliance in cm3 stored Compliance as compliance X 64 Range 0 00 to 6 00 cm3 Peak The pressure where the peak com Pressure pliance occurred stored in daPa Range 399 to 200 daPa Gradient Gradient value calculated as the pres sure difference at the compliance half peak points stored in daPa Range 1 to 600 daPa 1 No gradient has been cal culated yet 0 No gradient could be calculated End Index The data index where the last compliance data point is stored Range 1 to 87 1 No data was stored Slow Index The data index where the last com pliance data point measured at 600 daPa sec before the rate changes to 200 daPa sec is stored 1 No rate change occurred Fast Index The data index where the first compli ance data point measured at 600 daPa sec after changing back to 600 daPa sec from the 200 daPa sec rate is stored 1 No rate change back occurred Tympanometry compliance data point 0 in cm3 stored as compliance X 64 Range 0 00 to 3 98 cm3 A maximum of 88 data points are stored per Tympanometry test Tymp Tympanometry compliance data Data 87 point 87 in cm3 stored as compliance X 64 Tymp Scal
65. olume ECV measurement and test cavity volume measure ment for variations due to altitude Because the TM 262 is a pressure sensitive device which makes measurements relative to ambient air pressure changes in air pressure due to weather or altitude will affect the Ear Canal Volume ECV read out of the instrument The slight pres sure change resulting from changing weather conditions will usually yield volume read outs within 0 1 cm of the expected cavity value however pressure changes due to altitude can shift these cavity values by as much as 30 These changes in pressure do not affect the accuracy of the compliance measurement system in any way But many instrument operators prefer that their equipment give ECV values as they would appear at sea level The altitude calibration mode allows the operator to adjust his her Auto Tymp without the services of a qualified Welch Allyn Service Technician TABLE 2 2 Altitude Correction Altitude Correction Altitude ft Altitude Table cm 0to1 500 2 0 2 000 to 3 500 2 1 0 1 4 000 to 6 000 2 2 0 1 6 500 to 7 500 2 3 0 1 8 000 to 9 000 2 4 0 1 9 500 to 10 000 2 5 0 1 The altitude calibration mode can only be entered when the TM 262 is powered up from its off state while the PROGRAM mode button is depressed Hold the PROGRAM Frcs button for approximately five seconds STEP 1 When entering the altitude mode the display will read as follows Altitude Mode ECV 2 0
66. or Reflex test results reported in dB HL FIGURE 2 7 Display format for Reflex test results reported in dB HL and also shown with a tracing Tone Left ear presentation Plus 10 dB HL Cursor symbol symbol symbol Selected intensity level Selected frequency Handswitch Pulsed tone symbol symbol FIGURE 2 8 Display format for Audiometry 2 5 REAR AND BOTTOM PANEL LABELS CONNECTORS The rear panel labels and connectors are shown in Figure 2 9 and a description of each one follows R1 R2 R3R4 R5 R6 R7 R8 FIGURE 2 9 REAR PANEL R1 Company name address model serial number and country of origin R2 Symbol denotes a Type B Class II Product per IEC 878 as referenced in IEC 601 Standard R3 Symbol denotes Attention consult accompanying docu ments Vv R4 Symbol indicates a service adjustment part that is intended for service personnel use only 6 R5 Connector for handswitch Input impedance 47 K ohms pulls up to 5 volts t R6 Contra Insert Phone Function not available Q R7 Connectors for right and left earphones 130 ohm 2 50 volts rms i b maximum open circuit R8 Label describing low input voltage and current from wall mounted power supply R9 Power Input J ack 5 pin DIN connector for external wall mounted power supply R10 Power Switch with ON OFF indicators NOTE Symbol on the bottom panel indicates entry by qualified service personn
67. ortion of the probe counter clockwise until the nose cone is completely separated from the probe e Place the probe body securely on a table and inspect the nose cone for cerumen Use a pipe cleaner to remove any cerumen by inserting the pipe cleaner through the back portion of the nose cone and pulling it through the front opening It may be necessary to repeat this several times to remove all the cerumen NOTE The probe nose cone can be sterilized via many conventional methods includ ing autoclaving 3 2 2 The O Ring There is an O Ring seated at the end of the threads on the probe As a preventative maintenance measure and to ensure that the nose cone of the probe unscrews easily do not clean or remove the lubricant from this O Ring If the O Ring appears to be void of any lubricant or if the nose cone itself was difficult to remove apply the lubricant provided with the instrument refer to Figure 3 2 Grease here FIGURE 3 2 O Ring Care 1 Place a small drop of lubricant at the front outer surface of the O Ring 2 Using the finger or a cotton swab spread a thin layer of lubricant completely around the front and outer surface of the O Ring Assure that no lubricant spreads into the threaded area of the nose cone Only a thin layer of lubricant is necessary Excessive application or build up may affect test results 3 2 3 The Probe Wire Inside the probe body there is a metal tube which contains a wire re quire
68. over your ears and select a frequency e g 1000 Hz at 35 dB HL Select the right earphone While depressing the present bar flex the earphone cord next to the connector at both ends Listen for an intermittent signal an abrupt change in signal intensity level or a scratchy sound superimposed over the selected frequency that coin cides with the flexing of the cord The presence of any of these condi tions indicates that the cord should be replaced Also examine the earphone cord for cuts or tears in the covering shield and the earphone cushion for signs of damage If either problem is no ticed the earphone cord or cushion should be replaced Both parts are easily replaced without the need for recalibration However if the ear phone receives shock damage or is replaced for any reason the TM 262 will need to be recalibrated Repeat this same sequence with the left earphone J FIGURE 3 4 Earphone and Cord Care 3 4 PAPER SUPPLY To streamline each testing session check the amount of paper left inside the printer compartment and keep extra rolls of paper so that the paper can be easily changed without upsetting your schedule NOTE The number of tests per roll of paper will vary with the type of tests being performed See pages 58 and 60 for approximations and paper ordering information 3 5 TYMPANOMETRY TESTING INFORMATION Perform a test on a normal ear each day to make certain that your TM 262 Auto Tymp is fu
69. r on the right hand margin indicating that your header is now saved The square cursor will reappear next to Prn Header Cus tom It is now possible to exit the program mode or to sequence on to the next user selection To exit the program mode press the PRO GRAM button Enter a single test result and select PRINT SCREEN S button to see how the custom header looks NOTE If you had previously entered a custom header position the square cursor next to the asterisk in front of Prn Header Custom press SAVE to cause the line cursor to appear at the left hand margin along the bottom of the display The word SAVED will appear at the lower right margin indicating that the custom header is still selected 3 7 3 Audiometric Format During Printing The audiometric test results can be printed out in an audiogram format PRINT AUDIOGRAM or in a tabular format PRINT AUD TABLE The default setting for this function is the audiogram format Print Audiogram Print Aud Table NAME DATE Ts 338 500 750 i000 1500 2000 3000 4000 Gadd 800A z dB HL Lis 3 15 5 5 26 5 18 5 15 16 1a 125 508 LXR RON NOTE When a specific frequency is deselected for testing the result will be a break in the audiogram line at that frequency This eliminates the assumption that a threshold exists at that untested frequency To change the default setting to tabular format move the Hz C4 Jor Hz gt button to posi
70. r under test 0 Left ear not under test Bit 1 1 Right ear under test 0 Right ear not under test Bits 2 7 Not used Either the RIGHT ear is selected OR the LEFT ear is selected Both ears selected or no ear selected is invalid HL Threshold 10 to 100 dB HL x2 125 Hz NR Any value in the range of 231 to 450 NT 32 768 0x8000 Hexadecimal HL Threshold 10 to 100 dB HL x2 8000 Hz NR Any value in the range of 231 to 450 NT 32 768 0x8000 Hexadecimal uChar Checksum The hexadecimal sum of characters 1 to 56 Package CRY LE Terminator 5 3 4 Notes 1 uChar amp sChar designate unsigned and signed characters respectively single bytes represented in Hexadecimal by two ASCII characters Example 0xE9 is sent as E 9 2 ulnt and sint designated unsigned and signed 16 bit integers respectively expressed in HiByte LowByte sequence by four Hex ASCII characters Example 0xE196 is sent as E 1 9 6 3 Tympanometry compliance values are stored in the record scaled by 64 To convert to cm3 divide by 64 Example Tymp Data 0 4 2 0x42 66 decimal scaled X 64 66 64 1 03 cm3 4 Reflex compliance values are stored in the record scaled by 256 To convert to cm3 divide by 256 Example Reflex 1 Reflex 0 0 3 0 D 0x30D 781 decimal scaled X 256 781 256 3 051 cm3 5 Audiometry Threshold values are stored s
71. ratie 54 5 6 2 Cable Connections 0 cecccceeeeeeeeeeeeeeeeeteeeneenens 54 5 6 3 Communications Flow Control c cccccsesssseesreeeeeees 54 Service and Warranty Information 0 0 08 55 Specifications ee rene cones eee eer 56 Glossary Of Terms 0 0 0 0 ee eee teeeteteetenenenees 61 Bibliography oases esa esis casei epee pec deel e nent 62 Section 1 Introduction 1 1 INSTRUMENT DESCRIPTION The TM 262 Auto Tymp is a versatile combination instrument which provides testing capability for tympanometry alone tympanometry combined with screening acoustic reflex measurements and manual audiometry Two different versions are available to meet your individ ual testing needs The basic version provides two modes of operation tympanometry alone and tympanometry plus screening ipsilateral acoustic reflex testing The second version adds manual audiometry It is possible to field retrofit the manual audiometer to the basic version after the time of original purchase An RS 232 portis also available as an option This allows the transfer of data from the instrument to a computer A soft sided carrying case a dust cover patient handswitch patch cords and earphone sound enclosures may also be purchased as optional accessories see page 60 1 2 TYMPANOMETRY AND GRADIENT 1 2 1 Tympanometry Tympanometry is an objective technique used since the late 1960 s to measure the middle ear function Dur
72. sent bar is depressed To save the threshold value for each frequency press the SAVE button Note that the appropriate symbol O for right ear and X for left ear is positioned at the correct location on the audiogram If no re sponse was detectable over the intensity range available the appropri ate symbol or X appears It is possible to repeat a threshold check for any frequency by returning to that frequency using the Hz C4 and Hz buttons In this in stance the last threshold obtained and saved with SAVE button becomes the value saved in memory and is the value printed out on the audiometric test results NOTE Although the printout will combine the right and left ear test results on the same audiogram or table the screen can display only the results from one ear ata time Therefore if the RIGHT Cr or LEFT button is pressed while you are still testing a particular ear the screen will change to a new audiogram Once this happens it is not possible to return to the incomplete audiogram to complete the test sequence 3 10 1 Screening Audiometry Carefully position the earphones over the individual s ears so that the RED phone covers the RIGHT ear and the BLUE phone covers the LEFT ear Be sure that nothing is obstructing each earphone such as earrings eye glasses or a hearing aid Instruct the person being tested to raise a hand or a finger or press the optional handswitch whenever a tone is heard Encourage him her to respon
73. sicular chain is restricted in mo bility but the air pressure within the middle ear space is at atmo spheric pressure This tympanogram would depict a restricted compliance peak at or near 0 daPa 1 2 2 Gradient Gradient width measurements are used to describe the shape of a tympanogram in the vicinity of the peak Often the presence or ab sence of fluid in the middle ear is not clearly indicated by otoscopy and the tympanometric peak alone This evaluation is especially difficult when the peak pressure is in the normal range The presence of fluid within the middle ear space alters the shape of a tympanogram i e makes the tympanogram wider near its peak A larger than normal gradient can indicate the presence of fluid in the middle ear when other parameters are within normal limits In this way the gradient acts as an adjunct to the peak and ear canal volume measurements by helping to differentiate between tympanograms with similar peak values The TM 262 Auto Tymp determines tympanometric width gradient by measuring the pressure interval at one half of the peak height Differ ing peak widths can point to different middle ear conditions even when peak height and pressure are within normal range For example middle ear effusion brought on by secretory otitis media might result in an increased tympanogram width and therefore an increased gradient value This would occur because the ossicular chain cannot react to the
74. st Steady green test successfully started and in progress P3 Orange lamp A pressure leak has been detected 2 3 FRONT PANEL CONTROLS AND INDICATORS The front panel controls and indicators are shown in Fig 2 2 and are described follows F1l F10 F13 F16 F24 F25 F26 F1 F3 F4 F5 FO F7 F23 0 F2 U Ge O GUC F9 Ce ale F19 OO F20 F8 dBHL a F21 F22 F12 F14 F15 F18 F17 FIGURE 2 2 FRONT PANEL 4 F1 Power Indicator is illuminated when the TM 262 is receiving power F2 Print Screen Used to print the currently displayed page of memory F3 Print All Memory Used to print all pages of data from F4 memory Paper Advance Used to feed paper through printer m j F5 FM Used during the Audiometry mode to select a frequency modulated test tone When the present bar is depressed the letters FM appear on the display F6 Steady Tone Used during Audiometry mode to select a continuous test tone When present bar is depressed the steady symbol appears on the display F7 Pulsed Tone Used during Audiometry mode to select a pulsed tone When the present bar is depressed the pulsed tone symbol appears on the display F8 Attenuator Knob dB HL Used to increase or decrease the intensity of the test tone presented in Audio
75. stimulus intensity levels are available for the test The test sequences through each of the intensity levels only if required to obtain a measurable result The three intensity levels available vary with the frequency selected as follows IPSI 500 Hz 80 90 100 dB HL 1000 Hz 85 95 105 dB HL 2000 Hz 85 95 105 dB HL 4000 Hz 80 90 100 dB HL NOTE Although four frequencies are available during the tymp and ipsilateral reflex test mode most situations require only one or two frequencies to be tested The TM 262 Auto Tymp offers a selection from the most commonly used frequencies However it is strongly recommended that only one to two fre quencies are tested since holding the probe in the same position for the length of time it takes to test four frequencies sometimes becomes a problem for both the operator and the individual being tested 3 9 1 Programming Ipsilateral Acoustic Reflex Test Frequencies The TM 262 Auto Tymp default is a 1000 Hz test stimulus How ever any combination of the four available frequencies 500 1000 2000 4000 Hz can be selected either temporarily or as revised default parameters To temporarily modify the default condition push the TY MP REFLEX button and then the desired frequencies by selecting or deselecting the appropriate frequency button Each frequency selected will be indicated on the display as it is chosen The lowest frequency will appear on the screen at the top of the first
76. sting and hearing conservation refer to the Bibliography TABLE 2 3 Permissible Noise Levels Test Tone Frequency Hz 125 250 500 750 1000 1500 2000 3000 4000 6000 8000 Test Room Ears covered 34 0 22 5 19 5 21 5 26 5 26 5 28 0 33 5 34 5 38 0 43 5 maximum permissible octave band levels Ears covered 29 0 17 5 14 5 16 5 21 5 21 5 23 0 28 5 29 5 33 0 38 5 maximum permissible one third octave band levels 2 9 BIOLOGICAL CHECK To determine that your TM 262 is functioning properly perform a daily check on a normal ear your own if possible This allows you to listen for the probe tone and the stimulus tone during reflex and determine if the air pressure system is working properly Keep a copy of your chart for a day to day reference in checking your TM 262 If you purchased the TM 262 Auto Tymp with audiometry select the AUDIOMETRY button located in the center section of the front panel Note that the display changes to an audiogram format The Hz lt J and Hz gt buttons allow you to select each frequency and the dB HL knob allows you to alter the intensity of each frequency Position the test headset on your head so that each earphone is covering the ap propriate ear i e red is right and blue is left Select the right earphone by pressing the front panel button labelled R and check for the follow ing while depressing the present bar e Depressing the Hz _ button causes the frequency to change to a lower fr
77. tion the cursor in front of the description PRINT AUD TABLE Next select the SAVE m button to save this format as the new default parameter Note that the word SAVED ap pears in the lower right hand corner of the display to indicate that this new setting has been saved With PRINT AUD TABLE selected all audiometric test results will appear in a table with the frequency range typed horizontally along the top of the table followed by two lines of test data The test results for the RIGHT ear will appear next to the letter R and below each frequency tested Similarly the test results from the LEFT ear will follow below the right ear results NOTE This setting PRINT AUD selects the format for the printout only An audio gram always appears on the screen while in this mode 3 7 4 Normal Box Format It is possible to have the normal box as described by ASHA appear on the tympanogram screen and printout The boundaries for this normal box are 150 daPa to 100 daPa and 0 2 cm to 1 4 cm NOTE A compliance value of 1 5 cm or greater will automatically turn off the ASHA normal box Normal Box ASHA Normal Box Off A The normal box is the default setting To deselect this normal box move the square cursor with either the Hz lt _ or Hz gt button so that it is placed in front of the words Normal Box Off Select the SAVE button to save this feature as the new default setting Note that the word SAVED appears in the lower r
78. ung Children Quick Reference Guide for Clinicians AHCPR Publication No 94 0623 Rockville MD Agency for Health Care Policy and Research Public Health Service U S Department of Health and Human Services J uly 1994 Stool SE Berg AO Berman S Carney CJ Cooley R Culpepper L Eavey RD Feagans LV Finitzo T Friedman EM et al Otitis Media with Effusion in Young Children Clinical Practice Guideline Number 12 AHCPR Publication No 94 0622 Rockville MD Agency for Health Care Policy and Research Public Health Service U S Department of Health and Human Services J uly 1994 U S Department of Labor 1983 Occupational Noise Exposure CFR 1910 95 March 8 1983 Printed in U S A WA Welch Allyn Welch Allyn Inc 4341 State Street Road P O Box 220 Skaneateles Falls N Y 13153 0220 U S A Tel 800 535 6663 in U S A only or 315 685 4560 Fax 315 685 3361 Part No 1738 0101
79. urned off and the test result can be viewed on the instrument display before printing The probe can now be re moved from the ear canal FIGURE 3 6 Positioning the Probe The probe lamps will inform you of problems during testing as follows Yellow lamp The probe tip is occluded with cerumen or you are pressing too hard against the ear canal so that you have collapsed the canal at the tip of the probe Green lamp Still blinking seal has not been obtained to initiate the test sequence Orange lamp The ear canal is not properly sealed and a large pressure leak exists In all cases it is best to remove the probe examine the tip for cerumen and clean it if necessary A change of eartip size may also be appropri ate Start the test again 3 6 AUDIOMETRY TESTING INFORMATION Prior to testing ensure that the earphone cords are plugged into their appropriate connectors on the rear panel of the TM 262 Auto Tymp Select the desired tone type pulsed steady or FM CAUTION Always handle earphones with care DO NOT drop them or allow them to be squeezed together Severe mechanical shock may change their operating characteristics and require their replacement Insert the earphone cords between the earphone cushions during storage to prevent damage from mechanical shock 3 6 1 Instructing the Subject The operator should put the subject as much at ease as possible be fore the test begins In addition it is important

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