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MADSEN OTOflex 100 & OTOsuite Immittance Module User Manual

1. The Immittance OTOflex 100 Module amp V Probe OK c 9g e A Probe BLOCKED ga Probe LEAK JI x Probe NOT c INSERTED Adjust the position of the probe or clean the probe and continue testing 6 5 Preparing for the next patient When you have finished testing a patient and wish to test a new patient 1 For the sake of patient privacy when you receive a new patient make sure that the screen does not show any information about the patient you just finished 64 testing Otometrics Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing for the next patient If you have set Menu Procedure options Patient prompt to Oz OTOflex 100 will present the Patient and User info screen as part of the Done action sequence see 6 3 5 Test flow setup P 59 Enter the patient s name and date of birth to identify the data on the single page report See 6 3 4 Selecting patient folder and test type in OTOflex 100 58 If you do not enter these patient specific data you can write them in the blank fields on the printed report afterwards If required use the Test Selector or press On Off briefly to select the appropriate test type See 3 2 2 Test Selector mode 27 Perform the required tests The test data is saved as the new patient s data 65 Preparing OTOflex 100 and the Immittance Module for testing Preparing for the next patient
2. Probe plug press and hold the On Off key on the keypad until the start up PEN Screen screen appears Switching off Keypad Ja To switch off OTOflex 100 press and hold the On Off key on the keypad until the message Power Off appears Device colour code When you have installed OTOflex 100 there are a number of settings you can cust omise for your use See 12 2 4 Device settings P 145 Check the specific device settings If required adjust the altitude setting Set up the user s who will be using OTOflex 100 See 6 3 6 Users 60 Check the default test settings to acquaint yourself with the various settings See 12 1 Test settings P 135 If required create new test settings to suit your methods of testing 2 3 1 Language setting If the language setting in your OTOflex 100 has not been set to your local language from the factory select the appropriate language 1 Switch on your OTOflex 100 18 Ifthe Patient amp User screen appears press the softkey Return to previous menu to go to the Tympanometry test screen Ifthe Load Settings screen appears depending on setting in Menu gt Proce dure Options gt Settings prompt press the left softkey Cancel to go to the Tympanometry test screen Otometrics 2 4 2 5 Otometrics Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module CN DR Ww w Starting up the Immit
3. 107 I0T Sequencet sting cepere eet rv ARR Ue egeta eet e pee e dee ene a 107 10 1 1 Selecting a test sequence us eate oS EE oS Excess oua ae Ro Wai e d 107 10 1 2 T RS Tympanometry Reflex Screening sseseeeeses 107 10 1 3 T RT Tympanometry Reflex Thresholds 004 108 10 1 4 T RT RD Tympanometry Reflex Threshold Reflex Decay 108 10 1 5 Running a test sequence from the Immittance Module 108 10 2 Screening ga tassios spe eka ace teer ope ene ea eag de erect ree e e areas 109 10 2 1 Screening tympanometry sees n 109 10 2 2 Acoustic Reflex Screening i54 9522 63 ies dee Sea SCR E DEO aes UO elits 110 10 3 Tympanometrie testing cotes deett eee op e ee a epe CIbR EM 112 10 3 1 Diagnostic tympanometry 1 1 0 ec cc eee eens 112 10 3 2 ETF I Eustachian Tube Function Intact 005 206 ss44s0 es 114 10 4 Acoustic Reflex Threshold testing i d Ee E X var err bh ee Rep ERR 114 10 4 1 Automatic and semiautomatic threshold testing 000004 115 10 4 2 Manual threshold testing uva doa o ee Suncare du Pag at oboe 8 d 119 10 5 Acoustic Reflex Decay testing 2 user passera taie ce robes hn etdob ye ed o e ens 121 10 5 1 Automatic Acoustic Reflex Decay testing 122 10 5 2 Manual Acoustic Reflex Decay testing o 0 eee eee eee ee 123 10 6 ETF P Eustachian Tube Function Perforated 0 0 0 0 ccc ee eee 125 10 7 Managing test results rus po
4. Use this function to load or save predefined setups 12 2 4 Manage test results Select Menu Manage Test Results Otometrics 139 Immittance test setup in MADSEN OTOflex 100 General actions 140 Start Sequence Test Selector Printers Patient amp User My Settings Done Probe check Probe tone More Settings Manage Test Results Procedure Options Advanced Load Patient Swap Ear Results Del Sub test Del Current Test Del Patient Del All Printed Patients Del All Patients Load Patient Select this function to load a patient folder of your choice The patient folders are identified by date and time patient name date of birth gender and user Icons show whether the individual patient folders have been saved or printed Swap ear results This function assigns test data to the other ear for instance if you have forgotten to press the Ear Selector to define the ear currently being tested Del ete Sub test Select this function to delete individual measurements Del ete Current Test Select this function to delete all measurements in the cur rent test Del ete Patient Select this function to delete an entire Patient folder Del ete all printed patients Select this function to delete all patients that have been printed Otometrics immittance test setup in MADSEN OTOflex 100
5. Load Patient Swap Ear Results Del Sub test Del Current Test Del Patient Del All Printed Patients Del All Patients v Frequently used settings Sequence Auto start on seal Auto resume on seal Auto free memory First ear to test 226 Hz tymp unit 226 Hz defl unit Intensity safety Done prompt Print when done Patient prompt Settings prompt When you press Menu the most frequently used test specific settings you can view change are shown Otometrics immittance test setup in MADSEN OTOflex 100 Test settings Scroll to view other menu items Less frequently used settings Less used settings you can view change by selecting Menu gt More Settings Settings for automatic testing The settings listed in Menu gt More Settings gt Auto Settings apply to automatic testing Settings for sequence testing and automatic functions The settings listed in Menu gt Procedure Options are settings relating to automatic testing for instance when the test is part of a sequence of tests or when the individual test is done automatically You can change and save these settings as specific measurement setups with a specific name or you can download a setup of your choice from the Immittance Module When you activate OTOflex 100 the settings used in OTOflex 100 are automati cally shown in the Control Panel and the Measurement Settings dialog box in the Immit
6. The test DSI Tm WW More teu Dem Tu T c le tme IER L7 3 eo See OER KV OH iaa Tympanometry E zs CN os ee Rew rms Prodi sman nee Mebrubas iMm tke MM 1 Check and adjust the appropriate settings 2 Fit the patient with the probe i cl 3 Click Start on the Control Panel to start the Tympanometric measurementS Warning Ifthe patient is troubled by the test click Stop The pump pressure is relieved immediately The curve that has been recorded up to that point remains as a measurement If there is leakage this is shown on the screen See 10 8 Leakage P 127 The test progresses as follows The pump increases the pressure to the maximum value set in Tools gt Options gt Tymp and Reflex Scr gt Pressure axis Range and depending on Control Panel gt Sweep direction As soon as the predefined pressure has been reached the sweep starts As the sweep progresses the admittance for each pressure point is plotted out on the screen and forms the tympanogram curve During the measurement two diamond markers 4 signify the following an admittance marker just to the right of the admittance axis indicating the current admittance and a pressure marker on the pressure axis indicating the current pressure Tympanometric test results are shown in a results view in the top right corner of the window To make a new sweep click Start on the Control Panel You can save up to 3 separate measurem
7. 2 Click Start on the Control Panel without applying the eartip to the patient s ear This prepares the device to start measuring as soon as seal is achieved 3 Apply the probe to the patient s ear with a steady grip 4 The test starts automatically as soon as a good probe fit with an air tight seal is achieved Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested click Stop The test is interrupted immediately Already measured results are kept 5 If needed click Pause on the Control Panel to interrupt the test Click the flashing Pause button to resume After the pause the Immittance Module resumes at the intensity it came to or was interrupted in Settings Reflex screening Tools gt Options gt Tymp and Reflex Scr gt Stimulus Intensities gt Increment dB Step in dB between each stimulus intensity presented If e g the increment is set to 10 dB and the number of intensities is set to 2 the first presentation will be at the max intensity 10 dB 111 Testing with the OTOsuite Immittance Module Tympanometric testing To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL Tools gt Options gt General gt Auto start on seal If set to Sequence the test starts automatically as soon as a good probe fit with an airtight
8. D Decibel dB Intensity unit Deflection Change in admittance caused by contraction of the stape dius muscle The contraction is provoked by applying a stimulus in the same ipsilateral or opposite contralat eral ear Deflection scale Deflection scale type linear logarithmic The maximum value of the admittance scale for display of deflections Determines if the deflection scale for a reflex decay mea surement must be linear or logarithmic Deflection threshold The minimum deflection value regarded as sufficient to safely distinguish between a present or absent reflex response Deflection unit used for measurements with 226 Hz probe tone 226 Hz deflection unit The unit used for deflection curves measured with 226 Hz probe tone A selection of volume units cc cm ml and micro litres and mmho is available Does not apply to measurements made at 1000 Hz probe tone where the mmho unit is always used 237 App 3 Glossary Terminology 238 E Ear select Selection of the patient ear that measurements will be viewed for or performed on Eartip Disposable soft silicone part used to create a seal between the probe and the patient s ear For the contra insert phone eartips made from soft foam is used do not require a seal Equivalent ear canal volume ECV The volume of the ear canal measured at 226 Hz probe tone Eustachian tube func
9. Otometrics 199 Installing MADSEN OTOflex 100 Views of OTOflex 100 15 3 4 Front view ne ene ful IM EL Screen m un Vy e 9 Keypad A vy q Device colour code v e Loudspeaker optional 15 3 2 Top view Pneumatic connection Se a lt O 5S ail Lg Contralateral socket Probe socket 200 Otometrics Installing MADSEN OTOflex 100 Views of OTOflex 100 15 3 3 Bottom view Battery casing with cover 15 3 4 Reverse side view o ki E Track for probe cable fF M Labels l 15 3 5 The charger Front view Charger tab for charging the device Charging indicator Probe test cavity Base A Otometrics 201 Installing MADSEN OTOflex 100 The probe Rear view is n m ni NT idi socket 15 4 The probe robe body Threaded ring Probe tip Probe plug Air connector Transducer connector 15 5 Assembly and installation 15 5 1 Location Immittance testing is facilitated by a moderately quiet room A sound cabin or sound treated room is not necessary 2
10. App 2 1 App 2 1 1 Otometrics MADSEN OTOflex 100 Immittance Methodology and Features An introduction to immittance Immittance measurements are used to determine the middle ear s ability to transfer sound waves to the inner ear as well as assess the impact of middle ear mechanisms that alters this ability The purpose of the middle ear is to enhance the incoming soundwave in order to overcome the higher impedance of the inner ear fluids thus allowing the air borne sound wave to be transferred into a liquid wave without being deflected The main mechanism used to achieve the sound wave transformation is the differ ence in the surface area of the tympanic membrane and the stapes footplate Also the middle ear includes the three middle ear bones or ossicles malleus incus and stapes whose lever action adds to the sound pressure at the oval window Any alteration to the middle ear system such as fluid or air pressure build up in the mid dle ear cavity or inhibition of the ossicular chain movements will result in an ineffi cient transfer of acoustic energy through the middle ear This results in sound waves being reflected back through the outer ear Immittance testing Immittance testing as used in OTOflex 100 is characterised by the following A probe tone is delivered through the transducers of the probe into the ear The microphone of the probe then measures the acoustic energy that remains in the ear canal As the e
11. Otometrics Immittance Module Tools Options view and measurement options Measurement settings Stimulus intensities Warning Be careful when you enter the Max setting so as not to expose the patient to too high intensity levels You can extend the range to 105 dB 120 aB in Contra Ifyou do a warning will appear on the screen and the test screen will visually indicate that you are using extended range Stimulus Timing Pre stim ulus time Stimulus time Post stim ulus time Pause time Defines the recording time before each stimulus is pre sented Default value 0 2 seconds Defines the duration of the stimulus Displays the text Manual when set to 0 Default value 1 3 seconds Defines the recording time after each stimulus is termi nated Default value 0 5 seconds Defines the inter stimulus interval Default value 0 5 seconds Stimulus types Automatic Click to select the stimulus types to be included excluded At least one stimulus type must always be selected Available types 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN LBN and HBN Verification Select the type of verification strategy to be used after the deflection criterion has been met by the automatic threshold search Otometrics 185 Immittance Module Tools Options view and measurement options Measurement settings 186 13 3 5 Verification The stimul
12. Otometrics Testing with MADSEN OTOflex 100 Reflex Threshold testing The initial reflex threshold test screen with ipsilateral 1 kHz stimulus high lighted The dashed horizontal line in each graph indicates the predefined reflex crite rion It is therefore offset from the base line marker on the vertical axis The degree of offset is influenced by the setting in Menu gt More Settings gt Reflex criterion 2 If required press the Ear Selector key to toggle to the ear on which you wish to start the test 3 Ask the patient to sit very still and quiet during this test without moving head or jaw 4 If contralateral stimulation is included make sure that both the Ipsi probe and the Contra insert phone are in place before you start the measurement 5 To start testing gt Start semi automatic testing use the Scroll wheel to select the stimulus frequency and ipsi contra to be tested and press the Start stimulus softkey to start a semi automatic reflex threshold search for the selected stimulus gt P Start automatic testing press the Start stimuli softkey to start a fully automatic reflex threshold search for all preset stimuli 2 B Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press the Stop or Pause softkey or the Ear Selector Pressure Release key on the keypad to stop the test The test is interrupted immediately Already measured results are kept Note To a
13. Otometrics immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Use TPP offset Menu gt Select or deselect the use of pressure offset to stabilise the eardrum To change the current setting select Menu gt More settings TPP offset see also description below Off TPP is used if available On TPP TPP offset according to TPP sign are used Default value On TPP offset Menu gt More settings Select a pressure offset to stabilise the eardrum This may facilitate reflex recordings from ears showing steeply sloped tympanograms A positive value offsets in same direction as TPP sign 50 lt x lt 50 daPa offset according to TPP sign Default value 20 daPa Pump during stim ulation Menu gt More settings On Off If On the pump will actively keep the TPP pressure even during stimulus presentation If Off the pump will adjust the pressure between presen tations Default value Off pump kept inactive during the stimu lus period Reflex criterion Menu gt More settings Enter the appropriate setting for the reflex criterion The dashed horizontal line in each reflex graph indicates the predefined reflex criterion It is therefore offset from the base line marker on the vertical axis The degree of off set is influenced by this setting The applicable unit mmho cc ml cm or ul follows unit and probe tone settings Default criterion
14. Since an absolute difference cannot be negative the admittance values in the compo nent compensated admittance curve will always have a positive value throughout the curve and even a notched non compensated admittance tympanogram will typically become single peaked when compensated through this procedure The reason for this is that regardless of whether the admittance change is due to a change in Mass or Compliance contribution it is still an absolute change relative to the ear canal admit tance reference point 233 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Susceptance and Conductance B G 234 Otometrics App 3 App 3 1 Otometrics Glossary Terminology Symbols characters 226 Hz tymp unit A The unit used for tympanograms measured with 226 Hz probe tone A selection of volume units cc cm and ml and mmho is available Does not apply to measurements made at 1000 Hz probe tone where the mmho unit is always used Absolute Abs Admittance A The admittance of the ear canal tympanic membrane ear drum and middle ear system the total sum of admit tance of the 3 components Alkaline battery Disposable battery type not rechargeable Altitude above sea level Ante meridiam am Lets the user enter a height in metres Used to compensate for barometric pressure Before noon Audible seal status volume The volume of audible seal status feedb
15. Testing with MADSEN OTOflex 100 Tympanometry 4 To make a new sweep press the Start softkey gt You can save up to 3 separate measurements for each ear in a Patient Folder 5 When you have finished testing switch ears if required Press the Ear Selector key 9 on OTOflex 100 6 To continue testing press Start and test the other ear 7 When you have finished testing go to 8 1 When testing is done P 101 7 6 3 The diagnostic tympanometry result The Tympanometry test screen provides the tympanometric curves norm area the resulting Type TPP and ECV EBV All other tympanometric results are shown in the Tymp Data screen Note 77e probe tone shown in the test screen applies to the currently selected measure ment setting and may not reflect the probe tone setting that was used for the curve shown The actual probe tone applying to the curve shown can be found in the Tymp Data screen press On Off briefly to scroll to the Data screen The Tympanometry graph shows a maximum of 3 curves per ear per patient either all at once as layered curves or individually Use the Curve Selector 3 2 4 The Tympanometric Curve Selector 30 to select a specific curve for viewing The results for the highlighted curve are displayed 7 6 3 1 Changing view settings You can change the following view settings to customise your view None of these set tings influence the test data as such 78 Otometrics Otometrics 7 6 3 2 Te
16. 66 Otometrics 7 Testing with MADSEN OTOflex 100 This section describes how you perform tests using MADSEN OTOflex 100 For descriptions on how to test using the Immittance Module see 10 Testing with the OTOsuite Immittance Module 107 7 1 Fast diagnostics the quick approach 1 2 Load Settings Patient amp User Infant First Name Last name Birth Date D M Y Select settings Enter patient info test protocol Select User Switch ear Insert contra then Insert contra then probe probe Start sequence Start sequence auto or manual auto or manual Otometrics 67 Testing with MADSEN OTOflex 100 General test softkeys and shortcuts Gontirm testing Direct printout pane one ok 7 2 General test softkeys and shortcuts Left softkey Right softkey On Off Ear Selector Next test Scroll wheel Select Softkeys The current functions of the two softkeys are shown at the bottom of the screen just above each softkey Left Press and hold to view patient and user information 9 During testing o Pressure release Press for immediate release of air pressure and stop pause of measurement Between measurements e Ear selection Press to toggle the ear selection associated with the current measurement 68 Otometrics Testing with MADSEN OTOflex 100 Start testing e On Off Press and hold to turn the device on or off Toggle test type Press briefly to toggle betwee
17. ABC 20 09 2004 12 59 Smith Albert Male 28 ABC 20 09 2004 09 29 ABC 16 09 2004 09 24 ABC 15 09 2004 13 50 ABC 15 09 2004 09 25 ABC 04 08 2004 14 38 ABC 02 07 2004 11 03 n n 0000001 ABC 01 07 2004 15 57 ABC 09 06 2004 15 15 n n 0000001 ABC 09 06 2004 10 43 n n 0000001 ABC 09 06 2004 10 25 ABC ARC Select All Delete hide Saved Hide Printed Cancel Help Select from the dialog box shown 4 Click on the set of data you wish to upload and click OK If data is already available in OTOsuite you are prompted to either overwrite the data or cancel OTOsuite automatically disconnects from OTOflex 100 when data has been transferred 11 3 Data clean up If the memory of OTOflex 100 is running full or you want it to have as much mem ory available as possible you can clean up the data in OTOflex 100 In OTOflex 100 select Menu gt Manage Test Results This menu gives access to a number of functions for deleting specific or all test data Patient folders that have been saved in OTOsuite or printed will be deleted by OTOflex 100 when the memory is running full Otometrics 133 Data management in MADSEN OTOflex 100 Data clean up 134 Otometrics 12 12 1 12 1 1 Otometrics Immittance test setup in MADSEN OTOflex 100 Test settings A test setup consists of settings including procedure options such as currently selected test sequence auto start on seal etc which apply to the entire
18. Measurement settings Intensity Select the stimulus intensity from the drop down list If no reflex threshold is available the Control Panel gt Intensity setting is Off This is useful for admittance monitoring Default Threshold 10 dB or OFF Stimulus levels at or above the warning level gt 108 dB SPL re 2cc are marked by an orange bar in the Intensity drop down list Stimulus levels at or above the intensity safety level gt 115 dB SPL re 2cc are marked by a red bar in the Intensity drop down list Note The Intensity increment used in Reflex Decay is set in the Acoustic Reflex Threshold setup This is because the Reflex Decay stimulus level defaults to the reflex threshold 10 dB Stimulus side Ipsi Ipsi e Ipsi Stimulus is presented in the probe ear where the measurements are made Contra Stimulus is presented through an earphone or insert phone in the ear opposite to the probe ear Adult default Infant default Reflex Decay Test settings Click icon or select Tools gt Options gt Reflex Decay gt Measurement General Pump during stim ulus Yesl No Default value Off 187 Immittance Module Tools Options view and measurement options Measurement settings 188 General 50 daPa more to 50 daPa less offset according to TPP sign Default value 35 daPa Custom TPP offset Select a pressure offset to stabilise the eardrum Th
19. Controls and menu selections 32 Procedure Options gt Sequence 7 4 Sequence testing P 69 gt Auto start on seal gt Auto resume on seal gt Auto free memory gt First ear to test gt 226 Hz tymp unit gt 226 Hz deflection unit gt Reflex adjustment General settings gt Intensity safety see 12 2 2 Procedure options 141 General settings gt Done prompt page 49 gt Print when done page P 49 gt Patient prompt page P 49 gt Setting prompt page P 49 General actions Advanced Dissociate from PC Users Device settings Service password protected Advanced settings and actions Otometrics 4 Navigating in the OTOsuite Immittance Module The general functions for navigating in the OTOsuite main window are described in the OTOsuite manual Tympanometry elements Menu bar Tympanometry toolbar Control panel Result table Work area Screen descriptions You will find descriptions of the actual screens and how to use and view them in 4 3 The Tympanometry screen 37 4 4 The Acoustic Reflex screens 38 4 5 The ETF P screen 43 4 1 The Immittance Module menu system and toolbar The Menu bar is located at the top of the window Some of the menu items are also available as icons The icons available in the Toolbar depend on the test functions included in your OTOsuite Otometrics 33 Navigating in the OTOsuite I
20. Deflection Ip 308 Hy Field results Deflection curves The graph representing the automatically determined threshold at the top of the screen is shown in a frame The numerical values listed above each graph for instance 0 05 80 dB HL indicate the max deflection of the curve and the stimulus inten sity used Thresholds table e The determined threshold is shown in the Thresholds table in the bottom part of the screen If no threshold is detected the field in the Thresholds table will show the text None to indicate the absent threshold The Ipsi results appear in the top row The stimulus ear referenced contra lat eral results appear in the bottom row 40 Otometrics Navigating in the OTOsuite Immittance Module The Acoustic Reflex screens Thresholds table The Thresholds table shows reflex screening results if reflex screening mea surements are available The title field in the Thresholds table includes an indication of the probe tone used and the air pressure applied for instance 226 Hz 50 daPa The values refer to the field currently selected and therefore highlighted in the table As you click the individual fields in the table the values listed in the title field will be updated to reflect the field currently selected If subsequently a Reflex Threshold test is made the table becomes a Reflex Threshold results table now titled Thresholds db HL scr hidden The screening values wi
21. General actions Del ete all Select this function to delete all patients in the patients OTOflex 100 memory Note Patient folders that have been saved or printed will be deleted automatically when the OTOflex 100 memory is full 12 2 2 Procedure options These settings apply regardless of the test type or sequence selected To access these settings 1 Press Select to access the Menu 2 Scroll to Procedure Options and press Select Start Sequence Test Selector Printers Patient amp User My Settings Done Probe check Probe tone More Settings Manage Test Results Procedure Options Advanced Sequence Auto start on seal Auto resume on seal Auto free memory First ear to test 226 Hz tymp unit 226 Hz defl unit Intensity safety Done prompt Print when done Patient prompt Settings prompt Otometrics 141 immittance test setup in MADSEN OTOflex 100 General actions 142 Sequence Select the sequence to suit your purposes You can choose between e T RS Tympanometry and Reflex Screening e T RT Tympanometry and Reflex Threshold e T RI RD Tympanometry and Reflex Threshold and Reflex Decay To activate this function either select Menu gt Start Sequence or press and hold the right softkey in test mode Auto start on seal The system automatically starts the tympanometric mea surement or the selected sequence as soon as t
22. Menu gt Patient amp User fOTOflex 100 has been switched off and you wish to continue a test select Menu gt Manage Test Results gt Load Patient e If required use the Test Selector to select the appropriate test type See 3 2 2 Test Selector mode 27 e Perform the required tests The test data is saved as a Patient Folder including the current patient s data e When OTOflex 100 connects with OTOsuite you will be prompted to synchro nize data if required See 8 5 Communicating and synchronizing with OTOsuite 102 In OTOsuite You can enter patient and user information in the Client Details dialog in OTOsuite This information is then used in printed reports and can be saved in OTOflex 100 Press Crtl D or select Edit gt Client Details Selecting an existing patient in OTOflex 100 Select Menu gt Manage Test Results gt Load Patient scroll to the required patient s folder and press Select Test flow setup 1 A new patient folder is created automatically when you switch on OTOflex 100 2 The Patient amp User screen appears Enter the data related to the patient and user See 3 2 3 The Text Editor P 29 3 Set up your OTOflex 100 to facilitate the entire process of testing handling patient info and continuing with the next patient Select Menu gt Procedure Options gt Done prompt If you select On the Done prompt will appear set to On when you have finished test
23. R J Roeser M Valente amp H Hosford Dunn Eds Audiology Diagnosis or T L Wiley amp D T Stoppenbach 2002 Basic Principles of Acoustic Immittance Measures In J Katz Ed Handbook of Clinical Audiology Fifih Edition Otometrics App 2 2 2 Otometrics App 2 MADSEN OTOflex 100 Immittance Methodology and Features Tympanometry number of reasons one of them is to avoid the very low resonance frequency that is characteristic for infant ears A number of developmental aspects through the first few months of life are believed to significantly alter the acoustic response properties of the infant s middle ear thus also influencing tympanometry e g size increase of the external ear middle ear cavity and mastoid achange in the orientation of the tympanic membrane fusion of the tympanic ring e a decrease in the overall mass of the middle ear due to changes in bone density loss of mesenchyme connective tissue of the embryo tightening of the ossicular joints closer coupling of the stapes to the annular ligament e the formation of the bony ear canal wall The infant ear anatomy differs in many ways when compared with the adult ear Because of these differences a higher frequency probe tone is needed to collect tym panograms that will be useful in identifying middle ear effusion Infants below 4 months may demonstrate what appears to be a normal 226 Hz tympanogram even with confirmed middle ear effusion I
24. See 6 3 3 Probe check 57 192 Otometrics 14 4 Otometrics OTOflex 100 Service and Maintenance Cleaning and disinfecting the probe tip Cleaning and disinfecting the probe tip Note Always comply with local hygienic standards for disinfection and sterilization Thorough cleaning of the probe tip is required after use in infected ear canals Clean ing the threaded ring may also be necessary 1 To remove the probe tip hold the probe by the probe body and unscrew the threaded ring Take out the probe tip Probe body Threaded ring Threaded ring Probe tip Probe tip 2 Check to see if the sound channels of the probe tip are blocked If they are use the cleaning wire to clean the sound channels A Ways ckan from the r r Sound channels Cleaning wire 3 Ifyou are cleaning the probe tip during a session where you are testing a patient use the cleaning brush to clean the cleaning wire especially where it protrudes from the probe tip If you are cleaning the probe tip between patients use disinfectant to clean the cleaning wire and if you have used the brush disinfect the brush as well See 14 4 0 1 Cleaning and disinfecting procedures for the probe tip 194 Cleaning wire Caution Even the slightest amount of moisture may dissolve any residual cerumen and thus contaminate the sensitive parts in the body of the probe 193 OTOflex 100 Service and Maintenance Cleaning and
25. Select Menu gt Patient amp User e Scroll to the User field and press Select to access the field Turn the Scroll wheel to view the various users available and press Select to choose If you are using OTOflex 100 with OTOsuite you cannot access the Patient amp User screen Patient and user information is determined by OTOsuite e Ifthe user does not appear on the list you can create the user See Creating a user 61 If you are using OTOflex 100 as a stand alone device the list shows only the users you have entered in OTOflex 100 60 Otometrics 6 4 6 4 1 6 3 6 1 Preparing OTOflex 100 and the Immittance Module for testing Preparing the patient Creating a user 1 If you wish to create a new user in the user list of OTOflex 100 select Menu gt Advanced gt Users gt Create New User and press Select 2 Enter the appropriate data max 3 characters See 3 2 3 The Text Editor 29 3 When you have entered the appropriate data press OK Deleting a user 1 If you wish to delete a user from the user list of OTOflex 100 select Menu gt Advanced gt Users gt Delete User and press Select 2 Scroll to the appropriate user and press Select to delete See 3 2 3 The Text Editor 29 Selecting ear to be tested in OTOflex 100 Regardless of the type of test you have selected in OTOflex 100 you must select the ear on which you wish to start the test In OTOflex 100 you can select
26. This documentation contains information and warnings which must be followed to ensure the safe use of OTOflex 100 and the Audiometry Module Local government rules and regulations if applicable should also be followed at all times App 1 1 Symbols used App 1 1 1 OTOflex 100 symbols OTOflex 100 is marked with this symbol to indicate compliance with Type BF of the safety standard EN 60601 1 See Technical Specifica tions Standards in the OTOflex 100 Guide A OTOflex 100 is marked with this symbol when it is important that the user refers to associated information given in this manual cE XXXX A OTOflex 100 is CE marked according to the Medical Devices Direc tive 93 42 EEC and the Radio Equipment and Telecommunications Terminal Equipment Directive 1999 5 EC The instrument is marked with this symbol to indicate that it is elec tronic equipment covered by the Directive 2002 96 EC on waste electrical and electronic equipment WEEE In European countries the crossed out wheeled bin WEEE symbol reminds you that all the electrical and electronic products batteries and accumulators must be taken to separate collection at the end of their working life This requirement applies in the European Union Do not dispose of these products as unsorted municipal waste You can return your instrument and accessories to Otometrics or to any Otometrics supplier You can also contact your local authorities for advice o
27. canal component This is called Baseline compensation Baseline compensation must be selected to get the static admittance which is used in normative data such as the modified Jerger In contrast the No compensation mode includes the total admittance including the ECV You can set the scaling of each view setting individually When defining the view of the admittance axis you can enable either Not compensated or Baseline compen sated Baseline compensated Not compensated Enabling Baseline compensated displays a tympano gram view showing the compensated admittance curve as measured at the tympanic membrane level The tympanometric peak in the graph will represent the estimated admittance of the middle ear only See the description of Static Admittance in the OTOflex 100 documentation Select Baseline compensated to access the fields Scale Baseline compensated B G numeric component compensation for Y and Show normal area Select to display a tympanogram showing the total admittance curve as measured at the probe tip level The tympanometric peak in the graph will represent the total admittance of the ear canal and the middle ear Select Not compensated to access the field Scale Not compensated setting 171 Immittance Module Tools Options view and measurement options View settings Admittance axis B G numeric com ponent compensa tion for Y Calculates the middle ear admitta
28. gt Reflex Threshold gt Measurement General Pump during stimu lus Yes No Default value No Custom TPP offset daPa Reflex criterion mmho Select a pressure offset to stabilise the eardrum This may facilitate reflex recordings from ears showing steeply sloped tympanograms The TPP offset can be adjusted in increments of xx daPa morelless 50 daPa more to 50 daPa less offset according to TPP sign Default value 35 daPa Enter the appropriate setting for the reflex criterion It follows unit and probe tone settings Default 0 02 mmho Stimulus intensities Start value Increment value End value You can select the start and maximum stimulus intensi ties in fields directly below Stimulus Intensities Whenever the stimulus intensity level exceeds 108 dB SPL for example when you select 100 dB HL at 500 Hz Ipsi a warning will appear and the automatic test is paused You will be prompted whether to continue or skip to the next stimulus type To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL Select the required start level from 40 to 110 dB Select the step size to increment the stimulus intensity Sound Pressure Level in increments of 1 2 5 or 10 dB Default 10 dB Select the required maximum level up to 110 dB
29. is easily done with OTOflex 100 in its charger or placed on a surface nearby 1 Mount the cap on OTOflex 100 See above 2 Mount the handgrip as shown below Make sure that the handgrip is oriented correctly in relation to the cap Make sure that the snap locks click into place in the catches in the cap to secure the handgrip firmly on the cap and OTOflex 100 Otometrics 55 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 6 3 2 4 Removing the handgrip 1 To dismount the handgrip squeeze the sides of the handgrip firmly together at the points shown by the arrows Wriggle the snap locks out of the catches in the cap to free the handgrip from the cap 6 3 2 5 Using handgrip and cap For purposes such as screening you can use the handgrip with the cap 1 Mount the handgrip on the cap 56 Otometrics 6 3 3 Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 2 Use the probe with the long cable for testing Probe check It is recommended that you perform a probe check at the start of each day or when there has been a change in barometric pressure to make sure that the probe is func tioning correctly 1 Make sure that the probe tip has been cleaned and disinfected before you place it in the test cavity See 14 4 Cleaning and disinfecting the probe tip f 193 Note This is to make sure that the probe tip and filter do not infl
30. the screen is shown in a frame Thresholds table The determined threshold is shown in the Thresholds table in the bottom part of the screen If no threshold is detected the field in the Thresholds table will show the text None to indicate the absent threshold Audiogram The audiogram marker in the audiogram in the bottom right part of the screen indicates the threshold level or the highest intensity where threshold was not found If a measurement consists of more than 3 intensities click the graph selector to scroll between the graphs If you want to manually change the automatically determined threshold click on the drop down box of the specific field in the Thresholds table and select the stimulus intensity to be reported as the threshold value The manually selected value will be marked by an asterisk the appropriate graph at the top of the screen is framed accordingly and the audiogram marker in the audiogram in the bottom right part of the screen is updated If you want to continue with manual testing go to 10 4 2 Manual threshold testing P 119 Otometrics 10 4 2 Otometrics Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing Settings Automatic and semi automatic Reflex Threshold Tools Options General Auto resume on seal Off If there is a probe leak the test is interrupted You must resume testing manually if testing is paused due to a leak On Testing resumes aut
31. 02 mmho or greater and a reflex growth can be confirmed larger deflections observable with increasing stimulus intensities The reflex threshold is highly stimulus dependent for instance broad band noise has proven to elicit the reflex at stimulus levels about 15 20 dB lower than pure tone stimuli There may also be differences in detectability depending on the pure tone signal frequency that is used Acoustic reflex testing involves high stimulus levels which are used to elicit the reflex These high sound levels may be unacceptable to some patients Acoustic reflex decay The acoustic reflex decay adaptation test is used to investigate whether the stapedius muscle contraction can be sustained during prolonged stimulation A pure tone stim ulus at 500 Hz or 1000 Hz is presented 10 dB above the acoustic reflex threshold for 10 seconds A 226 Hz probe tone is used Adaptation is considered present if the deflection is decreased by 5096 of the initial magnitude The point in time after stimulus onset when the 50 criterion is reached is referred to as half life time and is reported as the test result A half life time less than either 5 seconds or 10 seconds are typically taken to indicate retrocochlear pathology The two different time criteria have been used by different researchers The acoustic reflex is more prone to adaptation with higher stimulus fre quencies Accordingly adaptation to the 500 Hz stimulus is considered a stronger
32. 1 Immittance testing 0 cece eee eee 221 App 2 2 Lyimpanomenty cies Weare ieee eee MERE 222 App 2 2 1 Tympanometry testing on infants 222 App 2 2 2 Tympanometric features issu ie eres 223 App 2 2 3 ETF I Eustachian Tube Function Intact 225 App 2 2 4 Valsalva s Maneuver 1122s iip Ier da 226 App 2 2 5 Toynbee s Maneuver si edd eee At EUR e el 226 App 2 3 Acoustic Reflex testing 202r oco d per ddp M ey 226 App 2 3 1 Acoustic Reflex Screening essa esee eer ea 227 App 2 3 2 Acoustic Reflex Threshold re es 228 App 2 3 3 Acoustic reflex decay aula irae ees eade 228 App 2 3 4 Admittance monitoring sa eps ssn cra Sokrates ces 229 App 2 4 ETF P Eustachian Tube Function Perforated 229 App 2 5 Susceptance and Conductance B G ires 229 App 2 5 1 Susceptance Bw eee eee 230 App 2 5 2 Cotiductalice Gies oe SN ee px lls 231 App 2 5 3 B G viewing of tympanograms sese 232 App 2 5 4 Component compensation 0 000000 005 232 GIOSSArY ieu ee eid E Deut eate deu US Cees 235 App 3 1 T ftitoldeye sebo eode Dn Bao bacs Phe e aa 235 App 3 2 Abbreviations 25 oxix Coe EL eS DEA REESE EAR RUTAS 246 MADSEN OTOflex 100 Icons 249 App 4 1 Navigation and editing symbols 0 0000 249 App 4 2 POWOHN Gs scenes b Seien e nei ice OS Vitale dor 250 App 4 3 Complet lali asi satia ceste redo epe e ee guo 250 App 4 4 Messages rss
33. After noon Post stimulus time The delay from the end of the applied stimulus to the end of recording of the deflection curve during a reflex mea surement Pre stimulus time The delay from the start of recording of the deflection curve to applying the stimulus during a reflex measure ment Pressure Air pressure e g applied to the ear canal 241 App 3 Glossary Terminology 242 Pressure offset A pressure relative to the tympanic peak pressure used during reflex measurements Pressure range The outher boundaries for the applied pressure for tym panometry Pressure release An instant change to atmospheric pressure in the ear canal Pressure sweep direc tion The direction in which the pressure is changed during tympanometry Probe check Probe tone A test performed in the test cavity to verify correct func tion of the probe and optionally to adjust the cavity read out The frequency of the steady tone emitted by the probe during measurement of admittance 226 Hz or 1000 Hz Procedure options Basic settings controlling device behaviour in relation to tests Pump speed The pressure gradient used during an automatic stan dard tympanometry or for an ETF P test where the pres sure build up is controlled automatically Reflex Contraction of the stapedius muscle caused by applying a loud sound stimulus The contraction is measured as
34. Handling and switching on OTOflex 100 Left softkey a ai Right softkey On Off Press amp hold A Press amp hold to switch on off Press to toggle between Ear Selector test modes ee Pressure release Of 19 Balsctky A Scroll wheel Select highlighted item Scroll to highlight item Toggle value settings E Change intensity level Press amp hold to activate Scroll to value setting Test Selector Scroll between test types Character Select in text editor mode Scroll wheel Turn the scroll wheel to shift the focus on the screen or change values P a Scroll up Turn counter clockwise to scroll up Moves the focus up or to the left or decreases a selected value i Scroll down Turn clockwise to scroll down Moves the focus down or to the right or increases a selected value Select Press and hold to activate the Test Selector see 3 2 2 Test Selector mode 27 Menu Press to access the Menu e Activate item Press to activate the selected item Additional scroll sheel modes rae Test Selector mode Scroll between test types 3 2 2 Test Selector mode 27 Text Editor mode Scroll to select characters 3 2 3 The Text Editor 29 22 Otometrics OTOflex 100 views and main description Handling and switching on OTOflex 100 Softkeys The current functions of the two softkeys are shown at the bottom of the screen j
35. Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default 500 Hz Stimulus 5 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default Off 160 Otometrics Otometrics immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Stimulus 6 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default Off Stimulus 7 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default Off Stimulus side Stimulus 8 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default Off Menu gt More settings Auto Settings LC I C C 5I Ipsi Contra Ipsi then Contra Contra then Ipsi Default I psi Max intensity Menu gt More settings Auto Settings Select the required maximum level of the stimulus inten sity up to 105 dB HI Default 105 dB HL Note To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL This intensity level is below the warning level for all available stimuli Automatic testing always stops after presenting the stimu lus at the Ma
36. Hz 1000 Hz 2000 Hz 4000 Hz BBN Off Default 4000 Hz Stimulus 4 Menu gt More settings 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN Off Default 500 Hz Stimulus 5 Menu gt More settings 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN Off Default Off Stimulus side Menu gt More settings Ipsi Contra Ipsi then Contra Contra then Ipsi diagnos tic version only Default Ipsi 154 Otometrics immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Screening setup Max intensity Menu gt More settings Select the required maximum level of the stimulus inten sity up to 100 dB Default 95 dB HL The test is interrupted at Max level and must be contin ued manually Warning Be careful when you enter the Max setting so as not to expose the patient to too high intensity levels Note To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL No of intensities Menu gt More settings 1 2 or 3 Define whether you wish to use more than one intensity during testing If set to 1 testing uses only max intensity If set to 2 testing starts at max intensity intensity incre ment and continues with max intensity if no reflex was found If set to 3 testing starts at max intensity 2 intensity increment and contin
37. Khare q bot P ADL Dock Uni prd Ap dc RE d 250 App 4 5 Leakage utat Eee d as qp apiid ait ed 251 Troubleshooting ssssseseeeeee 253 App 5 1 Powering Juste x pete ge ROC ede ede tete te 253 App 5 2 TEUD spines ites ec py Suena epe oat More Sa a aus o naar pn 253 App 5 3 Communication 1 0 0 eee ne 254 App 5 4 Probe fit related problems 445252 paaecae code E RR awe 254 Technical Specifications MADSEN OTOflex 100 255 App 6 1 OTOH TOO oiu vtta oetata auton Y AOI ween ihe leet 255 App 6 1 1 Compliance measuring system 0000 255 App 6 1 2 Acoustic Reflex vui od e acai rri Sos Oc Ed 255 App 6 1 3 Air pressure system oa esed utres Advent totals 256 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 10 App 6 1 4 Unit of admittance graph Y axis lusu 257 App 6 1 5 Unit of graph X axis sco iius eb aces Ae oes 257 App 6 1 6 Display ni derne tis cra ai Me wink la ep EA de 257 App 6 1 7 Interface sete nde ce E E E a 257 App 6 1 8 Type identification duele tency dots adamant title stimu os 257 App 6 1 9 l owersupbb Sc etse quss ba po s on paket pee 257 App 6 2 Charger unit aa Cete pic halt E ate yale E E EEE a Mp werde 257 App 6 3 Operating environment avo que Geant wea oe Vea es 258 App 6 4 Storing and handling 12 222 era wick oy tenet deett ie 258 App 6 5 Dimensions Lieu RIS toe doce Uh edic Ds e dU I Ut Re c 258 App 6 6
38. MADSEN OTOflex 100 Screening 7 4 2 7 5 70 Screening The Immittance Module In the Sequence field below the Navigation Panel click the drop down list to select T RS Tympanometry Reflex Screening Practical for basic hearing assessment T RT Tympanometry Reflex Threshold For full diagnostic hearing evaluation T RT RD Tympanometry Reflex Threshold Reflex Decay For full diagnostic hearing evaluation with suspicion of retrocochlear disorder Running a test sequence from OTOflex 100 Press and hold the right softkey to start the sequence In test mode you can always see which sequence is selected in the top line of the test screens Note The sequence starts as soon as probe seal is achieved if Menu gt Procedure options gt Auto start on seal 7 set to Sequence Warning Ifthe patient is troubled by the test stop the test Press the Pressure Release key 9 on OTOflex 100 If a leak is detected or the probe is removed from the patient s ear the sequence is automatically paused a sequence can also be paused manually The sequence can then be stopped or it can be resumed after a seal has been reestablished IfMenu gt Procedure options gt Auto resume on seal is On If the probe is removed from the patient s ear or in case of leakage the sequence will automatically resume from the pause state when the seal is reestablished When resumed a sequence will always continue from wher
39. See the OTOsuite documentation for instructions on j how to load settings in the Immittance Module Otometrics 12 2 General actions immittance test setup in MADSEN OTOflex 100 General actions These settings apply regardless of the test type or sequence selected To access these settings Select Menu General actions Start Sequence Test Selector Printers Patient amp User My Settings Start Sequence Starts the selected sequence set in Menu Procedure Options Sequence Alternatively to activate the Start Sequence function from the keypad press and hold the right softkey If you activate this item 5 times instead of using the short cut you will see the hint Press and hold right softkey to start sequence Test Selector Activates the Test Selector Alternatively to activate the Test Selector from the keypad press and hold Select If you activate this item 5 times instead of using the short cut you will see the hint Press and hold select key to select tests New patient folder Patient amp User Use this function for instance before you start testing a new patient OTOflex 100 automatically creates a new patient folder when switched on of if Menu Procedure Options Patient prompt is set to On Use this function to enter information about a patient and the user for instance before you start testing a new patient My Settings
40. TPP offset are used Default value Checked Manual mode Stimulus Select the stimulus types to be included Available types 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Otometrics Immittance Module Tools Options view and measurement options Measurement settings 1000 Hz Adult default BBN Infant default Select the stimulus intensity from the drop down list 70 dB HL Adult default 70 dB HL Infant default Stimulus levels at or above the warning level gt 108 dB SPL re 2cc are marked by an orange bar in the Intensity drop down list Stimulus levels at or above the intensity safety level gt 115 dB SPL re 2cc are marked by a red bar in the Intensity drop down list Ipsi Stimulus is presented in the probe ear where the measurements are made Contra Stimulus is presented through an earphone or insert g phone in the ear opposite to the probe ear Ipsi Adult default Ipsi Infant default Auto Ipsi Stimulus is presented in the probe ear where the measurements are made Contra Stimulus is presented through an ear phone or insert g phone in the ear opposite to the probe ear Ipsi then Contra Contra then Ipsi 183 Otometrics Immittance Module Tools Options view and measurement options Measurement settings 184 13 3 4 2 Reflex Threshold Test settings A Click icon or select Tools gt Options
41. This difference approxi mates equals the admittance fo the middle ear The term static compliance is used when a volume unit is chosen for the admittance Stimulus A sound applied to the ear to provoke a reflex response Stimulus intensity The intensity of the stimulus measured relative to the hearing threshold for normal individuals dB HL Stimulus intensity increment The difference from one stimulus intensity to the next used during a search for a reflex threshold measured in dB Stimulus intensity steps The maximum number of stimulus intensities that may be used during a reflex screening test to provoke a reflex response 1 2 or 3 Stimulus output side The side where a stimulus is applied relative to the side where the response is measured Same side Ipsilateral Opposite side Contralateral Stimulus time The duration of the stimulus during a reflex measure ment Stimulus type Type A pure tone at a given frequency or a given filtered noise Stop on results A stop criterion for the automatic tymp sweep The mea surement may stop when the needed information is avail able rather than waiting for the pressure sweep to reach the pressure boundary Swap ear results Swaps currently recorded data between ears used to cor rect mistakes System info Displays info about the software and hardware versions and memory usage T T Tympanometry tymp
42. To fit the probe eartip in the ear canal of the patient grasp the pinna and gently pull the pinna back and slightly away from the patient s head and insert the probe in the patient s ear canal twisting the eartip slightly as you insert it 2 Make sure that the eartip fits well Any leakage may interrupt the test During testing OTOflex 100 and the Immittance Module will show a probe icon indi cating probe fit See 6 4 3 Leakage P 64 To compensate for spontaneous movements of the patient s head Place the probe cable behind the patient s neck To keep the cable in place place a weighted shoulder harness over the cable from front to back of the patient across the shoulder opposite the ear being tested Make sure that the cable is not drawn tight as this may result in the probe being pulled out of position Note The eartip can be used for both ears However if you suspect infection in one ear exchange the eartip and clean the probe tip before you continue testing on the other ear See 14 3 2 Probe cleaning and maintenance P 192 6 4 2 1 Fitting the Ipsi probe in the ear canal Warning Be careful not to insert the probe too far into the ear canal of premature babies and newborns 1 Position the patient so that you can easily access the ear to be tested 2 Inspect the ear canal To do so grasp the pinna and gently pull back and slightly up and away from the patient s head Note Ifthe patient is a
43. Weight Qiicssibhtsxkdntausuebfebaecub pad eens 258 App 6 7 Miscellaneous 2 e fuae e bp bee robe i e AR a 258 App 6 8 Calibration 54s dust ee etna ecard datu an beau Duet der Qe 259 App 6 9 Standatds 5 ras abba Cae FEE AE PERRA Erb Pa 259 EEE EEEE EENE E A EE AENEA EERE ETET EEIT T 261 Otometrics 1 Introduction 1 1 MADSEN OTOflex 100 V e Thank you for purchasing OTOflex 100 OTOflex 100 is a compact and portable wireless immittance test device which offers a complete range of capabilities for middle ear diagnostics OTOflex 100 can be operated anywhere as a stand alone device or operated directly from OTOsuite OTOflex 100 integrates closely with the OTOsuite Immittance Module with full test control from both the device and OTOsuite When used with OTOsuite you gain additional features and diagnostic value offered by the comprehensive user inter face and NOAH compatibility of OTOsuite OTOflex 100 OTOsuite interfacing OTOflex 100 is designed to operate with the OTOsuite Immittance Module Bluetooth OTOflex 100 connects with OTOsuite via Bluetooth M which provides wireless connection between OTOflex 100 and OTOsuite up to a range of approximately 10 metres approx 33 ft and up to a range of 100 metres approx 330 ft for other electronic devices NOAH 3 The NOAH System is a HIMSA product for managing clients patients launching hearing test applications and fitting software and storing audiological test r
44. a Reflex Threshold measurement there are a number of settings you can adjust These settings are available either in the control panel on the left side of the screen or in the Tools Options Reflex Threshold Measurement dialog Otometrics 181 Immittance Module Tools Options view and measurement options Measurement settings 13 3 4 1 182 Acoustic Reflex Threshold Control panel settings Reflex Threshold Probe Tone Select the frequency for this measurement setup 226 Hz Adult default 1000 Hz Infant default If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc cm or ul as described in 13 2 2 Reflex Threshold view settings 174 For frequencies higher than 226 Hz admittance is shown only in mmho The value in Y scale automatically changes to mmho e 226 Hz 1000 Hz Recommended for testing on infants younger than 6 months See also the OTOflex 100 Guide Custom TPP offset Check or uncheck this checkbox to select deselect the use of pressure offset to stabilise the eardrum To change the TPP offset setting if Control Panel Custom TPP offset is checked select Tools gt Options gt Threshold gt Custom TPP offset see also description below Disabled TPP is automatically set to 25 daPa more Enabled TPP TPP offset according to TPP setting in Tools gt Options gt Threshold gt Custom
45. a reflex threshold avail able for the ear stimulus type and stimulus ear ipsi or contralateral that is chosen for reflex decay testing The decay test stimulus intensity will then automatically be set to the threshold level 10 dB Note There may be a warning that the stimulus level is in the extended intensity range Reflex decay may not be possible due to highly elevated threshold levels Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested click Stop on the screen The test is interrupted immediately Already measured results can be saved 2 Click Start stimulus in the Manual section of the Control Panel to do a single Jp reflex decay test 1 To interrupt the test if needed click Pause on the Control Panel 124 Otometrics Testing with the OTOsuite Immittance Module ETF P Eustachian Tube Function Perforated To resume testing click the flashing Pause After the pause the test continues at the intensity level during which the interruption occurred Measurements saved Since a reflex decay measurement typically is made using either ipsilateral or contral ateral stimulus side not both only two measurements are saved i e different stim uli and or ipsi contra To view the graphs click the appropriate field in the Half life time table at the bot tom of the screen 10 6 ETF P Eustachian Tube Function Perforated 1 Record a tympanogram to confirm
46. all patients select Menu gt Manage Test Results gt Del ete all patients Communicating and synchronizing with OTOsuite When OTOflex 100 is within range of OTOsuite and you click the Select Device icon in the Immittance Module it connects while the transfer is active and then dis connects If online it uses the already established connection When you click Select Device in the Immittance Module the data are synchronized If it is not the same Patient Folder in the Immittance Module and OTOflex 100 you are prompted to select the Patient Folder you would like to continue with select Session OTOsuite OTOflex CN bri en Q adm No name No name Unknown gender Get Session from OTOflex VY unknown gender Birthdate undefined Birthdate undefined nv Use Session from PC R T RS Session is empty 02 02 2009 X Cancel 27 11 2008 Note Connecting will override the OTOflex patient info Help Select from the dialog box shown Each test is identified by a timestamp the patient name gender birthdate the type of test done on a specific ear and the name of the user who did the test Otometrics Managing Test Results in OTOflex 100 Communicating and synchronizing with OTOsuite The test types are abbreviated as in the following T Tympanometry RT Reflex Threshold RS Reflex Screening RD Reflex Decay ETF P Eustachian Tube Function Perforated If data is already available in th
47. and values for this stimulus type are shown Reflexes are found for 1 kHz contralateral stimulus and BBN ipsilateral stimulus Reflexes are absent for 1 kHz ipsilateral and BBN contralateral stimuli Field results The deflection curves of the included intensities are displayed in the graphs for the highlighted stimulus Individual stimulus intensity and admittance change are listed below each graph yo Check marks or hyphens indicate whether a reflex has been detected or not This applies when the measurement setting Menu More settings No of intensities is set to 1 Numerical values or crossed out numerical values indicate whether a reflex has been detected or not This applies when the measurement setting Menu More settings gt No of intensities is set to more than 1 Blank cells indicate that the test has not been performed Changing view settings No view settings apply to the Reflex Screening test Settings Screening Menu gt Procedure Options gt Auto resume on seal ofr The screening eartip must remain in place against the patients ear If the probe is removed the test is interrupted Otometrics 7 6 Otometrics Testing with MADSEN OTOflex 100 Tympanometry On If the screening eartip is removed from the patient s ear the test continues from the intensity it came to or was interrupted in when there is seal Auto start on seal Menu gt Procedure options gt On Max inten
48. apply regardless of the test type or sequence selected 1 To change general settings select Tools gt Options gt Immittance gt General or click the Set Options icon on the toolbar 2 The Options dialog appears 3 Click on Immittance gt General 13 1 1 Available settings Measurement settings Auto Settings Auto resume on seal If set to On and a measurement is paused by a leak the test or sequence is automatically resumed when the probe is properly refitted in the ear canal Auto start on seal The system automatically starts the measurement as good seal is obtained in the ear canal Regardless of the setting in Tools gt Options gt Tymp and Reflex Scr gt Auto next curve the Immittance Module automatically changes to the next tymp curve for each tymp sweep This is to prevent overwriting already recorded tymps if a tymp measurement is triggered by accident This setting is part of the measurement setting Depend ing on the selected test setting define this setting to suit the specific test setting purposes First ear to test First ear to test Defines the first ear to be tested on a new patient Otometrics 169 Immittance Module Tools Options view and measurement options General settings 170 General Settings Name Enter the term name to be used for settings saved as a setup in OTOflex 100 Safety Intensity safety On When Intensity safe
49. automatic testing The automatic or semi automatic tests provided by OTOsuite provide the easiest way to measure acoustic reflexes Manual editing and testing is also available for spe cific stimulus intensities When you test reflexes using these automatic or semi automatic features the reflexes are automatically determined using different stimulus levels These levels are pre defined but can be adjusted by the user This means that in some cases it may be necessary to customise the settings relating to automatic testing These settings are found in the Automatic section in the Tools Options Reflex Threshold Reflex Decay Stimulus types dialogs Otometrics 10 4 1 Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing When you use automatic or semi automatic testing or when you use test sequences always make sure that these automatic settings are appropriate High stimulus intensities To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL When testing the stimulus types between 500 and 2000 Hz reflexes not found at this intensity are considered abnormally ele vated using a 2 standard deviation criterion from the average threshold level in adults Whenever a stimulus level exceeds the warning level gt 108 dB SPL re 2 cc corre sponding to gt 11
50. axis complying with the standard ANSI aspect ratio where 1 mmho corresponds to 300 daPa in magnitude Show norm area 172 For selecting deselecting display of the norm area in the graph The modified Jerger normative data applies to 226 Hz only Select to enable the Selected Norm Region list Otometrics Immittance Module Tools Options view and measurement options View settings Admittance axis Selected Norm Region Possible selection Adult 226 Hz which is based on the Jerger norm For controlling whether auto classification is performed and according to which norm The Show norm Area result is directly linked to the Adult 226 Hz norm This is because the tympanometric type classification is defined by the TPP relation to the range of the norm data Unit Changes the admittance compliance unit on the vertical axis for 226 Hz probe tone use See the description of admittance compliance in the OTOflex 100 Guide Curves Layered curves Enables a typical ETF I setting with layered tympano grams When Layered curves is checked this affects a number of areas Ifthe Autoscale tympanogram icon is selected the graph will be scaled to allow for showing the highest curve Auto scaling is still ear dependent e Ifa 1000 Hz tympanogram is included among the layered curves the applicable units and tymp results labels for 1000 Hz probe tone measurements will also be used for the 226 H
51. before you start the measurement 5 Scroll to select the stimulus intensity for a single presentation 6 Press Start stimulus J to present the stimulus 88 Otometrics Testing with MADSEN OTOflex 100 Reflex Threshold testing 7 Mark the intensity with which you associate the threhold 8 Adjust the intensitiy and press Start stimulus J to present the stimulus 9 Continue until you register the reflex threshold or until the max intensity is reached Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press the Stop softkey or the Ear Selector Pressure Release key on the keypad to stop the test The test is interrupted immediately Already measured results can be saved J m 10 The deflection curves are shown on the screen as the test progresses resulting in a complete Reflex deflection graph The curves shown are always sorted according to increased stimulus intensity The measurement stops automatically at the end of each stimulus presentation 11 Ifa threshold is not found increase the stimulus intensity until a reflex threshold is registered or until the max intensity is reached 12 To test another level use the Scroll Wheel to scroll to the next stimulus level and press the Start stimulus softkey n 13 Use the Scroll Wheel to scroll to the stimulus level to be reported as the thresh old value and press the Mark Unmark softkey to select If no threshold
52. buttons Test control buttons are used in the various panes in the Control Panel Start pause a sequence Start a test Start a fully automatic reflex test Start a semi automatic reflex test Start stimulus to present a single stimulus intensity Stop the test immediately e E E 9 EF Otometrics 4 2 3 4 3 Otometrics L Navigating in the OTOsuite Immittance Module The Tympanometry screen Pause to manually pause the progress of a sequence When Pause flashes click again to resume testing Skip the ongoing measurement and continue with the next Pressure control in ETF P Changing Control Panel settings When you activate the test device the settings used in the device are automatically shown in the Control Panel See the OTOsuite User Manual The Tympanometry screen f fede Cem Jem Tum he cp SeO zPs F oP ri aa m lead IL Tympanometry The Tympanometry screen shows the tympanometric curves norm area if selected Probe tone TPP Tympanometric Peak Pressure SA SC Static Admittance Static Compliance TW Tympanometric Width ECV Ear Canal Volume Type if selected if normal region and baseline are enabled 37 Navigating in the OTOsuite Immittance Module The Acoustic Reflex screens 4 4 38 Scaling the tympanogram Autoscale tympanogram Enables automatic rescaling to an appropriate value in order to display the entire curve When no data is available
53. control 1 3 Intended use 1 3 1 MADSEN OTOflex 100 OTOflex 100 is an audiodiagnostic device intended for clinical diagnostic and screening tympanometry and reflex measurements performed by audiologists ENTs and other health care professionals It is designed for use on infants children and adults and is lightweight fast reliable and easy to use OTOflex 100 uses technologies which are highly effective for clinical and screening purposes Tympanometry and Acoustic Reflex measurements measure the mechani cal response of the middle ear and form a basis for evaluating whether the related physiological structures are functioning correctly or not The OTOflex 100 probe is extremely lightweight only 4 5 grams and comes with comfortable easy to insert eartips This makes it ideal for use with children and adults OTOflex 100 can be configured for a wide variety of tests and it can be operated entirely manually or programmed for the user s own combination of manual and automatic operation In user programmable tests the user can select the default parameters of a particular test and combine tests to form a sequence of preset tests Otometrics 1 3 2 1 4 1 4 1 1 4 2 Otometrics Introduction About this manual The Immittance Module The Immittance Module is intended for clinical diagnostic and screening tympa nometry and reflex measurements performed by audiologists ENTs and other health care professionals About
54. crossed out numerical values indicate whether a reflex has been detected or not This applies when more than one intensity is selected in the test set ting Tools gt Options gt Tymp and Reflex Scr gt Stimulus intensities Number of Intensities Reflex Screening table Tympanometry screen The Reflex Screening section in the Tympanometry screen shows reflex screen ing values if reflex screening measurements are available or crossed out values if they are not The Ipsi results appear in the top row The stimulus ear referenced contra lateral results appear in the bottom row If subsequently a Reflex Threshold test is made using the same stimulus types as in Reflex Screening the screening values will disappear from the Reflex Screening results table in the Tympanometry screen Any stimulus types that are not tested during a Reflex Thresholds test will remain in the Reflex Screening results table Note Ifyou try to do a Reflex Screening for fields where Threshold values are available you will be prompted to decide whether to proceed Otometrics 39 Navigating in the OTOsuite Immittance Module The Acoustic Reflex screens When this happens always check your Reflex Thresholds screen to check whether you want to overwrite the Threshold results in question 4 4 2 The Reflex Threshold screen Click on one of the graphs in this icon group to scroll between the graphs in the 4 up reflex measurement Reflex Threshold
55. curve unless you manually select a curve When viewing ETF I results the following view setting is useful Select Menu gt Layered curves gt On Acoustic reflex testing Note You should always conduct a tympanometric test before making any acoustic reflex measurement and establish the acoustic reflex threshold before making a reflex decay mea surement The easiest way to measure acoustic reflexes is by using the automatic or semi auto matic test features provided by the OTOflex 100 Manual editing and testing is also possible for specific stimulus intensities When reflexes are tested using these automatic or semi automatic features the reflexes are automatically determined using different stimulus levels These levels are predefined but can be adjusted It may be necessary to customise the settings relating to automatic testing These settings are found in Menu gt More Settings gt Auto Settings High intensity levels To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL When testing the stimulus types between 500 and 2000 Hz reflexes not found at this intensity are considered abnormally ele vated using a 2 standard deviation criterion from the average threshold level in adults Whenever a stimulus level exceeds the warning level gt 108 dB SPL re 2 cc corre spo
56. ea ALEX wee oe E 169 13 2 View settings Suo dett tivi dee rpaueiet doses d Mare vit e deut 171 13 2 1 Tymp and Reflex Scr view settings a2 uas bye n eau peas REG 171 13 2 2 Reflex Threshold view settings 1 524 etud e eia aer eb aan eh a 174 13 2 3 Reflex Decay view settings ooi code ee awh ha E a le 175 13 24 ETE Pyiew SUELOS Des tea s ebd eo dd etae op e oed a S Ra a 175 13 3 Measurement settings L0 eerie e icto iphoto enn el Lone Ed Er Pe Ea cata Pb ia 175 13 31 Tympatometry setup wes ids pr TREE endo DRE RUM PUE Ct 176 13 9 2 CE TF F Setup deer ceo S Reve Tet uv ce eX sete Rescate s 179 13 3 3 Acoustic Reflex Screening setup alooiusa dos naci Roa e SCR E Me dU 179 13 3 4 Acoustic Reflex Threshold setup 2er ma 181 19 255 Reflex Decay setup 3p s Gasca e a pb PRICE EE dees EPI IER genes 186 NOG ETF P setup sped rog Leo SA Loo delta RERO nee eh 189 14 OTOflex 100 Service and Maintenance 191 14s Equipiment failure 2o estendere Warne qutd boe dicet to eee 19 15 2 Serviced rep it 165g us ete kal ates ee where Moe RC ee RU ace Be 191 14 3 Maintenance sasan DONA PENA EDO DA IU NET ep E Oro a 191 i due ecco der rcr 192 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 14 3 2 Probe cleaning and maintenance i iei red or LE PEREAT 192 14 4 Cleaning and disinfecting the probe tip 0 cece eee eee 193 14 4 1 Changing the wax filter sue pigeste kaon eo neds en wel
57. ete current test gt Del ete patient Del ete all printed patients Del ete all patients Procedure Options Sequence Auto start on seal Auto resume on seal Auto free memory First ear to test 226 Hz tymp unit 226 Hz deflection unit Intensity safety gt Done prompt gt Print when done gt Patient prompt gt Settings prompt Advanced gt Dissociate from PC gt Users gt Create user Delete user gt Device settings gt Device info Brightness Bluetooth Battery type Altitude ab ove sea level Bat tery power save Bat tery power off Charger powersave Otometrics OTOflex 100 views and main description Controls and menu selections Charger poweroff No power off before Localization gt Language Date for mat Decimal separator Probe standard Set time Calib old warning Load fac tory settings gt Service password protected 3 2 2 Test Selector mode Note The easiest way to change from one test to another is to briefly press the On Off button In Test Selector mode you can scroll through each of the displays for the individual tests types For tympanometry this includes a Tymp Data screen with additional results In Test Selector mode no items in the test screens will have focus i e no screen items can be selected and no deflection curves are displayed 1 Press and hold the Select key to see the double arrows at th
58. if testing was paused due to a leak Custom TPP offset Menu gt On The pressure is offset from the TPP by the TPP offset defined in Menu gt More settings gt TPP offset If the offset is set to a value with the post fix more it shifts the pressure in the same direction as the sign of the TPP and in the opposite direction if it is set to less When changed in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test setting but not vice versa Note The TPP value from the most recent tympanometric curve at the same probe tone is used in reflex measurements Otometrics 93 Testing with MADSEN OTOflex 100 Reflex Decay testing 94 7 10 4 The Reflex Decay results 7 10 4 1 When the measurement is completed the result fields show the detected half life time for each stimulus Emm Reflex Decay test result showing the half life time and the reflex decay curve for the 0 5 kHz contralateral stimulus The unbroken line above the graph indicates the duration of the stimulus The dashed line is the x axis indicating the total duration of the measurement Field results The result fields show the detected half life time for each stimulus Changing view settings You can change the following view setting to customise your view This setting does not influence the test data as such Menu gt More Settings gt Deflection scale Changing view settings You can change the
59. is detected the field is crossed out to indicate the absent thresh old vo 14 To make another test for instance if the test result was not satisfactory press the Start stimulus softkey to start a new test n 7 9 6 The Reflex Threshold results If no threshold is detected marked the field is crossed out to indicate the absent threshold If you repeat a measurement at a specific intensity the previous measurement for that intensity will be overwritten As a consequence you cannot see several curves with the same intensity 7 9 7 Manually selecting deselecting Reflex Threshold values To manually select deselect a threshold value Otometrics 89 Testing with MADSEN OTOflex 100 Reflex Decay testing Mark Unmark v ag Select Activate Exit manual testing Access stimulus level field Scroll wheel Select stimulus level 1 Use the Scroll Wheel to scroll to the stimulus level 2 Press Select to access the field 3 When you scroll in this field OTOflex 100 displays the Mark threshold left softkey function for already measured stimulus intensities Press the softkey to mark the intensity representing the threshold Likewise press the Unmark softkey to deselect an already marked threshold The three curves showing reflex responses with the highest intensity where the threshold value has been detected are stored automatically by the system 7 10 Reflex Decay testing 90 The decay test stimulus lev
60. mwheel to navigate Frobe Check Probe tone Baseline comp Return to previous Tunp scale Return to test screen Test menu Selector Layered curve Softkeys t Left e Press to return to previous screen tt Right Press to return to test screen Test Selector Menu From the Menu you can access general functions test specific functions and func tions related to device settings See the list below Start sequence 7 4 2 Running a test sequence from OTOflex 100 70 Test selector 3 2 2 Test Selector mode f 27 25 OTOflex 100 views and main description Controls and menu selections 26 Printers 9 Printing P 105 Patient amp User 6 3 4 Selecting patient folder and test type in OTOflex 100 58 incl Select User My settings 12 1 Test settings P 135 gt Load settings gt Save settings gt Save settings as gt Delete settings gt Load factory settings Done 6 3 5 Test flow setup P 59 Probe check 6 3 3 Probe check 57 Most frequently used test specific settings are listed directly in the Menu See the specific test settings in 12 Immittance test setup in MADSEN OTOflex 100 135 More settings Sub menu containing less frequently used test specific settings See the specific test settings in 12 Immittance test setup in MADSEN OTOflex 100 135 Manage test results gt Load patient gt Swap ear results gt Del ete sub test gt Del
61. newborn gently pull the pinna down and back For older infants pull the pinna up and back 3 Look into the ear canal If you can see apparent narrowing of the ear canal it may be blocked by vernix or debris or it may not be straight Note Because the ear canals of newborns are very soft they are easily pressed out of shape If this is the case wait until the ear canal returns to its original shape Release the pinna and try again Gently massaging the area may help opening the ear canal 4 If the ear canal is blocked this will affect the result of the test Clean the ear canal if required Otometrics 63 Preparing OTOflex 100 and the Immittance Module for testing Preparing for the next patient 5 Insert the probe with the eartip in the patient s ear canal 6 4 3 Leakage Testing may be complicated by a number of factors which can result in leakage or probe problems Leakage can for instance be caused by badly fitting eartips eartip not inserted properly in the ear canal ear canal debris blocking for proper ear tip seal old hardened eartip pneumatic probe plug not inserted properly in OTOflex 100 threaded ring holding probe tip not tightened properly Probe problems may be caused by an occluded probe a blocked wax filter Leak detection If there is leakage or if the probe is blocked during testing it is indicated in OTOflex 100 and the Immittance Module by one of the leak icons below
62. pic ture of the state of the middle ear especially when testing the infant population where the ear is still undergoing maturation and resonance frequency alterations Component compensation Interpretation of tympanograms relating to high frequency probe tones may be dif ficult because no straightforward approach is available Baseline compensation In order to assess the middle ear admittance alone the ear canal contribution to the total ear admittance must be eliminated This is called baseline compensation e Using low frequency probe tones Baseline compensation is achieved by subtracting simple ear canal admittance from the total admittance but this is really only valid when using low frequency probe tones such as 226 Hz The reason is that the middle ear is typically stiff ness controlled at 226 Hz and accordingly the middle ear Mass elements will not influence the admittance curve Admittance is therefore made up of Compli ance and Conductance properties alone Compliance and Conductance properties vary similarly throughout the pressure sweep making it possible simply to subtract the ear canal Compliance and Con ductance measured at one extreme point in the pressure sweep In other words the stiffness and friction alone contribute equally to each point of the admittance curve throughout the pressure sweep including the extreme point where the ear canal admittance is determined e Using higher frequency probe tones Oto
63. post fix more it shifts the pressure in the same direction as the sign of the TPP and in the oppo site direction if it is set to less Note The TPP value from the most recent tympanometric curve at the same probe tone is used in reflex measurements Verification Menu gt More Settings gt Auto Settings gt Depending on your settings you can select the type of verification to be used The lowest stimulus intensity where the reflex criterion was met may be retested 87 Testing with MADSEN OTOflex 100 Reflex Threshold testing for reproducibility or the next one or two intensity levels can be used to confirm the reflex growth properties 7 9 5 Manual Reflex Threshold testing Ifa threshold is not found during automatic or semi automatic testing you can test specific stimulus intensities manually Start stimulus Mark Unmark 44 Ai selected levels vox Select Activate manual testing Access stimulus level field Exit manual testing Scroll wheel Select stimulus level 1 Press On Off briefly to select the Reflex Threshold test screen and press Select to activate manual test mode 2 If required press the Ear Selector key to toggle to the ear on which you wish to start the test 3 Ask the patient to sit very still and quiet during this test without moving head or jaw 4 If contralateral stimulation is included make sure that both the Ipsi probe and the Contra insert phone are in place
64. preiet an Ey EER obo a Moos a bei Ma RAE 59 63 0 Users ales ka othe E E AE re E A ue O E ER 60 Preparing the patient Joao aa NE anota the tee erate tate e bii 61 6 4 1 Fitting the eartip on the probe gt 5e Fara te von e vee ne OR AL HR S 61 6 4 2 Fitting the probe in the patient s ear Lesestetepesteebbeee eee eed 62 O3 Leakage oe eiae Braten RO ade e dOkcbgis ede oer eee NES qM 64 Preparing for the next patient 62 cos Peta CP Et ak f EO cT or UO tot eo asd 64 Otometrics Otometrics Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 7 Testing with MADSEN OTOflex 100 0 67 7 1 Fast diagnostics the quick approach nis sod ne ro e od EY ee nV a 67 7 2 General test softkeys and shortcuts acid nt ne EU REPE EE RE 68 LOT Stare testing Sess te Aol en ssh ot ade supp s oe D a pen os Bo ea sb o SC Ma tide ae a ea iota 69 PAS Sequence testine ni dde arson a PW dee ie nie deu ee Morbus Wet pe ct Rib ge deb da 69 7 4 1 Selecting a test sequence inci da pied o eb ead dc dee ia 69 7 4 2 Running a test sequence from OTOflex 100 002 70 7 593 S r el cius ues doe ee etw RR wena a RP CUR RUPTURE e gs 70 7 5 1 Screening tympanometry 2 1 eee ne 71 Zu oRellecscreeli g qepi edane dita wok Lector Ro A RP obe ca ROS BO 71 7 5 3 Settings Screening 2 6 ee eee en 74 76r Tympanometiy 44 2 46 nie eee LEUR awash ERREUR E ES 75 7 6 1 Iympanometry softkeys and s
65. probe tip over the acoustic filter in the probe body and and screw the threaded ring back onto the probe body Tighten well 14 5 Cleaning OTOflex 100 Prerequisites Before cleaning switch off OTOflex 100 and disconnect it from any external power source e Dismount the probe from OTOflex 100 Otometrics 195 OTOflex 100 Service and Maintenance Cleaning OTOflex 100 14 5 1 14 5 2 14 5 3 196 Eartips Regular cleaning Clean OTOflex 100 with a damp cloth if required use a surface disinfectant Note Never use liquids Note Always make sure that no moisture enters the probe or the sockets charger insert and probe sockets Note Never immerse OTOflex 100 into water or other cleaning solutions Clean the screen periodically Use an anti static non solvent solution on a lint free cloth Use a soft brush to remove dust Use a small amount of mild detergent on a damp cloth to clean the cabinet and front Eartips are in direct contact with your patients and you should therefore observe strict hygienic precautions to prevent passing infections from one patient to another Use only disposable ear tips Dispose of eartips after use Disposal OTOflex 100 eartips and foam eartips for the E A RTONE 3A insert phone are dis posable and should not be cleaned or re used Always throw away disposable eartips after use on a patient See 14 5 2 Disposal of disposable articles gt 196 for instruc tions on disp
66. range of tests available in OTOflex 100 You can make changes to specific settings and save these changes as a test setup of your choice You can either use these settings change the settings or load a test setup which you have defined Note When OTOflex 100 connects to OTOsuite the measurement settings in OTOflex 100 are automatically transferred to the Immittance Module If you make changes in the measurement setup of both OTOflex 100 and OTOsuite OTOflex 100 will use the most recent settings When OTOflex 100 is connected to OTOsuite you can make changes in the mea surement setup in the Immittance Module and or on OTOflex 100 as you like The setup is synchronised and OTOflex 100 will always use the latest changes Changing individual settings When you are going to make a test and you have selected the test type you can access a number of settings Press Select to access the Menu 135 immittance test setup in MADSEN OTOflex 100 Test settings Actions Settings specific to the selected test type General settings 136 mi Nun uL uo Ae Start Sequence Test Selector Printers Patient amp User My Settings Done Probe check Probe tone More Settings Manage Test Results Procedure Options Advanced Dissociate from Users Device Settings Service Frequently used settings Less used settings Auto Settings v
67. refers to all the test results and sub test data of a specific patient OTOflex 100 automatically creates a new patient folder when you switch on OTOflex 100 You can create more than one folder for each patient if required If you have to interrupt testing of a patient you can resume testing within the same date by selecting the patient s specific folder With NOAH If you are using OTOflex 100 with the Immittance Module and NOAH and you have created a new Patient the patient s name is downloaded from NOAH to OTOflex 100 e To learn more about the communication between OTOflex 100 OTOsuite and NOAH see 11 Data management in MADSEN OTOflex 100 gt 131 OTOflex 100 Stand alone If you are using OTOflex 100 stand alone without communicating with the Immit tance Module a new patient folder is created automatically when you switch on OTOflex 100 You will be prompted for patient and user info if Menu gt Procedure Options gt Patient prompt is On Otometrics 6 3 5 Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 Creating a new patient Depending on your setting in the Quick flow setup 6 3 5 Test flow setup P 59 a new patient is created automatically when you switch on OTOflex 100 If required you can also create a new patient Entering patient and user information In OTOflex 100 e Use the text editor to enter patient related information when prompted or select
68. seal is achieved If not press Start on the Control Panel to prepare OTOflex 100 to start measur ing as soon as seal is achieved Tools gt Options gt General gt Auto resume on seal If you use screening eartips it is recommended that this setting is On The test is then activated or resumed as soon as there is seal i e when the screening eartip is pressed against the ear If set to Off The screening eartip must remain in place against the patients ear If the probe is removed the test is interrupted Tools Options Tymp and Reflex Scr Auto Reflex Screening Reflex Criterion Sequence settings Reflex screening If you are performing a Tympanometry Reflex Screening autosequence using screening eartips set Tools Options General Auto start on seal to Sequence The test will start with Tympanometry testing and continue automatically from Tympanometry to Reflex Screening 10 3 Tympanometric testing Note You should always conduct a tympanometric test before making any acoustic reflex measurements Also you should always determine the acoustic reflex threshold before mak ing a reflex decay measurement 10 3 1 Diagnostic tympanometry The default setup available in the tympanometry test is designed for any of the tym panometry tests you can perform Adjust the settings to suit your purposes 112 Otometrics Otometrics Testing with the OTOsuite Immittance Module Tympanometric testing
69. sequence Press to stop tympanometry sweep 7 6 2 Diagnostic tympanometry The default setup available in the tympanometry test is designed for any of the tym panometry tests you can perform To make a Tympanometry test 1 Fit the patient with the probe 2 Press Start y to start the Tympanometric measurement 76 Otometrics Otometrics Testing with MADSEN OTOflex 100 Tympanometry Warning Ifthe patient is troubled by the test stop the test Press the Pressure Release key 9 on OTOflex 100 3 The test progresses as follows The pump increases the pressure to the maximum value defined in Menu gt More Settings gt Pressure range and depending on Menu gt More Set tings gt Sweep direction As soon as the predefined pressure has been reached the sweep starts As the sweep progresses the admittance for each pressure point is plotted out on the screen and forms the tympanogram curve During the measurement there are two diamond markers an admittance marker just to the right of the admittance axis indicating the current admittance and a pressure marker below the pressure axis indicating the current pressure Tympanometric test results are shown in a results view Use the Test Selector and scroll to the Tympanometry Results screen or press On Off briefly To display additional results press Select for I second To return to the standard tymp view press again 77
70. softkey functions Softkeys Functions Left B Stop stimulus Press and hold to display patient and user info Right Il Steady Press to pause test Flashing Press to continue Select Return to idle mode Otometrics 83 Testing with MADSEN OTOflex 100 Reflex Threshold testing 84 7 9 1 3 Manual mode functions Softkeys Functions Left Niy Mark ClearMark Available only if test for stimulus intensity has been performed Press and hold to display patient and user info Right 14 Start stimulus If safety intensity level is gt safety limit request confirmation to con a tinue anyway Stop stimulus Scroll wheel Select intensity Flashing value indicates intensity warning gt 108 dB SPL in 2 cc Select Return to idle mode Note This test is available only if OTOflex 100 supports diagnostic testing Warning Tell the patient that the test involves high stimulus levels which are used to elicit the reflex If the high sound levels are unacceptable to the patient you may have to abort testing Automatic and semi automatic Reflex Threshold testing Semi automatic We ate 74 Automatic testing level icti Start stimuli all selected CA M bM levels Scroll wheel Select stimulus level Select stimulus type and presentation side ipsi contra Select Activate manual testing mode 1 Press On Off briefly to select the Reflex Threshold test screen
71. standard infant setup Infant You can save these setups under a name of your choice and then change to meet your requirements To create a specific Test Setup do the following Load the most appropriate setup Select Menu gt My Settings gt Load Settings Select Menu gt My Settings gt Save settings as You will first be prompted for a name Edit or press Select js a docs The File to replace screen appears Scroll to a field named Empty and press Select or if you want to overwrite an existing setup scroll to the required setup and press Select VA Make the required changes to the various settings 6 If you are not in the Menu press Select to access the Menu Editing a test setup If you want to make additional changes to a test setup do the following Select Menu My Settings Load settings Select the test setup of your choice and press Select Change the required settings Select Menu My Settings Save settings WR UD N o The test setup is overwritten Using a test setup If you want to use another test setup than the one currently selected do one of the following 1 Select Menu gt My Settings gt Load settings If Menu gt Procedure Options gt Settings prompt is set to Oz you will auto matically be prompted to load a test setup See also 6 3 5 Test flow setup 59 2 Scroll to select the test setup of your choice and press Select or A
72. stimulus J to start the test Otometrics 95 Testing with MADSEN OTOflex 100 Reflex Decay testing 96 7 10 5 1 7 10 5 2 Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press the Stop softkey or the Ear Selector Pressure Release key on the keypad to stop the test The test is interrupted immediately Already measured results can be saved m 8 Each measurement stops automatically at the end of each stimulus presentation 9 To make another test i Use the Scroll Wheel to scroll to the next stimulus type and press Select If required scroll to adjust Intensity Press the Start stimulus softkey to start the stimulus If you repeat a measurement for a specific stimulus type the previous mea surement will be overwritten As a consequence you cannot see several mea surements for the same stimulus type Note Jfa result field indicating the half life time of an already measured stimulus is selected using the Select key the stimulus level appears and the test can be overwritten with a new measurement Settings Manual Reflex Decay When testing manual reflex decay the following settings are useful Custom TPP offset Menu gt On The pressure is offset from the TPP by the TPP offset defined in Menu gt More settings gt TPP offset If the offset is set to a value with the post fix more it shifts the pressure in the same direction as the
73. the Control Panel Note Ifyou want to generate a very fast tympanogram set Autostart on seal to Iymp instead of Sequence Otometrics Immittance Module Tools Options view and measurement options Measurement settings Stop when results are available Select Tools gt Options gt Tymp and Reflex Scr gt Measurement and enable this function The measurement stops automatically when satisfactory values have been registered 13 3 2 ETF I Setup ETF I tests are done using the standard Tympanometry view and test settings 13 3 2 1 ETF I Control panel settings No special settings are needed for ETF I tests except for the following Sweep direction Make sure that the same sweep direction is used for all the curves to be compared 13 3 2 2 ETF I Test settings A Click icon or select Tools gt Options gt Tymp and Reflex Scr gt Measurement iz No special settings are needed for ETF I tests except for the following Auto next curve Enable Auto next curve to facilitate recording of multiple tympanograms See Auto next curve 179 13 3 3 Acoustic Reflex Screening setup When you perform a Reflex Screening measurement there are a number of settings you can adjust These settings are available either in the control panel on the left side of the screen or in the Tools Options Tymp and Reflex Scr Measurement dialog 13 3 3 1 Acoustic Reflex Screening Control
74. the OTOflex 100 Guide Place the batteries as indicated in the battery compartment see 15 6 2 Batteries 206 for further details Use only rechargeable batteries when OTOflex 100 is placed in the charger unit If you are using alkaline batteries do not attempt to charge your OTOflex 100 Your alkaline batteries may be damaged and leak and this may in turn cause damage to OTOflex 100 Batteries should be removed if equipment is not likely to be used for some time from GN Otometrics A S A OTOflex 100 should only be connected to charger type 1012 Charger Note 1 There are no user serviceable parts inside the OTOflex 100 cabinet For the sake of safety and in order not to void the warranty the cabinets should only be opened and serviced by authorized service personnel In case of defects please Otometrics 217 App 1 Standards and safety OTOflex 100 and the Immittance Module Warning notes make a detailed description of the defect s and contact your supplier Do not use a defective instrument Note 2 Keep OTOflex 100 away from liquids Do not allow moisture inside the instru ment Note 3 Do not use the instrument in the presence of flammable anesthetics gases Note 4 Unwanted noise may occur if OTOflex 100 is exposed to a strong radio field Such noise may interfere with the process of recording correct measurements Many types of electrical devices e g mobile telephones may generate ra
75. the admittance components conductance and susceptance or admittance data Toolbar A Auto scale tympanogram ATO Click on this icon to select deselect autoscaling of a tympanogram When you change the ear or the patient the scale will revert to the default scale When auto scale is active this icon is displayed as being enabled lighter background colour The Immittance Module Control Panel The general function of the Control Panel is described in the OTOsuite User Man ual The appearance of the control panels is specific to the OTOflex 100 connected to the Immittance Module and to the selected test type See 5 1 Setting up communication with the test device P 45 35 Navigating in the OTOsuite Immittance Module The Immittance Module Control Panel 36 If OTOsuite is connected to OTOflex 100 a Reflex Threshold control panel may appear as shown The control panel is divided into panes Test settings specific to the individual tests e Ifyou wish to change the default test settings simply select from the drop down menus and click on the appropriate radio buttons or check boxes See also 13 Immittance Module Tools Options view and measurement options 169 Sequence selection The drop down list for selecting sequences is located in the Sequence field below the Control Panel em um te mite bas Test sequences are described in detail in 10 1 Sequence testing P 107 Test control
76. the batteries in OTOflex 100 and leave it to charge in the OTOflex 100 charger for at least 14 hours and preferably overnight before switching on OTOflex 100 Rechargeable batteries will reach full capacity when they have been recharged a couple of times Alkaline batteries If required OTOflex 100 can be powered by non chargeable Alkaline batteries Warning When using OTOflex 100 with Alkaline batteries always switch off the power supply to the charger Failure to do so may cause the Alkaline batteries to leak and cause damage to OTOflex 100 Otometrics Installing MADSEN OTOflex 100 Powering To protect the Alkaline batteries from charging and to make sure that the OTOflex 100 battery indicator displays the correct status when Alkaline batteries are used change the battery type setting in OTOflex 100 to reflect the type you have inserted Select Menu gt Advanced gt Device Settings gt Battery type and press Select to toggle to Alka When you are using Alkaline batteries the battery icon in the top right corner of the screen will remain even if you place OTOflex 100 in the charger 15 6 2 1 Inserting batteries 1 The batteries and the battery cover are delivered in a small bag Warning Do not put the battery cover in place without first inserting the batteries 2 Insert the batteries as shown below If you are in doubt look inside the battery casing where you will see small red plus signs indicating which
77. the first ear to be tested Menu Procedure options gt First ear to test Press Select to toggle Or 2 Toggle the Ear selector key on the keypad until the Ear icon on the screen shows the probe ear Preparing the patient Fitting the eartip on the probe Warning Choking hazard Do not leave eartips unsupervised within the reach of chil dren You can choose between various types of eartips depending on the type of test you wish to do e Screening eartips e Regular eartips Infant eartips 1 Check the sound channels in the probe tip every time you have used the probe Even small amounts of cerumen or vernix can block the sound channels Clean the sound channels if required 2 Select an ear tip that fits the patient s ear canal You may have to try out a num ber of sizes in order to select the appropriate size 61 Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing the patient 62 B cB s W AT err 3 Gently push and twist the eartip A onto the probe tip until it rests firmly against the base of the probe B Make sure that the eartip covers the collar C of the probe tip Note Accurate testing is only guaranteed if you use the eartips designed specifically for OTOflex 100 by Otometrics Note The eartip can be used for both ears However if you suspect infection in one ear exchange the eartip and clean the probe tip before you continue
78. the perforation The resulting tympanogram curve will be flat and the ear canal volume will be abnormally high because it includes the volume of the entire middle ear If needed see 10 3 1 Diagnostic tympanometry P 112 for instructions 2 Press PageDown to go to the ETF P test screen or select the test from View Immittance 3 The ETF P screen appears tusta tion tube epemimqe Cae Note The pressure range available for positive and negative pressures including 400 daPa and 600 daPa is commonly used in ETF P testing See Control Panel gt Positive Negative pressure Otometrics 125 Testing with the OTOsuite Immittance Module Managing test results 4 The end time is always max 60 seconds but to facilitate viewing you can set a lower initial time value in Tools gt Options gt ETF P gt Time axis gt Scale sec which will then be shown on the horizontal axis If the initial time scale value is exceeded during the measurement the axis auto matically expands by 10 second steps to a maximum of 60 seconds IfControl Panel gt Initial pressure is set to Positive the Pressure control 4 5 Click the Pressure control button on the Control Panel to start testing button points upwards If Control Panel gt Initial pressure is set to Negative the Pressure control button points downwards Press to automatically build up pressure until the first opening of the Eustachian tube or max pressure is reache
79. the scale selected will be used Note Autoscaling adjusts viewing dynamically according to the highest of all currently displayed curves so that you can visually compare ear results Viewing the tympanogram The tympanogram can be viewed in four different ways traditional total admittance Y traditional baseline compensated admittance Y susceptance B and conductance G both total and compensated component compensated admittance Ym Tympanometric curves The Tympanometry graph shows a maximum of 3 curves per ear per patient 1 Click on one of the curves in this icon group to view a specific curve on the tym panogram The Acoustic Reflex screens To perform acoustic reflex threshold testing see 10 4 Acoustic Reflex Threshold testing P 114 To perform acoustic reflex decay testing see 10 5 Acoustic Reflex Decay testing P 121 Otometrics Navigating in the OTOsuite Immittance Module The Acoustic Reflex screens 4 4 1 The Reflex Screening screen LITT x Fu Sede Qvam up imb Wet QU Se eQ ips x vo H i m i eaa ILI Tympanometry Gye cae 1 dafs vorm Fm TL EM CN e Pini hoon Mn fd Ve ie Soe Eee DX AN Field results Check marks or hyphens Y or indicate whether a reflex has been detected or not This applies when only one intensity is selected in the test setting Tools gt Options gt Tymp and Reflex Scr gt Stimulus intensities gt Number of Intensities Numerical values or
80. the wall mount 1 Otometrics 205 Installing MADSEN OTOflex 100 Powering 15 6 206 15 6 1 15 6 2 Powering Powering OTOflex 100 Batteries Device e OTOflex 100 device is powered by batteries See 15 6 2 Batteries P 206 Charger The OTOflex 100 charger is connected to the electrical power outlet It is recommended that you leave OTOflex 100 in the charger when not in use This ensures that the device is always ready for testing See the following descriptions for powering Power related settings You can customize the various power related settings in OTOflex 100 to suit your purposes and save power batteries See 12 2 4 Device settings P 145 Note Do not insert the battery cover in OTOflex 100 before you have inserted batteries If you do the cover will lock in place inside the device Caution Use only the battery types listed in App 6 Technical Specifications MAD SEN OTOflex 100 P 255 OTOflex 100 attempts to check the battery type when you switch it on or place it in the charger and will prompt you for the battery type if it seems to be wrongly con figured e NiHM rechargeable batteries OTOflex 100 is delivered with rechargeable NiHM batteries Before you can operate OTOflex 100 insert
81. to On Off 4 Press the left softkey to exit Communication via Bluetooth has now been enabled disabled Note OTOflex 100 must be switched on to be able to communicate with OTOsuite For further information on communicating with OTOsuite please see the OTOsuite User Manual 211 Installing MADSEN OTOflex 100 Powering 212 Otometrics 16 Otometrics Configuring OTOsuite The Configuration Wizard guides you through the process of customizing the vari ous features and functions that apply to OTOsuite 1 Select Tools gt Configuration wizard and click on Configure next to Immit tance Synchronizing Resolve Synchroniza tion Conflicts 1 Click the specific button defining the action you wish when you need to synchronize OTOflex and OTOsuite data 2 Click Next to continue or Close to exit Immittance configuration OTOflex Connect to the device you wish to use for testing 1 Click on the device you wish to use If the device is not listed check the checkbox My device is turned on and ready to be found and click on Search Select the device and click Next or Close 2 If connection to the device has been interrupted click on Repair Upgrade the device firmware OTOflex Firmware Upgrade Upgrades the firmware of your device 213 Configuring OTOsuite 214 Otometrics App 1 Standards and safety OTOflex 100 and the Immittance Module
82. to a power outlet Otometrics 209 Installing MADSEN OTOflex 100 Powering 210 15 6 3 2 15 6 3 3 First time charging Charging applies only if you use rechargeable batteries Leave OTOflex 100 to charge for at least 14 hours before you put it into use Charger status When OTOflex 100 is placed in the charger you can follow the status of the charg ing process on the charging indicator on the charger front When charging the diode indicates the following Green steady OTOflex 100 is not charging Note that charging is resumed when the device is reinserted into the charger or the device is turned on Amber steady OTOflex 100 is charging Note that charging is automatically discontinued based on a timer This is done to ensure that batteries are not over charged Amber flashing There is a fault in the charger Contact your supplier 15 6 4 Switching on OTOflex 100 15 6 5 Bluetooth To switch on OTOflex 100 press and hold the On Off key on the keypad until the splash screen appears approximately 2 3 seconds Sima OTOflex 100 Middle ear analyzer GA Otometrics Communication via Bluetooth is set to On as default To enable disable Bluetooth communication 1 Switch on OTOflex 100 Otometrics Installing MADSEN OTOflex 100 Otometrics Powering 2 Press Select to access the Menu followed by Advanced gt Device Settings 3 Scroll to Bluetooth and press Select to toggle
83. to protect the patient from cross infection and setting up equipment such as speakers test device and computers The test environment The test environment should in some cases be adapted to suit the specific test types Immittance tests require no specific test environment with regard to noise However a quiet location is always more conducive to testing both with regard to noise and to making sure that the patient is not influenced by factors other than the test itself and the person performing the test 49 Preparing OTOflex 100 and the Immittance Module for testing Hygienic precautions 6 2 Hygienic precautions e Be sure to follow any established infection control procedures for the setting in which you are working e Always use clean eartips e Swab the probe tip with disinfectant between ears If one ear is infected test the healthy ear first and change eartips between ears To prevent cross infection use a clean eartip when you test the next patient 6 3 Preparing OTOflex 100 6 3 1 Preparing the probe Select the appropriate probe for testing Using probe with short cable To mount the cap see 6 3 2 1 The cap 51 The short cable is best suited for use combined with the cap mounted on OTOflex 100 Using probe with long cable If available the probe with the long cable is best suited for diagnostic and clinical test purposes It a
84. tuere eee beet ER Meee eae rares 126 I A T T sisand subtest os SEP TELA REO gle bed DINERO ER TERR BE REE 126 10 7 2 Swapping eat Abd Loos sedes deed xr eo Inu AS e f A adele 126 10 7 3 Deleting datis acp dobterettetoteten deep edo ac Ao eto ern 127 10 8 Leakage quede sd ines hasta bo Ra opa AA d Ro bota dne doa a ciae Rer DE ay 127 10 9 Testing tie Othel ed stirea i petiit doen et I deos th e dokn tin La et neni 128 10 10Saving measurements lees he 128 10 10 1 Standards used in NOAH eta ob ate ica eaten eene Rent et tens iret 128 10 11Preparing for the next patient 24s suave ns icio Seale Sep Ee e hc UR Me dn 129 11 Data management in MADSEN OTOflex 100 131 11 1 Data handling te uos Sok a stt i ev aote ee cto rie at tS pics sU bude bop ave ba the d 131 11 1 1 Interruption of communication 2st reir poor e E deve MT doe 131 1112 Synchronization ooo ec v e eee he eee aa EAR E ERE GEAR 131 11 2 Uploading test results to OTOsuite afoot oe tye rx pere eee eene 132 Lh Dau clean tl sisa ie eal ea eins bit oct adc e OR want a eA kp qn 133 Otometrics Otometrics Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 12 Immittance test setup in MADSEN OTOflex 100 135 LCM l est S tblgs ra dh tance hese eso ee oko mee daha red ke dU ote tae uo es itg d 135 12 1 1 Changing individual settings s ia iti toco E Renae aeons ek 135 12 1 2 Uploading test setti
85. two intensity levels can be used to confirm the reflex growth properties Settings Off Repeat Include next Include next 2 Default Incl next Menu gt More seitings gt Auto Settings Defines the inter stimulus interval i e the pause from the end of one measurement after post stim time has elapsed to the start of the next when pre stim time starts Default value 0 5 seconds 162 Otometrics 12 6 Otometrics immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Decay setup Acoustic Reflex Decay setup When you perform a Reflex Decay measurement there are a number of settings you can adjust Probe Tone Menu gt Decay can be measured only with a 226 Hz probe tone Default 226 Hz With a probe tone at 226 Hz you can set admittance to be shown in the admittance unit mmho or in the compli ance volume units ml cc cm or pl Use TPP offset TPP offset Menu gt Select or deselect the use of pressure offset to stabilise the eardrum To change the current setting select Menu gt More settings TPP offset see also description below Off TPP is used if available On TPP TPP offset according to TPP sign are used Default value On Menu gt More settings Select a pressure offset to stabilise the eardrum This may facilitate reflex recordings from ears showing steeply sloped tympanograms A positive value offsets in same direction as TPP sign 50 x
86. updated continuously on the screen See 10 4 1 Automatic and semiautomatic threshold testing 115 6 Depending on your method of approach repeat using the appropriate stimulus levels until the test is satisfactory 7 To manually determine a threshold click on the drop down box of the specific field in the Thresholds table and select the stimulus intensity to be reported as the threshold value Deflection curves The graph representing the manually determined threshold in the Thresholds table is framed accordingly Thresholds table Until a threshold value in the Thresholds table in the bottom part of the screen has been manually determined a highlighted box will show the text None to indicate that no threshold has been determined When deter mined the manually selected value will be marked by an asterisk Audiogram The audiogram marker in the audiogram at the bottom right of the screen indicates the threshold level or the highest intensity where threshold was not found When a threshold is manually determined the audiogram marker is updated Important The audiogram symbol for Not found will remain until a threshold is determined manually Otometrics 10 5 Otometrics 3 Mp Testing with the OTOsuite Immittance Module Acoustic Reflex Decay testing If a measurement consists of more than 3 intensities click the graph selector to scroll between the graphs Measurements saved You can save se
87. you should take special notice 1 5 1 Navigation Menus icons and functions to select are shown in bold type as for instance in 14 Otometrics Introduction Typographical conventions A Click the Set options icon on the toolbar or select Tools gt Options Otometrics 15 Introduction Typographical conventions 16 Otometrics 2 Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module 2 1 Unpacking 1 Inspect the package and its contents for possible visual damage 2 Check with the packing list to make sure that you have received all necessary parts and accessories If your package is incomplete contact your supplier 2 2 Installation 1 Install OTOsuite from the OTOsuite Installation CD See the OTOsuite User Manual 2 Install OTOflex 100 as described in 15 Installing MADSEN OTOflex 100 gt 199 2 3 Starting up OTOflex 100 1 Starting up OTOsuite is described in the OTOsuite User Manual 2 To switch on OTOflex 100 press the On Off key On Off Press amp hold to switch A on off i we Otometrics 17 Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module Starting up OTOflex 100 a X i Ag Handling Y eee Beis To operate OTOflex 100 hold it EN with one hand left or right Use your thumb to press the keys on the keypad and turn the scroll wheel Switching on To switch on OTOflex 100
88. 0 4 4 3 The Reflex Decay screen 2 ecce estes Sore pde de Far tec Sce hee ats 42 4 5 The LEsPscreet katy ain tat Mate UNSER weite erede 43 4 5 1 The post analysis tool suka bunt i haces bab ad dd d ovt iod ca 43 5 Test Device Management in OTOsuite 45 5 1 Setting up communication with the test device 25s esso s p FER EdisdR 45 9 1 1 Selecting Test devices ubere debe tob Rota wld Bank aa ob e vede dob 45 TEZ Connection bb eee hey e eof vr efe tote doe etit 46 5 1 3 Connecting to a test device rode ERRORS On ee LIA REDIT 46 5 1 4 Reconnecting to a test device LacotuseibexEx SERE bcr E air ru 46 5 1 5 Test device information 4 i oicvadet et Ras taraen wearers dulce d 46 5 1 6 Firmware upgrade test devices i69 ps dex en era SG ee eRe EE 46 6 Preparing OTOflex 100 and the Immittance Module for testing 49 6 1 6 2 6 3 6 4 6 5 Preparing the test environment weavings V EP Mr i Re Vs EO hoa decl 49 6 1 1 The test environment de LAT es nA ev e EP Rae rep E PETS 49 Hygienic precautions soisi 6 hn 50 Preparing OTOflex 100 oi Sou taping Bra Eg asagece Sana lobe rererere arere 50 63th Preparing the probe ssi sores pt Wek BKK Rr Boek ARES Eee 50 6 3 2 Using cap and or handgrip 2 corset aon are REOUR a ed Rr AO eee 51 56 93 Probecheck s opta ea e o dto Ae M e tas Airtel eatin eli alten 57 6 3 4 Selecting patient folder and test type in OTOflex 100 00 58 63 5 Testflow setup
89. 0 02 mmho 157 Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Deflection scale Show 500 Hz Show 1000 Hz Menu gt More settings Defines the size of the admittance scale for reflex measur ing The applicable unit mmho cc ml cm or ul follows unit and probe tone settings If ul is used for 226 Hz probe tone then all values are multiplied by 1000 Default 0 15 mmho for 226 Hz probe tone Default 0 30 mmho for 1000 Hz probe tone Menu gt More settings Select the stimulus type to be included in manual thresh old testing Default On Menu gt More settings Select the stimulus type to be included in manual thresh old testing On Off Default On Show 2000 Hz Show 3000 Hz Menu gt More settings Select the stimulus type to be included in manual thresh old testing On Off Default Off Menu gt More settings Select the stimulus type to be included in manual thresh old testing On Off Default Off 158 Otometrics immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Show 4000 Hz Menu gt More settings Select the stimulus type to be included in manual thresh old testing On Off Default Off Show BBN Menu gt More settings Select or deselect Broad Band Noise to be included in manual threshold testing On Off Default Off Show LBN Show HBN Menu
90. 0 5 Manual Bellex Decay 23 cites ao ieee as ini EO ea ee On Ee PA uns 95 7 11 ETF P testing Eustachian Tube Function Perforated 2 2 e ieee Ree 97 7 11 1 Idle mode functions 223 5309 coo aceon Soaked vi aa PONE cud Soe hanes ad s 97 7 11 2 Pressure build functions 125 4 tale t i eter canal stating ica ae mage gl Wd 97 Plled ThetEst RE TIMIDI 98 dell The ETF P result e ons wt ane aan N Pate al E A pet ir neret 99 7 11 5 The Immittance Module post analysis tool ETF P 0 99 Managing Test Results in OTOflex 100 101 8 1 When testing is done a oec tes can SO e rain C CINE le ou Nes wa ney Roa Rud d 101 8 2 SWAP eaf results sisi metsis eris I Deve E dol e WY a bae ste doa ed Rr e egi Pola 101 8 3 Deleteuieisttemente sac wax e OR ER ae ee CER REIR ea EROR VIO RE 101 8 33 Eyrpanobietty uer Great ata weispe ceret ete ptt e e ed 101 5 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 83 2 Reflex Threshold inssi epsa a Sasi Seve te EPOR EE EIER 101 8 4 Deleting Test Results i22320 32D XE Duos aa Qo 0 pad at pa baa dub Va 102 8 5 Communicating and synchronizing with OTOsuite lees 102 Bob Synchronizi g data ierosina vole aioe con Qoo ostia E D evan a Res 103 8 5 2 Synchronization of corrections made to Patient Folders 103 S IPDHBIng ou oso a dudo Seded ecu bonu Ra bc Pe AL dd 105 10 Testing with the OTOsuite Immittance Module
91. 02 Otometrics Installing MADSEN OTOflex 100 Assembly and installation To ensure safe performance you must make sure that OTOflex 100 is correctly installed and that the requirements listed in App 1 Standards and safety OTOflex 100 and the Immittance Module 215 are complied with OTOflex 100 can be used as a hand held device with no specific requirements to location However keep OTOflex 100 away from all liquids and sources of heat for detailed specifications see App 6 3 Operating environment P 258 15 5 2 Desktop installation If you are using the desktop charger mount the charger on the charger base as shown below 1 Use the hexagonal key to screw the hexagonal screws into place P mA NS AV Hexagonal key Charger body Base 2 Make sure that you tighten the screws well so that the charger is stable when you place OTOflex 100 in the charger Otometrics 203 Installing MADSEN OTOflex 100 Assembly and installation Hexagonal key 15 5 3 Wall mount installation Pd dd 3 p ASA oe po a e 2 washers a 730 2 e 2 2 rawl plugs wafcrsher 4 wallmount backplate plastic shelf 204 Otometrics Installing MADSEN OTOflex 100 Assembly and installation 1 Drill 2 x 6 mm diameter holes 130 mm 5 12 apart 2 Insert rawl plugs 3 Insert the screws with the washers mounted through the backplates of
92. 161 no of intensities acoustic reflex screening setting 155 output setting acoustic reflex decay 165 output setting acoustic reflex threshold 161 post stim time setting acoustic reflex decay 164 post stim time setting acoustic reflex threshold 160 post stim time setting AR 185 post stim time setting ART 188 pre stim time setting acoustic reflex decay 164 pre stim time setting acoustic reflex threshold 159 pre stim time setting ART 185 188 Otometrics Otometrics setting acoustic reflex decay 165 setting acoustic reflex threshold 160 side acoustic reflex screening setting 154 start intensity acoustic reflex threshold setting 162 stim time setting acoustic reflex decay 164 stim time setting acoustic reflex threshold 159 stim time setting ART 185 188 Storing 199 Swap ear results 101 Sweep direction setting 151 setting ETF I 152 Switching on device 210 Synchronization of data 103 131 I Technical specifications 255 Test devices Immittance connecting to 46 firmware update 46 information about 46 Test Selector 27 Testing Acoustic Reflex 81 Acoustic Reflex Decay 121 Acoustic Reflex Decay automatic 122 Acoustic Reflex Decay manual 123 Acoustic Reflex Screening 110 Acoustic Reflex Threshold 114 Acoustic Reflex Threshold automatic 115 Acoustic Reflex Threshold manual 119 Diagnostic tympanometry 112 diagnostic tympanometry 80 ETF I 114 ETF P 125 leakage 64 Reflex Decay automatic 92 Reflex De
93. 226 Hz admittance is shown only in mmho The value on the Admittance scale auto matically changes to mmho 226 Hz 1000 Hz Recommended for testing on infants younger than 4 6 months See also App 2 2 1 Tympanometry testing on infants 222 148 Otometrics immittance test setup in MADSEN OTOflex 100 Tympanometry setup Baseline comp ensation Menu On The middle ear admittance alone after subtraction of the ear canal contribution is measured Off The total ear admittance including the ear canal is mea sured Default Oz Tymp scale Menu This setting follows unit probe tone and baseline comp settings Default 1 5 mmho 226 Hz Default 3 0 mmho 1000 Hz Layered curves Menu When Layered curves is On this affects a number of areas If Auto scale is checked the graph will be scaled to allow for showing the highest curve Auto scaling is still ear dependent e Ifa 1000 Hz tympanogram is included among the layered curves the applicable units and tymp results labels for 1000 Hz probe tone measurements will also be used for the 226 Hz curves e The widest pressure range used will be applied The selected curve is highlighted and shown as a bold full line Note This setting is not saved as part of a measurement setup Default On Otometrics 149 immittance test setup in MADSEN OTOflex 100 Tympanometry setup Auto next curve P
94. 5 dB SPL in 0 5 cc the stimulus intensity value will start flashing and automatic testing is paused You are then prompted to decide whether to con tinue or skip to the next stimulus type Warning When you test on small ears the sound pressure level will increase in the ear canal It is therefore not recommended to exceed the warning level when testing on patients with small ear canals Automatic and semiautomatic threshold testing Before reflex testing e Warn the patient about the high stimulus levels which are used to elicit the reflex If the high sound levels are unaccept able to the patient you may have to abort testing e Ask the patient to sit very still and quiet during this test without moving head or jaw e Ifcontralateral stimulation is included make sure that both Ipsi probe and Con tra insert phones are in place before you start the measurement See the OTOflex 100 Guides Automatic and semi automatic Threshold testing 1 Press PageDown to go to the Reflex Threshold test screen or select the test from View gt Immittance gt The Reflex results shown in the Reflex Threshold view are reflex screening results If you subsequently make a Reflex Threshold test using the same stimu lus type see 10 4 1 Automatic and semiautomatic threshold testing 115 the results from this test will replace the ones shown in this view Reflex Threshold automatically follows the tympanometry sweep if you start the T RT seque
95. 50 daPa offset according to TPP sign Default value 20 daPa Pump during stim Menu gt More settings On Off If Oz the pump will actively keep the TPP pressure even during stimulus presentation If Off the pump will adjust the pressure between presen tations Default value Off 163 Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Decay setup Deflection scale Show 500 Hz Menu gt More settings Enter the appropriate setting for the reflex decay deflec tion scale The applicable unit mmho cc ml cm or ul follows unit and probe tone settings If ul is used for 226 Hz probe tone then all values are multiplied by 1000 If a negative scale is selected the graph by default leaves room for negative deflections and vice versa However the zero axis will automatically move if the deflection graph should go in the opposite direction Default 0 30 mmho Menu gt More settings Select the stimulus type to be included in reflex decay test ing Default On Show 1000 Hz Menu gt More settings Select the stimulus type to be included in reflex decay test ing Default On Pre stim ulus time Menu gt More settings Defines the recording time before each stimulus is pre sented Default value 1 0 seconds Stim ulus time Menu gt More settings Defines the duration of the stimulus Default value 5 0 seconds Post stim ulu
96. BUT orofliex 100 MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual e Doc no 7 50 0880 EN 12 ot O m et r C S Copyright notice No part of this Manual or program may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise without the prior written con sent of GN Otometrics A S Copyright 2010 GN Otometrics A S Printed in Denmark by GN Otometrics A S Denmark All information illustrations and specifications in this manual are based on the latest product information available at the time of publication GN Otometrics A S reserves the right to make changes at any time with out notice Version release date 7 June 2010 Technical support Please contact your supplier FM template version 01 02 2010 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual Otometrics 1 Introduction fichiers repel soul a b CERE Fa Pac ea PS 11 t1 MADSEN OTOflex TOOS Srde eut tatevec eue a E 11 1 2 OPOsutte and the Immittance Module dier ott cov ate oka Male ee cad 11 1 2 1 The flexibility of the OTOsuite Immittance Module 12 1 3 Intended se ireo aenn p cit Sina aon Qut Satoh thane d co d Diod Ro Ugo San uaa 8 12 JO MADSEN OTOflex 100 atin eeu ee Ray MEER MERGE 12 1 3 2 The Immittance Module 239152 uda Eee cea b sedat id dec 13 1 4 About this manual cci nd iode bedi
97. EN OTOflex 100 Screening 4 If required press the Ear Selector key to toggle to the ear on which you wish to start the test 5 If contralateral stimulation is included make sure that both the Ipsi probe and the Contra insert phone are in place before you start the measurement Note To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL See also 7 8 Acoustic reflex testing P 81 lie required press the Pause softkey to interrupt the test Press the flashing Pause softkey to resume After the pause OTOflex 100 continues from the intensity it came to or was interrupted in 7 5 2 2 The reflex screening result 1 Press On Off briefly to select the Reflex Screening test screen The deflection curves of the included intensities are shown in the graphs for the highlighted stimulus Individual stimulus intensity and admittance change are listed below each graph Selected test setting Selected test and frequency The initial reflex screening test screen with ipsilateral 1 kHz stimulus highlighted PPL As indicated by the Start softkey the screening is automatically performed for all preset stimuli Otometrics 73 Testing with MADSEN OTOflex 100 Screening 7 5 3 74 Reflex Screening test result where the result field for contralateral BBN is high lighted and the curve
98. PIX QM SR ESSI ETSI IUS EVIS RWS XA EZ rechargeable 206 set type in device 208 Battery type settings 146 BBN setting acoustic reflex threshold 159 Bluetooth enabling 210 enabling communication 146 Brightness device setting 146 C Calibration 192 Cap attaching 51 detaching 54 use with handgrip 56 cc setting tympanometry 143 Charger charging status 210 desktop installation 203 first time use 210 power off mode 147 power save mode 147 powering 209 view 201 wall mount installation 204 Cleaning autoclaving 194 device 195 probe 192 probe test cavity 194 probe tip 193 cm setting tympanometry 143 Communication interruption 131 sending to OTOsuite 132 synchronization 103 131 Configuration Wizard 213 Contra setting acoustic reflex screening 154 261 262 Contral stim output setting acoustic reflex threshold 161 stimulus side setting acoustic reflex decay 165 Curve Selector 30 Curves auto next curve setting 150 layered c ETF I setting 152 layered c tympanometry setting 149 overwriting setting 150 D Data clean up 133 delete measurements 101 editing data 29 entering data 29 management 131 sending to OTOsuite 132 synchronization 103 131 Date format 148 Deflection unit 143 Deleting data 133 Device icons 249 Device info 146 Device settings 145 Diagnostic tympanometry 80 112 Display icons used 249 view 24 Disposal batteries 196 eartips 196 E Ear leakage 64 swap results 101 Ear sel
99. Pa per second e 50 100 200 400 daPa s or e AFAP As Fast As Possible 500 600 daPa s in 2 0 5 cc Forces the pump to work as fast as possible The actual pressure build up depends on the amount of air escaping from probe and ear Infant default AFAP daPa s Adult default 200 daPa s Sweep direction Menu gt More settings The air pressure determines the direction of the pressure sweep from a positive value to a negative value or vice versa positive from a negative towards a positive value negative from a positive towards a negative value Default Negative Stop when results are available Tymp auto scale Menu gt More settings The measurement stops automatically when satisfactory values have been registered Default On Menu gt More settings Enables automatic rescaling to an appropriate value in order to show the entire curve Note The autoscaling adjusts dynamically according to the highest of all currently displayed curves so that you can visu ally compare ear results Default Off Norm type Menu gt More settings None or Jerger For controlling whether auto classification is performed and according to which norm Default Jerger 151 immittance test setup in MADSEN OTOflex 100 Tympanometry setup Show Norm Area Menu gt More settings Switch for displaying the normative area in the graph Important This setting is not saved as part
100. Patient prompt e Settings prompt 12 2 3 Advanced These settings apply regardless of the test type or sequence selected To access these settings 144 Otometrics immittance test setup in MADSEN OTOflex 100 Select Menu gt Advanced Start Sequence Test Selector Printers Patient amp User My Settings Done Probe check Probe tone More Settings Procedure Options Advanced Manage Test Results Dissociate from Users Service Device Settings General actions PC Users Dissociate from If selected any user trying to connect and control OTOflex 100 will get a warning e gt Create New User See 3 2 3 The Text Editor 29 on how to enter text in the fields in this screen e gt Delete User Scroll to select the user to be deleted and press Select Device Settings Accesses a menu where the items relate to the settings of the test device in general See 12 2 4 Device settings P 145 Service pass word protected This menu item is for service purposes only Device settings These settings apply regardless of the test type or sequence selected To access these settings Select Menu Advanced Device Settings 145 Immittance test setup in MADSEN OTOflex 100 General actions 146 Device Info Displays technical information about hardware firmware and Bl
101. Start test Scroll wheel Manual pressure A 7 w Automatic pressure build up build up 4 Press Start test to start the test 98 Otometrics Testing with MADSEN OTOflex 100 ETF P testing Eustachian Tube Function Perforated 5 Depending on the setting in Menu gt Initial pressure OTOflex 100 automati cally builds up positive pressure until the first opening of the Eustachian tube or max pressure is reached as indicated by right softkey A The pressure control is automatically reversed after one of the two criteria has been reached If the initial time scale value is exceeded during the measurement the axis auto matically expands by 10 second steps to a maximum of 60 seconds 7 11 4 The ETF P result One curve per ear is saved The Immittance Module To view the graphs click the appropriate field text removed here at the bottom of the screen to view the Eustachian tube open and close pressures Haul t ETF P T RT RD ETF P test result showing how the pressure changes throughout the measurement as the Eustachian tube briefly opens and closes The ETF P test screen in OTOflex 100 provides a simple view for quickly assessing the Eustachian tube function For more extensive analysis retrieve the numerical pressure values using the Immittance Module ETF P screen post analysis tool Changing view settings You can change the following view setting to customise your view This setting does not influence the test dat
102. The highest applied stimulus intensity during reflex screening or automatic reflex threshold Maximum positive pressure The maximum positive pressure that may be applied dur ing the ETF P test The pressure will often not be reached as a spontaneous opening of the Eustachian tube may occur at a lower pressure Maximum pressure The maximum applied pressure positive pressure value for tympanometry Acts also as the starting pressure for negative sweep direction Menu A list of selectable items Middle ear pressure The pressure of the middle ear Roughly indicated by the MEP tympanic peak pressure Minimum pressure The minimum applied pressure negative pressure value for tympanometry Acts also as the starting pressure for positive sweep direction Minute min Minute Modified Jerger The name of internationally recognized normal region and tymp classification Month mm Month Mushroom Shape of standard eartip N Negative target pres sure The highest negative pressure that will be applied during the ETF P test The pressure will be reached as there is no spontaneous opening of the Eustachian tube for negative pressures NiMH Rechargeable battery type NOAH action A collection of test results relating to one patient and one ear NOAH session A collection of NOAH actions for one client NOAH System Standardized software for PC allowing conduction of tests NOAH a
103. a change in admittance in the middle ear due to stiffening of the ossicular chain and related structures such as the tympanic membrane Reflex decay The adaptation phenomenon through which an elicited reflex decrease in magnitude over time even when the pro voking stimulus is maintained Reflex decay test RD Reflex half life time Test showing how fast in seconds the reflex decays to half its maximal magnitude The result of the reflex decay test time from stimulus onset to the deflection decays to half its maximum mag nitude Reflex screening RS A quick assessment of whether the reflex reaction is pres ent or not in a subject patient ear The test typically involve a quite strong stimulus that is expected to elicit the reflex in normal subjects Otometrics Otometrics App 3 Glossary Terminology Reflex screening result a An indication of whether a reflex was detected or not at a single stimulus intensity b An indication of the lowest intensity at which a reflex was detected up to 3 intensities used Reflex threshold The lowest stimulus intensity that can elicit a reflex Reflex threshold test A search for the reflex threshold made by applying stimuli RT at increasing intensities until a reflex is detected Reflex threshold veri Defines how the result of an automatically performed fication reflex threshold test is verified Stop Repeat test at
104. a warning is displayed on the display as long as this mode is active Implemented for research purposes Inter stimulus pause Ipsilateral Ipsi The pause imposed between deflection recordings Refers to stimulus applied to the same ear as where the measurement is performed L Layered tympano Up to 3 tympanograms can be shown at the same time in grams the same graph Leak An insufficient seal between the eartip and the ear canal wall causes air to leak in or out of the ear canal making it difficult or impossible to conduct a measurement Leak indicator Angraphical or audible indication of the leak status on the display License A permission to use a certain functionality License info Displays info about the currently installed licenses Low band noise LBN Stimulus type covering a mix of frequencies in the low end of the stimulus spectrum Maintain pressure for reflex measure ments The test device will actively try to maintain the target pressure typically TPP in case of slight leaks Maintain pressure manual tympanom etry The test device will actively try to maintain the set pres sure in case of slight leaks when the user stops adjusting the pressure 239 App 3 Glossary Terminology 240 Manual tympanom etry Tympanometric test where the user controls the applied ymp PP pressure manually Max stimulus inten sity
105. a as such Menu gt More Settings gt Initial time scale 7 11 5 The Immittance Module post analysis tool ETF P In the Immittance Module you can adjust the time pressure graphs manually if needed Otometrics 99 Testing with MADSEN OTOflex 100 ETF P testing Eustachian Tube Function Perforated 1 Click the line closest to the pressure value to be adjusted 2 Click and hold the left mouse button on the line to move it to the desired posi tion 3 The corresponding values in the ETF P table at the bottom of the screen change accordingly 4 To delete a line click on the line and press Delete on your keyboard 5 To delete the entire measurement click on the graph and press Delete on your keyboard Settings ETF P When testing ETF P the following setting is useful Initial time scale Menu gt The end time is always max 60 seconds but to facilitate viewing you can set a lower initial time value which will then be shown on the horizontal axis 100 Otometrics 8 Managing Test Results in OTOflex 100 8 1 When testing is done When you have tested both ears OTOflex 100 will prompt you according to the set tings selected as described in 6 3 5 Test flow setup P 59 8 2 Swap ear results If you have tested a patient with the wrong ear selected in OTOflex 100 you can swap the ear results so that they are assigned to the other ear You can swap ear results during a session or after a session Swappi
106. ack Can be turned off 0 volume Audible test status volume The volume of audible test status feedback Can be turned off 0 volume Auto delete test Automatically delete test results when they have been suc cessfully reported or uploaded to the PC Auto new Patient Folder Start of the first measurement after reporting will cause the test device to store results in a new patient folder N A for online measurements Auto resume on seal Directs the test device to automatically continue an inter rupted test when a seal is obtained 235 App 3 Glossary Terminology 236 Auto settings Settings controlling an automatically performed measure ment Auto start on seal Directs the test device to automatically initiate a test when a seal is obtained Automatic reflex threshold measure ment A search for the reflex threshold for a set of stimulus types Automatically select next tymp curve upon start Auto next Increase tympanogram curve number at each new tymp measurement B Baseline Reference admittance value For tymp the reference admittance is conventionally measured at 200 daPa ear canal pressure where the contribution from the middle ear is small For reflex measurements the baseline is the com pliance without an applied stimulus Baseline compensa tion Battery indicator Subtraction of baseline admittance from the result before pre
107. alateral Threshold measurements Reflex Decay RD If an action contains both ipsilateral and contralateral Reflex Decay measurements IS If an action contains only Ipsilateral Decay measurements cs If an action contains only Contralateral Decay measurements ETF P ETFP ETF P Eustachian Tube Function Perforated 10 11 Preparing for the next patient When you have finished testing a patient and wish to test a new patient 1 For the sake of patient privacy when you receive a new patient make sure that computer screen and test device do not show any information about previous patient 2 Select or create a new patient If you have not already saved the test results you will be prompted to do so Click Save or Cancel as needed 3 Prepare for the next patient as described in 6 Preparing OTOflex 100 and the Immittance Module for testing B 49 Otometrics 129 Testing with the OTOsuite Immittance Module Preparing for the next patient 130 Otometrics 11 Data management in MADSEN OTOflex 100 11 1 Data handling Handling of data shared by OTOflex 100 and OTOsuite is to a large degree auto mated As a general rule Communication between OTOsuite and OTOflex 100 is defined by OTOflex 100 This means that the patient folder currently shown on OTOflex 100 will be transferred automatically to OTOsuite Measurements settings are always synchronised allowing OTOflex 100 to con tinue unaffected if the connection to the PC sho
108. alues are saved in the probe assembly and follows the probe The probe can be plugged to any OTOflex 100 and used right away This also applies to the contra insert phone Calibration frequency The OTOflex 100 device and probes must be calibrated once a year by your autho rized service department 14 3 2 Probe cleaning and maintenance Note Never immerse OTOflex 100 probe into water or other cleaning solutions The probe body Caution For periodical cleaning of the probe body contact your authorized service department The probe tip Note Never place the probe tip in the ear canal without using a clean eartip The probe tip usually does not come into contact with the skin or secretion from the ear canal as it is covered by the eartip However in some cases large amounts of ceru men in the ear canal may result in debris being deposited on the probe tip If this is the case clean the probe tip sound channels with the cleaning wire Note Check the channels in the probe tip every time you have used the probe Even small amounts of cerumen or vernix can block the probe channels Clean the channels if required Note Wipe the plastic probe tip with a disinfectant for example ethanol between patients or replace it with a spare one e Ifyou have replaced the probe tip and or the acoustic filter do a probe test NEVER insert the probe tip into the test cavity of OTOflex 100 without first cleaning and disinfecting the probe tip
109. anogram Test cavity A well defined cavity used to test adjust volume readings and probe function Otometrics Otometrics App 3 Glossary Terminology Test device A physical apparatus like OTOflex 100 used for assess ment of the hearing or balance condition of a patient Test mode A mode where the currently selected test or test sequence can be controlled Test selector A mode where the test device scroll wheel is used to browse results from the current patient and to select a new test Test sequence A sequence of 2 or more different test types e g tymp and reflex screening Test settings All settings controlling how a measurement is performed The current measurement settings can be named and saved Saved settings can be recalled and used as current settings Time stamp Date and time of the measurement patient folder Tool bar A collection of tool buttons placed as a horizontal strip in theupper part of the application window Tree tip Synonymous for infant eartip Tymp The curve showing the result of the tympanometry test Tymp auto scale Setting directing the tympanogram scale to adapt to actual tympanogram hight peak admittance value Tymp classification Tymp scale Classification of the shape and peak position of a tym panogram in regards to normal data according to an established standard The maximum value of the admittance scale for display of tympa
110. ar canal air pressure or middle ear muscle activity alters the mobility of the middle ear system different amounts of remaining acoustic energy can be mea sured at the probe depending on the amount of air pressure or muscle activity applied The maximum acoustic energy admittance the point at which the most acoustic energy enters the middle ear is obtained when the middle ear mobility is maximised This occurs when the ear canal air pressure is equal on both sides of the eardrum membrane and the middle ear muscles are in a neutral state 221 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Tympanometry App 2 2 222 When using a 226 Hz probe tone the acoustic admittance of air enclosed in a 1 cc cavity is 1 mmho Therefore in 226 Hz immittance measurements the admittance unit mmho is interchangeable with the volume units cubic centimetres cc or cm or millilitres ml as a measure of the acoustic compliance This 1 1 admittance versus volume equivalence is only applicable for the 226 Hz probe tone Further because the middle ear admittance is primarily determined by stiffness compliant suscep tance in this frequency region the middle ear compliance can only be considered isolated using low frequency probe tones In OTOflex 100 you can choose between any of the compliance or admittance units cc cm3 or mmho respectively when you use a 226 Hz probe tone When you use a higher frequency probe tone all adm
111. are your way of defining how the test results should be carried out Otometrics 175 Immittance Module Tools Options view and measurement options Measurement settings 13 3 1 Tympanometry setup When you perform a tympanometry sweep there are a number of settings you can adjust These settings are available either in the Control Panel on the left side of the screen or in the Tools gt Options gt Tymp and Reflex Scr dialog 13 3 1 1 Tympanometry Control panel settings Probe Tone Select the frequency for this measurement setup 226 Hz Adult default 1000 Hz Infant default If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc or cm as described in 13 2 1 Tymp and Reflex Scr view settings 171 For frequencies higher than 226 Hz admittance is shown only in mmho The value in Y scale automatically changes to mmho e 226 Hz e 1000 Hz Recommended for testing on infants younger than 6 months See also the OTOflex 100 Guide Pump speed Changes the speed of the pressure sweep Indicated in daPa per second 50 100 200 400 daPa s or e AFAP As Fast As Possible 500 600 daPa s in 2 0 5 cc Forces the pump to work as fast as possible The actual pressure build up depends on the amount of air escaping from probe and ear Default AFAP daPa s Pressure range You can choose between Normal and C
112. atus low in test device Recharge the test device Air hose cable connection prob lems Check the connections See 6 3 Preparing OTOflex 100 50 App 5 4 Probe fit related problems Leakage Problem Possible cause Solution Leakage Leakage can be caused by a num e Pneumatic probe plug not inserted ber of factors such as properly Inappropriate ear tip size either too small or too large e Ear canal debris blocks for good ear tip seal 254 Otometrics App 6 Technical Specifications MADSEN OTOflex 100 App 6 1 OTOflex 100 App 6 1 1 Compliance measuring system Probe tone THD Frequency accuracy Range App 6 1 2 Acoustic Reflex 226Hz 85dBspl 1 5dB 1000Hz 75dBspl 1 5dB 396 in 2 cc 0 5 0 1 ml to 8 0 ml 5 or 0 1 ml whichever is greater Contralateral Stimulation Pure tones Frequency accuracy Noise Range at Step size dB E A RTONE 3A Otometrics 500Hz 1000Hz 2000Hz 3000Hz 4000Hz 0 5 White Noise according to IEC 1027 Low Pass 400 to 1600 Hz High Pass 1600 to 4000 Hz Roll off gt 12 dB Octave BBN LPN at 50 to 100 dB HL 3 dB HPN at 50 to 95 dB HL 3 dB 1 2 5 10 dB 255 App 6 Technical Specifications MADSEN OTOflex 100 OTOflex 100 256 App 6 1 3 Range at THD Immittance probe Range at THD Ipsilateral Stimulation Tone Frequency accuracy Noise Step siz
113. capacity is low OTOflex 100 will power off instead of entering power save Press any key or operate OTOflex 100 from OTOsuite to resume full operation Otometrics immittance test setup in MADSEN OTOflex 100 General actions Bat tery power off This setting applies when OTOflex 100 is running on battery power After this time period in power save mode OTOflex 100 will power off Power off preserves battery capacity Recommended setting 7 minutes or as short as possible Ch ar g er power save This setting applies when OTOflex 100 is placed in a powered charger and uses rechargeable batteries After this time in active mode without any user actions on OTOflex 100 or via OTOsuite OTOflex 100 will enter power save mode where the display changes to a power save screen and the auto start and auto resume functions stop working Power save mode reduces power consump tion and allows the batteries to charge Note OTOflex 100 will only charge while in power save or while turned off In active mode the batteries will still loose power Recommended setting 5 minutes or as short as possible Press any key or operate OTOflex 100 from OTOsuite to resume full operation Ch ar g er power off This setting applies when OTOflex 100 is placed in a powered charger and uses rechargeable batteries After this time period in power save mode OTOflex 100 will power off Power off allows the batteries to charge and p
114. cay manual 95 97 Reflex Threshold automatic and semi automatic 84 Reflex Threshold manual 88 Screening tympanometry 109 screening tympanometry 71 Index U V W X Y Z Text Editor 29 Toynbee s maneuver 226 TPP acoustic reflex decay setting 163 acoustic reflex threshold setting 157 ART setting 182 186 description 223 offset acoustic reflex decay setting 163 offset acoustic reflex threshold setting 157 offset ART setting 184 188 Troubleshooting 253 TW description 224 Tymp scale tympanometry setting 149 Tympanometric width description 224 Tympanometry automatic mode softkeys 76 basic functions 19 classification system 224 data screen 79 description 222 diagnostic 80 112 ETF I 114 features 223 layered curves 149 preparing for testing 20 screening 71 109 settings 148 testing infants 222 type description 224 Tympanometry screening settings 152 U Unpacking 199 User interface 33 Users 60 V Valsalva s maneuver 226 View settings tympanometry 78 267 268 Views 199 W Warning notes 217 Wax filter 195 U VW X Y Z Otometrics
115. ce Module functions are described in 4 Navigating in the OTO suite Immittance Module 33 19 Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module Immittance Module features Preparing for testing Before you receive the client and start the session of testing and explaining test results your time is well spent preparing for the session Test preparations are described in 6 Preparing OTOflex 100 and the Immittance Module for testing P 49 20 Otometrics 3 OTOflex 100 views and main description 3 1 Handling and switching on OTOflex 100 eg Handling Y bii Probe To operate OTOflex 100 hold it N w with one hand left or right Use i your thumb to press the keys on the keypad and turn the scroll wheel 7 Switching on To switch on OTOflex 100 Probe plug press and hold the On Off key on the keypad until the start up Screen Screen appears Switching off To switch off OTOflex 100 press and hold the On Off key on the keypad until the message Power Off appears Keypad Device colour code 3 1 1 Keypad main functions To operate OTOflex 100 hand held hold it with one hand left or right Use your thumb to press the keys on the keypad and turn the scroll wheel You can access most of the functions available in OTOflex 100 via the Menu or by pressing one or more keys and softkeys Otometrics 21 OTOflex 100 views and main description
116. d 92 Otometrics Testing with MADSEN OTOflex 100 Reflex Decay testing 2 If required press the Ear Selector key to toggle to the ear on which you wish to start the test 3 If contralateral stimulation is included make sure that both the Ipsi probe and the Contra insert phone are in place before you start the measurement 4 Ask the patient to sit very still and quiet during this test without moving head or jaw 5 Press Start stimuli to start the test The thresholds are automatically determined for all preset stimuli Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press the Stop softkey or the Ear Selector Pressure Release key on the keypad to stop the test The test is interrupted immediately Already measured results can be saved M 6 To pause the test if required press Pause Il To resume testing press the flashing Pause After the pause the test resumes at the intensity level during which the interrup tion occurred If Auto resume on seal is On testing resumes when probe fit is good 7 10 3 Settings Automatic Reflex Decay When testing automatic reflex decay the following settings are useful Auto resume on seal Menu gt Procedure options gt Off If there is a probe leak the test is interrupted You must resume testing man ually if testing is paused due to a leak On Testing resumes automatically when a proper seal is obtained
117. d The pressure control is automatically reversed after one of the two criteria has been reached 6 To view the graphs click the appropriate field in the Half life time table at the bottom of the screen 7 Onecurve per ear is saved 10 7 Managing test results 10 7 1 Tests and subtests Test Covers all test results from e g a reflex threshold examination or all tymp curves one ear only Sub test Covers the currently selected part ofa test e g all tested intensities for a specific stim ulus for a reflex test or a single tymp curve 10 7 2 Swapping ear data 126 If you have tested a patient with the wrong ear selected in OTOsuite you can swap the ear data so that it is assigned to the other ear Note You cannot swap ear data that has already been saved or printed You can swap ear data during a session or after a session Swapping applies to all data in the selected Patient Folder To do so select Edit gt Swap Ear Results If you select Yes the data will be assigned to the other ear Otometrics Testing with the OTOsuite Immittance Module Leakage 10 7 3 Deleting data Deleting results When you select Edit gt Delete Selected Sub Test you delete Any single tympanometric curve identified by curve number Any full set of curves relating to a specific reflex stimulus type for one of the reflex tests e g all Reflex decay curves for Ipsi 2000 Hz stimuli The ETF P curve Deleting sub tes
118. de procedure 1 Place OTOflex 100 in a powered charger near V A the PC and Bluetooth adapter 2 Connect to the specific OTOflex 100 you want to upgrade from OTOsuite as if you wanted to do testing 3 Disconnect OTOflex 100 4 In OTOsuite select Tools gt Configuration Wizard gt Immittance Configure gt Next to go to the Firmware Update screen 5 Click the Upgrade OTOflex firmware button 6 The Kernel Upgrade kerning window appears Selected OTOflex Note Your OTOflex 100 Name OTOflex 209198 name and serial number will Serial No 000209198 differ from that shown Current kernel Dec 12004 10 25 54 2 01 0156 New Kernel for Lies Upgrade will display New Kernel for Upgrade the newest firmware ver Aug 15 2005 11 08 15 2 01 0170 sion available 7 Click Upgrade to upgrade the OTOflex 100 firmware 47 Test Device Management in OTOsuite Setting up communication with the test device 8 Wait Do not interrupt the upgrade in any way 9 Turn OTOflex 100 off and back on 10 When you have restarted OTOflex 100 click OK 11 Check that there is No newer kernel for upgrade Click OK to finish the OTOflex 100 firmware upgrade 48 Kernel Upgrade Selected OTOflex OTOflex 209198 000209198 Dec 12004 10 25 54 2 01 0156 Upgrading in progress COCO Upgrading Please wait KernelUpgrade KernelUpgrade Please close do
119. dio fields We recommend that the use of such devices in the vicinity of OTOflex 100 is restricted as much as possible Note 5 Changes or modifications not expressly approved by the manufacturer could void the user s authority to operate the equipment Note 6 This equipment has been tested and found to comply with the limits for a Class B digital device pursuant to part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference in a residential installation This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to radio communications However there is no guar antee that interference will not occur in a particular installation If this equip ment does cause harmful interference to radio or television reception which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures Reorient or relocate the receiving antenna Increase the separation between the equipment and receiver Connect the equipment into an outlet on a circuit different from that to which the receiver is connected Consult the dealer or an experienced radio TV technician for help Note 7 For use in Canada To prevent radio interference to the licensed service this device is intended to be o
120. disinfecting the probe tip 194 14 4 0 1 4 Make sure that the sound channels are completely dry before you fit the tip back onto the probe body tighten well or use a spare probe tip Caution 77e probe body contains sensitive components Never clean the sound chan nels in the probe body mechanically or with liquids Doing so may cause damage to the probe 5 Fit the probe tip and screw the threaded ring firmly back onto the probe body Tighten well to prevent leakage Cleaning and disinfecting procedures for the probe tip The probe tip material is highly resistant to a wide range of temperature and chemical influences Regular cleaning Use a wet tissue for regular surface cleaning e Use ultrasonic cleaning to remove contaminants for instance before autoclaving Disinfecting You can choose between a number of methods for disinfecting the probe tip for instance Immersion of the probe tip in a bath of 70 90 ethyl or isopropyl alcohol for 10 30 minutes contact time Immersion of the probe tip in a Sodium Hypochlorite solution at high concen trations and extended contact time considered a cold sterilant When you have cleaned the probe tip rinse it thoroughly in regular water Autoclaving Use autoclaving in accordance with the national standards for vapour cleaning with an exposure time of up to 45 minutes at a maximum temperature of 150 C The probe tip is designed to withstand up to 3 000 autoclavin
121. e Otometrics 29 OTOflex 100 views and main description Controls and menu selections To edit data in the Patient amp User screen 1 Scroll to the field you wish to edit and press Select to access the field 2 Press and hold Select 4 to access Character select mode The bottom of the screen shows double arrows to indicate that you can scroll to the required position in the field Editing characters 1 Scroll to the required position 2 Press Select and scroll to change the character as required Deleting characters To delete a character scroll to the character to be deleted and press the DEL soft key Editing settings e Scroll to the setting you wish to change There are two main methods of editing data such as measurement settings Settings with two value options Press Select to toggle the value in the settings field Settings with several value options Press Select to access the settings field and use the Scroll Wheel to scroll to the required setting 3 2 4 The Tympanometric Curve Selector With the Curve Selector 215 you can switch between the different tympano metric curve views The data shown in the test screen or in the Tymp Data screen relates to the curve in focus Press the left softkey below the Curve Selector icon to toggle between the various curves if available If Menu Layered curves is O all recorded tympanograms for the ear are shown overlayed with the selected curve h
122. e There may be a warning that the stimulus level is in the extended intensity range Reflex decay may not be possible due to highly elevated threshold levels Max intensity levels 500 Hz 1000 Hz Ipsi 50 to 105 dB HL 3 dB 50 to 120 dB HL 3 dB Contra 50 to 115 dB HL 3 dB 50 to 120 dB HL 3 dB 121 Testing with the OTOsuite Immittance Module Acoustic Reflex Decay testing 10 5 1 Automatic Acoustic Reflex Decay testing 1 Press PageDown to go to the Reflex Decay test screen or select the test from View gt Immittance Tare Peet Cone lets lam Wire Hep 6 amp SB82 ea e BSS OHS KY oH Pm Reflex Decay Deflection Noll ite time seconde Note The decay test stimulus intensity pre supposes that there is a reflex threshold avail able for the ear stimulus type and stimulus ear ipsi or contralateral that is chosen for reflex decay testing The decay test stimulus intensity will then automatically be set to the threshold level 10 dB Note There may be a warning that the stimulus level is in the extended intensity range Reflex decay may not be possible due to highly elevated threshold levels Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested click Stop on the screen The test is interrupted immediately Already measured results can be saved 2 Click Start in the Auto section of the Control Panel to start a fully automatic reflex d
123. e sequence starts as soon as probe seal is achieved If the patient is troubled by the test click Stop to stop the test The test is interrupted immediately If a leak is detected or the probe is removed from the patient s ear the sequence is automatically paused a sequence can also be paused manually The sequence can then be stopped or it can be resumed after a seal has been reestablished 4 Click Pause if you wish to manually pause the progress of the sequence When you resume reflex testing the test continues at the intensity level during which the interruption occurred When Pause flashes click again to resume testing Click Skip to skip the ongoing measurement and continue with the next 6 Click Stop sequence to stop the entire sequence gN E If Tools gt Options gt General gt Auto resume on seal is Off The probe must remain in place throughout the sequence If the probe is removed the test will restart with Tympanometry testing when testing is resumed 108 Otometrics 10 2 Screening Control Panel 10 2 1 Otometrics Testing with the OTOsuite Immittance Module Screening If Tools gt Options gt General gt Auto resume on seal is On If the probe is removed from the patient s ear or if there is leakage the sequence will automatically resume from the pause state when the seal is reestablished When a sequence is resumed it will always continue from where it was paused An inte
124. e setting 150 setting max 150 setting min 150 Pressure release key 23 68 Probe cleaning and maintenance 192 connecting to device 51 detaching 51 standard 148 view 202 wax filter 195 Probe test cavity cleaning 194 Probe tip cleaning 193 cleaning procedure 194 Probe tone acoustic reflex decay setting 163 acoustic reflex screening setting 153 acoustic reflex threshold setting 156 tympanometry setting 148 PIS QM SR ESSI IET RU EVIS AWS XAA EZ Procedure option settings 141 Pump active during stimulation acoustic reflex decay 163 active during stimulation acoustic reflex threshold 157 active during stimulation ART 184 187 speed ETF P 166 speed screening tympanometry 152 speed tympanometry 151 R Rechargeable batteries 206 Reflex Decay automatic 92 Reflex Decay manual 95 97 Reflex screening 110 Reflex testing Decay automatic 92 Decay manual 95 97 Threshold automatic and semi automatic 84 Threshold manual 88 Reflex Threshold automatic and semi automatic 84 Reflex Threshold manual 88 Results deleting 102 tympanometry on screen 79 viewing Acoustic Reflex Threshold 86 S SA description 223 Safety Audiometry Module 215 warning notes 217 Safety information 197 Screen icons used 249 Screening Acoustic Reflex 110 Tympanometry 109 Screening tympanometry 71 109 settings 152 Otometrics Otometrics Scroll wheel 22 69 Select key 22 28 69 Sequence selecting setup 167 setup setting 142 Setting
125. e Immittance Module you are prompted to either overwrite the data or cancel 8 5 1 Synchronizing data Data is usually transferred from OTOflex 100 to OTOsuite It is never deleted with out confirmation from the user Synchronization takes just a few seconds and is usually automatically initiated upon connection If the following dialog box appears click the appropriate selection select Session OTOsuite OTOflex CN t VS edm No name No name Unknown gender Get Session from OTOflex Ww Unknown gender Birthdate undefined Birthdate undefined p gt Use Session from PC R T RS Session is empty 02 02 2009 amp rem 27 11 2008 Note Connecting will override the OTOflex patient info Help Note Only the Patient Folder currently shown in OTOflex 100 will be transferred to OTOsuite during synchronization Other Patient Folders made while OTOflex 100 was off line must be transferred manually 8 5 2 Synchronization of corrections made to Patient Folders If you have made changes to for instance reflex thresholds or tympanometric classi fication values either in OTOflex 100 or in the Immittance Module these will be synchronized The most recent change regardless of whether it was made in OTOflex 100 or in the Immittance Module will be applied or synchronised Otometrics 103 Managing Test Results in OTOflex 100 Communicating and synchronizing with OTOsuite 104 Otometrics You can print results
126. e bottom of the screen The double arrows indicate that you can use the scroll wheel to scroll in either direction to view the specific test types dara Current sequence ECU 1 24 Test selector mode Current test Menu and settings Print 2 Scroll to the required test type and press Select You can now carry out testing view data etc Note To return to the test that was selected when you activated the Test Selector mode without selecting the displayed test Press and bold the Select key Otometrics 27 OTOflex 100 views and main description Controls and menu selections Keypad Select e Press and hold to activate the Test Selector see 3 2 2 Test Selector mode 27 e Press to activate the selected test e Press and hold in Test Selector mode to return to the test that was selected when you activated the Test Selector Softkeys Left e Press to carry out the function according to the icon shown Tymp curve select or Enter menu Press and hold to display patient and user info Right e Press to carry out the function according to the icon shown typically starts stops pauses or continues a test Print is always available in this mode Press and hold to start the currently selected test sequence indicated at the top of the screen Icons Menu and settings icon Press Select to access when high lighted Test selector or Text editor Use scro
127. e cap P 51 Note The probe forks on the charger base plate or on the wall mounting provide a prac tical place to keep the probe whenever you are not using the device for instance when the batteries are charging Using cap and or handgrip 6 3 2 1 When you have selected the probe for testing you must decide how you wish to per form the test The setups described below are intended as suggestions for use or you can use a setup of your own choice The cap You can fit the probe directly on the cap of OTOflex 100 If you are using the probe with the short cable you can place the cable in the cable track at the back of OTOflex 100 51 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 52 1 Fit the probe and if required insert phone on the OTOflex 100 2 Mount the cap on OTOflex 100 To do so place the two small projections located on the rear side of the cap in the groove on the top front edge of OTOflex 100 Cap Wings Projections Groove m j PULL TO OPEN 3 Snap the wings into place by pressing them downwards into the two recesses in the top rear edge Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 E 4 Place the neck of the probe in the probe holder i
128. e dB Range at THD Air pressure system Range Pressure sweep rate 500Hz at 50 to 105dB HL 3dB 1000Hz at 50 to 120dB HL 3dB 2000Hz at 50 to 115dB HL 3dB 3000Hz at 50 to 105dB HL 3dB 4000Hz at 50 to 110 dB HL 3dB lt 3 in 2 cc measured 5 dB below max output 500Hz at 50 to 105dB HL 3dB 1000Hz at 50 to 120dB HL 3dB 2000Hz at 50 to 115dB HL 3dB 3000Hz at 50 to 105dB HL 3dB 4000Hz at 50 to 110 dB HL 3dB lt 3 in 2 cc measured 5 dB below max output 500Hz 1000Hz 2000Hz 3000Hz 4000Hz 0 5 White Noise according to IEC 1027 Low Pass 400 to 1600 Hz High Pass 1600 to 4000 Hz Roll off gt 12 dB Octave 1 2 5 10 dB 500Hz at 50 to 105dB HL 3dB 1000Hz at 50 to 120dB HL 3dB 2000Hz at 50 to 115dB HL 3dB 3000Hz at 50 to 105dB HL 3dB 4000Hz at 50 to 110 dB HL 3dB 3 in 2 cc measured 5 dB below max output Normal 4200 to 400 daPa s Extended 400 to 600 daPa s 50 100 200 400 daPa s A EA P A E A P will start at 500 daPa s and slow down to 400 daPa when at peak is detected Otometrics App 6 1 4 App 6 1 5 App 6 1 6 App 6 1 7 App 6 1 8 App 6 1 9 App 6 2 Otometrics App 6 Technical Specifications MADSEN OTOflex 100 Charger unit Pressure accuracy 10 or 10 daPa whichever is greatest Pump measure direction Positive to negative or negative to positive Safety Separate safety 530 daPa and 730 daPa 70 daPa Software saf
129. e it was paused An interrupted reflex stimulus will be repeated Note Ifthe leak appears during the tympanometric measurement the tymp part of the sequence will not be repeated Press Stop and restart the sequence if you need to repeat the tympanometric measurement Note Use screening eartips for screening Otometrics Testing with MADSEN OTOflex 100 Screening 7 5 1 Screening tympanometry Start 1 Load a test setting configured for screening patients in the relevant age group See recommended settings below 2 Press Start p without applying the eartip to the patient s ear Oo Apply the probe to the patient s ear with a steady grip 4 The test starts automatically as soon as a good probe fit with an airtight seal is achieved Settings Screening tympanometry When you perform screening tympanometry the following settings make this test even quicker Auto start on seal Menu gt Procedure options gt Tymp default Off Pump speed Menu gt More Settings gt AFAP default infant AFAP default adult 200 daPa s Stop when results are available Menu gt More Settings gt On default Off 7 5 2 Reflex screening Note In screening mode the safety intensity level cannot be exceeded Note Ifyou are performing a Tympanometry Reflex Screening autosequence using screening eartips and with Menu gt Procedure Options gt Auto start on seal sez to On the test will start
130. e pressure graphs manually if needed 1 Click the line closest to the pressure value to be adjusted Otometrics 43 Navigating in the OTOsuite Immittance Module The ETF P screen 2 Click and hold the left mouse button on the line to move it to the desired posi tion The corresponding values in the ETF P table at the bottom of the screen change accordingly Note You can only adjust the line within the range determined by the adjacent lines This is because the lines are linked to their individual result fields in the ETF P table 3 To delete a line click on the line and press Delete on your keyboard 4 To delete the entire measurement click on the graph and press Delete on your keyboard 44 Otometrics 5 Test Device Management in OTOsuite 5 1 Setting up communication with the test device The first time you set up communication between your test device and OTOsuite do as follows Communication with one test device If you are setting up communication between OTOsuite and one test device see 5 1 1 Selecting test devices 45 5 1 1 Selecting test devices To set up communication between a test device and OTOsuite do as follows 1 The test device must be turned on and not connected to another pc 2 Click the Select Device icon or select Tools Select and Manage Test SS Devices 3 Currently known test devices are listed with name and serial number Click the Search button if the device you want to co
131. e reflex threshold or tympanometric classifi cation values either in OTOsuite or in OTOflex 100 these changes are given a time stamp The most recent change regardless of whether it was made in OTOsuite or in OTOflex 100 will be applied or synchronised Synchronizing patient folders If patient folders on the PC and in the test device are not synchronized when OTO suite connects to OTOflex 100 they will be synchronized automatically or you will be prompted to resolve synchronization conflicts depending on the settings in the Configuration Wizard In OTOsuite select Tools gt Configuration Wizard gt Configure Immittance Select the setting of your choice See 16 Configuring OTOsuite f 213 Uploading test results to OTOsuite Use OTOsuite to get test results from OTOflex 100 When you use OTOsuite you can transfer patient folders from the OTOflex 100 To do so q In the Immittance Module Click the Get Test Results icon Or Select Measurement Get Test Results from Device If Bluetooth communication is enabled in OTOflex 100 OTOsuite automatically connects to OTOflex 100 to get data and then disconnects If online it uses the already established connection Otometrics Data management in MADSEN OTOflex 100 Data clean up Get Patient Folder from Device Time Patient User 08 11 2004 09 56 n n 0000001 ABC 28 10 2004 12 47 n n 0000001 ABC 25 10 2004 12 41 ABC 20 09 2004 15 32 Johson Edna Female
132. ecay test for the preset stimuli To interrupt the test if needed click Pause on the Control Panel le To resume testing click the flashing Pause After the pause the test continues at the intensity level during which the interruption occurred 3 If Tools Options General Auto resume on seal is O testing resumes when probe fit is good 122 Otometrics 10 5 2 Testing with the OTOsuite Immittance Module Acoustic Reflex Decay testing Measurements saved Since a reflex decay measurement typically is made using either ipsilateral or contral ateral stimulus side not both only two measurements are saved i e different stim uli and or ipsi contra To view the graphs click the appropriate field in the Half life time table at the bot tom of the screen Settings Automatic Reflex Decay Tools gt Options gt General gt Auto resume on seal Off If there is a probe leak the test is interrupted You must resume testing manually if testing is paused due to a leak On Testing resumes automatically when a proper seal is obtained if testing was paused due to a leak Control Panel gt Custom TPP offset Checked The pressure is offset from the TPP by the TPP offset defined in Tools gt Options gt Reflex Decay gt General gt Custom TPP offset If the offset is is set to a value with the post fix more it shifts the pressure in the same direction as the sign of the TPP and in the opposite di
133. ection ear selector key 23 68 setting 143 PIS EG SRI ESSI Malin RU EVIS AWS EXE AY EZ Eartips disposal 196 EBV see ECV 224 ECV description 224 Editing data 29 Entering data 29 Equivalent ear canal volume 224 ETF I 114 description 225 layered curves 152 settings 152 Toynbee s maneuver 226 Valsalva s maneuver 226 ETF P 125 description 229 Eustachian tube function see ETF I or ETF P 225 229 F Firmware update test devices Imm 46 G General actions my settings 139 new patient folder 139 patient amp user 139 start sequence 139 test selector 139 H Half life time description 228 Handgrip attaching 55 detaching 56 use with cap 56 HBN setting acoustic reflex threshold 159 Hotkeys general test functions 68 tympanometry test functions 76 Otometrics Otometrics Icons autoscaling 35 get test results 34 select and manage test devices 35 select curve 35 show admittance data 35 show conductance and susceptance data 35 toggle reflex curve 35 used in device 249 Immittance 33 introduction 221 Immittance Module user interface 33 Insert phone connecting to device 51 Intensity safety setting 144 setting acoustic reflex screening 155 setting acoustic reflex threshold 161 start i setting acoustic reflex threshold 162 step size setting acoustic reflex threshold 162 Ipsi setting acoustic reflex screening 154 stim output setting acoustic reflex threshold 161 stimulus side setting acoustic
134. een manually determined If a field is blank this indicates that the test has not been performed 86 Otometrics 7 9 4 Otometrics Testing with MADSEN OTOflex 100 Reflex Threshold testing The dashed horizontal line in each graph indicates the predefined reflex criterion It is therefore offset from the base line marker on the vertical axis The degree of offset is influenced by the setting in Menu gt More Settings gt Reflex criterion Changing view settings You can change the following view settings to customise your view This setting does not influence the test data as such Menu gt More Settings gt Deflection scale Menu gt More Settings gt Show 500 Hz Show 1000 Hz Show 2000 Hz Show 3000 Hz Show 4000 Hz Show BBN Show LBN Show HBN If there is test data for a frequency it will be shown anyway Settings Automatic and semi automatic Reflex Threshold When testing automatic reflex threshold the following settings are useful Auto resume on seal Menu gt Procedure options gt Off If there is a probe leak the test is interrupted You must resume testing manually if testing is paused due to a leak On Testing resumes automatically when a proper seal is obtained if testing was paused due to a leak Custom TPP offset Menu On The pressure is offset from the TPP by the TPP offset defined in Menu More settings TPP offset If the offset is set to a value with the
135. el pre supposes that there is a reflex threshold available for the ear stimulus type and stimulus ear ipsi or contralateral that is chosen for reflex decay testing The decay test stimulus level will then automatically be set to the threshold level 10 dB If no reflex threshold is available the stimulus level is Off This is useful for admit tance monitoring For a maximum amount of monitoring time set the Menu gt More Settings gt Stim time setting to 26 seconds The resulting curve can be saved as an ordinary decay graph Note There may be a warning that the stimulus level is in the extended intensity range Reflex decay may not be possible due to highly elevated threshold levels Max intensity 500 Hz 1000 Hz levels Ipsi 50 to 105 dB HL 3 dB 50 to 120 dB HL 3 dB Contra 50 to 115 dB HL 3 dB 50 to 120 dB HL 3 dB Otometrics 7 10 1 Keys and functions Testing with MADSEN OTOflex 100 Reflex Decay testing 7 10 1 1 Idle mode functions Softkeys Functions Left Press and hold to display patient and user info Right gt gt Press to start auto test see below Press and hold to start sequence Select e If stimulus types I psi or C ontra are in focus press to activate manual mode e If the Menu icon is in focus press to access Menu 7 10 1 2 Automatic mode functions Softkeys Functions Left Stop stimulus and return to idle mode Pres
136. ening eartips Recommended setting Sequence with T RS sequence selected Auto resume on seal Probe Tone Menu gt Procedure options gt Auto resume on seal Off The screening eartip must remain in place against the patient s ear If the probe is removed the test is inter rupted On If the screening eartip is removed from the patient s ear the test continues from the intensity it came to or was interrupted in when there is seal Menu Scroll to select the appropriate frequency for this measure ment setup Adult default 226 Hz Infant default 1000 Hz If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc cm or ul For frequencies higher than 226 Hz admittance is shown only in mmho The value in Admittance scale automati cally changes to mmho 226 Hz 1000 Hz Recommended for testing on infants younger than 4 6 months See also App 2 2 1 Tympanometry testing on infants 222 Stimulus 1 5 Menu gt More settings Select the stimulus types to be included See the following 153 Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Screening setup Stimulus 1 Menu gt More settings 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN Default 1000 Hz Stimulus 2 Menu gt More settings 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN Off Default 2000 Hz Stimulus 3 Menu gt More settings 500
137. ent ears teria iini ini e UE dots 13 oL Sabet ye mir AT MORI Y orbe PP aces page Behe soe gk ROS P E WHO ERE en d 15 152 Installation soc stent aed e Ed Ped ae da eed al bed t PLA DES 13 1 4 3 Descriptions and testing 43 cse epe de Rub ENA DEDERE PUES 14 1 4 4 Preparing for ROSE Ces Las eai Scan tae car dade aei ou DU RA pr s 14 Dopo DEBERE kc re a CAU HOA E we ee ere 14 1 4 6 Maintenance and cleaning aoo se aie Dex eee Pu alot 14 1 5 Typographical conventions voids cotes ex eo eee eee ea 14 Jot OINGWIBSEDOR Sia Sx aes a ici E Foe or cote ee ety ae Aa a cae 14 Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module LLutuuuuusese 17 241 TOR PACKINO tn cae uod teet eae nae a te edd eene euh 17 2 2 Tnstallation type pace oe eR ore ave ance x Dep VOLARE CE o b E plar pl sc ules 17 29 staring npo POM ee TOU us sea deri tee dob rt E doles UNIT deo o Manage red 17 2 3 1 Languageset ng c4 ee SR A E MEER Vai 18 2 4 Starting up the Immittance Module ere vu eheu ese ventre 19 2 5 Immittance Module features dou sha wd ne See ca DR enw eee ena eas 19 OTOflex 100 views and main description 21 3 1 Handling and switching on OTOflex 100 4 siete esa wie eee tae baee te aS 21 3 1 1 Keypad main functions 93 4 olea coe DU abt Re decis rat ovi nd 2 25 2 SEHE displag xtest mode oucse toto d eo EE E ERE DER ERO UR BORD ES 24 3 2 Controls and menu selections esed eee ON teeth eee gebe
138. ents for each ear in a Patient Folder 113 Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing 10 4 114 Settings Diagnostic tympanometry Tools gt Options gt Tymp and Reflex Scr gt Auto next curve ETF I Eustachian Tube Function Intact Note This test is available only if OTOflex 100 supports diagnostic testing The test 1 Record a tympanogram See 10 3 1 Diagnostic tympanometry 112 for instructions 2 Instruct the patient to perform either Valsalva s or Toynbee s maneuver see the OTOflex 100 Guides 3 Record a second tympanogram 4 Compare the tympanograms from step 1 and 3 in a multilayered tympanogram set Tools gt Options gt Tymp and Reflex Scr gt Layered curves to Yes 5 It may be useful to repeat the procedure using different techniques and maneu vers in a sequence of testing to fully evaluate the functioning of the Eustachian tube Settings ETF I Tools Options Tymp and Reflex Scr Auto next curve Acoustic Reflex Threshold testing This test type is available only if OTOflex 100 supports diagnostic testing e 10 4 1 Automatic and semiautomatic threshold testing 115 e 10 4 2 Manual threshold testing f 119 Note You should always conduct a tympanometric test before making any acoustic reflex measurement Also you should always establish the acoustic reflex threshold before making a reflex decay measurement Automatic and semi
139. eret ea 25 Sol TheMenu gerar ren Eaa e ense e do pat os BAUER Vo SERUUM UE SUM ence 25 3 22 besbselsatol mod d odwse osorioi oi e a RR ce cs Ada aa uen 27 3 2 3 Ihe Tet Editor 22593 id o xx prp bs Sale AR baw en E pole ME Beb gos 29 3 2 4 The Tympanometric Curve Selector 25 00 2005 ca x RR 30 225 TheOT Olen 100 Ment ct 5 iia ke Xt choke cota dea ne e a i 30 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual 4 Navigating in the OTOsuite Immittance Module 33 4 1 The Immittance Module menu system and toolbar 0 cece eee eee 33 Bash OPHIUIDEDE outer hated an Taster LACE rtis 34 Abs Me as rement IDEIMO Cu ovra deep Vote De wane ae CR MORE SCR ca E SC a 34 413 Tools menu 2 2 osi edo preda eei E aaret opc DP TE anao teh 34 4 1 4 Additional icons osssauo iussi e hat tie Piceni Pc aves 25 42 The Immittance Module Control Panel 0 eee eee 35 Ar Sequence selection xq duros eae etd opa el Aero a od ial oa 36 4 2 2 Test control buttons 2 ocio etti ace dro porn Ne oC Rol eae a 36 4 2 3 Changing Control Panel settings idiota pk Ta ads tes petite Ee pd 37 4 3 The Tympanometiy screen 5152s esL Ueex Solana pebiada a oes quad aod a 37 4 4 The Acoustic Reflex screens usa er be on MERE MERE ME REPE NE BE E MA 38 4 4 1 The Reflex Screening screen bx 05 tach wh Sade SERIE RE RD Roca dpa Des 39 44 2 The Reflex Threshold screen 22 a eee ere ett e acy estab eres Aot dna ia 4
140. eshold 162 stim output acoustic reflex threshold 161 stim time acoustic reflex decay 164 stim time acoustic reflex threshold 159 stim time ART 185 188 stim x acoustic reflex decay 165 stim x acoustic reflex threshold 160 stimulus side acoustic reflex decay 165 stimulus side acoustic reflex screening 154 stimulus acoustic reflex screening 153 stop when results are available screening tympanometry 152 stop when results are available tympanometry 151 swap ear data 140 sweep direction 151 sweep direction ETF I 152 TPP offset acoustic reflex decay 163 TPP offset acoustic reflex threshold 157 tymp auto scale 151 tymp scale 149 use TPP offset acoustic reflex decay 163 use TPP offset acoustic reflex PIX EG SR ESSI IET UO EVIS RWS EXT YS EZ threshold 157 users create user 145 users delete user 145 users 145 using setup 138 verification include 162 viewing in OTOsuite 137 Softkeys 23 Acoustic Reflex Screening screening mode 72 83 84 91 97 General use 23 68 Menu 25 Test Selector 28 tympanometry automatic mode 76 Specifications technical 255 Static admittance description 223 Stimulus acoustic reflex screening setting 153 intensity increment acoustic reflex screen ing setting 155 intensity increment AR screening setting 181 184 intensity step size acoustic reflex threshold setting 162 max intensity acoustic reflex screening setting 155 max intensity acoustic reflex threshold setting
141. eshold search To pause the test if needed click Pause on the Control Panel To resume testing click the flashing Pause After the pause the test continues at the intensity level during which the interruption occurred 2 If Tools gt Options gt General gt Auto resume on seal is On testing resumes when probe fit is good Otometrics Otometrics Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing Threshold not found immediately The stimulus intensities will increase until a reflex threshold is registered or until the max intensity is reached Threshold found immediately The test will automatically decrease the stimulus intensities until a threshold is no longer registered 3 Depending on your settings in Tools gt Options gt Reflex Threshold gt Verifica tion you can select the type of verification strategy to be used after the deflection criterion has been met by the automatic threshold search The lowest stimulus intensity where the reflex criterion was met may be retested for reproducibility or the next one or two intensity levels can be used to confirm the reflex growth properties 4 As the test progresses various fields are updated continuously on the screen Deflection curves The deflection curves are shown on the screen eventually resulting in a com plete Reflex deflection graph The curves shown are always sorted according to increased stimulus intensity Ty
142. esults OTOflex 100 test results can be stored in the NOAH 3 database via OTOsuite 1 2 OTOsuite and the Immittance Module El OTOsuite otometrics Otometrics The OTOsuite Immittance Module offers real time presentation of test results and full test control of MADSEN OTOflex 100 directly from a PC Test devices with integrated user interfaces can be operated independently of the Immittance Module although additional features and diagnostic value is offered by the Immittance Mod ule s comprehensive user interface and NOAH compatibility The test functionalities of the OTOsuite Immittance Module depend on the con nected device as does the selection of test parameters and remote control 11 Introduction Intended use The OTOsuite Immittance Module lets you work with NOAH or save and view results via XML files The OTOsuite Immittance Module supports screening and diagnostic tympanometry Reflex Threshold testing Reflex Decay testing ETF P e user defined tests Immittance Module OTOflex 100 interfacing The Immittance Module is designed to operate with OTOflex 100 as the test device produced by Otometrics 1 2 1 The flexibility of the OTOsuite Immittance Module When used for testing the OTOsuite Immittance Module adapts to the connected test device Consequently the test functionalities of the OTOsuite Immittance Module depend on the connected device as does the selection of test parameters and remote
143. esults 139 max intensity acoustic reflex screening 155 max intensity acoustic reflex threshold 161 negative pressure 166 no of intensities acoustic reflex screening 155 no power off before 147 norm type 151 patient prompt 144 pause time 165 pause time 162 185 188 positive pressure 166 post stim time acoustic reflex decay 164 post stim time acoustic reflex threshold 160 post stim time ART 185 188 pressure range 150 pre stim time acoustic reflex decay 164 pre stim time acoustic reflex threshold 159 pre stim time ART 185 188 print when done 144 probe standard 148 probe tone acoustic reflex decay 163 probe tone acoustic reflex screening 153 probe tone acoustic reflex threshold 156 probe tone tympanometry 148 procedure options 141 265 266 pump during stimulation acoustic reflex decay 163 pump during stimulation acoustic reflex threshold 157 pump during stimulation ART 184 187 pump speed 151 pump speed ETF P 166 pump speed screening tympanometry 152 reflex criterion acoustic reflex screening 156 reflex criterion acoustic reflex threshold 157 reflex criterion AR screening 180 184 sequence setup 142 service 145 set time 148 show BBN acoustic reflex threshold 159 show HBN acoustic reflex threshold 159 show LBN acoustic reflex threshold 159 show norm area 152 show xxx Hz acoustic reflex decay 164 show xxx Hz acoustic reflex threshold 158 start intensity acoustic reflex thr
144. ety 450 daPa and 650 daPa 70 daPa Unit of admittance graph Y axis ml cc mmho pl Unit of graph X axis daPa sec Display Graphic 128x128 dots Interface Wireless Bluetooth data transfer to PC Type identification OTOflex 100 is type 1012 from GN Otometrics A S Power supply Battery types Rechargeable Ni MH type AA R6 1 2V 4 pcs Use only rechargeable batteries supplied by GN Otometrics A S Alkaline AA R6 1 5V 4 pcs Battery supply voltage Nom 5V max 6 4V min 4 0V instrument power off voltage Charger unit Type identification Charger unit is type 1012 Charger from GN Otometrics A S 257 App 6 Technical Specifications MADSEN OTOflex 100 Operating environment Power 100 240 VAC 10 50 60 Hz Power consumption lt 10VA App 6 3 Operating environment Temperature 15 C to 35 C 59 F to 95 F Rel humidity 30 to 90 non condensing Warm up time lt 2 min Air pressure 600 hPa to 1060 hPa Operation at temperatures below 20 C or above 60 C may cause permanent dam age App 6 4 Storing and handling Temperature 20 C to 60 C 4 F to 140 F Rel humidity lt 90 non condensing Air pressure 500 hPa to 1060 hPa App 6 5 Dimensions OTOflex 100 HxWxD 20 cm x 4 9 cm x 7 8 cm 7 9 x 1 9 x 3 0 Charger unit HxWxD 8 cm x 4 9 cm x 7 8 cm 6 9 x 1 9 x 3 0 App 6 6 Weight OTOflex 100 0 6 kg 1 3 Ib Charger unit 0 23 kg 0 5 Ib Ap
145. following view settings to customise your view This setting does not influence the test data as such Menu gt More Settings gt Deflection scale Menu gt More Settings gt Show 500 Hz Show 1000 Hz Measurements saved Since a reflex decay measurement typically is made using either ipsilateral or contral ateral stimulus side not both only two measurements are saved i e different stim uli and or ipsi contra Otometrics Testing with MADSEN OTOflex 100 Reflex Decay testing 7 10 5 Manual Reflex Decay Note The manual reflex decay test available in the OTOflex 100 Quick Check version cannot be remotely controlled from OTOsuite A 5 718 start stimulus 9 Select Scroll wheel Activate manual testing Select stimulus level mode 1 If required press On Off briefly to select the Reflex Decay test screen This screen opens up in automatic mode 2 If required press the Ear Selector key to toggle to the ear on which you wish to start the test 3 If contralateral stimulation is included make sure that both the Ipsi probe and the Contra insert phone are in place before you start the measurement 4 Ask the patient to sit very still and quiet during this test without moving head or jaw 5 Scroll to the appropriate stimulus type and press Select 4 to activate manual test mode Tibia 215 6 Scroll to select the stimulus intensity for a single presentation 7 Press Start
146. for 226 Hz reflex measurements mmho cc ml cm ul Default mmho 143 Immittance test setup in MADSEN OTOflex 100 General actions Intensity safety On When Intensity safety is on no stimulus intensities higher than 115 dB SPL measured in a 2cc cavity can be selected or will be applied Off When Intensity safety is off stimulus intensities up to the technical limits of the device and probe can be selected and applied A warning triangle is displayed on screen whenever intensities above 115 dB SPL are selected Intensity safety is automatically set to On whenever the Ear Selector button is toggled or a new patient folder is selected Note e Whenever a stimulus level exceeds the warning level gt 108 dB SPL re 2cc the stimulus intensity value will start flashing and all automatic testing is paused You are then prompted to decide whether to continue or to move on to the next stimulus type In Manual testing whenever a stimulus level exceeds the Intensity Safety level gt 115 dB SPL re 2cc the stimulus intensity value will start flashing Warning When you test on small ears the sound pressure level will increase in the ear canal It is therefore not recom mended to exceed the warning level when testing on patients with small ear canals Default On Quick flow set See 6 3 5 Test flow setup P 59 for a description of the set tings tings below e Done prompt e Print when done
147. from trying to charge the non chargeable Alkaline batteries Warning When using OTOflex 100 with Alkaline batteries always switch off the power supply to the charger Failure to do so may cause the Alkaline batteries to leak and cause damage to OTOflex 100 5 Press the left softkey to exit 6 If required press and hold the On Off key on the keypad to switch off OTOflex 100 Otometrics 15 6 2 3 Installing MADSEN OTOflex 100 Powering Powering status OTOflex 100 powered by batteries only C Cal mm When OTOflex 100 is powered by batteries only i e when it is not placed in the charger or Alkaline batteries are used it shows the approximate remaining capacity of the batteries in the top right corner of the screen OTOflex 100 powered by charger T When OTOflex 100 is charging a small power plug icon is shown in the top right corner of the screen 15 6 3 The charger 15 6 3 1 A Powering the charger Caution Operating at the wrong voltage may blow the fuses See the label on the char ger for input voltage Before you connect the power cable to the charger make sure that the voltage from the electrical power outlet matches the voltage shown on the identification label on the charger 1 Plug the end A of the supplied power cable into the power inlet on the charger see below 2 Connect the power cable of the OTOflex 100 charger
148. from OTOsuite If you print via OTOflex 100 when connected to OTOsuite printing will be done on the PC s default printer Printing from OTOsuite is described in the OTOsuite User Manual Otometrics 105 Printing 106 Otometrics 10 10 1 10 1 1 10 1 2 Testing with the OTOsuite Immittance Module Sequence testing A test sequence is a predefined set of automatic tests which can be performed auto matically The Immittance Module will always perform the most recently selected sequence regardless of whether it has been selected in the Immittance Module or in OTOflex 100 Selecting a test sequence e Select the appropriate test sequence OTOflex 100 Menu gt Procedure Options gt Sequence The Immittance Module In the Sequence field below the Navigation Panel click the drop down list to select T RS Tympanometry Reflex Screening For procedures see 10 3 Tympanometric testing 112 and 10 2 2 Acoustic Reflex Screening P 110 Practical for basic hearing assessment The Tympanometry and Reflex results are available in two different views where the Tympanometry view shows a small Reflex table and the Reflex view shows a small Tympanometry graph From the Tympanometry view you can perform Reflex Screening For a more elabo rate view select Reflex Threshold either as an individual test or in a sequence with Tympanometry Initially only reflex screening results are shown in both the Tym
149. g cycles in which tem peratures typically reach 134 C Make sure that the probe tip has not been deformed by the autoclaving process Cleaning and disinfecting the test cavity Caution The test cavity is located in the charger which contains electrical components and electrical power connection Therefore do not use bath or autoclaving Otometrics OTOflex 100 Service and Maintenance Cleaning OTOflex 100 If the test cavity has been contaminated with debris from the probe tip use gas clean ing according to local hygienic standards i e with ethyleneoxide at a temperature of 55 C at a pressure of 0 8 to 1 0 bar 14 4 4 Changing the wax filter If you are warned that there is a probe error or that the probe is not OK check whether the probe tip is blocked If it is not the wax filter of the probe may be dam aged or blocked by cerumen If this is the case change the wax filter Note Never immerse the OTOflex 100 probe into water or other cleaning solutions 1 To replace the wax filter remove the probe tip See 14 4 Cleaning and disinfect ing the probe tip 193 2 Use the extraction lever to take out the wax filter from the probe tip Wax filter Extraction lever Note Filters are disposables See 14 5 2 Disposal of disposable articles P 196 for instructions on disposal Do not put used filters in the accessory box 3 Insert a new filter Be careful not to damage the filter openings 4 Fit the
150. gt More settings Select or deselect Low Band Noise to be included in man ual threshold testing On Off Default Off Menu gt More settings Select or deselect High Band Noise to be included in man ual threshold testing On Off Default Off Pre stim ulus time Menu gt More settings Defines the recording time before each stimulus is pre sented Default value 0 2 seconds Stim ulus time Menu gt More settings Defines the duration of the stimulus Displays the text Manual when set to 0 Default value 1 3 seconds Otometrics 159 Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Post stim ulus time Menu gt More settings Defines the recording time after each stimulus is termi nated Default value 0 5 seconds Stimulus 1 8 Menu gt More settings gt Auto Settings Select the stimulus types to be included See the following Stimulus 1 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Default 1000 Hz Stimulus 2 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default 2000 Hz Stimulus 3 Menu gt More settings gt Auto Settings 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz BBN LBN HBN Off Default 4000 Hz Stimulus 4 Menu gt More settings gt Auto Settings 500
151. half life time where the curve decreases to 50 of its initial deflection Half life time seconds Results table Ifthe deflection decreases to 50 or more of the initial deflection during pre sentation of the stimulus the point in time when this occurs is shown If no decay is registered the field shows a dash The Ipsi results appear in the top row The stimulus ear referenced contra lat eral results appear in the bottom row Tympanogram In the top right corner of the screen the most recent tympanogram if available for the currently used probe tone is displayed and a marker on the pressure axis indicates the current ear canal pressure The curve number is also indicated Otometrics Navigating in the OTOsuite Immittance Module The ETF P screen 4 5 The ETF P screen To perform ETF P testing see 10 6 ETF P Eustachian Tube Function Perforated gt 125 fie fete Devens Tete Tod Wr Pp GS BSa8Si2 e PSs EPR XY os Denim xi ETF P Lustachian tabs openings date Field results The time pressure graph As soon as the measurement is completed the results are automatically deter mined and the pressure values are reported in the ETF P result table Eustachian tube openings daPa The pressure values denoting the openings and closings of the Eustachian tube are determined from the plateaus of the curve 4 5 1 The post analysis tool You can adjust the tim
152. hargeable or fit OTOflex 100 with new batteries The charging indicator does not light up when I place OTOflex 100 in the charger e The charger is not connected to the electrical power sup ply e There are no batteries in the OTOflex 100 unit or the batteries are inserted incor rectly e Wrong battery type Connect the charger to the electrical power supply e Place batteries in the battery com partment and make sure they are inserted correctly App 5 2 Testing Problem I forgot to switch to the correct ear in OTOflex 100 before test ing Possible cause Solution See 8 2 Swap ear results 101 Otometrics 253 App 5 Troubleshooting Communication App 5 3 Communication Bluetooth Problem Possible cause Solution Installation of driver software on WIN98 PC Bluetooth communication fail ure The file bcbthub sys on Blue tooth Install Disk cannot be found Bluetooth communication fails and cannot be restored You may get this error when installing the IOGEAR Bluetooth driver on a Windows 98 PC In the Copy fields from field write C WINDOWS SYSTEM and press OK to continue Remove the USB Bluetooth dongle and reinsert Test Problem The wrong test device was selected Test device does not perform cor rectly device Possible cause Solution See 5 1 1 Selecting test devices 45 Battery st
153. he pressure will be applied to both the ear canal and middle ear cavities The patient is then instructed to swallow some water which typically causes a functioning Eustachian tube to open Any pressure equalisation through the tube will show as a sudden pressure drop toward but not necessarily reaching atmospheric pressure 0 daPa This is repeated until the pressure is equal ised or until the test time has elapsed The pressures at which the tube opens and closes are reported as test results Typically an initial build up of positive pressure will cause the Eustachian tube to open spontaneously In order to avoid premature spontaneous pressure equalisation related to positive pressure build up the pump speed should be kept at a maximum of 50 daPa s The pressure range available for positive and negative pressures including 400 daPa and 600 daPa is commonly used in ETF P testing App 2 5 Susceptance and Conductance B G The admittance Y of the ear consists of the contribution of the two components Susceptance B and Conductance G The admittance magnitude is the vector length derived from the Cartesian graph as described below Otometrics 229 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Susceptance and Conductance B G 230 jB Compliance i a ees Admittance G Conductance mmho Phase angle Susceptance mmho jB Mass Susceptance B Susceptance is determined by the ease
154. he probe and if needed insert phone to the opposite ear s 3 Continue testing 10 10 Saving measurements The Immittance Module keeps 3 curves for each ear When you have made the num ber of measurements you require you can save the curves d 1 To save the patient folder select File Save or click the Save measurements icon on the OTOsuite toolbar You can save 3 separate tympanometric measurement results for each ear If you wish to delete any of the curves see Deleting results 127 Note Contralateral measurements saved apply to the stimulus ear 10 10 1 Standards used in NOAH When measurements relating to the stimulus ear are saved in NOAH they are denoted by specific abbreviations for instance T IT ID ETFP The following abbreviations are used for the various test types when test results are saved in NOAH Tympanometry T Tympanometric measurements 128 Otometrics Testing with the OTOsuite Immittance Module Preparing for the next patient Reflex Screening RS If an action contains both ipsilateral and contralateral Reflex Screening measurements IS If an action contains only Ipsilateral Screening measurements cs If an action contains only Contralateral Screening measurements Reflex Threshold RT If an action contains both ipsilateral and contralateral Reflex Threshold measurements IT If an action contains only Ipsilateral Threshold measurements CT If an action contains only Contr
155. he probe is properly fitted in the ear canal Regardless of the setting in Menu gt More Settings gt Auto next curve OTOflex 100 automatically changes to the next tymp curve for each tymp sweep This is to prevent overwriting already recorded tymps if a tymp measurement is triggered by accident Default Tymp Auto resume on seal Ifa measurement is paused by a leak the test or sequence is automatically resumed when the probe is properly refit ted in the ear canal Default On Otometrics Otometrics immittance test setup in MADSEN OTOflex 100 General actions Auto free memory Setting for defining automatic deletion of patient folders from the OTOflex 100 memory when memory is close to running full and a new patient folder is to be created Old patient folders are deleted according to the following rules If set to Off only patient results that have been safely doc umented which means either saved to the PC or printed will be deleted automatically without prompting For other patient results a message will inform you saying Memory full If set to On deletion will always take place without prompting for permission Default On First ear to test Defines the first ear to be tested on a new patient Default Right 226 Hz tymp unit Select the unit for 226 Hz tympanometry mmho cc ml 3 cm Default mmho 226 Hz defl ection unit Select the unit
156. hortcuts 125i oi hos rre S Fare E s 76 7 6 2 Diagnostic tympanometry 4 pace eerta deka o or e oti e Eo e ene bU AE 76 7 6 3 The diagnostic tympanometty result o eue Dodo eet oe 78 7 6 Settings Diagnostic tympanometry 00 cece eee eee eee 80 7 7 ETF I Eustachian Tube Function Intact leen 80 RAE Settings AE EEN vele tere Lantern te dc dpe e a a a on ang ania SR ec ES ab Gates 80 7 9 ACOUSTIC reflex testing iu xa png du pens face ordo eR EORR TERRE eee os 81 7 9 Reflex Threshold testing sic bids 2H ES EHE Od c ees Aad Ies AD une A AF E a 82 TO c REVS ANU f nc ons seneni rer to iex ito ae o ate voi Eie 83 7 9 2 Automatic and semi automatic Reflex Threshold testing 84 7 9 3 Viewing Reflex threshold results 5 3g Cei rii p d bo 86 7 9 Settings Automatic and semi automatic Reflex Threshold 87 7 9 5 Manual Reflex Threshold testing was Stace EU pied dak kde des 88 7 9 6 The Reflex Threshold results iis we gave ue ehh Cac Pe SERE Pup OUR 89 7 9 7 Manually selecting deselecting Reflex Threshold values 89 PAO Reflex Decay testing oroi acai boty cate wahoo e a p tiice die ashen eed cere Ae ma 90 7051 es and functions Sateen esM Un dua Dc tos Meu ed 91 7 10 2 Automatic Reflex Decay testing 6E Lec Em ee P UR FO E UR 92 7 10 3 Settings Automatic Reflex Decay cas binds 22a a eye eee deine 93 7 104 The Reflex Decay results au aas ck go PEE en Se oe ed SE RARER EE Ate 94 7 1
157. ics immittance test setup in MADSEN OTOflex 100 Test sequences A sequence is a predefined set of automatic tests using current test settings OTOflex 100 will always perform the most recently selected sequence regardless of whether it has been selected in OTOflex 100 or in OTOsuite You can choose between the following sequences e Tympanometry Reflex Screening Practical for basic hearing assessment e Tympanometry Reflex Thresholds For full diagnostic hearing evaluation Tympanometry Reflex Threshold Reflex Decay For full diagnostic hearing evaluation with suspicion of retrocochlear disorder Note The Reflex Thresholds must be included in the test sequence in order to measure Reflex Decay since the decay stimulus levels are based on thresholds 12 8 1 Selecting a sequence setup You can select sequences and thus define which tests are to be performed in a battery of tests 1 Select Menu gt Procedure Options gt Sequence 2 Press Select and scroll to view the appropriate sequence You can choose between T RS Tympanometry Reflex Screening T RT Tympanometry Reflex Threshold T RT RD Tympanometry Reflex Threshold Reflex Decay 3 Press Select to select the sequence Otometrics 167 immittance test setup in MADSEN OTOflex 100 Test sequences 168 Otometrics 13 Immittance Module Tools Options view and measurement options 13 1 General settings These settings
158. ighlighted 3 2 5 The OTOflex 100 Menu The Menu icon must be highlighted If required scroll to highlight Press Select to access the Menu From the Menu you can access most functions available in OTOflex 100 When you navigate the menu the following functions are available 30 Otometrics Otometrics OTOflex 100 views and main description Provo Press to return to Menu gt Controls and menu selections Scroll bar Use scroll wheel to navigate Press to return to test screen Test Selector From the Menu you can select menus and menu items for accessing general and Test management related actions test specific and procedure related settings as well as general procedure and device settings Start sequence 7 4 Sequence testing P 69 Test selector 3 2 2 Test Selector mode P 27 Printers 9 Printing f 105 Patient amp User My settings gt Load Settings gt Save Settings gt Save Settings As gt Delete Settings gt Load Factory Settings Done 6 3 5 Test flow setup P 59 Probe Check 6 3 3 Probe check P 57 Actions Probe tone More Settings Settings specific to the selected test type Manage Test Results Swap Ear Results Del ete Sub test gt Del ete Current Test Del ete Patient gt Del ete All Printed Patients gt Del ete all Patients a General settings 31 OTOflex 100 views and main description
159. indicator of abnormality than adaptation to the 1000 Hz stimulus Otometrics 228 App 2 MADSEN OTOflex 100 Immittance Methodology and Features ETF P Eustachian Tube Function Perforated App 2 3 4 Admittance monitoring The default stimulus level is automatically set to Off when no reflex thresholds have been established This facilitates admittance monitoring done in order to evaluate baseline fluctuations resulting from for instance tensor tympani muscle contractions or interference from vascular flow or eustachian tube dysfunction The stimulus can of course also be set to Off manually if this type of admittance monitoring is to be done after the reflex thresholds have already been measured App 2 4 ETF P Eustachian Tube Function Perforated ETF P can be performed on ears with eardrum perforations prior to reconstructive surgery to evaluate whether the middle ear could be ventilated through the Eusta chian tube following tympanoplasty Air must be able to pass through the Eustachian tube in order to equalise the middle ear pressure following reconstructive surgery For testing the Eustachian tube function in ears with perforated eardrums ETF P a method different from immittance measurements is used In ETF P the ear air pressure is monitored continuously to detect any airflow through the Eustachian tube An initial positive or negative air pressure is applied to the ear through the probe Due to the eardrum perforation t
160. ing a patient i e when you have performed the same number of tests on both ears 59 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 Print when done set to On If the Done prompt is set to On and you press Yes in response to the prompt the results will be printed see 9 Printing 105 When printing is done the Done prompt reappears If printing was successful select Yes to continue OTOflex 100 creates a new patient folder Patient prompt set to On If the Patient prompt is set to On the Patient amp User screen for entering patient data appears when a new patient folder is created Setting prompt set to On When you have entered patient data the Load Settings screen appears if any customized settings are available Select the test settings of your choice and con tinue with testing 4 If required select the appropiate test type by pressing repeatedly on the ON OFF button See 3 2 2 Test Selector mode 27 5 Perform the required tests See 7 Testing with MADSEN OTOflex 100 67 6 The test data is saved as the current patient s data 6 3 6 Users If several users are using OTOflex 100 you can select a user for the session or create a new user This will be reflected in the various reports User selection in OTOflex 100 is zor reflected in personalised settings and protocols Selecting a user
161. ioning tuba How to perform the maneuver e Instruct the patient to block the nostrils by pinching the nose using the thumb and index finger e Instruct the patient to swallow a few times It may help to provide some water to drink App 2 3 Acoustic Reflex testing 226 The term Acoustic Reflex refers to the stapedius reflex a middle ear muscle con traction which is normally elicited binaurally by particularly loud sounds The acous tic reflex is assessed through the measuring of an acoustic admittance change as the ear is stimulated with different loud pure tones or with filtered noise As the stapedius muscle contracts tension in the ossicular chain stiffens the middle ear and conse Otometrics App 2 3 1 Otometrics App 2 MADSEN OTOflex 100 Immittance Methodology and Features Acoustic Reflex testing quently compromises the acoustic energy flow through the middle ear The probe microphone detects this change as the acoustic energy remaining in the ear canal is increased The resulting graph shows the admittance change on the vertical axis and time on the horizontal axis The properties of the reflex are determined from a curve deflection referenced to an initial baseline The baseline is the total ear admittance without any stimulus applied It is important to note that the change in admittance which results from the func tioning of the reflex mechanism is very small It is further diminished if the eardrum is
162. ions 198 Otometrics 15 Installing MADSEN OTOflex 100 15 1 Unpacking OTOflex 100 1 Unpack OTOflex 100 carefully When you unpack OTOflex 100 it is a good idea to keep the packing material in which it was delivered If you need to send OTOflex 100 in for service the original packing material will protect against damage during transport etc 2 Inspect the equipment for possible visual damage If damage has occurred do not put OTOflex 100 into operation Contact your supplier for assistance 3 Check with the list accompanying the package to make sure that you have received all necessary parts and accessories If your package is incomplete con tact your supplier 15 2 Storing OTOflex 100 If you need to store OTOflex 100 before you put it into operation follow the guide lines below Store OTOflex 100 and accessories in the box provided to protect the equip ment from damage Store OTOflex 100 as stated in App 6 4 Storing and handling 258 15 3 Views of OTOflex 100 This section provides you with views of OTOflex 100 and its charger from various angles as well as instructions on how to assemble the charger 15 3 1 Front view f 200 15 3 2 Top view f 200 15 3 3 Bottom view 201 15 3 4 Reverse side view 201 15 3 5 The charger 201 15 5 2 Desktop installation f 203 You will find a description of the keypad and how to navigate and enter data in OTOflex 100 in 3 2 Controls and menu selections 25
163. is may facilitate reflex recordings from ears showing steeply sloped tympanograms The TPP offset can be adjusted in increments of xx daPa morelless Stimulus side Ipsi Ipsi Ipsi Stimulus is presented in the probe ear where the measurements are made Contra Stimulus is presented through an ear phone or insert phone in the ear opposite to the probe ear e psi then Contra Contra then Ipsi Adult default Infant default Stimulus Timing sec Pre stim ulus time Stimulus time Post stim ulus time Pause time Defines the recording time before each stimulus is pre sented Default value 0 2 seconds Defines the duration of the stimulus Displays the text Manual when set to 0 Default value 1 3 seconds Defines the recording time after each stimulus is termi nated Default value 0 5 seconds Defines the inter stimulus interval Default value 0 5 seconds Otometrics 13 3 6 ETF P setup Otometrics 13 3 6 1 13 3 6 2 Immittance Module Tools Options view and measurement options Measurement settings Stimulus types Automatic Select the stimulus types to be included excluded At least one stimulus type must always be selected Available types 500 Hz 1000 Hz ETF P Control panel settings Initial pressure The pressure used for the first part of the test Positive pressure Select the maximum positive pressure to be
164. isation of negative pressure will displace the tympanometric peak in a positive direction in the tympanogram It is less common with standing positive pressure in the middle ear due to the anatom ical properties of the Eustachian tube The tube is likely to be forced open by the pressurised air itself Equalisation of positive pressure will displace the tympanomet ric peak in a negative direction in the tympanogram Typical special equalisation techniques used are the Valsalva and Toynbee maneuvers App 2 2 4 Valsalva s Maneuver This maneuver equalises the pressure or induces positive pressure in the middle ear by forcing air through the tuba into the middle ear cavity This is a common proce dure used for pressure equalisation when diving or flying In some ears this maneu ver can also induce a standing positive pressure However as mentioned above this is usually difficult to maintain without the air spontaneously leaking out back through the tuba The resulting tymp peak after this maneuver will often appear around 0 daPa approx 15 daPa How to perform the maneuver e Instruct the patient to block the nostrils by pinching the nose using the thumb and index finger Instruct the patient to carefully blow some air out of the mouth but with the lips tightly sealed App 2 2 5 Toynbee s Maneuver This maneuver primarily creates a negative middle ear pressure since air will be evac uated from the middle ear through a funct
165. ittance components are measured and the unit is accordingly always mmho For reflex testing with OTOflex 100 the volume unit ul can also be chosen for 226 Hz measurements When i is used the corresponding numerical values are multiplied by factor 1000 Tympanometry In tympanometry you can measure the acoustic admittance of the middle ear system as a function of ear canal air pressure The resulting tympanogram is predominantly determined by the ear cavity volumes the mobility of the eardrum and the ossicular chain and the middle ear air pressure Admittance values are shown on the vertical axis of the tympanogram and the ear canal air pressure is shown on the horizontal axis Tympanometry is used to indicate or in conjunction with other audiological tests confirm disorders such as ossicular discontinuity otosclerosis flaccid hypermobile eardrum eardrum perforation obstruction of the ear canal middle ear effusion or Eustachian tube malfunctions The tympanometry tests are controlled by a number of default settings which you can either leave as they are or customize to your requirements Tympanometry testing on infants It is strongly recommended that the 1000 Hz probe tone is used for infant tympa nometry up to 6 months of age The 1000 Hz probe tone is recommended for a 1 Fora comprehensive understanding of immittance vector principles see e g Margolis amp Hunter 2000 Acous tic Immittance Measurements In
166. ll be removed from the Reflex Threshold table and can only be found in the Reflex Screening table Tympanometry screen Accordingly screening results and threshold results are never mixed in a results table Ifyou want to manually change the threshold click on the drop down box of the specific field in the Thresholds table and select the stimulus inten sity to be reported as the threshold value The manually selected value will be marked by an asterisk the appropriate graph at the top of the screen is framed accordingly and the audiogram marker in the audiogram in the bottom right part of the screen is updated Tympanogram In the top right corner of the screen the most recent tympanogram if available for the currently used probe tone is displayed and a marker on the pressure axis indicates the current ear canal pressure The curve number is also indicated Audiogram The audiogram marker in the audiogram in the bottom right part of the screen indicates the threshold level or the highest intensity where threshold was not found Otometrics 41 Navigating in the OTOsuite Immittance Module The Acoustic Reflex screens 42 The Reflex Decay screen e Ps xe oH Reflex Decay Deflection Contra 188 Hy 160 d Hali Whe tme eecoeds Field results Deflection The deflection graph is limited by blue markers indicating stimulus on and off A third marker appears to indicate the
167. ll wheel to change test in test select mode or to move to another character in character position mode during text editing Print Print test results 9 Printing P 105 28 Otometrics OTOflex 100 views and main description Controls and menu selections 3 2 3 The Text Editor Entering data Y k Cancel ee all CANCEL aaa accept the do not use the edited text edited text Scroll wheel Select Scroll to highlight field Press to access field Scroll to select character Press to enter character Press and hold to enter Character Select mode In some screens you can enter text and numeric values 1 Scroll to the field Press Select The field now contains a small highlighted square Turn the Scroll Wheel until the required digit or letter is displayed and press Select Continue in this manner until you have entered the text or value required Press OK to confirm Turn the Scroll Wheel to go to the next field and press Select to access the field ol Gy MES If you need to move the cursor and insert or delete letters digits in the data field see below for editing entered data Editing data Character select indicator D p sadi DEL INS y_ Insert Delete 7 Press to insert space for a Press to delete character character 9 Scroll wheel Scroll to highlight character Select e Scroll to select character Press to return to character entry mod
168. llows for placing OTOflex 100 near the patient or for using it wall mounted in a fixed position See 6 3 2 2 Removing the cap 54 If the probe cap is mounted on OTOflex 100 remove it 50 Otometrics 6 3 2 Otometrics 6 3 1 1 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 Connecting probe and insert phone The following applies both to the OTOflex 100 probe and the E A RTONFE 3A insert phone OTOflex 100 comes with a probe for immittance testing The probe is fitted with either a long or a short cable depending on how you wish to use the device Sugges tions for use are described in 6 3 1 Preparing the probe 50 The OTOflex 100 probe Plug the OTOflex 100 probe into the probe socket Make sure that you insert the pin for the pneumatic pump into the pneumatic connection The E A R TONE 3A insert phone If available plug the E A R TONE 3A insert phone into the contralateral socket Probe Pneumatic connection Contralateral socket Probe socket Caution Both the probe plug and the contralateral plug are equipped with a locking mechanism Therefore when you disconnect the probe do not pull the plug by the cable Grip the probe by the sleeve of the plug and free it by gently pulling it away from the device The probe will not be released if you pull anywhere else than by the sleeve of the plug To fit the cap see 6 3 2 1 Th
169. lly the most common are the Acoustic Reflex Threshold see App 2 3 2 Acoustic Reflex Threshold 228 and the Acoustic Reflex Decay App 2 3 3 Acoustic reflex decay P 228 Acoustic Reflex Screening Acoustic Reflex Screening is not a threshold search but provides useful information about presence absence of acoustic reflexes within normal stimulus levels Normal hearing individuals or individuals with symmetrical sensorineural hearing loss where there is no suspicion of retrocochlear pathology may be tested with a con densed screening protocol to indicate normal acoustic reflex behaviour A single stim 227 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Acoustic Reflex testing ulus frequency 1000 Hz is recommended with 226 Hz probe tone is presented ipsilaterally If the reflex is not detected within normal stimulus levels in relation to the pure tone audiogram a complete and thorough acoustic reflex threshold investi gation is recommended Infant testing Acoustic reflex testing may also be used for infant screening purposes The main objective is to confirm general middle ear function For this purpose a test protocol using a 1000 Hz probe tone ipsilateral stimulation and broad band noise stimulus is recommended Acoustic Reflex Threshold The reflex threshold is the lowest stimulus level at which a measurable reflex is elic ited The acoustic reflex is typically considered present when deflections are 0
170. lly control the pump instead of using the pressure control softkeys 6 The manual pressure control works in accordance with the current softkey symbol Softkeys After positive pressure build functions initial state if Initial pressure is set to Neg Right v Pressure control Press to automatically build up negative pressure until the first opening of the Eustachian tube or max pressure is reached The pressure control is automatically reversed after one of the two criteria has been reached Left Stop and go to idle mode Press and hold to display patient and user info Otometrics 97 Testing with MADSEN OTOflex 100 ETF P testing Eustachian Tube Function Perforated Scroll wheel Optional method Turn the scroll wheel counter clock wise to manually control the pump instead of using the pressure control softkeys The manual pressure control works in accordance with the current softkey symbol 7 11 3 The test 1 Use the On Off button to toggle to the Tympanometry test screen 2 Make a tympanogram to confirm the perforation The resulting tympanogram curve will be flat and the ear canal volume will be abnormally high because it includes the volume of the entire middle ear See 7 6 2 Diagnostic tympanometry P 76 3 Press On Off briefly to select the ETF P test screen This screen shows results if available from a previous test mie LUE S F P T RT b
171. ls o DE eds 195 14 5 Cleaning OTOflex 100 us tute sank nies nk e perat patios aep ue aa ast 195 Id 5T REUS bn tee de Re ees Seo bo Stag te a an oaii tolo tte ce d 196 14 5 2 Disposal of disposable articles 2230 cre ea P eate 196 1555 Datteriesand charger oarece lat Moats ee ore tte alo Rant et ts res 196 14 5 4 Safety information en aes shee oe aa e s Rew e BA NER Ree 197 14 5 5 Environmental protection ici soe 4 0 440d aieya Dare oa Face dob Barer nahn 198 15 Installing MADSEN OTOflex 100 sess 199 15 1 Unpacking OTOflex 100 ai iste dehet eee estacde inay eet bovacea e Db ind et 199 15 2 Storing COLO T00 rerin a red be E ete ORC CREE IE RC eR toe 199 13 9 Views of OT Oller TOO oe aeie Coo os hats ciate DERE nee ler vende 199 15 2 3E JELODENIGW uae esL RE ORTU oed o sot ise a en e a rod 200 15 9 2 LOP VIEW aD fett east teste Moon ie up ouv et psc oe Pd e 200 15 29 9 Bottom VIEW ient veo ae ueste date Ras pastas RUE Ee dcture 201 15 3 4 Reverseside Mew o ter vU teria be e Dra RE quida x DOLI S 201 15 2 TRIS EE soe t a tl NU eint ed odas M Nabe E M LEAD 201 154 The ptob ss fsa ya gp scence Mon tre uf iret RR eR eda eto e epatis et Al ads 202 15 5 Assembly and installation 3 5592 2 epa ag eR Sk HEE Be RE a OG ee eke AEN 202 15 5 L Location oni Booted cate trou TUAM EODIHUS RE ADU A ORNA E S atten Abt ates 202 155 2 Desktop installation 3e etn pthc EE RR PEU RE RE 203 15 5 3 Wall m
172. lude The options will show according to the selected step size Note You cannot extend the range to include stimulus lev els exceeding 100 dB HL in this test Whenever the stimulus intensity level exceeds 108 dB SPL for example when you select 100 dB HL at 500 Hz Ipsi a warning will appear and the automatic test is paused You will be prompted whether to continue or skip to the next stimulus type Otometrics Immittance Module Tools Options view and measurement options Measurement settings Stimulus intensities To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL Increment dB Select the step size to increment the stimulus intensity Sound Pressure Level in increments of 10 15 or 20 dB Default 10 dB Stimulus side Stimulus side Ipsi Stimulus is presented in the probe ear where the measurements are made Contra Stimulus is presented through an ear phone or insert phone in the ear opposite to the probe ear Ipsi then Contra Contra then Ipsi Default Ipsi Stimulus types Stimulus types 13 3 4 Acoustic Reflex Threshold setup Select the stimulus types to be included excluded At least one stimulus type must always be selected Available types 500 Hz 1000 Hz 2000 Hz 4000 Hz BBN When you perform
173. lus intensity value will start flashing ETF P setup When you perform an ETF P measurement there are a number of settings you can adjust 165 Immittance test setup in MADSEN OTOflex 100 Test sequences Initial pressure Menu gt The pressure used for the first part of the test Default value Pos itive Pos itive Pres sure Menu gt Select the maximum positive pressure to be presented to the ear canal middle ear cavity 100 to 400 daPa presented in 50 daPa increments Default 400 daPa Neg ative pres sure Menu gt Select the maximum negative pressure to be presented to the ear canal middle ear cavity 100 to 600 daPa presented in 50 daPa increments Default 400 daPa Pump speed Menu gt Changes the speed of the pressure sweep Indicated in daPa per second See App 2 4 ETF P Eustachian Tube Function Perforated P 229 Note is highly recommended that the lowest setting 50 daPa s is always used for ETF P Default 50 daPa Initial time scale Menu gt 30 60 seconds If the test exceeds the time axis the axis will expand automatically to show first 40 seconds then 50 and finally 60 seconds Any of the settings available can be predefined for the axis Default value 30 seconds 12 8 Test sequences The OTOflex 100 tests are available as test sequences where individual test types are combined into one sequence 166 Otometr
174. m with the SA peak appearing to the left of the rectangle thus showing a negative TPP more negative than 100 daPa e In addition Type D may be used to indicate a multiple peaked tympanogram Adult 226 Hz tymp classification system OTOflex 100 uses the Adult 226 Hz norm originating partly from Jerger The deter mination of types A Ad As B and C is based on the location pressure and static admittance of the peak of the tympanogram as shown below Ad Ad Ad 1 7 C C ix B B B 100 50 daPa Bis used instead of As for curves with no significant peak e Pressure limits 100 to 50 daPa Static admittance limits 0 3 to 1 7 mmho ETF I Eustachian Tube Function Intact ETF I is done to examine how well the middle ear is ventilated through the Eusta chian tube Air must be able to pass through the Eustachian tube in order to equalise the middle ear pressure For testing the tube function in ears with intact eardrums ETF I multiple tym panograms are recorded with different middle ear pressure equalisation maneuvers done between the measurements The tympanogram tympanometric peak pressures are compared to evaluate whether pressure equalisation is successful 225 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Acoustic Reflex testing In general people have a slight negative middle ear pressure quite normal even with a fully functioning Eustachian tube A successful equal
175. metrics Otometrics App 2 MADSEN OTOflex 100 Immittance Methodology and Features Susceptance and Conductance B G The covariation between Susceptance and Conductance is no longer true when the probe tone frequency is increased approaching a Mass controlled frequency region As the influence on the Susceptance curve of Mass elements increases when approaching the peak pressure the relationship between the Susceptance and the Conductance will no longer remain the same throughout the pressure sweep When this happens you can no longer subtract the ear canal admittance measured at one extreme point of the sweep from each point of the total admit tance curve Baseline compensation for Susceptance and Conductance curves However using baseline compensation is appropriate for the Susceptance and the Conductance curves individually Le you can subtract the isolated ear canal Sus ceptance measured at e g 200 daPa from every Susceptance point throughout the sweep taking variations in Mass and Compliance contribution into account Likewise you can subtract the ear canal Conductance from each point of the Conductance curve After these separate component compensations the middle ear admittance can be correctly calculated from the two compensated Suscep tance and Conductance curves The resulting admittance tympanogram Each point of the resulting admittance tympanogram describes the difference from the admittance of the ear canal alone
176. metry graph shows a maximum of 3 curves per ear per patient 177 Immittance Module Tools Options view and measurement options Measurement settings 13 3 1 3 178 Tympanomeiry Y wil JN Off Recorded tympanograms will always be stored in the selected curve number overwriting any previous graph in that curve memory You must toggle the Curve selector on the toolbar to the next curve number to preserve a previously recorded tymp On Every time a new measurement is initiated the curve number is advanced automatically before the tympano gram is recorded except if the current curve memory is empty In this way the first 3 tympanograms recorded are automatically stored If you continue measuring the curve number is cyclically increased and older tympano grams overwritten Default Oz Stop when results are The measurement stops automatically when satisfactory available values have been registered Screening tympanometry If this test is made in conjunction with Reflex screening the following settings are needed Pump speed In the dropdown list on the Control Panel select AFAP As Fast As Possible Auto resume on seal Select Tools gt Options gt General gt Measurement and enable this function This function is ideal for speeding up the test procedure Autostart on seal Select Tools gt Options gt General gt Measurement and select Sequence below
177. metry test screen is not designed specifically for screening tympanometry 1 Click Start on the Control Panel without applying the eartip to the patient s ear This prepares OTOflex 100 to start measuring as soon as seal is achieved Apply the probe to the patient s ear with a steady grip The test starts automatically as soon as a good probe fit with an air tight seal is achieved 109 Testing with the OTOsuite Immittance Module Screening 10 2 2 110 Settings Screening tympanometry When you perform screening tympanometry the following settings make this test even quicker Tools gt Options gt General gt Auto start on seal Sequence The test starts automatically as soon as a good probe fit with an airtight seal is achieved Regardless of the setting in Tools gt Options gt Tymp and Reflex Scr gt Auto next curve the Immittance Module automatically changes to the next tymp curve for each tymp sweep This is to prevent overwriting already recorded tymps if a tymp measurement is triggered by accident Tools Options Tymp and Reflex Scr Stop when results are available On Control Panel Pump Speed AFAP Reflex Screening results The Reflex results shown in the Reflex Threshold view are reflex screening results If subsequently a Reflex Threshold test see 10 4 1 Automatic and semiautomatic threshold testing 115 is made using the same stimulus types as in Reflex Screen ing the
178. mmittance Module The Immittance Module menu system and toolbar Tympanometry icons VM 12349 RR Some of the icons in the Immittance toolbar are toggle icons Click to toggle to another selection 4 1 1 Edit menu See 10 7 3 Deleting data 127 Po See 10 7 3 Deleting data 127 4 1 2 Measurement menu Get Test Results hy Opens the dialog box for uploading patient folders from the test device See 11 2 Uploading test results to OTOsuite 132 4 1 3 Tools menu See description in 11 2 Uploading test results to OTOsuite 132 For setting up a range of settings relating to test han dling and viewing See 13 Immittance Module Tools Options view and measurement options 169 ae 34 Otometrics 4 1 4 4 2 Otometrics Navigating in the OTOsuite Immittance Module The Immittance Module Control Panel Additional icons Toolbar Select device SA Opens the dialog box for selecting the device for test ing See 5 1 1 Selecting test devices 45 Toolbar Show previous next curves 17 Toggles between specific curves on the tympanogram See 4 3 The Tympanometry screen 37 Toolbar Show previous next reflex curve p Toggles between the visible reflex curves See 4 4 The 88 Acoustic Reflex screens P 38 Toolbar A Show B G or Y Show conductance and sus B G Y ceptance data Show admittance data Toggle this icon to see
179. mory You must manually advance the curve number to preserve a previously recorded tympanogram On Every time a new measurement is initiated the curve number is advanced auto matically before the tympanogram is recorded except if the current curve mem ory is empty In this way the first 3 tympanograms recorded are automatically stored If you continue measuring the curve number is cyclically increased and older tympanograms overwritten 7 7 ETF I Eustachian Tube Function Intact Record a tympanogram Instruct the patient to perform either Valsalvas or Toynbee s maneuvers Advance to the next curve number Record a second tympanogram Compare the tympanograms from step 1 and 3 in a multilayered tympanogram It may be useful to repeat the procedure using different techniques and maneuvers in a sequence of testing to fully evaluate the functioning of the Eustachian tube 7 7 1 Settings ETF I 80 Menu gt More Settings gt Auto next curve Otometrics 7 8 Otometrics Testing with MADSEN OTOflex 100 Acoustic reflex testing If Menu gt More Settings gt Auto next curve is Off a new tympanometric measurement will always be made to overwrite the currently selected curve You must manually switch curves if you want to preserve the curve you just made before making a new one If Menu gt More Settings gt Auto next curve is On a new tympanometric measurement will be made in the NEXT
180. mpanogram In the top right corner of the screen the most recent tympanogram if avail able for the currently used probe tone is displayed and a marker on the pres sure axis indicates the current ear canal pressure The curve number is also indicated Audiogram The applicable acoustic reflex threshold symbols appear in the audiogram in the bottom right corner of the screen The Not found symbol is used until the threshold level has been reached The following symbols are used in the audiogram Pure tone air unmasked masked L A L1 Pure tone bone unmasked masked L Ipsi Thr found not found L I rm L Fo Contra Thr found not found Stim R Important Although the audiogram symbols for the contralateral reflex measurement refer to the stimulus ear i e symbol and colour for the non probe ear the symbols are shown in the probe ear audiogram Thresholds table The determined threshold is shown in the Thresholds table in the bottom part of the screen The Ipsi results appear in the top row The stimulus ear referenced contralateral results appear in the bottom row 117 Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing 118 nas me 45 EPs xt oH a Reflex Threshold Deflection Ip 368 Hy The measurement stops automatically when satisfactory values have been regis tered Deflection curves The graph representing the automatically determined threshold at the top of
181. n disposal Otometrics 215 App 1 Standards and safety OTOflex 100 and the Immittance Module Symbols used ASSIA Y Mu Classified with respect to electrical shock fire mechanical and other specified hazards only in accordance with UL2601 1 and CAN CSA C22 2 NO 601 1 90 OTOflex 100 carries this symbol to indicate that in France it is only permitted to use the device indoors FCC This device complies with part 15 of the FCC rules Operation is sub ject to the following two conditions 1 This device may not cause harmful interference 2 This device must accept any interference received including interference that may cause undesired operation Refer to Notes 5 through 7 in App 1 2 Warning notes 217 for more details The term IC before the certification registration number only sig nifies that the Industry Canada technical specifications were met Interference may occur in the vicinity of OTOflex 100 Local regula tions and precautions for other equipment in the environment should always be followed to avoid interference The separation distance from OTOflex 100 to other devices comply ing with standard immunity requirements in EN 60601 1 2 is mini mum 0 35 m 1ft For use in restricted areas the OTOflex 100 features the ability to turn off the built in Bluetooth module i e disabling the Bluetooth radio communication OTOflex 100 has built in storage capabilities to s
182. n test types Scroll wheel Turn the scroll wheel to shift the focus on the screen change values and control pressure Select Press and hold to activate the Test Selector see 3 2 2 Test Selector mode P 27 Activate item Press to activate the selected item to accept a selected value and to toggle values 7 3 Start testing 1 When you switch on OTOflex 100 you are first presented with the Patient amp User screen 2 Use the Text Editor to enter patient information 3 2 3 The Text Editor 29 3 When you have entered patient information press t or OK to go to the Load Settings screen if enabled in Menu gt Procedure Options gt Settings prompt or directly to the test screen with the OTOflex 100 in test mode 4 Use the On Off button to toggle to the next test 5 You are now ready to start testing 7 4 Sequence testing A test sequence is a predefined set of automatic tests which can be performed auto matically OTOflex 100 will always perform the most recently selected sequence regardless of whether it has been selected in the Immittance Module or in OTOflex 100 Note The Reflex Thresholds are included in the test sequences in order to measure Reflex Decay since the decay stimulus levels are based on thresholds 7 4 1 Selecting a test sequence e Select the appropriate test sequence OTOflex 100 Menu gt Procedure Options gt Sequence Otometrics 69 Testing with
183. n the cap Make sure that the probe cable fits in the small indent Probe holder Probe neck SP N X Indent for probe cable Otometrics 53 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 CS ii z Probe cable track 5 If you are using the probe with the short cable you can place the cable in the cable track on the back of OTOflex 100 to avoid cables getting tangled Removing the cap 1 Remove the probe from the cap 2 Remove the cap from OTOflex 100 To do so press the wings of the cap gently towards each other and ease the cap out of its groove 6 3 2 2 Otometrics 54 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 6 3 2 3 The handgrip You can use the probe with the handgrip fitted on OTOflex 100 The handgrip provides enhanced maneuverability when you are testing with a screen ing eartip If you are testing with a short probe cable and with the handgrip attached to OTOflex 100 the whole unit becomes a practical immittance screening device Screening where the handgrip can be used in combination with a long probe cable
184. nce see 10 1 Sequence testing 107 Otometrics 115 Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing 116 Fh Ele i LRQ RE Ern er IE L7 eo SSR OES KY OK 7 Reflex Threshold Daler mew I CN o tnm nde ee ae en e The bold horizontal line in each graph indicates the predefined reflex criterion It is offset from the base line marker on the vertical axis The degree of offset is influenced by the setting in Tools gt Options gt Reflex Threshold gt General Reflex criterion mmho Note 70 avoid automatic or semi automatic testing being interrupted because of high stimulus levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL See also 10 4 Acoustic Reflex Threshold testing P 114 Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press Stop The test is interrupted immediately Already measured results can be saved To start automatic testing Click Start in the Auto section of the Control Panel to start a fully automatic reflex threshold search for all preset stimuli To start semi automatic testing Click Start in the Manual section of the Control Panel to start a semi auto matic reflex threshold search for the stimulus type selected on the Control Panel The settings in Tools gt Options gt Reflex Threshold gt Stimulus Types gt control the thr
185. nce by subtracting the susceptance B and conductance G individually from the baseline reference B and G values recommended for baseline compensation in 1000 Hz tympanometry Note The curve will never have negative admittance val ues since any difference from a reference point is always pos itive That is why the curve may not look like a traditional tympanogram at the negative tail This is perfectly normal This strategy is more important when using high fre quency probe tones to account for phase shifts during the pressure sweep but can also be used for 226 Hz Phase shifts are much smaller when using 226 Hz and have traditionally been considered negligeable Hence common subtraction of admittance Y is typically used for baseline compensation although it is not as correct Scale Baseline compensated The two different scale values separated by a slash e g 3 0 6 0 are probe tone dependent The first value applies when 226 Hz probe tone is used the second applies when 1000 Hz is used Auto scale icon Enables automatic rescaling to an appropriate value in order to display the entire curve Scale Not compen sated The two different scale values separated by a slash e g 3 0 6 0 are probe tone dependent The first value applies when 226 Hz probe tone is used the second applies when 1000 Hz is used When tympanograms are displayed with a scale of 1 5 or 3 0 mmho or cc cm ml the graph will show an
186. nd storage of results from hearing assessments and hear ing instrument fittings Otometrics Otometrics App 3 Glossary Terminology Norm type The name of the normal region classification system used The only implemented norm in release 1 is the modified Jerger Normal region Established reference ranges for e g admittance and tym Norm panic peak pressure based on measurements on a large group of normal individuals The normal area can be visualized as a square box in the tympanogram graph O Opening pressure The pressure at which the Eustachian tube opens Otometrics Manufacturer of OTOflex and OTOdiagnostics Suite OTOsuite The name of the PC software package that communicates with the test device and additional device Output intensity safety limits P A set of fixed stimulus intensity safety limits apply to each reflex test type and stimulus side Patient The person being tested the term client is used in NOAH Patient Folder A collection of test results relating to one patient both ears refer also to NOAH action Phase compensation Post meridiam pm Admittance differences static compliance static admit tance deflection results from a subtraction of 2 admit tance values Admittance has both an amplitude and phase The phase compensation takes phase differences into account during subtraction to produce more accurate results
187. nding to gt 115 dB SPL in 0 5 cc the stimulus intensity value will start flashing and automatic testing is paused You are then prompted to decide whether to con tinue or to move on to the next stimulus type Caution When you test on small ears the sound pressure level will increase in the ear canal It is therefore not recommended to exceed the warning level when testing on patients with small ear canals 81 Testing with MADSEN OTOflex 100 Reflex Threshold testing Measurements saved OTOflex 100 automatically keeps the last 3 deflection curves measured When saving in NOAH up to 52 individual reflex deflection curves screening threshold and decay are saved Priority is given to deflection curves documenting increasing deflections with increasing stimulus intensity above the threshold 7 9 Reflex Threshold testing 82 Semi automatic testing Start stimulus Threshold X Automatic testing search at one frequency Start stimuli Threshold ony w search at all programmed M b M stimulus frequencies f Select Scroll d Activate manual testing Select stimulus leve mode for highlighted Select stimulus type and stimulus frequency presentation side ipsi contra Automatic testing Press Start stimuli to start automatic testing Runs a fully automatic threshold search on all pre programmed stimuli Menu gt More Settings Auto Settings See 7 9 2 Automatic and semi automatic Reflex Threshold testi
188. ness or steepness of the tympanogram TW is the curve width at half the height of the curve SA 2 TW is measured in daPa in accordance with the illustration below Tympanometric Width Tympanometric Width Admittance Pressure Equivalent Ear Canal Volume ECV Equivalent Ear Canal Volume ECV is measured as the compliance at 200 daPa ear canal pressure Accordingly the ECV is only shown when a 226 Hz probe tone is used When using a higher frequency probe tone the Equivalent Baseline Volume EBV is shown instead of ECV Measurement plane tympanogram Baseline compensation OFF Total Admittance Tympanometry type Type Tympanometry type Type is a classification method of the shape of the 226 Hz tympanogram This is the modified Jerger classification system 224 Otometrics App 2 2 3 Otometrics App 2 MADSEN OTOflex 100 Immittance Methodology and Features Tympanometry The classification is carried out in relation to a normative range shown as a rectangle in the tympanometry graph Note This classification system does not take the tympanometric width or gradient into account Type A is a normal tympanogram with a single SA peak within the rectangle Type Ad is a high admittance tympanogram reaching above the rectangle Type As is a low admittance tympanogram with the peak below the rectangle Type B is a flat tympanogram with no discernible peak Type C is a tympanogra
189. ng P 84 Semi automatic testing Press Start stimulus to start semi automatic testing Performs an automatic threshold search for the currently highlighted stimulus type side See 7 9 2 Automatic and semi automatic Reflex Threshold testing P 84 Manual Press Select to activate manual mode Activates the currently highlighted stimulus type side for manual testing See 7 9 5 Manual Reflex Threshold testing P 88 Before reflex testing 1 Warn the patient about the high stimulus levels in the test and ask the patient to sit very still and quiet during this test without moving head or jaw 2 If contralateral stimulation is included make sure that both Ipsi probe and Con tra insert phone are in place Otometrics Testing with MADSEN OTOflex 100 Reflex Threshold testing 7 9 1 Keys and functions 7 9 1 1 Idle mode functions Softkeys Functions Left gt Press to run semi automatic test see below Press and hold to display patient and user info Right gt D Press to start auto test see below Press and hold to start sequence Scroll wheel Select stimulus type and side moves between preset settings only Allows the user to skip the rest of the intensities for cur rent stimulus type in pause mode Select e Ifstimulus types I psi or C ontra are in focus press to activate manual mode Ifthe Menu icon is in focus press to access Menu 7 9 1 2 Automatic and semi automatic
190. ng applies to all tests made on that patient Select Menu gt Manage Test Results gt Swap ear results The results are now assigned to the other ear 8 3 Delete measurements 8 3 1 Tympanometry You can delete a single sub test curve performed either from a multi curve graph or a multiple graph action from the grid All 3 test results are shown on the screen simultaneously 1 1 2 3 Toggle to select one of the curve or graph numbers in this icon group to view a specific curve or graph The curve will then be highlighted 2 To delete a curve select Menu gt Manage Test Results gt Del ete Sub test 8 3 2 Reflex Threshold In Reflex Threshold you cannot delete a single curve only a complete test including all the stimulus intensities for the selected stimulus type Otometrics 101 Managing Test Results in OTOflex 100 Deleting Test Results 8 4 8 5 102 Deleting Test Results 8 4 0 1 8 4 0 2 Deleting current test To delete the current test select Menu gt Manage Test Results gt Del ete Current Test Deleting individual patients To delete the specific individual patients select Menu gt Manage Test Results gt Del ete Patient Scroll to select the specific Patient and press Select to delete Deleting all printed patients If you wish to delete all printed patients select Menu gt Manage Test Results gt Del ete all printed patients Deleting all patients If you wish to delete
191. ngs to the Immittance Module 137 12 13 Creating a SEEUD uro cnibste x dye apr dolere key bloss t anaa d Y e oed sh ob ota Edd a a 138 I2 4 Editing atest setup asu eode RATE One OR Dc eae e n ae 138 12 1 5 Using a test setup uei Uer eme eu e He eed ned tea reed 138 12 2 General acions JA babe obedire ovt dto L e Md el obo 139 12 2 1 Manage test results eredi gere Sopdet di DS M ERES Rh dps 139 12 2 2 Provednresoptotis riyri cdr deseo E EREDE EUO E REEKS R nE 141 12 2 3 Advanced es beter n ieee ro ed be ab oss vut a D a 144 12 24 Device setings m ruo et rM EXC II MERE E IE FERE UE EN 145 12 3 T vmpanotuetri setup gets eta ewe veers ESO DURER Ka b Su Hua loce 148 12 3 1 Screening tympanometry 2 1 enn 152 1232 ETE Setup see Pope das ree key ek ECC EP RP dea p 152 12 4 Acoustic Reflex Screening setup oed oe Ll add ei IE MPO RM VE EN ES 153 12 5 Acoustic Reflex Threshold setup su uento eO e a eee ke pato cR COE 156 12 6 Acoustic Reflex Decay setup 4 cuc CI or RED Ra RHET aas oe nbn et Ae brates 163 12 Te EB Seu pie auno LESE A EVE E tU bem E m eb eig 165 12 8 Lest Sequences saranan DES ET tls pete Nae qe i a der pa Ate titans Aha ola 166 12 8 1 Selecting a sequence setup 4 desee ate cuve is re REEL ER RE 167 13 Immittance Module Tools Options view and measurement options ssss 169 13 1 General settings a doc eetetata n Net EE PARU REESE MEE 169 I3 I1 Available setings rir exea CX are OL
192. nnect to is not listed Searching for devices may take a couple of minutes All test devices visible within the Blue tooth range will be added to the list 4 Highlight the appropriate test device and click Select OTOsuite will connect to the selected test device and close the dialog 5 If needed right click the device name and select Rename to change the name of the test device You can change the name of a test device only when it is switched on within range and not connected to another pc Removing test devices Right click the device name and select Delete to remove the test device from the list Removed devices can be added again using the Search button Restoring a faulty connection Click the Repair button to repair a faulty connection to the highlighted test device Click Search if the repair function only made the test device disappear from the list Otometrics 45 Test Device Management in OTOsuite Setting up communication with the test device 46 Connection OTOsuite automatically connects to the test device when you activate the Control Panel Make sure that the device is switched on Connecting to a test device To connect to a test device in OTOsuite click on Control Panel in the toolbar The Control Panel relating to the test device and the selected test type is shown in the left side of the screen License key OTOsuite requires that you enter a connection license key for connecting to the test de
193. nograms Tympanogram curve number Tymp Numbering of tympanograms that are memorized sepa rately and may be layered curve Tymp Tympanogram gradi A horisontal line divides the tymp curve at the height ent Grad where TPP 50 daPa intersects with the tympanogram The gradient is the ratio between the peak height from this horisontal line and the total peak height measured from the positive tail Tympanogram width The width of the tympanogram measured at half the tym panogram height halfway between the positive tail and peak Y values Width is given in daPa 245 App 3 Glossary Abbreviations Tympanometric The pressure at which the peak of a tympanogram is peak pressure TPP found If multiple peaks occur the TPP is n a Tympanometry Measurement of admittance as function of applied ear canal pressure The pressure is usually controlled auto matically acccording to pressure settings minimum pres sure maximum pressure pressure sweep direction and pump speed U User The user doing the testing V View A set of graphical elements presenting test results with focus on one or two test types View settings All settings controlling the presentation of results View settings cannot be saved explicitly but will be remem bered automatically WwW Wallmount Shelf designed for the test device Y Year yy Year Z Zodiac Another immi
194. ns are described in the OTOsuite User Manual 13 Introduction Typographical conventions 1 4 3 Descriptions and testing If your new system is already installed see 2 Getting started with MADSEN OTOflex 100 and the OTOsuite Immittance Module 17 e 4 Navigating in the OTOsuite Immittance Module 33 7 Testing with MADSEN OTOflex 100 67 1 4 4 Preparing for testing Before you receive the client and start the session of testing and explaining test results your time is well spent preparing for the session See 6 Preparing OTOflex 100 and the Immittance Module for testing P 49 1 4 5 Printing e For instructions on how to print OTOflex 100 results see 9 Printing P 105 For instructions on how to print from the PC see 14 OTOflex 100 Service and Maintenance 191 1 4 6 Maintenance and cleaning For instructions on how and when to clean OTOflex 100 please see the OTOflex 100 Guide We recommend that you take particular note of the cleaning and maintenance instructions Failure to use and maintain the OTOflex 100 correctly may void your warranty 1 5 Typographical conventions The use of WARNING CAUTION and NOTE For safety reasons and appropriate use of OTOflex 100 the Guide contains WARN INGS CAUTIONS and NOTES which you should read carefully Warning indicates that there is risk of danger to persons and or device Caution indicates that there is risk of damage to the device Note indicates that
195. ofa test setting 12 3 1 Screening tympanometry When you perform tympanometric screening there are a number of settings you can adjust The following settings are relevant Sequence Menu Procedure Options Select T RS Auto start on seal Menu gt Procedure Options Select On Stop when results Menu gt More Settings are available Select On Pump speed Menu gt More Settings Select AFAP As Fast As Possible 12 3 2 ETF I setup When you perform an ETF I test there are a number of settings you can adjust Layered curves Menu gt Set to On to enable a typical ETF I setting with layered tympanograms Note This setting is not saved as part of a measurement setup Auto next curve Menu gt More Settings when starting Select On or Off to define whether the system will auto new measure matically select the next curve number available for the ment new measurement results Sweep direction Menu gt More Settings Make sure that the same sweep direction is used for all the curves to be compared 152 Otometrics 12 4 Otometrics Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Screening setup Acoustic Reflex Screening setup When you perform a Reflex Screening measurement there are a number of settings you can adjust Auto start on seal Menu gt Procedure options gt Auto start on seal Typically for use with scre
196. omatically when a proper seal is obtained if testing was paused due to a leak Control Panel Custom TPP offset Checked The pressure is offset from the TPP by the TPP offset defined in Tools gt Options gt Reflex Threshold gt General gt Custom TPP offset If the offset is is set to a value with the post fix more it shifts the pressure in the same direction as the sign of the TPP and in the opposite direction if it is set to less Note The TPP value from the most recent tympanometric curve at the same probe tone is used in reflex measurements Note When the Control Panel gt Custom TPP offset setting is changed in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test set ting to ensure consistent reflex testing but not vice versa Tools gt Options gt Reflex Threshold gt Verification Depending on your settings you can select the type of verification to be used The lowest stimulus intensity where the reflex criterion was met may be retested for reproduceability or the next one or two intensity levels can be used to con firm the reflex growth properties Manual threshold testing If a threshold is not found during automatic or semi automatic testing you can test specific stimulus intensities manually 1 Press PageDown to go to the Reflex Threshold test screen or select the test from View gt Immittance The bold horizontal line in each graph indicate
197. osal Disposal of disposable articles Disposable articles such as eartips and cleaning wires should be disposed of accord ing to local regulations Batteries and charger Note For disposal of old batteries see 14 5 5 Environmental protection P 198 1 To change batteries press the cover inwards and upwards until it is released and snaps out of place Otometrics OTOflex 100 Service and Maintenance Cleaning OTOflex 100 2 Insert the batteries as shown below If you are in doubt look inside the battery casing where you will see small red plus signs indicating which way the batteries fit 3 To put the battery cover back in place insert the cover with the curved edge fac ing upwards in the opening Press the cover inwards and downwards until it clicks into place LU 14 5 4 Safety information Otometrics Explosion hazard Do not throw the batteries into the fire and keep them away from fire as they may explode e Incorrect handling applying excessive charging current can overcharge or destroy the batteries e The battery terminals must under no circumstances be short circuited Do not open alter or dismantle the charger 197 OTOflex 100 Service and Maintenance Cleaning OTOflex 100 14 5 5 Environmental protection e OTOflex 100 can be disposed of as normal electronic waste according to local regulations e Dispose of batteries according to local regulat
198. ount installation 344 oae oe rhe Rent ae o eee cda 204 SE Powering APP 206 15 6 1 Powering OTOflex 100 aici its wantin oU ERE epee ae ke Po epee 206 156 2 Batteries Svat tes e kot er NC Nee Ma ene tone seman 5 206 155 5 Thechatget sirsa oicacu ts ay ch may aeolian MU ute aS xpo dn 209 15 6 4 Switching on OTOflex 100 1i isses ded nee a dae apa 210 15 65 Bl ietooth abe d eda ERO e bb Put UP Ta Er Pct rfr hs 210 16 Configuring OTOsuite sisse 213 App 1 Standards and safety OTOflex 100 and the Immittance Module ssssus 215 App 1 1 Symbols used 0229s d eee ean Ea a PRAE a RE dela 215 App 1 1 1 OT Oflex 100 symbols iif ELI ee 215 App 1 1 2 Charger unit symbols 2 2 see acd erre ee 216 App 1 1 3 The OTOsuite Audiometry Module 217 App 1 2 Warning not s ee euer Ree ni ie e 217 App 1 2 1 OTOflex 100 warning notes esee 217 App 1 2 2 Charger unit warning notes 00 00 219 App 1 3 NIaitifactikelo pates enay tib idee iota Dates ln t et mida et 219 App 1 3 1 Responsibility of the manufacturer usu 219 Otometrics Otometrics App 2 App 3 App 4 App 5 App 6 Table of Contents MADSEN OTOflex 100 amp OTOsuite Immittance Module User Manual MADSEN OTOflex 100 Immittance Methodology and Features 221 App 2 1 An introduction to immittance 5 es canes erret ey ea 221 App 2 1
199. p 6 7 Miscellaneous 2cc coupler 258 Otometrics App 6 Technical Specifications MADSEN OTOflex 100 Calibration Clock and calendar App 6 8 Calibration Equipment should be calibrated regularly according to EN 61027 and ANSI 3 39 App 6 9 Standards Safety EN 60601 1 UL 2601 1 CAN CSA C22 2 NO 601 1 90 OTOflex 100 EN 60601 1 Class II Internal Powered Type BE IPXO Charger unit EN 60601 1 Class II IPXO EMC EN 60601 1 2 EN 300 328 2 EN 301 489 17 Impedance Admittance EN 61027 Type 1 ANSI S3 39 Type 1 Otometrics 259 App 6 Technical Specifications MADSEN OTOflex 100 Standards 260 Otometrics Index Otometrics Acoustic Reflex description 226 infant testing 228 screening settings 153 testing 81 threshold settings 156 Acoustic Reflex Decay automatic testing 122 description 228 manual testing 123 testing 121 Acoustic Reflex Screening 110 description 227 screening mode softkeys 72 83 84 91 97 settings 153 Acoustic Reflex Threshold automatic test 115 description 228 manual test 119 settings 156 testing 114 viewing results 86 Admittance monitoring 229 Advanced settings 144 Altitude setting 146 Auto resume on seal setting 142 Auto scaling setting 151 Auto start on seal setting 142 Autoclaving 194 B Baseline compensation tympanometry setting 149 baseline compensation 171 Batteries Alkaline 206 inserting 207 NiHM 206 power off mode 147 power save mode 146
200. panel settings Probe Tone Click the appropriate radio button to select the fre quency for this measurement setup 226 Hz Adult default 1000 Hz Infant default Otometrics 179 Immittance Module Tools Options view and measurement options Measurement settings Probe Tone If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc cm or ul as described in 13 3 1 2 Tympanometry Test settings 177 For frequencies higher than 226 Hz admittance is shown only in mmho The value in Y scale automatically changes to mmho e 226 Hz 1000 Hz Recommended for testing on infants younger than 6 months See also the OTOflex 100 Guide 13 3 3 2 Acoustic Reflex Screening Test settings m Click icon or select Tools gt Options gt Tymp and Reflex Scr gt Measurement Reflex criterion mmho Auto Reflex Screening Enter the appropriate setting for the reflex criterion It follows unit and probe tone settings Default 0 02 mmho Stimulus intensities Start 180 Depending on the increment selected you can select or deselect the intensity You can select up to three stimulus intensities The complete range of intensities available will appear when you deselect all When the list is shown simply click on a specific inten sity to select Then consider which adjacent intensities you wish to inc
201. panometry view and Reflex Threshold view Ifa threshold measurement is made at the same frequency as the current screening result then the threshold overwrites that specific screening result in the threshold view This means that only Reflex Screening results are shown in the reflex view as long as no Reflex Threshold tests have been made 107 Otometrics Testing with the OTOsuite Immittance Module Sequence testing 10 1 3 T RT Tympanometry Reflex Thresholds For procedures see 10 3 Tympanometric testing 112 and 10 4 1 Automatic and semiautomatic threshold testing 115 For full diagnostic hearing evaluation 10 1 4 T RT RD Tympanometry Reflex Threshold Reflex Decay For procedures see 10 3 Tympanometric testing B 112 and 10 4 1 Automatic and semiautomatic threshold testing 115 and 10 5 1 Automatic Acoustic Reflex Decay testing P 122 For full diagnostic hearing evaluation with suspicion of retrocochlear disorder Note The Reflex Thresholds are included in the test sequence in order to measure Reflex Decay since the decay stimulus intensities are based on thresholds 10 1 5 Running a test sequence from the Immittance Module 1 Connect to the test device 2 Select the desired sequence from the drop down list below the Immittance Mod ule Control Panel 3 Click Start pause to start the entire sequence selected If Tools Options General Auto start on seal is set to Sequence th
202. parate test measurements for a particular stimulus type e g different frequencies or noise for each ear You can always highlight a graph which will then be overwritten when you make a new measurement The three curves showing reflex responses with the highest intensity where the threshold value has been detected are stored automatically by the system If you repeat a measurement at a specific intensity the previous value will be over written As a consequence you cannot see several curves with the same intensity If a measurement consists of more than 3 intensities toggle the graph selector to view the graphs Acoustic Reflex Decay testing Note Ifyou are using an OTOflex 100 Quick Check test device you cannot control Acoustic Reflex Decay testing from the OTOsuite Immittance Module The decay test stimulus level pre supposes that there is a reflex threshold available for the ear stimulus type and stimulus ear ipsi or contralateral that is chosen for reflex decay testing The decay test stimulus level will then automatically be set to the threshold level 10 dB If no reflex threshold is available the Control Panel gt Intensity setting is Off This is useful for admittance monitoring Fora maximum amount of monitoring time set the Tools Options Reflex Decay Stimulus Timing Stimulus setting to 26 seconds and Control Panel Intensity to Off The resulting curve can be saved as an ordinary decay graph Not
203. perated indoors and away from windows to provide maximum shielding Equipment or its transmit antenna that is installed out doors is subject to licensing Note 8 No parts may be eaten burnt or in any way used for purposes other than audi ometry or the fitting of hearing aids Note 9 OTOflex 100 can be disposed of as normal electronic waste according to local regulations Please investigate local regulations concerning the disposal of rechargeable and alkaline batteries 218 Otometrics App 1 Standards and safety OTOflex 100 and the Immittance Module Manufacturer Note 10 For safety reasons accessories connected to the equipment s outlet fittings must be identical to the type supplied with the system Note 11 It is recommended that an annual calibration be performed on accessories con taining transducers Furthermore it is recommended that calibration be per formed if the equipment has suffered any potential damage e g transducers dropped on the floor Note that calibration has been performed only on the transducers supplied If you wish to use any other transducer for testing with OTOflex 100 please contact your local supplier Note 12 To comply with EN 60601 1 1 computer and printer must be placed out of reach of the patient i e not closer than approx 1 5 meters 5 ft App 1 2 2 Charger unit warning notes In order to disconnect the charger unit from the electrical power supply N the power cable mu
204. presented to the ear canal middle ear cavity 0 to 400 daPa presented in 50 daPa increments Default 400 daPa Negative pressure Select the maximum negative pressure to be presented to the ear canal middle ear cavity 100 to 600 daPa presented in 50 daPa increments Default 400 daPa ETF P Test settings Click icon or select Tools gt Options gt ETF P gt Measurement Pump speed daPa s Changes the speed of the pressure sweep Indicated in daPa per second Note is highly recommended that the lowest setting 50 daPals is always used for ETF P 189 Immittance Module Tools Options view and measurement options Measurement settings Pump speed daPa s While the pump is operating a scale at the top of the screen indicates the current pump position graphically i e the proportion of the pumps capacity being used to obtain the static pressure used for the measurement 190 Otometrics 14 OTOflex 100 Service and Maintenance 14 1 Equipment failure Warning Do not use a defective instrument If you believe the correct function or operation safety of OTOflex 100 to be faulty in any way disconnect OTOflex 100 from the power supply remove the batteries and make sure that it cannot be used by others until it has been serviced Warning Under no circumstances disassemble OTOflex 100 Contact your supplier 14 2 Service and repair Under no circumstances disas
205. rectionif it is set to less Note The TPP value from the most recent tympanometric curve at the same probe tone is used in reflex measurements Note When the Control Panel gt Custom TPP offset setting is changed in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test set ting to ensure consistent reflex testing but not vice versa Manual Acoustic Reflex Decay testing Note The manual reflex decay test available in the OTOflex 100 Quick Check version cannot be remotely controlled from the OTOsuite Immittance Module 1 Press PageDown to go to the Reflex Decay test screen or select the test from View gt Immittance 123 Otometrics Testing with the OTOsuite Immittance Module Acoustic Reflex Decay testing m We Hep amp 9 EDS XP oH eflex Decay Defiection Nall ite theme seconds Select the appropriate Stimulus Intensity and Stimulus Side in the Control Panel Control Panel gt Custom TPP offset If checked in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test setting but not vice versa Ifneeded adjust the view setting Deflection scale Ifyou select a Control Panel gt Stimulus setting not included in your view setting setup the Thresholds table is automatically updated to show the selection when the test is started Note The decay test stimulus intensity pre supposes that there is
206. reflex decay 165 J Jerger 224 classification system 224 setting 151 K Keypad ear selector pressure release 23 68 general test functions 68 main functions 23 Menu softkeys 25 On Off 23 69 210 scroll wheel 22 69 select key 22 28 69 Index U V W X Y Z softkeys 23 68 Test Selector softkeys 28 tympanometry test functions 76 L Language selection 148 Layered curves setting ETF I 152 setting tympanometry 149 LBN setting acoustic reflex threshold 159 Leakage 64 Localization 148 Maintenance cleaning device 195 Manufacturer 219 responsibility 219 Max intensity setting acoustic reflex screening 155 setting acoustic reflex threshold 161 Measurement setup creating 138 editing 138 using 138 Measurement unit tympanometry 143 Menu 25 31 accessing 25 30 ml setting tympanometry 143 mmho setting tympanometry 143 N Navigation Immittance Module 33 Next patient 64 No power off before mode 147 Norm type setting 151 P Patient auto create new 144 263 264 Patient folders description 58 Powering battery status 209 battery types 206 charger 209 device 206 first time charging 210 Preparations before next patient 64 connecting probe and insert phone 51 creating user 61 deleting user 61 device 50 first patient of the day 59 probe 50 selecting user 60 Preparing for testing Tympanometry 20 Pressure initial setting ETF P 166 negative setting ETF P 166 positive setting ETF P 166 rang
207. ress ure range Menu gt More settings Select On or Off to define whether the system will auto matically select the next curve number available for the new measurement results when you press Start to start a new measurement Example If the setting is Off and the curve number shown is no 3 the results currently applying to this number will be over written Default On Menu gt More settings The pressure range selected in the measurement setup You can choose between Normal and Custom pressure range Normal The normal range of pump pressure is from 400 daPa to 200 daPa Custom The custom range Custom min press and Custom max press settings listed below can be accessed if Custom is selected You can extend the pressure range of 400 to 200 daPa to as much as 600 to 400 daPa or decrease it to 50 to 50 daPa Default Normal Custom min press ure Custom max press ure Menu gt More settings Custom minimum pressure ranges from 50 to 600 daPa in steps of 50 daPa Default 600 daPa Menu gt More settings Custom maximum pressure ranges from 50 to 400 daPa in steps of 50 daPa Press Select and scroll to the appropriate pressure value Default 400 daPa 150 Otometrics Otometrics immittance test setup in MADSEN OTOflex 100 Tympanometry setup Pump speed Menu gt More settings Changes the speed of the pressure sweep Indicated in da
208. results from this test will replace the screening values shown in this view Acoustic Reflex Screening In the Tympanometry test screen the Reflex Screening section shows reflex screening values if reflex screening measurements are available or crossed out values if they are not If subsequently a Reflex Threshold test see 10 4 1 Automatic and semiautomatic threshold testing gt 115 is made using the same stimulus types as in Reflex Screen ing the results from the RT test will replace the RS values shown in this view Any stimulus types not tested during a Reflex Threshold test will remain in the Reflex Screening results table Reflex Screening automatically follows the tympanometry sweep if you start the T RS sequence see 10 1 Sequence testing 107 Otometrics Otometrics Testing with the OTOsuite Immittance Module Screening Doi Magra S LI e nma eo See 0 EPS KT OF HI Fad talot oar Tympanometry A r Temp ieis me i 4 er hg an voreenius 8 ten ss m s CN os ee nee targe te obse mentees ee ie MM 1 If needed adjust the appropriate settings Important Jn Screening mode the safety intensity level cannot be exceeded Note 70 avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL See also 10 4 Acoustic Reflex Threshold testing P 114
209. rolongs device lifetime Recommended setting 60 minutes or as short as possible No power off before This setting applies when OTOflex 100 is placed in a powered charger and uses rechargeable batteries Prevents automatic power off until a certain hour of the day Adjust the setting to the end of your typical working day if you like to keep OTOflex 100 powered and ready for use during working hours Set it to 0 to always allow automatic power off Otometrics 147 immittance test setup in MADSEN OTOflex 100 Tympanometry setup Localization Menu item with access to Language selection Date setting Probe standard ISO ANSI or Ref EAR 3A Set time Set the year month day hour format hour and minute settings Calib old warning For setting up he device to warn when the calibration is one year old Default is On Load factory set tings For loading the preset factory settings 12 3 Tympanometry setup When you perform a tympanometry sweep there are a number of settings you can adjust Probe Tone Menu Scroll to select the appropriate frequency for this measure ment setup Adult default 226 Hz Infant default 1000 Hz If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc or cm as described in App 2 2 Tympanometry 222 For frequencies higher than
210. rrupted reflex stimulus will be repeated If the leak appears during the tympanometric measurement the tymp part of the sequence will not be repeated Press stop and restart the sequence if you need to repeat the tympanometric measurement Use screening eartips for screening It is important that you hold the probe with a steady grip to prevent probe movements from resulting in leakage or changes in admittance Do as described in 6 Preparing OTOflex 100 and the Immittance Module for testing Bf 49 Switch on OTOflex 100 If you want to perform the test from OTOflex 100 see the OTOflex 100 manual for instructions Open the Immittance Module with the Tympanometry test selected Click the Control Panel icon on the Immittance Module toolbar The device settings are shown in the Control Panel If needed press the Ear Selector key to toggle to the ear on which you wish to start the test Load a test setting configured for screening patients in the relevant age group If contralateral stimulation is used in the reflex test make sure that both the Ipsi probe and the Contra insert phone are in place before you start the measure ment Ask the patient to sit very still and quiet during the test without moving head or jaw Continue with either 10 2 1 Screening tympanometry P 109 or 10 2 2 Acoustic Reflex Screening 110 Screening tympanometry L The default test setting applying to the Tympano
211. s Done prompt 144 Settings prompt 144 226 Hz deflection unit 143 226 Hz tymp unit 143 advanced settings 144 altitude above sea level 146 auto free memory 143 auto next curve 150 Auto resume on seal 142 auto start on seal 142 baseline compensation tympanometry 149 battery power off 147 battery power save 146 battery type 146 bluetooth 146 brightness 146 changing 135 charger power off 147 charger power save 147 creating setup 138 custom max pressure 150 custom min pressure 150 custom TPP offset ART 182 184 186 188 date format 148 deflection scale 158 159 160 162 164 165 185 188 deflection scale acoustic reflex decay 164 deflection scale acoustic reflex threshold 158 delete all patients 141 delete all printed patients 140 delete current test 140 delete measurement 140 delete test 140 device info 146 device settings 145 dissociate from 145 editing setup 138 First ear to test 143 Index Qu IRE ESS EDS US EV EWA XJ VS EZ for acoustic reflex screening 153 for acoustic reflex threshold 156 for ETF I 152 for screening tympanometry 152 for tympanometry 148 initial pressure 166 initial time scale 166 intensity increment acoustic reflex screening 155 intensity increment AR screening 181 184 intensity safety 144 intensity step size acoustic reflex threshold 162 language selection 148 layered curves ETF I 152 layered curves tympanometry 149 load patient 140 localization 148 manage test r
212. s time Menu gt More settings Defines the recording time after each stimulus is termi nated Default value 1 0 seconds 164 Otometrics 12 7 Otometrics immittance test setup in MADSEN OTOflex 100 ETF P setup Stimulus 1 Menu gt More seitings gt Auto Settings 500 Hz 1000 Hz Default 500 Hz Stimulus 2 Menu gt More settings Auto Settings 500 Hz 1000 Hz Off Default 1000 Hz Stimulus side Menu gt More settings Auto Settings I C Il gt C C gt I1 Ipsi Contra Ipsi then Contra Contra then Ipsi Default I psi Pause time Menu gt More settings Auto Settings Defines the inter stimuli interval Default value 0 5 seconds Note The Intensity increment used in Reflex Decay is set in the Acoustic Reflex Threshold setup This is because the Reflex Decay stimulus level defaults to the reflex threshold 10 aB Warning When testing manually be careful when you select the Stimulus intensity so as not to expose the patient to too high intensity levels Note e Whenever a stimulus level exceeds the warning level gt 108 dB SPL re 2cc the stimulus intensity value will start flashing and all automatic testing is paused You are then prompted to decide whether to continue or to move on to the next stimulus type In Manual testing whenever a stimulus level exceeds the Intensity Safety level gt 115 dB SPL re 2cc the stimu
213. s and hold to display patient and user info Right Steady Press to pause test Flashing Press to continue 7 10 1 3 Manual mode functions Softkeys Functions Left Press and hold to display patient and user info Right Start stimulus If the safety intensity level is greater than the safety limit you will be prompted for confirmation to continue any way Stop stimulus Otometrics 91 Testing with MADSEN OTOflex 100 Reflex Decay testing Scroll wheel Select intensity default value is reflex thresh old 10 dB if measured otherwise blank Select Return to idle mode Before reflex testing 1 Warn the patient about the high stimulus levels in the test and ask the patient to sit very still and quiet during this test without moving head or jaw 2 If contralateral stimulation is included make sure that both Ipsi probe and Con tra insert phone are in place 7 10 2 Automatic Reflex Decay testing Automatic testing Start stimuli all selected levels Scroll wheel Select stimulus level Select Select stimulus type and Activate manual testing presentation side ipsi contra mode 1 If required press On Off briefly to select the Reflex Decay test screen This screen opens up in automatic mode 1 L LI LI r D Tibia i sooo r sqlhoaoe The initial reflex decay test screen with ipsilateral 1 kHz stimulus highlighte
214. s the predefined reflex criterion It is shown in relation to the base line marker on the vertical axis The distance between 119 Testing with the OTOsuite Immittance Module Acoustic Reflex Threshold testing Manual Stimulus 1000 Hz Intensity 75 dB HL wv Stimulus side Ipsi O Contra 120 the two is influenced by the setting in Tools Options Reflex Threshold Gen eral Reflex criterion mmho 2 Check and adjust the appropriate Control Panel and Test settings Select the appropriate Stimulus Intensity and Stimulus Side in the Control Panel Control Panel Custom TPP offset If checked in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test setting but not vice versa If needed adjust the view setting Deflection axis Scale If you select a Control Panel Stimulus setting not included in your view setting setup the Thresholds table is automatically updated to show the selection when the test is started Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested click Stop on the screen to stop the test The test is interrupted immediately Already measured results can be saved 3 Click Start stimulus in the Manual section of the Control Panel to present a sin gle stimulus intensity 4 If there is leakage an icon visualises the problem on the screen 5 As the test progresses various fields are
215. same intensity Include next intensity Include next 2 inten sities Report A printout containing all test results for the patient S Screening eartip Umbrella shaped eartip to be pressed against the ear canal opening rather than being inserted into the canal Screening handle An ergonomic handle that can can be inserted into the probe holder to improve the grip the probe handle may be mounted on the device Seal Semi automatic reflex threshold mea surement Hermetic tightness between the eartip and the ear canal wall A search for the reflex threshold for a single stimulus type Shoulder harness Accessory placed over the patient s shoulder to which probe cables can be fixed via a cable clip to relief strain Sound pressure level SPL Standard eartip Scientific intensity level scale Mushroom shaped eartip for normal sized ears Start pressure The starting pressure for manual tympanometry The device will automatically apply the starting pressure before the manual control takes effect Start stimulus inten sity The intensity used initially in search for reflex thresholds 243 App 3 Glossary Terminology 244 Static admittance SA Similar to static compliance The term static admittance is used when the admittance unit is mmho Static compliance SC The difference between the peak admittance value and the baseline admittance value
216. semble OTOflex 100 Contact your supplier Parts inside OTOflex 100 must only be checked or serviced by authorized personnel Warning Do not disassemble OTOflex 100 charger as there is a risk of electric shock For the sake of safety and in order not to void the warranty service and repair of elec tromedical equipment should be carried out only by the equipment manufacturer or by service personnel at authorised workshops In case of any defects make a detailed description of the defect s and contact your supplier The manufacturer reserves the right to disclaim all responsibility for the operating safety reliability and performance of equipment serviced or repaired by other parties Following repair the equipment should be tested by suitably qualified personnel On request your supplier can obtain a Service Manual from the manufacturer The Service Manual contains electrical diagrams descriptions lists of components and calibration information etc 14 3 Maintenance OTOflex 100 requires no preventive maintenance However it is recommended that you observe the guidelines below Otometrics 191 OTOflex 100 Service and Maintenance Maintenance 14 3 1 Calibration OTOflex 100 and the probes are delivered fully calibrated The device is calibrated from the factory in dB SPL or dB HL using the stated reference equivalent thresholds dB HL are related to sound pressure levels dB SPL dB re 20 uPA The probe calibration v
217. sentation Rough indication of the remaining battery capacity Battery type Bluetooth NiHM or Alkaline A type of wireless radio communication commercially available for PC equipment Broad band noise BBN Stimulus type covering a mix of frequencies across the full stimulus spectrum C Cable clip Accessory used with the shoulder harness Cable holder Fork for the charger cradle desktop base into which a probe cable can be placed to prevent the probe from fall ing to the floor Calibration Measurement and storage of the frequency specific cor rection factors needed to produce a linear probe charac teristic Otometrics Otometrics App 3 Glossary Terminology Cap Transparent plastic part into which the probe can be mounted Provides a better grip for the probe Can be mounted on the test device Allows a screening handle to be inserted Charger cradle Charger cradle designed for test device charging and desktop or wallmount operation Closing pressure The pressure at which the Eustachian tube closes Compliance C Synonymous for admittance The term compliance is used when admittance is used in volume units not mmho Connect Contralateral Con tra Establish radio connection via Bluetooth Opposite side ear to where the measurement is per formed Control panel A vertical pane with controls to remote control testing from the PC
218. sequence Menu and settings Selected test Tympanometric curve selector Start measurement test sequence Icons Ear selection the ear selection icon shows the ear selected for R us L testing jos Connection indicator Bluetooth communication disabled in menu p Connection indicator Bluetooth communication is estab i lished ished ye Connection indicator Bluetooth communication is inter a rupted J Power indicator OTOflex 100 receives power from the char ger mm Power indicator OTOflex 100 is powered by batteries Menu and settings icon Press Select to access when high lighted 1 23 Curve selector See the specific test procedures Otometrics OTOflex 100 views and main description Controls and menu selections 3 2 Controls and menu selections 3 2 1 The Menu E 9 Otometrics You can access most of the functions available in OTOflex 100 via the Menu or by pressing one or more keys and softkeys There are a number of shortcuts and softkeys available for quick and easy navigation of OTOflex 100 See 7 Testing with MADSEN OTOflex 100 67 Test specific shortcuts and softkeys are listed in the specific test sections Scroll to the Menu icon and press Select to access the Menu From the Menu you can access most functions available in OTOflex 100 When you navigate the menu the following symbols are used as softkey functions Scroll bar Use scroll
219. sign of the TPP and in the opposite direction if it is set to less When changed in Acoustic Reflex Threshold this setting is automatically applied in the Acoustic Reflex Decay test setting but not vice versa Note The TPP value from the most recent tympanometric curve at the same probe tone is used in reflex measurements Measurements saved Since a reflex decay measurement typically is made using either ipsilateral or contral ateral stimulus side not both only two measurements are saved i e different stim uli and or ipsi contra Otometrics Testing with MADSEN OTOflex 100 ETF P testing Eustachian Tube Function Perforated 7 11 ETF P testing Eustachian Tube Function Perforated 7 11 1 Idle mode functions Softkeys Functions Left Press and hold to display patient and user info Right Press to run test clear curve and wait for pump direc tions 7 11 2 Pressure build functions Softkeys Positive pressure build functions initial state if Initial pressure is set to Pos Right A Pressure control Press to automatically build up positive pressure until the first opening of the Eustachian tube or max pressure is reached The pressure control is automatically reversed after one of the two criteria has been reached Left E Stop and go to idle mode Press and hold to display patient and user info Scroll wheel Optional method Turn the scroll wheel clockwise to manua
220. sity Menu gt More Settings gt To avoid automatic or semi automatic testing being interrupted because of high stimulus intensity levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL No of intensities Menu gt More Settings gt 1 intensity Check marks v or dashes indicate whether a reflex has been detected or not 2 or 3 intensities Numerical values or crossed out numerical values indicate whether a reflex has been detected or not Intensity increment Menu gt More Settings gt Step in dB between each stimulus intensity presented If e g the increment is set to 10 dB and the number of intensities is set to 2 the first presentation will be at the max intensity 10 dB Tympanometry Note You should always conduct a tympanometric test before making any acoustic reflex measurement Also you should always establish the acoustic reflex threshold before making a reflex decay measurement 75 Testing with MADSEN OTOflex 100 Tympanometry 7 6 1 Tympanometry softkeys and shortcuts Left softkey Right softkey le E Ear Selector 243 Onor Qo Pressure amp Release i Scroll wheel Select Softkeys Functions Left Press to choose between 3 tympanometry test results the number and curve currently shown are high lighted Press and hold to display patient and user info Right b Press to start tympanometry sweep Press and hold to start
221. st be detached from the power source Note 1 There are no user serviceable parts inside the charger unit cabinet For the sake of safety and in order not to void the warranty the cabinets should only be opened and serviced by authorized service personnel In case of defects please make a detailed description of the defect s and contact your supplier Do not use a defective instrument Note 2 The charger unit can be disposed of as normal electronic waste according to local regulations App 1 3 Manufacturer GN Otometrics A S 2 Dybendalsvaenget DK 2630 Taastrup Denmark T 45 45 75 55 55 F 45 45 75 55 59 www otometrics com App 1 3 1 Responsibility of the manufacturer The manufacturer is to be considered responsible for the effects on safety reliability and performance of the equipment ONLY IF Otometrics 219 App 1 Standards and safety OTOflex 100 and the Immittance Module Manufacturer e All assembly operations extensions re adjustments modifications or repairs are carried out by personnel authorised by the manufacturer The electrical installation to which the equipment is connected is grounded and complies with IEC requirements And the equipment is used in accordance with the instructions for use The manufacturer reserves the right to disclaim all responsibility for the operating safety reliability and performance of equipment serviced or repaired by other parties 220 Otometrics App 2
222. sting with MADSEN OTOflex 100 Tympanometry Menu gt Baseline comp ensation Menu gt Tymp scale Menu gt Layered curves Menu gt More Settings gt Pressure range Menu gt More Settings gt Tymp auto scale Menu gt More Settings gt Norm type Menu gt More Settings gt Show norm area The Tymp Data screen If required press On Off briefly to select the Tymp Data screen Curve 25 i4 daFPFa 1 25 mmhao ol daPa cms 3 G The results shown in the Tymp Data screen reflect the curve currently selected in the Tympanometry test screen The following features are described in detail in App 2 2 2 Tympanometric features P 223 Tympanometric Peak Pressure TPP e Static Admittance SA Static Compliance SC when volume units are used Tympanometric Width TW Equivalent Ear Canal Volume ECV Equivalent Baseline Volume EBV when 1000 Hz probe tone is used e Tympanometry type Type e Probe tone P in Hz Press Select briefly to return to the standard tymp screen 79 Testing with MADSEN OTOflex 100 ETF I Eustachian Tube Function Intact 7 6 4 Settings Diagnostic tympanometry The Tympanometry graph shows a maximum of 3 curves per ear per patient To select deselect automatic curve increment select Menu gt More Settings gt Auto next curve off Recorded tympanograms will always be stored in the selected curve number overwriting any previous graph in that curve me
223. t between moving molecules in the system Conductance typically increases when more energy reaches the structures of the middle ear when the sweep pressure approaches the tympanometric peak pres sure Being a frictional element Conductance can never take a negative value Otometrics 231 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Susceptance and Conductance B G 232 App 2 5 3 App 2 5 4 B G viewing of tympanograms Viewing dual component B G tympanograms is preferable to admittance magni tude Y tympanograms in the higher probe tone frequency region This is because the Mass elements have an increasingly pronounced impact on the tympanogram with higher frequencies When the probe tone frequency approaches the Mass controlled frequency region the increasing Mass and the decreasing Compliance contribution to Susceptance will pull the Susceptance curve down and cause notching of the curve Notching if suf ficiently pronounced will also show in the total Admittance curve and may make the curve difficult to interpret especially with regard to normative data High frequency probe tones Since the B G viewing is of interest only for high frequency probe tones this method is clinically valuable in conjunction with multi frequency tympanometry where the normative data is based on resonance frequency However even when measuring with a single high frequency probe tone the B G components provide a clearer
224. t is also possible to obtain what appears to be abnormal 226 Hz tympanograms in normal ears The 1000 Hz probe tone has proven to be the best choice for immittance measurements in infants See also Probe frequency in 12 3 Tympanometry setup 148 Tympanometric features Tympanometric Peak Pressure TPP Tympanometric Peak Pressure TPP denotes the air pressure value on the horisontal axis where the admittance peak is registered This value may be taken to approximate the current middle ear pressure Static Admittance SA Static Admittance SA is a measure of the middle ear admittance calculated as the difference between the admittance at the peak of the tympanogram including both the middle ear and ear canal components and the baseline admittance measured at 200 daPa approximates the isolated ear canal component In accordance with this static admittance is often referred to as the peak to tail difference The SA is shown only when the baseline compensation is enabled i e when the admittance is shown relative to the baseline admittance When a 226 Hz tympanogram is shown in volume units the term Static Compli ance SC is used instead of SA 223 App 2 MADSEN OTOflex 100 Immittance Methodology and Features Tympanometry Note Static Admittance SA is the same as the ANSI S3 39 1987 peak compensated static acoustic admittance Peak Ytm Tympanometric Width TW Tympanometric Width TW provides a measure of the sharp
225. t screen M Start semi automatic testing di Start automatic testing 3 Stimulus H Stop testing Powering C Battery status empty mu Battery status good m Battery status normal J Powered by charger Communication 3 Bluetooth communication disabled u Bluetooth communication enabled OTOflex 100 connected to OTOsuite t OTOflex 100 disconnected from OTOsuite Printer Messages error message info message Otometrics 250 App 4 MADSEN OTOflex 100 Icons Leakage warning message App 4 5 Leakage Probe leak status blocked mr Probe leak status leak gt q oam Probe leak status not inserted uum aliam Probe leak status OK Otometrics 251 App 4 MADSEN OTOflex 100 Icons Leakage 252 Otometrics App 5 App 5 1 Powering Troubleshooting Problem OTOflex 100 does not power on even though I press the power button Possible cause e The batteries are inserted incorrectly The batteries need charging if rechargeable or replac ing Solution Insert the batteries correctly e Charge the batteries if recharge able or fit OTOflex 100 with new batteries OTOflex 100 powers off and cannot power on even though I press the power button The batteries need charging if rechargeable or replacing Charge the batteries if rec
226. t value applies when 226 Hz probe tone is used the second applies when 1000 Hz is used Unit e For 226 Hz probe tone the units available are mmho cc ml cm and ul e For 1000 Hz probe tone the unit mmho is always used 174 Otometrics Immittance Module Tools Options view and measurement options Measurement settings Threshold table Always show Lists the stimulus types that are always shown In addi tion any measured stimulus types are also shown Select and deselect stimulus types One stimulus type must always be selected as a minimum 13 2 3 Reflex Decay view settings Decay table Always show Lists the stimulus types that are always shown In addi tion any measured stimulus types are also shown Select and deselect stimulus types One stimulus type must always be selected as a minimum Deflection axis Scale Unit For defining the scale setting relating to the unit used above For 226 Hz probe tone the units available are mmho cc ml cm and ul 13 2 4 ETF P view settings Time axis Scale sec When the end of the time axis is reached it will automat ically extend with 10 more seconds up to the max time value 60 seconds The graph can be rescaled to show more detail even after the measurement has been completed Default value 30 seconds 13 3 Measurement settings Measurement settings
227. tance Module With the cursor highlighting the Menu icon Bl press Select on the keypad to activate the Menu Use the Scroll Wheel to scroll to Advanced and press Select Scroll to Device Settings and press Select Scroll to Localization and press Select With Language highlighted press Select V to access the language options Scroll to the language of your choice and press Select Press the softkey Return to test screen tt to go to the Tympanometry test screen Starting up the Immittance Module Starting the Immittance Module depends on the setup of the program I 2 Switch on OTOflex 100 if you wish to test patients or transfer test results Follow the instructions in the OTOsuite User Manual Select or create a client in OTOsuite Select the test type Activate the Control Panel Select test ear Immittance Module features General features Depending on the configuration of OTOflex 100 and the Immittance Module you can handle patient lists view and print test results view the progression of a range of tests online view historic tympanometry results from NOAH or XML view online tympanometry results during testing perform over the rim testing using the audiometer as a handy control panel while you follow stimulus settings and test progress on your PC display plan patients for offline testing upload test results from offline tests The basic Immittan
228. tance Module To change the settings directly in OTOflex 100 select the appropriate test screen 1 Press Select scroll to the appropriate setting and press Select again If the setting is not available directly in the Menu select More settings and if required Procedure Options and scroll to the appropriate setting The settings may appear in abbreviated form but when you scroll to the setting the actual wording is shown 2 Settings can be changed in two ways If there is a list of values to choose from press Select to access the values scroll to view the required value and press Select again to apply the shown value Ifthere are only two values to choose from press Select to toggle to the required value 3 The new setting is now shown in a highlighted box Note The value in focus is selected even if you leave the menu without pressing Select Note fthere are unsaved changes in a test setup this is indicated on the display by an asterisk next to the setup name 12 1 2 Uploading test settings to the Immittance Module When you connect to OTOsuite the settings used in OTOflex 100 are automatically shown in the Control Panel and the Test Settings dialog of the Immittance Module Otometrics 137 Immittance test setup in MADSEN OTOflex 100 Test settings 138 Creating a setup OTOflex 100 comes with the following default setups The standard adult setups IS Pedi TI TIC and TICD The
229. tensioned by a static pressure differential between the ear canal and the middle ear Therefore measurements are made with an ear canal air pressure applied corre sponding to the tympanometric peak pressure See Tympanometric Peak Pressure TPP P 223 Always perform tympanometry before attempting to assess the acoustic reflex Atmo spheric pressure 0 daPa is used in case no tympanometric peak data is available The tympanometric peak data is probe tone specific In case of baseline instability due to a hyperflaccid eardrum a pressure offset of 20 30 daPa in the same direction as TPP displacement may be used A pressure offset of this magnitude will stabilise the flac cid eardrum without obscuring the reflex induced admittance change Due to the physiology of the neural pathways involved acoustic reflexes can be elic ited either with stimulation of the ipsilateral probe ear or contralateral ear This means that the acoustic reflex is a binaural phenomenon This is used for diagnostic purposes since different configurations of reflex integrity when comparing ipsi and contralateral measurements suggest different sites and types of lesions Acoustic reflex tests are used to indicate or in conjunction with other audiological tests confirm disorders such as retrocochlear pathology brainstem lesions Bell s palsy conductive hearing loss cochlear hearing loss etc Many different features of the acoustic reflex may be studied Clinica
230. testing on the other ear Fitting the probe in the patient s ear Note This procedure does not apply to screening eartips which should simply be held firmly against the ear canal opening of the patient Inspecting the patient s ear 1 Position the patient so that you can easily access the ear to be tested 2 Grasp the pinna and gently pull back and slightly away from the patient s head 3 Look into the ear canal It is strongly recommended that you perform an otos copy to assess the status of the outer ear before you insert the probe If you can see apparent narrowing of the ear canal it may be blocked by vernix or debris or it may not be straight Note Because infants ear canals are very soft they are easily pressed out of shape If this is the case wait until the ear canal returns to its original shape Release the pinna and try again Gently massaging the area may help opening the ear canal 4 If the ear canal is blocked this may affect the result of the test Clean the ear canal if required Fitting the eartip in the ear of the patient Warning Be careful not to insert the probe too far into the ear canal of premature babies and newborns Caution Never insert the probe without a proper size ear tip applied Using a probe with an unsuitably sized eartip or applying excessive force may irritate the ear canal Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing the patient 1
231. this manual Safety Installation This is your guide to using MADSEN OTOflex 100 and the OTOsuite Immittance Module It also introduces you to the key features of the program by providing you with working scenarios for performing tests and viewing and printing test results We recommend that you read this manual and make yourself familiar with the OTOflex 100 and how it operates with the OTOsuite Immittance Module so that you become familiar with the device before testing on a client Note Ifyou are using the OTOsuite Immittance Module with NOAH 3 we recom mend that you are familiar with the screens and functions provided in NOAH 3 We recommend that you make yourself familiar with the issues listed below This manual contains information and warnings which must be followed to ensure the safe performance of OTOflex 100 Warning Local government rules and regulations if applicable should also be followed at all times Safety information is stated where it is relevant and general safety aspects are described in App 1 Standards and safety OTOflex 100 and the Immittance Module 215 e To install the new system see 15 Installing MADSEN OTOflex 100 199 Installation of OTOsuite is described in detail in the OTOsuite User Manual Connecting to OTOflex 100 See the OTOsuite User Manual Configuring the OTOsuite Immittance Module e See 16 Configuring OTOsuite 213 Basic OTOsuite functions The basic OTOsuite functio
232. tion test with intact tympanic membrane ETF I A set of tympanograms is recorded Between each record ing the patient is manipulated to provoke a change in middle ear pressure by allowing air to pass through the Eustachian tube Eustachian tube function test with perforated tympanic membrane ETF P The pressure applied to the ear canal passes the perforated tympanic membrane and can pass directly through the Eustachian tube The pressure is recorded as a function of time F Factory defaults Factory installed default settings First ear to test First ear Applies when testing starts on a new patient G Get test results from device Fetch results from the test device test memory to the PC H Hearing level HL Intensity level scale adjusted to a normal hearing profile High band noise Stimulus type covering a mix of frequencies in the high HBN end of the stimulus spectrum HIMSA Manufacturer of NOAH and PAX software Hour hr Hour Otometrics Otometrics App 3 Glossary Terminology Immittance Contraction of impedance and admittance The term covers all the tests types Infant eartip Tree shaped eartips for tiny ears Initial pressure polar ity Determines whether an ETF P test starts with a test at positive or negative applied pressure Intensity safety off A mode where the safety limits are temporarily disabled
233. tore data measured offline and these data can later be transferred in other locations Symbols on buttons to operate OTOflex 100 see 3 2 Controls and menu selections 25 and 7 Testing with MADSEN OTOflex 100 67 App 1 1 2 Charger unit symbols The charger unit is marked with this symbol to indicate compliance with Class II requirements of the safety standard EN 60601 1 Oo A The charger unit is marked with this symbol when it is important that the user refers to associated information given in this manual 216 Otometrics App 1 Standards and safety OTOflex 100 and the Immittance Module Warning notes CE The charger unit is CE marked according to the Medical Devices XXXX Directive 93 42 EEC OAM The charger unit is marked with this symbol to indicate it is a UL rec ognized component for Canada and the United States P The charger unit is marked with this symbol to indicate that it is suit able for alternating current only App 1 1 3 The OTOsuite Audiometry Module CE The Audiometry Module and this documentation are CE marked xxxx according to the Medical Devices Directive 93 42 EEC Used in error messages if program fails See the detailed information A in the dialog box App 1 2 Warning notes App 1 2 1 OTOflex 100 warning notes OTOflex 100 should only be provided with prescribed battery types see Technical Specifications in
234. ts To delete a sub test 1 Click on one of the curve or graph icons in this icon group to view a specific 1 7 curve or graph The curve will then be highlighted 2 To delete a curve select Edit gt Delete Selected Test 10 8 Leakage Testing may be complicated by a number of factors which can result in leakage or probe problems Leakage can for instance be caused by badly fitting eartips cartip not inserted properly in the ear canal ear canal debris blocking for proper ear tip seal old hardened eartip pneumatic probe plug not inserted properly in OTOflex 100 probe tip not tightened properly Probe problems may be caused by an occluded probe e a blocked wax filter Leakage and probe occlusion is shown on the screen during testing Leak detection If there is leakage or if the probe is blocked during testing the window in the top right corner of the screen visualises the problem c V e Probe seal obtained 9 to A Probe blocked Otometrics 127 Testing with the OTOsuite Immittance Module Testing the other ear ga A Probe leak x Probe not inserted Adjust the position of the probe or clean the probe and continue testing 10 9 Testing the other ear When you have finished testing one ear select the other ear if needed ear 1 Toggle the Ear selection icon on the OTOsuite toolbar before testing the other The icon shows the currently active probe ear 2 Switch t
235. ttance device from Otometrics App 3 2 Abbreviations Abs Absolute A Admittance am Ante meridiam BBN Broad band noise C Compliance 246 Otometrics Contra dB ECV ETF I ETF P HL HBN hr Ipsi LBN MEP NiHM pm RS RT SA SC SPL TPP Otometrics App 3 Glossary Abbreviations Contralateral Decibel Equivalent ear canal volume Eustachian tube function test with intact tympanic mem brane Eustachian tube function test with perforated tympanic membrane Hearing level High band noise hour Ipsilateral Low band noise Middle ear pressure Battery type rechargeable Post meridiam Reflex decay test Reflex screening test Reflex threshold test Static admittance Static compliance Sound pressure level Tympanometry tympanogram Tympanometric peak pressure 247 App 3 Glossary Abbreviations 248 Otometrics App 4 MADSEN OTOflex 100 Icons The following icons are used in OTOflex 100 App 4 1 Navigation and editing symbols Arrow left KI Arrow right Lan Cancel Curve marker iL Delete 5 Ear left c Ear right Ins Insert uf Mark xf Unmark Menu a Test or character select mode D Patient 3 Play A Pressure build up positive ETF P Pressure build up negative ETF P Otometrics 249 App 4 MADSEN OTOflex 100 Icons Powering App 4 2 App 4 3 App 4 4 Return to previous menu tt Return to tes
236. ty is on no stimulus intensities higher than 115 dB SPL measured in a 2cc cavity can be selected or will be applied Off When Intensity safety is Off stimulus intensities up to the technical limits of the device and probe can be selected and applied A warning triangle is displayed on screen whenever intensities above 115 dB SPL are selected Default On Warning When you test on small ears the sound pressure level will increase in the ear canal It is therefore not recom mended to exceed the warning level when testing on patients with small ear canals Intensity safety is automatically set to On whenever the Ear Selector icon is toggled or a new patient folder is selected Note Stimulus levels at or above the warning level gt 108 dB SPL re 2cc are marked by an orange bar in the Intensity drop down list Stimulus levels at or above the intensity safety level gt 115 dB SPL re 2cc are marked by a red bar in the Intensity drop down list Whenever a stimulus level exceeds the warning level all automatic testing is paused You are then prompted to decide whether to continue or to move on to the next stimulus type Otometrics 13 2 13 2 1 Otometrics Immittance Module Tools Options view and measurement options View settings View settings Tymp and Reflex Scr view settings Tympanometry Admittance axis Admittance axis The admittance axis can be configured to exclude the ear
237. uence the probe test and that the test cavity is not contaminated Test cavity for probe check 2 Select Menu gt Probe Check 3 Insert the probe tip without eartip in the test cavity in the charger The probe check starts automatically The probe is checked for occlusion and leakage If the probe is OK the probe is automatically calibrated to 2cc Note In case of a probe error check the following 57 Preparing OTOflex 100 and the Immittance Module for testing Preparing OTOflex 100 58 Make sure that the threaded ring holding the probe tip in place is firmly tight ened Make sure that the sound channels in the probe tip are clear and that the probe is connected e Check that the altitude setting Menu gt Advanced gt Device settings gt Alti tude ab sea corresponds with your geographical location as the barometric pressure may influence the admittance readings If the probe should be faulty contact your authorized service department for repair and use another probe if available Note fyour test environment changes for instance if there is an increase in humidity or if you are going to test at an altitude different from the one set in OTOflex 100 adjust the altitude setting and make another probe check Selecting patient folder and test type in OTOflex 100 Patient folders A Patient Folder contains the test results saved during testing in one single session and
238. ues up to max intensity or until a reflex is detected Default 1 Intensity incre ment Menu gt More settings Select the step size to increment the stimulus intensity Sound Pressure Level in increments of 10 15 or 20 dB Default 10 dB Otometrics 155 immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Reflex criterion Menu gt More settings Enter the appropriate setting for the reflex criterion It fol lows unit and probe tone settings The applicable unit mmho cc ml cm or pl is selected automatically when Unit is set If ul is used for 226 Hz probe tone then all values are multiplied by 1000 Default criterion 0 02 mmho 12 5 Acoustic Reflex Threshold setup When you perform a Reflex Threshold measurement there are a number of settings you can adjust Probe Tone Menu gt Scroll to select the appropriate frequency for this measure ment setup Adult default 226 Hz Infant default 1000 Hz If 226 Hz is selected you can set admittance to be shown in the admittance unit mmho or in the compliance vol ume units ml cc cm or pl For frequencies higher than 226 Hz admittance is shown only in mmho The value in Y scale automatically changes to mmho 226 Hz 1000 Hz Recommended for testing on infants younger than 4 6 months See App 2 2 1 Tympanometry testing on infants P 222 156 Otometrics
239. uetooth Brightness For adjusting the brightness of the display Wheel click vol For adjusting the wheel click volume Button click vol For adjusting the button click volume Bluetooth Defines whether Bluetooth communication is on or off Allows you to completely disable Bluetooth communica tion in case OTOflex 100 is to be used in extremely radio sensitive environments Battery type Altitude ab sea NiHM or Alka line Must be set according to the battery type inserted in the battery compartment If OTOflex 100 suspects that the setting is wrong based on battery voltage checks you will be prompted once for selection of the battery type The altitude above sea level affects the barometric pressure and thus the air density This setting is used to optimize the pump operation according to the current air density The setting is listed in increments of 100 meters 100 meters approx 330 ft 100 to 4000 metres Bat tery power save This setting applies when OTOflex 100 is running on battery power After this time period in active mode with out any user actions on OTOflex 100 or via OTOsuite OTOflex 100 will enter power save mode where the dis play changes to a power save screen and the auto start and auto resume functions stop working Power save mode reduces power consumption and preserves battery capac ity Recommended setting 3 minute or as short as possible If the battery
240. uld be lost 11 1 1 Interruption of communication Communication via Bluetooth is in OTOflex 100 set to Oz as default If the Bluetooth connection between OTOflex 100 and OTOsuite is interrupted communication with OTOflex 100 is disconnected freconnecting while the current patient folder is the same in OTOflex 100 and OTOsuite synchronisation is done automatically e If reconnecting after the current patient folder is changed on either OTOflex 100 or in OTOsuite you will be prompted to synchronise data or can cel 11 1 2 Synchronization Data is usually transferred from OTOflex 100 to OTOsuite and the data is never deleted without confirmation from the user Synchronization takes just a few seconds and is in many cases automatically initiated on connection e f you synchronize the patient folder shown in OTOflex 100 will be overwrit ten Ifyou cancel synchronization you can save print out the patient folder shown in OTOflex 100 and then synchronize Otometrics 131 Data management in MADSEN OTOflex 100 Uploading test results to OTOsuite 11 2 132 Note Only the patient folder currently shown in the test device will be transferred to OTOsuite during synchronization Other patient folders made while OTOflex 100 was off line must be transferred manually To do so see 11 2 Uploading test results to OTOsuite P 132 Synchronization of corrections made to measurements If you have made changes to for instanc
241. us may be retested for reproducibility or the next one or two intensity levels can be used to confirm the reflex growth properties Default Do next level Reflex Decay setup 13 3 5 1 When you perform a Reflex Decay measurement there are a number of settings you can adjust These settings are available either in the control panel on the left side of the screen or in the Tools gt Options gt Reflex Decay gt Measurement dialog Reflex Decay Control panel settings Acoustic reflex decay is tested using a 226 Hz probe tone It is typically not recom mended to perform supra threshold reflex testing such as decay on infants Reflex Decay Custom TPP offset Enable or disable to select deselect the use of pressure offset to stabilise the eardrum To change the TPP offset setting if Control Panel Custom TPP offset is enabled select Tools gt Options gt Decay gt Custom TPP offset see also description below Disabled TPP is automatically set to 25 daPa more Enabled TPP TPP offset according to TPP setting in Tools gt Options gt Reflex Decay gt Measurement gt Cus tom TPP offset are used Default value Enabled Manual mode Stimulus Select the stimulus types to be included Available types 500 Hz 1000 Hz 1000 Hz Adult default Not currently avail Infant default able Otometrics Otometrics Immittance Module Tools Options view and measurement options
242. ust above each softkey y During testing Pressure release Press for immediate release of air pressure and stop pause of measurement Between measurements e Ear selection Press to toggle the ear selection associated with the current measurement On Off Press and hold 3 5 seconds to turn the device on or off Toggle test type Press to toggle between test types Otometrics Left softkey Right softkey m gt Tymp curve selector Start tymp measurement a Stop reflex measurement P Start automatic measurement Start automatic reflex measure ment M Start semi automatic measure Il Pause measurement ment Flashing resume measurement Start reflex search for selected stimulus Mark threshold A Start single stimulus E Unmark threshold m Stop tymp measurement t Return to previous menu r Automatically pump to positive pressure in ETF P B Menu Automatically pump to nega tive pressure in ETF P Press amp hold for patient info tt Return to test screen Press amp hold to start test sequence 23 OTOflex 100 views and main description Handling and switching on OTOflex 100 24 3 1 2 Left softkey Right softkey amp Print 9 Printing P 105 The display test mode The test screens display a number of icons Selected test setting Connection indicator Ear selection L Left R Right i Power indicator 3 5 x AC Patient Selected test
243. ustom pressure range 176 Otometrics Otometrics Immittance Module Tools Options view and measurement options Measurement settings Pressure range Normal Custom Custom range where the pressure range settings are disabled unless Custom range is enabled Shows the pressure range selected in the measure ment setup that is currently used The normal range of pump pressure is from 400 daPa to 200 daPa where you can access and change these values To do so enable Custom range Enable to access and change the values in the Pressure range fields You can extend the pressure range of 400 to 200 daPa to as much as 600 to 400 daPa or decrease it to 50 to 50 daPa in steps of 50 daPa Default min pressure 600 daPa Default max pressure 400 daPa Sweep direction The air pressure determines the direction of the pressure sweep from a positive value to a negative value or vice versa positive from a negative towards a positive value negative from a positive towards a negative value Default Negative Tympanometry Test settings Click icon or select Tools Options Tymp and Reflex Scr Measurement Tympanometry Auto next curve Enable or disable to define whether the system will auto matically select the next curve number available for the new measurement results when you press Start to start a new measurement The Tympano
244. vice Contact your supplier if you do not have such a license key Firmware update If a Firmware Update message appears see 5 1 6 Firmware upgrade test devices gt 46 Reconnecting to a test device If the control panel for a test type is shown and communication with the selected test device is interrupted a message appears stating that there is no longer connection to the device Click the Connect button on the Control Panel to reconnect to the selected test device Test device information To see information relating to the test device select Help About Device Firmware upgrade test devices If your OTOsuite version contains a more recent firmware for your OTOflex 100 it is recommended that you update the firmware to make sure that OTOflex 100 and OTOsuite perform correctly Upgrading of the firmware will leave your device settings unchanged The new firmware may take up slightly more OTOflex 100 memory than the previ ous version If the memory is full of patient results the upgrade process will automat ically erase some of the oldest patient results from the OTOflex 100 memory if needed results that have been saved or printed will be deleted first Otometrics Otometrics Test Device Management in OTOsuite Setting up communication with the test device It is recommended that you manually delete some or all patient results from OTOflex 100 to create the necessary space for the upgrade Firmware upgra
245. void automatic or semi automatic testing being interrupted because of high stimulus levels when reaching the warning limits it is recommended that you set the max intensity to 95 dB HL See also 7 8 Acoustic reflex testing P 81 Otometrics 85 Testing with MADSEN OTOflex 100 Reflex Threshold testing 6 To pause the test if required press Pause Il To resume testing press the flashing Pause After the pause OTOflex 100 continues from the intensity it came to or was interrupted in If Auto resume on seal is On testing resumes when probe fit is good Ifa threshold is not found immediately the stimulus intensities will increase until a reflex threshold is registered or until the max intensity is reached Ifa threshold is found immediately the test will automatically decrease the stimulus intensities until a threshold is no longer registered 7 9 3 Viewing Reflex threshold results The test screen Reflex Threshold test result showing the three deflection curves for the highlighted 1 kHz ipsilateral stimulus Manually changed thresholds are marked with an asterisk The dashed horizontal line indicates the predefined reflex criterion Field results If the field simply shows a value with no extra marks the threshold has been deter mined automatically If the field is crossed out this indicates that no threshold has been detected at this highest test level If the field is marked by an asterisk the threshold has b
246. way the batteries fit 3 To put the battery cover back in place insert the cover with the curved edge fac ing upwards in the opening Press the cover inwards and downwards until it clicks into place Otometrics 207 Installing MADSEN OTOflex 100 Powering 208 15 6 2 2 Ee 4 The next time you change batteries press the cover inwards and upwards until it is released and snaps out of place S a A 5 Check the battery type setting in OTOflex 100 See 15 6 2 2 Battery type setting P 208 6 Ifyou are using rechargeable batteries leave OTOflex 100 to charge for at least 14 hours and preferably overnight before you put it into use see 15 6 3 The charger 209 for details Battery type setting OTOflex 100 is delivered preset for NiHM rechargeable batteries 1 Ifyou are in doubt of the setting or if you are using Alkaline batteries check the battery type and the setting in OTOflex 100 When OTOflex 100 is ready for use switch it on Press and hold the On Off key on the keypad 2 Press Select to access the Menu followed by Advanced Device Settings Bo Scroll to Battery type 4 To change the setting press Select to toggle to the correct battery type You can choose between NiHM rechargeable or Alka line Caution fyou are using Alkaline batteries and place OTOflex 100 in the charger make sure that you set the battery type to Alka line This will prevent OTOflex 100
247. with Tympanometry testing and continue automatically from Tympanometry to Reflex Screening Otometrics 71 Testing with MADSEN OTOflex 100 Screening 72 7 5 2 1 Screening mode Softkeys Functions Left Press and hold to display patient and user info Right bbl Press to start test Press and hold to start sequence ll Steady Press to pause test Flashing Press to continue a Press to stop test mu Start If Auto start on seal is OFF Warning Ifthe patient is troubled by the high stimulus levels in the ear currently being tested press the Stop or Pause softkey or the Ear Selector Pressure Release key on the keypad to stop the test The test is interrupted immediately Already measured results are kept E 1 You can either perform Reflex Screening using ordinary eartips or using screen ing eartips If you use screening eartips it is recommended that you use the setting Menu gt Procedure Options gt Autostart on seal set to Sequence When a good probe fit with an airtight seal is achieved i e when the screening eartip is pressed gen tly against the ear testing will start with a tympanometric test and continue with this test 2 Ask the patient to sit very still and quiet during this test without moving head or jaw 3 Hold the probe with a steady grip to prevent probe movements from resulting in leakage or changes in admittance Otometrics Testing with MADS
248. with which energy flows through the Compli ant elements of the ear and the ease of energy flow through the Mass elements of the ear Compliant elements are the tympanic and round window membranes the ossicu lar ligaments the middle ear muscles and the air in the ear canal and middle ear Mass elements are the ossicles and the slugs of air in the middle ear mastoid air cells moving as units without compression or expansion The compliance and mass contribution to the total Susceptance is frequency depen dent Compliant Susceptance is greater with low frequencies and gradually decreases with higher frequencies Mass Susceptance is greater with high frequencies and gradually decreases with lower frequencies The total Susceptance is the algebraic sum of the positive Compliance and the negative Mass contributions jB jB Positive Susceptance If a major portion of the probe tone energy flows through the Compliance elements of the ear Susceptance is positive The ear is in this case stiffness controlled Otometrics App 2 MADSEN OTOflex 100 Immittance Methodology and Features Susceptance and Conductance B G This is true when the probe tone frequency is less than the resonance frequency of the ear Negative Susceptance If a major portion of the probe tone energy flows through the Mass elements then the Susceptance is negative The ear is in this case Mass controlled This is true when the probe tone frequenc
249. wn OTOflex and tum it back ops When ready press OK a Kernel Upgrade Selected OTOflex Name OTOflex 209198 Serial No 000209198 Current kernel Aug 15 2005 11 08 15 2 01 0170 Disconnect Kernel for Upgrade Jo newe Otometrics 6 6 1 6 1 1 Otometrics Preparing OTOflex 100 and the Immittance Module for testing Preparing for testing is an important part of testing It is time saving for both you and the client if the environment the client and the test device setup and program are ready for the test To prepare for testing e Decide whether to use the cap and or handgrip See 6 3 2 Using cap and or handgrip f 51 Connect the appropriate probe and if required the insert phone See 6 3 1 Preparing the probe 50 e Prepare OTOflex 100 and the Immittance Module select the appropriate patient and test setup See the OTOsuite User Manual Prepare the patient See 6 4 Preparing the patient f 61 e Prepare probe and eartip See 6 4 1 Fitting the eartip on the probe 61 and 6 4 2 Fitting the probe in the patient s ear 62 e If this is the first test of the day make a probe check See 6 3 3 Probe check 57 Preparing the test environment Before you start testing make sure that the test environment is conducive to testing This includes factors such as selecting a test location where environmental influence on test results is minimal and ensuring that hygienic precautions are taken
250. x intensity For safety reasons testing at higher intensities is possible only in manual mode Warning When testing manually be careful when you select the Stimulus intensity so as not to expose the patient to too high intensity levels 161 Immittance test setup in MADSEN OTOflex 100 Acoustic Reflex Threshold setup Note Whenever a stimulus level exceeds the warning level gt 108 dB SPL re 2cc the stimulus intensity value will start flashing and all automatic testing is paused You are then prompted to decide whether to continue or to move on to the next stimulus type In Manual testing whenever a stimulus level exceeds the Intensity Safety level gt 115 dB SPL re 2cc the stimulus intensity value will start flashing Start intensity Menu gt More settings gt Auto Settings Select the required start level of the stimulus intensity from 40 to 105 dB Default 70 dB HL Intensity Incre ment Menu gt More settings Auto Settings Select the step size to increment the stimulus intensity in increments of 1 2 5 or 10 dB This setting also applies to Manual testing and Reflex Decay testing Default 5 dB Verification Pause time Menu gt More settings Auto Settings Select the type of verification strategy to be used after the reflex criterion has been met by the automatic threshold search The stimulus may be retested for reproducibility or the next one or
251. y is greater than the resonance frequency of the ear Zero Susceptance If equal amounts of probe tone energy flow through the Compliance elements and Mass elements then the Susceptance is zero The ear is in this case neither stiffness nor Mass controlled This means that the probe tone frequency is the same as the res onance frequency of the ear Baseline compensation In order to quantify the middle ear Susceptance it is helpful to baseline compensate the Susceptance curve This is achieved through subtraction of the ear canal Suscep tance The tympanic membrane is tensioned with high air pressure so that the probe tone reflects off the tensed tympanic membrane and accordingly a negligible portion of the probe tone is admitted into the middle ear At high pressures we only measure the Susceptance of the air that is enclosed between the probe tip and the tympanic membrane resulting in the ear canal Susceptance This Susceptance is mainly Compliance Susceptance since the Mass element in this enclosed air is negligible The value of the notch in the Susceptance tympanogram can then be determined from the corresponding value on the vertical axis and the rela tion of the probe tone frequency to the ear resonance frequency can be estimated according to the above description App 2 5 2 Conductance G Conductance is the amount of energy that dissipates as heat due to the friction in the ear system Friction occurs as a result of contac
252. z curves The widest pressure range used will be applied When Layered curves is enabled the curves are denoted by the following graphical conventions mex n Cur vel Full line SESS RRR Curve 2 Dotted line a mmm Curve 3 Dashed line The selected curve is highlighted and shown as a bold full line Otometrics 173 Immittance Module Tools Options view and measurement options View settings Pressure axis Range Enables using the same aspect ratio for all pressure sweeps regardless of whether they are for instance 200 to 400 or 400 to 600 If the 200 to 400 range is selected but a wider custom pressure range is used the pressure scale will automati cally be set to 400 to 600 Acoustic Reflex Screening view settings Always show Reflex screening table Lists the stimulus types that are always shown In addi tion any measured stimulus types are also shown auto matically Select and deselect stimulus types One stimulus type must always be selected as a minimum ETF I view settings No special settings are needed for ETF I tests except for the following Curves Layered curves Enables a typical ETF I setting with layered tympano grams 13 2 2 Reflex Threshold view settings Deflection axis Scale 226 1000 Hz The two different scale values separated by a slash e g 3 0 6 0 are probe tone dependent The firs

MADSEN OTOflex 100 & OTOsuite Immittance Module User Manual

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MADSEN OTOflex 100 &amp; OTOsuite Immittance Module User Manual

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MADSEN OTOflex 100 & OTOsuite Immittance Module User Manual