D-0004576-I – 2017/11
Additional Information
Affinity
2.0
/ Equinox
2.0
Hearing Aid Analyzer
Table of Contents
1 AC440 .............................................................................................................................. 1
1.1 About AC440 Module ..................................................................................................... 1
1.2 Launching AC44 0 with Databa ses ................................................................................. 2
1.2.1 Lau nchin g from Ot oA ccess™ ...................................................................................... 2
1.2.2 Lau nchin g AC440 from Noah....................................................................................... 3
1.2.3 Usi ng t he Tone S cr een................................................................................................ 4
1.3 The S pee ch Screen Elements ...................................................................................... 10
1.3.1 Speech Audiometry in Graph Mode ............................................................................ 13
1.3.1.1 Dual Speec h Gra phs................................................................................... 14
1.3.1.2 50% Discri m i nat ion Line .............................................................................. 14
1.3.1.3 Bönninghaus & Röser cal culati on ................................................................ 15
1.3.2 Speech Audiometry in Table M ode .............................................................. 16
1.3.2.1 The SRT ta bl e ............................................................................................ 16
1.3.2.2 The W R Tabl e ............................................................................................ 17
1.4 Binaural speech........................................................................................................... 18
1.5 Full 2(4) channel S peech in noise................................................................................ 19
1.6 Counselli ng Ta b .......................................................................................................... 21
1.6.1 Sound Studio ............................................................................................................ 21
1.7 Clinica l Appli ca tion of the AC440 Test s ...................................................................... 22
Ai r Conduct i on Audi ometry .................................................................................................... 22
1.7.1 High Fre quency Audi omet ry ...................................................................................... 24
1.7.2 Multi Freque ncy A udi om etry ...................................................................................... 25
1.7.3 Bone Con duction Au diometry .................................................................................... 26
1.7.4 Masking 27
1.7.5 Speech Audiometry................................................................................................... 28
1.7.5.1 Speech Rece pt i on Thres hold (SRT) in T abl e Mode ....................................... 30
1.7.5.2 W ord Recognit i on (WR ) in table mode ......................................................... 31
1.7.5.3 Speech T esti ng with a Micr ophone .............................................................. 32
1.7.5.4 Speech T esti ng with a n external C D P l ayer .................................................. 33
1.7.5.5 Speech tes ting with Wa ve Files ................................................................... 34
1.7.6 Mas king Level Difference (M LD ) ................................................................................ 36
1.7.7 Mas ter Hearing A i d (MHA)......................................................................................... 38
1.7.8 Heari ng Los s Sim ul ation (HLS ) .................................................................................. 40
1.7.9 Short Increment S ensit ivity In dex ............................................................................... 42
1.7.10 Weber .................................................................................................................. 44
1.7.11 Knaster .................................................................................................................. 45
1.7.12 ABLB/Fowler ............................................................................................................ 47
1.7.13 St enger Test ............................................................................................................. 48
1.7.14 TE N Te s t .................................................................................................................. 50
1.7.15 QuickSIN .................................................................................................................. 51
1.7.16 Tone Decay.............................................................................................................. 53
1.7.17 ANL Test
1.7.18 S IQ Tes t .................................................................................................................. 61
1.7.19 S IN Te s t .................................................................................................................. 63
18
............................................................................................................... 56
1.8 Working with Individua l Se tups (Test Pro toc ols)......................................................... 65
1.8.1 Sel ec ting a Test P rot ocol:.......................................................................................... 65
1.8.2 Creating new Protocol s ............................................................................................. 66
1.8.2.1 Common Setu p .......................................................................................... 66
1.8.2.2 Tone Testing S et up..................................................................................... 68
1.8.2.3 Speech T esti ng S etup ................................................................................. 80
1.8.2.4 MLD testi ng Setup ..................................................................................... 88
1.8.2.5 MHA Couns el ling Setup .............................................................................. 90
1.8.2.6 Knaster Testi ng S etup................................................................................. 92
1.8.2.7 HLS C ouns el l i ng S etup ............................................................................... 94
1.8.2.8 SISI Testi ng Set up ...................................................................................... 97
1.8.2.9 W eber Tes t i ng Setup .................................................................................. 98
1.8.2.10 Quic kSIN Setup .......................................................................................... 99
1.8.2.11 Quic kSIN Addit i onal F eat ures S etu p ...........................................................101
1.8.2.12 AB LB/Fowl er an d S teng er S etup ................................................................103
1.8.2.13 TEN test Setup ..........................................................................................103
1.8.2.1 ANL Test S etup .........................................................................................104
1.8.2.2 SIQ Test S etup ..........................................................................................106
1.8.2.3 SIN T es t Set up ..........................................................................................108
1.8.3 Fini shing the Test P rotocol .......................................................................................110
1.8.4 Changing a Test P rot ocol P ermanentl y .....................................................................110
1.8.5 Changing a Test P rot ocol Tem por ari l y ......................................................................111
1.8.6 Imp ort i ng and Ex port i ng Test P rot ocols .....................................................................112
1.8.6.1 Imp ort i ng a Test P rot ocol: ..........................................................................112
1.8.6.2 Exporting a Test P rot ocol: ..........................................................................113
1.9 General Setup .............................................................................................................114
1.9.1 Symbol edi t or ..........................................................................................................115
1.9.2 Noah database sett i ngs............................................................................................116
1.9.3 Tone and speech settings ........................................................................................116
1.10 General Suite Settings and Examiner .........................................................................117
1.10.1 Startup 117
1.10.2 Examiner s etti ngs ....................................................................................................117
1.10.3 Language ................................................................................................................118
1.10.4 PDF Print ................................................................................................................119
1.11 Pa ssword pro te ction ..................................................................................................120
1.12 The AC440 Menu I te m s ...............................................................................................121
1.13 PC Shortcut Manager .................................................................................................123
1.14 Standalone Database Settings....................................................................................124
1.15 FAQ ............................................................................................................................125
1.16 Appendix 1 .................................................................................................................127
1.16.1 Imp ort i ng W ave Fil es – Speech fr om Hard Drive ( ISF440) ..........................................127
1.17 Appendix 2 .................................................................................................................132
1.17.1 Audi ometer Implement ati on of the TE N(HL) Test for Diagnosing Cochlear
Dead Regions .........................................................................................................132
1.18 Appendix 3 .................................................................................................................139
1.18.1 Mas king Help/Automaski ng Quick G ui de ...................................................................139
2 REM440 ........................................................................................................................144
2.1 Quick Guide................................................................................................................144
2.2 About REM440 ............................................................................................................146
2.3 REM440 Te st s .............................................................................................................146
2.4 Launching R EM4 40 wi th Databases ...........................................................................147
2.4.1 Lau nchin g RE M440 fro m Noah 4: ..............................................................................147
2.4.2 Lau nchin g RE M440 fro m Ot oAccess™: ....................................................................147
2.5 The REM Screen Elements ........................................................................................149
2.6 Background on Real-Ear Measurements using REM 440 ............................................156
2.6.1 Requi red It ems ........................................................................................................156
2.6.2 Calibration ..............................................................................................................158
2.6.3 Gain versus Res pons e Vie w.....................................................................................159
2.6.4 Real-ear Meas urements on Op en F i t tings .................................................................160
2.6.4.1 Calib rat e fo r Open Fit.................................................................................161
2.6.5 Probe Pl ac ement .....................................................................................................162
2.6.6 St i m ul i for Real-e ar M eas ures...................................................................................162
2.6.6.1 Tone Stimul i ..............................................................................................162
2.6.6.2 Speech St i m ul i / ISTS ..................................................................................163
2.6.6.3 Composite Signals/ICRA ............................................................................163
2.6.6.4 W hat Stimulus t o Choose? .........................................................................163
2.6.6.5 Pres enting a St i m ul us ................................................................................164
2.6.7 W ork i ng wi t h F i tting Targets .....................................................................................165
2.6.7.1 Calc ulating the Target ................................................................................165
2.6.7.2 Choosing a Fi tting P rescription ...................................................................165
2.6.7.3 DSL m[ i / o] opti ons....................................................................................166
2.6.7.4 NAL-NL1/NAL-NL2 opt ions .........................................................................168
2.6.8 Com paring to the Heari ng Ai d F i t ting S oftwa re...........................................................169
2.6.8.1 On Top Mod e ............................................................................................169
2.6.8.2 Table Mode ...............................................................................................170
2.6.8.3 Show Cursor o n t he Graph .........................................................................170
2.4.1 Speech Int el l igibi l i ty Ind ex (SI I) .................................................................................171
2.6.9 Dis pl ay Peaks and Valleys .......................................................................................171
2.6.10 Prec onditioning a nd Sweep Delay.............................................................................172
2.6.10.1 Preconditioning..........................................................................................172
2.6. 10.2 Swee p Delay ..............................................................................................172
2.6.11 Sm oot hi ng a C urve ..................................................................................................172
2.6.12 Comparing Curves ...................................................................................................173
2.6.13 Managing Mult i pl e Cur ves ........................................................................................173
2.6.13.1 Curve Dis pl ay Opt i ons ...............................................................................174
2.6.13.2 Deleting Cur ves .........................................................................................174
2.6.13.3 Com bi ned S creen View ..............................................................................174
2.6.13.4 Changing the Curve Colour ........................................................................174
2.7 Clinica l application of Real -Ear Measurements using REM 440 ..................................175
2.7.1 REUR/ REUG Measur e m ents....................................................................................175
2.7.1.1 Predic ted RE UR ........................................................................................177
2.7.1.2 REU G / RE UR from a pr evious Sessi on ........................................................178
2.7.1.3 REUR/ REUG in both ears view...................................................................178
2.7.2 REA R/ RE AG M eas urement s ....................................................................................179
2.7.3 REI G M easu rement s ...............................................................................................181
2.7.4 REC D M easurem ents ..............................................................................................183
2.7.4.1 REC D using t he cl i ent’s own ear mould .......................................................184
2.7.4.2 REC D using t he SP L Probe........................................................................187
2.7.4.3 Own Mould versus SP L Probe ....................................................................189
2.7.4.4 Predicted RECD Curve ..............................................................................189
2.7.4.5 Meas ured RE CD com pare d to a pr edi c ted RE CD ........................................189
2.7.4.6 Re-using a Coupl er C urve ..........................................................................190
2.7.4.7 REC D from a p revious S ession ..................................................................191
2.7.4.8 Tes t Box/Coupl er B ase Fitting (S i mul ate d RE M ) ..........................................191
2.7.4.9 The “ Coupler Appro ach” .............................................................................191
2.7.4.10 The “ Real-e ar approach” ............................................................................193
2.7.4.11 Imp ort i ng t he RECD into the Hearing A i d M anu fac tu rers S oft war e ................193
2.7.4.12 Counselli ng t he P arents in V i sible S peec h M apping .....................................193
2.7.5 REOR/RE OG measu rement s ...................................................................................194
2.7.6 Measuri ng Input /Out p ut ............................................................................................195
2.7.7 Directionalit y Meas urements.....................................................................................197
2.7.8 Bi naural REM Measurements ...................................................................................198
2.5 FM System Verification...............................................................................................206
2.5.1 FM T rans parency ....................................................................................................206
2.5.2 Ear Level, F M only ...................................................................................................209
2.6 Working with Individua l Se tups (Test Pro toc ols)........................................................212
2.6.1 Sel ec ting a Test P rot ocol..........................................................................................212
2.6.2 Creating new Test P rot ocols.....................................................................................213
2.6.2.1 REUG/REUR Se tti n gs................................................................................216
2.6.2.2 REAR/REAG Settings ................................................................................218
2.6.2.3 REI G Sett i ngs ...........................................................................................220
2.6.2.4 REC D Sett i ngs ..........................................................................................222
2.6.2.5 REOR/REOG Settings ...............................................................................224
2.6.2.6 Input /Output S ettings .................................................................................226
2.6.2.7 Directionalit y Settings.................................................................................228
2.6.2.8 Pause Set t i ngs ..........................................................................................230
2.6.2.9 Vi s i bl e Speech M apping Set tings ................................................................230
2.6.3 Com bi ned S creen Setup ..........................................................................................231
2.6.4 Fit ting P res cript i on S etup .........................................................................................232
2.6.4.1 DSL ..........................................................................................................233
2.6.4.2 NAL-NL 2 Settings ......................................................................................234
2.6.4.3 NAL-NL 1 S ettings ......................................................................................235
2.6.4.4 Print Layout Set tings ..................................................................................236
2.6.5 Fini shing the Test P rotocol .......................................................................................237
2.6.6 Changing a Test P rot ocol P ermanentl y .....................................................................237
2.6.7 Changing a Test P rot ocol t emporarily........................................................................238
2.6.8 Imp ort i ng and Ex port i ng Test P rot ocols .....................................................................238
2.6.8.1 Imp ort i ng a Test P rot ocol ...........................................................................238
2.6.8.2 Exporting a Test P rot ocol ...........................................................................239
2.7 General Setup .............................................................................................................240
2.8 The REM 440 Menu Ite m s ...........................................................................................242
2.9 Visible S pe ech Mapping (VSPM440) ...........................................................................245
2.9.1 About Vis i bl e S peec h M apping .................................................................................245
2.10 The V isible Spee ch Mapping Screen ..........................................................................246
2.11 Ve rifica tion with Vi sible S pee ch Ma ppi ng...................................................................252
2.11.1 Considerations b efore you be gi n...............................................................................252
2.11.2 Vi s i bl e Speech M apping (in ear m ode) ......................................................................252
2.11.3 Vi s i bl e Speech M apping (in coupler mode/ t est box mode) ..........................................253
2.12 Visual Tools for Counseling and Ve rifica tion .............................................................256
2.12.1 Perc entile A nalysi s ..................................................................................................256
2.12.2 Dis pl ay Peaks and Valleys .......................................................................................257
2.12.3 Show E xam pl es.......................................................................................................257
2.12.4 Speech Int el l igibi l i ty Ind ex ........................................................................................258
2.12.5 Speech Spectrum ....................................................................................................258
2.12.6 Dynam i c Range Vi ew ...............................................................................................259
2.12.7 Ai ded versus Unaide d ..............................................................................................259
2.13 2.13 Vi sible S pee ch Ma ppi ng Setting s........................................................................259
2.14 FAQ ............................................................................................................................262
2.15 Appendix 1 .................................................................................................................268
2.16 The REM440 Test Signal Characteristics ....................................................................268
2.17 REM PC Shortcuts ......................................................................................................270
2.18 Technica l S pe cifica tions of the REM4 40 Softw are......................................................271
3 HIT440...........................................................................................................................272
3.1 HIT440 Quick Guide ....................................................................................................272
3.2 About HIT440 ..............................................................................................................274
3.3 HIT 440 T e st s ..............................................................................................................275
3.4 Launching the HIT 440 Software from Data bases .......................................................255
3.4.1 Lau nchin g HIT4 40 from Noah ...................................................................................255
3.4.2 Lau nchin g HIT4 40 from OtoA ccess™ .......................................................................255
3.5 The HIT440 Screen......................................................................................................257
3.6 Hea ring I nstrum ent Testing using HIT440 ..................................................................262
3.6.1 Tes t i ng Hearing Ins t ruments: ....................................................................................262
3.6.2 Tes t i ng bone anchored devic e using t he SK S10 Sk ul l Simul at or .................................263
3.6.3 Inst al l ing t he S kull Simul at or License i n t he H IT440 Software: ....................................264
3.6.3.1 How to receive a n ew H I T license ...............................................................264
3.6.3.2 Ac tivating the new HIT licens e ....................................................................265
3.6.3.3 Usi ng t he Skul l S i m ul ator protocol...............................................................266
3.6.3.4 Set up of SK S 10 i n the Affini t y test chamber.................................................267
3.6.4 Runni ng P re-programmed Test P rot ocols ..................................................................269
3.6.5 Aut om atic T esting (Auto Run) ...................................................................................269
3.6.6 Prec onditioning a nd Sweep Delay.............................................................................270
3.6.6.1 Preconditioning..........................................................................................270
3.6.6.2 Sweep Del ay .............................................................................................270
3.6.7 Sm oot hi ng a C urve ..................................................................................................270
3.6.8 Show Cursor o n t he Graph .......................................................................................271
3.6.8.1 Managing Multiple Cur ves ..........................................................................271
3.6.8.2 Curve Dis pl ay Opt i ons ...............................................................................272
3.6.8.3 Com bi ned S creen View ..............................................................................272
3.6.8.4 Changing the Curve Color ..........................................................................272
3.6.9 Com pari ng Curves ...................................................................................................273
3.6.10 Com paring to the manufacturers speci fic ation s heets .................................................274
3.6.10.1 Telec oil Test ing .........................................................................................274
3.7 Application of the HIT4 40 Tests..................................................................................276
3.7.1 Freq uenc y Response ...............................................................................................276
3.7.2 Gain Cur ve ..............................................................................................................277
3.7.3 Harm oni c Dis t orti on .................................................................................................278
3.7.4 Inte rm odulati on Di stort ion.........................................................................................280
3.7.5 Attack/Reco very Time ..............................................................................................280
3.7.6 Bat tery Current Drai n/Bat t ery Life Time .....................................................................282
3.7.7 Equivalent Input Noise .............................................................................................284
3.7.8 Reference Tes t Gain ................................................................................................285
3.7.9 Microph one Dir ecti onal i t y .........................................................................................286
3.7.10 Si ngle F req uency.....................................................................................................287
3.7.11 Response/Gain/Input/Output ....................................................................................288
3.7.12 Delay 289
3.7.13 OSPL90 290
3.5.1 3.7. 14 F ul l-on Gain ..................................................................................................290
3.8 Working with Individua l Se tups (Test Pro toc ols)........................................................292
3.8.1 Sel ec ting a (s t andard) test protoc ol : ..........................................................................292
3.8.2 Desi gning a Cust om i ze d T est P rot ocol ......................................................................293
3.8.2.1 Freq uenc y Response Sett i ngs ....................................................................295
3.8.2.2 Gain Curve s etti ngs ...................................................................................298
3.8.2.3 Harm oni c Dis t orti on Sett i ngs ......................................................................299
3.8.2.4 Input /Output S ettings .................................................................................301
3.8.2.5 Inte rm odulati on Di stort ion S ettings..............................................................303
3.8.2.6 At tack/Rec overy Time Setti ngs ...................................................................305
3.8.2.7 Bat tery Current Drai n S etti ngs ....................................................................307
3.8.2.8 Equivalent Input Noise Settings ..................................................................308
3.8.2.9 Reference Test Gai n S ettings .....................................................................312
3.8.2.10 Directionalit y Settings.................................................................................314
3.8.2.11 Si ngle F req uency Sett i ngs..........................................................................315
3.8.2.12 Response/G ai n/Input/Output Sett i ngs .........................................................317
3.8.2.13 Delay S ettings ...........................................................................................318
3.8.2.14 Pause Set t i ngs ..........................................................................................320
3.8.3 Com bi ned S creen Setup ..........................................................................................321
3.8.4 Print Layout Set tings ................................................................................................322
3.8.5 Fini shing the Test P rotocol .......................................................................................323
3.8.6 Changing a Test P rot ocol P ermanentl y .....................................................................324
3.8.7 Changing a Test P rot ocol Tem por ari l y ......................................................................325
3.8.7.1 Imp ort i ng and Ex port i ng Test P rot ocols .......................................................325
3.8.7.2 Import i ng a Test Prot ocol ...........................................................................325
3.8.7.3 Exporting a Test P rot ocol ...........................................................................326
3.9 General Setup .............................................................................................................327
3.10 The HIT440 Menu Items ..............................................................................................330
3.11 HIT440 Software – Te chnica l S pecifications ...............................................................332
3.12 Appendix 1 .................................................................................................................334
3.12.1 The H IT440 T est S i gnal cha rac teris t i cs .....................................................................334
3.13 Appendix 2: ................................................................................................................335
3.13.1 Connecti ng the TBS25 to Af fini ty
2.0
/Equinox
2.0
...........................................................335
4 PRI NTING AND MAKING REPORTS .....................................................................337
4.1 The P rint W iza rd .........................................................................................................337
4.1.1 Desi gning a Cust om i ze d P ri nt Templat e ....................................................................339
4.1.2 Desi gn El em ent s .....................................................................................................340
4.1.2.1 Gen eral E l ements ......................................................................................340
4.1.2.2 Taskbar 343
4.2 Creati ng Reports ........................................................................................................344
4.2.1 Ope rat i on of the Re port E ditor ..................................................................................344
4.2.1.1 The R eport Edit or ......................................................................................344
4.2.1.2 The Template Edi t or ..................................................................................346
5 RECO VERY MANAGER ...........................................................................................347
6 CRA SH REPO RTS .....................................................................................................349
7 Q UICK GUI DE S ..........................................................................................................351
8 REFERENCES ............................................................................................................353
Affinity
2.0
Additional I nforma tion Page 1
1 AC440
1.1 About AC 440 Module
AC440 is t he PC-based audiometry module for the Affinity
The AC440 software i s an independent two-channel audiometer. It feat ures tone audiometry for air and
bone, s peech t est ing and a vari ety of mas ki ng and s ignal t ypes . S timul i are present ed using the PC
key board, m ouse or a dedicat ed audiomet ry key board. Test result s are displ ayed on s creen and saved to t he
associ ated databas e (e.g. Noah, OtoAccess™). They are im mediat ely available for inspec tion, hearing aid
fitt ing, printout , ex port, and so on. The AC440 modul e can als o be operated ext ernal to a database in standalone mode.
The modul e is flex ible, enabling the indivi dual c lini cian to tai l or the system acc ording to their s pecific
preferences . It permi ts t he creat ion of an unli mit ed number of personaliz ed tes t protoc ol s ett ings and
funct ions for different purpos es and/ or for different c linic ians work ing at the s ame locat ion. The sy stem also
provides you with the option to make individual print l ayouts , keep reports el ec tronic al l y , and compare actual
curves t o previous ses s i ons. These num erous s etup opti ons c an be very helpful and t i m e saving in t he dai l y
cl i ni cal work envi ronm ent.
In additi on to the s etup func tions , t he AC440 als o cont ains couns elling t ools i n order to help both pat ient and
relati ves t o get a better underst anding of t he cons equences of hearing i mpairment and why hearing
ampli ficati on may be needed.
The AC440 c ontai ns t he foll owing tests:
Air Conduction Audiometry
o High Frequency Audiometry
o Multi F requenc y audi om etry
Bone Conduction Audiometry
Free Field Audiometry
Speech Audiometry
Masking Level Difference (MLD)
Mas ter Hearing A id (M HA ) (counselling tool)
Hearing Loss Sim ul ation (HLS) (counselling tool)
Short Increment Sensitivity Index (SISI)
Weber
Knaster
Stenger
Tone Dec ay Test
TE N t e s t
QuickSIN
2.0
and Equinox
2.0
hardware platforms.
Affinity
2 3 4
2.0
Additional I nforma tion Page 2
1.2 Launching AC440 with Databases
1.2.1 Launching from Oto Access™
Ens ure that t he A ffinit y i s s witc hed on and c onnect ed before opening the software suite. If the hardware is
not det ected, a dial og box wi ll appear aski ng i f you want to run t he A ffinit y Suite i n Simul at i on mode, si m i l ar
to t he foll owi ng:
To s t art the A ffinity Sui t e from Ot oA ccess™ :
1. Open OtoA cc ess ™
2. Sel ec t the patient y ou want t o work wit h by cl i c king on it; it will t hen highl ight bl ue t o i ndi cate
selection.
3. If the pat ient is not yet l ist ed:
- press the New client button
- fil l i n at leas t the mandat ory fields, mark ed wit h a red asteris k.
- save the patient detai l s by pres sing the Save patient information button.
4. Double click on the Affinity Suite in t he Select Ins tr ument box.
For further ins truct ions about working wit h t he databas e, pleas e see the operation m anual for OtoA cc ess ™.
Affinity
2.0
Additional I nforma tion Page 3
1.2.2 Launching AC440 from Noa h
Ensure that t he A ffi nity is s witc hed on and connect ed before opening the s oftware module. If the hardware
is not detec ted, a di al og box wil l appear asking if you want t o run the A ffinity Sui t e i n Simul at i on mode.
To s t art the A ffinity Sui t e from Noah 4:
1. Open Noah 4
2. Searc h for and selec t the pat ient you want to work with from the left -hand s ide of t he sc reen.
3. If the pat ient is not yet l ist ed:
- Cl i ck on t he Add a New P at i en t icon
- F i l l i n t he requi red fields and cl i ck OK
4. Clic k on the Affinity Suite module icon at t he t op of the s creen.
For further ins truct ions about working wit h t he databas e, pleas e see the operation m anual for Noah 4.
Affinity
Menu provides access to Print, E di t, View, Tests, Set up, and Help
Print allows for print ing the ses sion’ s ac quired dat a.
Sav e & New S ession saves the current s essi on i n Noah or OtoA ccess™
Sav e & E xit saves the current sessi on i n Noah or O t oAccess™ and exits the
Go to Tone Audiometry ac tivates t he tone sc reen when in another tes t.
Go to Speech Audiometry act ivat es t he s peech s c reen when in anot her
Extended Range +20 dB ex t ends the testi ng range and can be activated
range on automatically by going to t he setup menu.
2.0
Additional I nforma tion Page 4
1.2.3 Using the Tone Scree n
The following s ect ion desc ribes the elements of the tone sc reen.
and opens a new one.
Suite.
Collapse the l eft side panel.
test.
when t he t esti ng di al sett i ng gets within 55 dB of the m aximum l evel of the
transducer.
Note that the extended range butt on wil l flas h when it needs activati on for
reaching higher intensities.
To switc h on the ex tended range autom atically, select the Sw itch extende d
Affinity
Fold an area so that it only shows the l abel or the buttons of that area.
Unfold an area so that al l but tons and label s are vi sible
Show/hide areas can be found by right mouse c lic ki ng on one of the areas.
List of De fined Protocols allows for sel ecti ng a t est protoc ol for the
Tem pora ry Setup allows for mak ing temporary c hanges to the selec t ed
List of historical sessi o n s acc esses hi stori c al sessions for com parison
Right Clicking on a hi stori ca l session will al l ow you to see ex actly
Go to Current Se ssi on brings you back to the current sessi on.
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The visibil i ty of the different areas as well as t he spac e t hat they take on t he
screen is locall y saved to the exam i ner.
current tes t session. P l ease refer t o section 1.7 for more informati on about
protocols. Right m ouse click on a protoc ol allows the current ex am i ner to
set or deselect a default startup protocol.
protoc ol . The c hanges wil l be valid for the current s essi on only. After
mak ing the changes and returning to the mai n s creen, the name of the
protoc ol will be foll owed by an asterisk (*).
purposes. The audiogram of t he selec ted sessi on, indicated by the
orange bac kground, is shown i n colours as defined by t he used sym bol
set. All other audi ogram s t hat are selec ted by check mark s show on
sc reen in the c olours as indic ated by t he tex t c olour of the date and tim e
stamp. Not e that thi s listing can be resiz ed by dragging t he doubl e lines
up or down.
whic h measurem ents have been performed i n t hat sessi on. This i s useful
when t ry i ng to find a speci al test amongs t several sessi ons without
opening the sessi on i ndi vidually to find the dat a you need.
The tes ts which have been performed wil l have a green light next to t hem .
You c an also cl ick on Deselec t all selected sessio n s ov er l ay s after
right c l i cki ng on t he sessions to remove any histori c sessi on overlays you
have chos en t o di splay .
Affinity
Edit Mode button ac ti vates the editing func tion. Left cl ick ing on t he graph
will add/ m ove a poi nt to t he posit i on of the cursor.
point
Furthermore,
threshol d, Add
n
unmasked thres holds where masked
Mouse controlle d audiometry enables you to do the audi om et ry using
the m ouse only.
the t hreshold is st ored wit h the ri ght mous e button.
The dB st e p size button indicates to which dB step siz e increment the
system is currentl y is set. It rot ates from 1 to 2 to 5 dB
number i ndi cates the setti ng.
The hide unmasked threshold will hide t hose unmas ked t hresholds
where masked thresholds exist.
Toggle M ask ing Help will acti vate or deac tivate t he M aski ng Help. The
mas king help funct i on c an be removed from this int erfac e through
amending the settings in the
For more informat ion
A
Toggle A utomas k ing will ac ti vat e or deacti vat e t he Aut omask ing feature.
For more informat ion on
Appendix
Talk Forward activates the Talk Forward microphone. The arrow keys
can be us ed t o set the talk forward level through the currently selec t ed
trans ducers . The l evel will be ac curat e when VU meter indic ates to be at
zero dB .
High Frequency1 s hows frequenc i es on the audi ogram (up to 20 kHz for
High Freque ncy Zoom act ivates high frequency tes ting and zooms in on
Single audiogram toggles between viewing t he i nformat i on of both ears
Multi frequencies2 activate tes ting wit h frequenc i es in between the
Synchronize channels locks the two channels together. This functi on
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the A ffinity
2.0
/Equinox
2.0
). However, you wil l only be abl e t o t est in the
frequency range the selected headset is calibrated for.
the hi gh frequency range. Pl ease refer to section 1.6.1 for more
informat ion on high frequenc y testi ng.
in a s i ngl e graph and two separate graphs.
standard audiometric test frequencies. The frequency resolution can be
adjus ted i n the AC440 set up.
may be used t o perform sy nchronous mas king.
By right clicking on a
it is possible to Delete the recorded point or t he entire c urve.
right m ouse click provi des t he opt i on t o Add unmasked
no response, Add masked threshold, Add masked-
o-response threshold, Copy bone thresholds to other ear, and Hide
exist.
The stimul us i s presented wit h the left mouse button, and
and the l arger
Prot ocol Setup (See t his in s ection 1.7.2. 2).
on M aski ng Hel p, please s ee s ect ion 1.7.2.2 or
ppendix 4 for the Mas king Help Quic k Guide
Aut omask ing, please refer to section 1.7.2.2 or to
4 for the M aski ng Hel p Quic k Guide.
1
H F requires an additional license for the AC440. If not purchased, the button is grayed out.
2
M F requires an additional license for the AC440. If not purchased, the button is greyed out.
Affinity
Sel ecti ng the Monitor Ch1 and/or Ch2 chec k boxes al l ow y ou t o m oni tor
one or both channels through an ext ernal louds peaker/ headset c onnect ed
to the monitor input . The monit or intens it y is adjus ted by t he arrow k eys .
The Talk back chec k box enabl es y ou t o lis t en to the pat i ent. Note that
you need to be equi pped with a mi crophone c onnected to the talk back
input and an ex ternal l oudspeak er/heads et c onnect ed to the monitor
input.
The Patient monitor opens an always -on-top window with the tone
audiograms and all its counselling overlays s
easi er lay out to counsel the patient.
monitor gets saved for each examiner individually.
The Phonemes couns elli ng overlay s hows phonemes as it i s configured
in t he prot ocol that is currently i
The Sound e xam pl es couns elli ng overlay s hows pict ures (png-
files ) as they are s et up i n the protoc ol that is currentl y i n use.
The Speech banana c ounsel ling overlay shows the speech area as it is
set up in the protocol that i s current l y i n u
The Severity counselling overlay shows the degrees of hearing los s as it
is set up i n t he prot oc ol t hat i s current l y i n use.
The Max. test ab l e v al u es overlay highlights t he area beyond the
max imum intens ity
trans ducer cal ibrati on and
Selecting HL, MCL, UCL or Tinnitus sets t he sym bol types that are current l y
in us e by the audi ogram
stands for
Note that these buttons
current l y selec t ed sym bol set.
Each ty pe of meas urem ent is saved as a s eparat e c urve.
Binaural and Aided allows for indic ating i f the t est i s performed wit h heari ng
aids or binaurall y with corres pondi ng sy m bol s. The m easurement s wil l be
saved as separate curves.
In the Comments section y ou c an type comments rel at ed to any audiom et ri c
test. T he used space by t
double l i ne wi t h y our m ouse. Pressi ng t he
separat e window for adding notes to the c urrent s essi on. The report editor
and comment box contain t he same tex t. In c as e the formatt i ng of t
import ant, thi s can only be set withi n the report edit or.
about the Report Edi tor.
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Additional I nforma tion Page 7
hown. This provides an
The s i z e and pos i tion of the pati ent
that the system allows. This is a reflect ion of the
n use.
se.
differs when the extended range is activated.
for different tes ts . HL st ands for hearing l evel, M CL
most comfortable level and UCL stands for uncomfortable level.
display the unmask ed right and l eft s ym bols of the
he comments area can be s et by dragging the
Note that aft er s aving the session c hanges can only be added to the report
withi n t he s ess ions date. Therefore once t he date changes y ou c annot add
anyt hing further or mak e am endments . See s ecti on 4.2
Report editor but ton opens a
he text is
for more information
Affinity
The Output list for c hannel 1 provides the opti on to test through head
The Output list for c hannel 2 provi des t he option to test through head
Man and Rev allows toggling between Manual and Reverse test modes. In
Pulsation allows for single and cont inuous puls ati ng presentat ion. The
Sim/Alt al l ows togging between Simultaneous and Alternate pres entati on.
Masking indic ates i f channel 2 is currently i n use as a m aski ng channel
dB HL Increase and Decrease buttons allow increasing/decreasing the
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phones, bone conduc tor, free field s peakers or ins ert phones. Not e that the
system only s hows the cal i brat ed t rans ducers.
The Input list for channel 1 provi des t he option to sel ect pure tone, warbl e
tone, narrow band noise (NB ) and white noi se (WN).
Note that the background s hadi ng is according to the s i de that i s sel ec ted,
red for right and blue for left.
phones, free field s peakers , insert phones or insert m ask ing phone. Note
that the system only s hows the cal i brat ed transducers.
The Input list for channel 2 provi des t he option to sel ect pure tone, warbl e
3
tone, narrow band noise (NB ), white noi se (W N) and TEN noise
.
Note that the background s hadi ng is according to the s i de that i s sel ec ted,
red for right, blue for left, and white when off.
manual t he st imul us is pres ented only when m anually ac ti vat ed. In revers e
the signal is presented continuously until i nt errupt ed by t he t one swit ch.
duration of the stimul us can be adj usted in t he A C440 setup.
Ch1 and Ch2 will pres ent t he s tim ulus s imul taneousl y when S im is
sel ected. When Alt is selected, the stimulus will alternate between Ch1 and
Ch2.
R+L allows for the s ys tem t o perform binaural mas king and t one
simultaneously. This setting wi l l need to be enabled in eac h channel. The
tes t s creen wil l t urn grey t o i ndicat e thi s.
and i n t hat way m akes sure m aski ng sym bol s are us ed in the Audiogram.
For ex ample in paediatric tes ti ng t hrough free field s peakers , channel 2 c an
be set as a s econd testing c hannel . Not e that a s eparate s tore funct ion for
channel 2 is available when c hannel 2 is not used for mas ki ng.
int ensit ies of channel 1 and 2.
The arrow keys on the PC k eyboard c an be used for increasing/decreasing
channel 1 intens it ies.
PgUp and P gDn on the PC keyboard c an be used for
increasing/dec reasing channel 2 intensit i es.
3
TEN noise requires an additional license for the AC440. If not purchased, the stimulus is not available.
Affinity
Stimuli buttons will light up when hoveri ng the mouse over it . This indicates
Freque ncy a nd I ntensity display area shows what is current ly pres ented.
Frequency increase/decrease i ncreases and decreases t he frequenc y
Storing thresholds fo r c hannel 1 is done by pressi ng S or by a left mouse
The hardware indication picture indi cat es whet her t he hardware is
The Examiner indi cates the current cl ini cian who i s testi ng t he patient. The
on t he protocol s electi on l i st).
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the pres entati on of a sti m ulus.
A right mous e c l i c k in the Stimul i area will store a no response t hreshold. A
left mous e click in the Sti m uli area will s tore the t hres hol d at the current
position.
Channel 1 s timul ation c an al s o be obt ai ned by pressi ng the space bar or
left Ctrl key on the PC k eyboard.
Channel 2 s t i m ul ation c an al so be obtained by pres sing the right Ct rl k ey on
the P C keyboard.
Mous e movem ents i n t he St imuli area for both channel 1 and channel 2 can
ignored dependi ng on t he setup.
To t he left t he dB HL value for channel 1 is shown and to the right for
channel 2 In the centre the frequency is displayed.
Notice that the dB di al setting will flash when try i ng t o go louder than t he
max imum available intensity.
The patient response indi cator will appear i nbetween t hese values when the
pati ent respons e butt on is depres sed. The colour of t his indi cat or will
depend upon which patient response side is used, a red l i ght i ndi cates the
right pat i ent response and a bl ue li ght i ndi cates t he l eft pat i ent res ponse.
respec ti vely . This c an al so be obtained usi ng t he l eft and right arrow key s
on t he PC key board.
cl i ck in the at tenuator of channel 1. St ori ng a no response threshold can be
done by press i ng N or by a right m ouse c l i ck in the stimuli button of channel
1.
Storing thresholds for channel 2 i s available when channel 2 is not the
mas king c hannel . It i s done by pres sing <Shift> S or by a l eft mouse click
in t he stim ul i button of channel 2. Storing a no res ponse t hreshold can be
done by press i ng <Shift> N or by a right mouse cl i ck in the at tenuator of
channel 2.
connected. Simulation mode is indicated when operating the software
without hardware.
W hen opening the S ui t e the system will automat i cally search for the
hardware. If it does not detec t the hardware a dialog box pops up and asks
if you want to cont inue in s imul ation mode.
exam i ner is saved wi t h a s essi on and c an be printed with the resul t s. This
information is taken from the l ogi n on the dat abase from whic h the S ui t e i s
launc hed, or t he s ui te can be c onfigured i n the ‘General Sui t e S et tings ’ to
request an exam iner name on s tart-up.
For each exam i ner, t he S ui te stores how it is set up with regards to the use
of space i n t he screen. The ex am i ner will find that the sui te st arts up l ooking
the same as it di d t he last tim e t hey used the software. Also the examiner
can select which prot ocol mus t be s el ected at start up (by right mous e c l i ck
Affinity
Input levels sl i ders al l ow for adjus ting the input l evel to 0 VU for t he
WR1, WR2 and WR3 (Word Recognition) all ows s el ecti ng di fferent speech
The Output l i s t for c hannel 1 provi des t he opt i on t o t est through head
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1.3 The Speech Screen Elem ent s
The following s ect ion desc ribes the elements of the speech s creen i n addit ion t o t he t one sc reen:
sel ect ed input . This ensures that correct calibrat i on is obtained for M i c1,
Mi c2, CD1, and CD2.On t he V U M eter the dial int ensit y i s achi eved when
the signal is at t he 0 m ark.
list set ups as defined by the sel ec ted prot ocol. The labels of t hese list s
whic h go along with t hese buttons c an al s o be c ustom i zed in the protocol
setup. (See sec tion
1.7.2.3).
phones, bone conduc tor, free field s peakers or ins ert phones. Note t hat the
system only s hows the cal i brat ed t rans ducers.
The Input li st for c hannel 1 provides t he option to sel ect white noi s e (WN),
speech noi se (SN), mi crophone 1 or 2 (Mic1 and M ic2), CD1, CD2 and
wave file.
Note that the background s hadi ng of t he s peech A udiogram is according to
the side that is sel ect ed, red for ri ght and blue for left.
Affinity
The Output l i s t for c hannel 2 provi des t he opt i on t o t est through head
Speech Scoring:
a) Correct: A mouse cl i ck on this button will s t ore the word as correct l y
Phoneme sc oring:
a) Phoneme sc oring: If phonem e sc oring i s sel ected i n t he AC440
own arrow keys will score as
Freque ncy a nd I ntensity display shows what is current l y presented. On
monit ors t he num ber of words pres ented during the tes t.
a b c
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Additional I nforma tion Page 11
phones, free field s peakers , i nsert phones or insert m ask ing phone. Not e
that the system only s hows the cal i brat ed transducers.
The Input list for channel 2 provides the opti on to selec t whi te noi se (W N),
speec h nois e (S N), mic rophone (M ic1 and Mic 2), CD1, CD2 and wave file.
Note that the background s hadi ng is according to the s i de that i s sel ec ted,
red for right, blue for left, and white when off.
Shuffled Wave file Test ing
repeated. The left arrow key can al so be used for storing as c orrect.
b) Incorrect: A mouse c l i ck on this butt on wil l s tore t he word as
inc orrec tly repeat ed. The ri ght arrow key can als o be us ed t o score as
incorrect.
c) Store: A mouse click on this butt on wil l s tore t he speech t hres hol d in
the speech graph. A point c an al s o be s tored by pres sing S.
setup, m ous e c l i ck on the c orres pondi ng number t o i ndi cate phoneme
score. Clicking on the Up arrow and the D
correc t and incorrec t, respec tively.
b) Store: A mouse c lic k on this but ton wil l st ore the speec h threshol d in
the speech graph. A point c an al so be stored by pressi ng S.
the l eft t he dB value for c hannel 1 is shown and on the right side for
channel 2.
In the centre of the current Speech S core in % and the W ord Count er
1) By clicki ng on t he ‘Shuffle’ ic on you can randomize the order of the
wave fil es for speech test present at i on
2) Re-cli c king on the ‘shuffle’ ic on wi l l al low y ou t o revert bac k to the
non-randomized material
3) When l ooking t hrough the mat erial y ou c an quick ly see which list has
been random ized by the highl i ghted Randomi ze but ton and if t he
feature i s on then the l i st will be randomized when the list is selected.
Affinity
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This feature gives much more flexi bilit y and cont rol when S peech t est ing. This feature is al so
implement ed in ot her areas of the software where we are using s peech wave files, for example in t he
SIN and SIQ t est s.
There i s a setting wit hi n the protocol configuration t o enabl e thi s feature t o be defaulted on
Affinity
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1.3.1 Spe ech Audiometry i n Gra ph Mode
Graph m ode presentati on set tings i n the lower left corner and in the presentat i on opti ons (Ch1 and Ch2) i n
the upper part of t he screen y ou can adjus t the t est parameters during the t est.
1) The graph: The c urves of the recorded speech graph will be dis played on y our s creen.
The x-axis shows the int ensity of the speech si gnal and the y-axis shows the percentage s core.
The score is als o dis pl ayed i n t he bl ack di splay i n t he upper part of the screen along wit h a word
counter.
2) The norm curv es il lus trate norm values for S (Single syllabi c) and M (Multi s yllabi c) speech m at eri al
respectively. The curves can be edit ed acc ording to the normat i ve data you wish t o use in t he AC440
setup (s ee sec tion
1.7.2.3)
3) The s haded area ill ustrat es how high in intensi t y the system will al l ow. The Extended Range +20 dB
butt on can be press ed to go higher. The max imal l oudness is det ermined by t he trans ducer
calibration.
Affinity
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1.3.1.1 Dual Speech Graphs
The graphs can be s hown as a dual audiogram to show l eft and right (s ee ex ample bel ow) this can be
enabled i n the S peech Set up S creen by cl i cki ng on t he button c al led ‘ Dual Graph’.
1.3.1.2 50% Discrimination Line
The Graph View al l ows y ou to add a 50% di scri m i nat i on li ne (s ee above dual audiogram im age for example).
This is enabled by checking on the ‘ Show 50% Dis c riminat ion Line’ s ett ing in t he Speec h Norm Curves s etup
(see i mage below).
Affinity
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1.3.1.3 Bönninghaus & Röser calculation
The Bönninghaus & Röser calculation has been implemented for t he Germ an mark et.
This is a marker to recognise t he accurac y of the tes t in relat i on t o t he patient s audi om etry and al so to
ident ify when the patient is s uitabl e for compens ation/ ins urance.
Set tings i n t he speech s etup need B önni nghaus and SRT enabled in order to show this score.
The score will appear as WR weighted (see ex am pl e below).
NOTE: The Bönni nghaus & Rös er Calc ulat ion is int ended for use wi th the Freiburger S peech Test and the
Freiburger Speec h Norm Curves.
Affinity
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1.3.2 Speech A udiometry in Table Mode
The AC440 Table Mode c onsis ts of two tabl es:
1) The SRT (Speech Reception Threshol d) t abl e. When the SRT test is active, i t i s indicated in orange
2) The WR (W ord Recogni t i on) tabl e. When WR1, W R2, or WR3 is acti ve t he corresponding l abel wi l l be
orange
1.3.2.1 The SR T table
The SRT tabl e (Speech Reception Threshold t able) all ows for measuri ng m ulti ple SRTs us ing different t est
parameters, e.g. Trans ducer, T est Type, Int ensit y, Mask i ng, and Aided.
Upon changing Transducer, Mask ing, and/or Aided and re-tes ting, an additional SRT entry will appear in the
SRT table. This all ows for mul tiple SRT m easurement s to be s hown in the SRT table.
Please refer to section 1.6.5.1 for more informat ion about S RT t est ing.
Affinity
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1.3.2.2 The WR Table
The word recogni tion (W R) t able all ows for meas uring m ulti ple W R s cores us ing different parameters (e.g.
Trans duc er, Test T ype, Intensi t y, Mas ki ng, Binaural and Aided).
Upon c hanging Transduc er, M ask ing, Binaural and/or Aided re-t esti ng an addit i onal W R entry wil l appear i n
the WR tabl e. This al l ows for m ul tiple WR measurem ent s to be shown in the WR table.
Please refer to section 1.6.5.2 for more informat ion about W ord Recognition testing.
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1.4 Bi naural speech
It is only possible t o test Speech binaurall y in the Speec h audiomet ry s creen. This can be done if channel 1
and channel 2 are using the same air conduc tion t ransduc er and onl y when a different out put is chos en. E .g.
right ear i n c hannel 1 and left ear in channel 2 or vic e vers a.
W hen the binaural m ode is ac ti vat ed
see bel ow:
in graph mode the stored symbol wi ll be s hown as a “B”
W hen the binaural m ode is ac ti vat ed
in table both res ul ts wi ll be stored even if the level is
different. Thi s m eans when thi s is stored i t wi l l store the channel 2 level and di splay the result s as well as
channel 1. See below:
In ‘Binaural mode’ t he Pure Tone A verage (P TA) c alc ulati ons will be calc ulated m onaurally only , al though
the value will be di splay ed above eac h Audiogram.
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1.5 Full 2(4) channel Speech in noise
The ability to test via Ful l 2(4) Channel Speech i n noi s e all ows t he abi l i t y to t est whils t st i m ul ating s peech
and noi se i n both channel s at the s ame tim e.
If the R+ L is c hosen in c hannel 1 the l evel presented i n Channel 1 will be equal in bot h Left and right
trans ducer at the sam e time and vi ce versa. W hen this i s enabled the Audiograms wil l both be coloured grey .
Channel 1 s erves as the stimul us i n this i nstanc e and c hannel 2 serves as the m aski ng. This wil l be
present ed to both ears si m ul t aneously , therefore alteration of frequency or int ensit y is applied bi naural l y.
W hen the R+ L i s activated
If it is used in s peech mode it wi l l be stored equally to the bi naural mode, as ment i oned above.
the s tored sym bol wi l l be shown as a “B ”. See bel ow:
W hen the R+ L i s activated
stored even if t he l evel is different. This resul ts i n s econd c hannel dat a being st ored at t he same t i m e.
The t able s creen i s s plit up in t wo which m eans the trans ducer and t he st ored level i s shown for c hannel 1
first and t hen channel 2. See below:
in the speech s ecti on and di splay ed via t he tabl e m ode both resul ts wi ll be
Affinity
Bi naural Stimul us Intensi ty
Bi naural Maski ng Intensit y
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Channel 1 Channel 2
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1.6 Counselling Ta b
Under t he m enu ic on there is a tab titl ed c ounsl ling. Thi s is where t he couns elli ng features of
the software are cont ai ned.
1.6.1 Sound Studio
The SoundS t udi o is a counselli ng tool whi ch al lows you to rec reat e s ound environments t o simul ate
real-life si tuati ons for use during hearing ai d fit ting and c ouns elling.
To fi nd this pleas e go to the M enu ic on in the top l eft corner and s elec t Counselli ng.
For more informat ion regarding t he S oundSt udio, pleas e
Affinity
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1.7 Clinic a l Ap plica tio n o f the A C440 Tests
This s ect ion will give a short i ntroduc tion t o t he cl inic al appl icat ions of the AC440 modul e. The m ethods
desc ribed here primaril y bas ed on the text books by St ach (1998) and K atz (2002) and desc ribes one way of
performing the individual tes ts. Other s tandards may, however, dict ate other procedures .
Air Conduction Audiome try
In ai r c onducti on audiometry, a tes t signal is presented to the tes t subj ect via headphones or i nsert phones.
The tes t subjec t responds to the s i gnal by pressing a pati ent res ponse butt on. The audiometric threshold is
defined as the l owes t int ens i ty at which the pat i ent is abl e to detec t the test signal 50% of t he time
The purpose of air-c onducti on audiometry is to est abl i sh the hearing sens i t i vity at vari ous frequencies. The
test provides information about the conducti ve and s ensory system s of hearing but cannot dis tinguis h
between conductive and sensorineural hearing losses.
Require d I te m s:
• The Affinity
• Licensed AC440 Audiometry modul e within y our Affinity
• Headphones or insert phones
• A res ponse button
Test Procedure :
1) Open t he Affinit y Sui t e through y our pati ent managem ent sy st em, Noah or O t oAccess™.
2) E nsure you are i n the A UD modul e of the Suite and i f needed selec t a tes t protocol in t he List of
Protocols.
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hardware
2.0
hardware
3) P erform otoscopy to m ake sure that any anat om i cal abnormali t i es are taken into account and that
cerum en is not obs truct i ng the ear c anal . P erform a medical hi story to find out whet her there are any
confounding fact ors whic h may prevent you from performing the test or make considerat i ons for. It is
als o good to ask i f t he pat i ent i s experienc i ng ti nni t us . If yes , y ou m ay cons ider doing the t est usi ng
warble tones or narrow band noi se inst ead of pure tones whic h can be hard to di st inguis h from t he
ti nni t us at some frequenci es.
4) S el ect the input and output for channel 1.
If ma sk i ng i s needed, use the channel 2 to determine mas ki ng level and frequency . Note t hat this
deci sion i s us ually m ade after performi ng an unmas ked audi ogram bas ed on differences in thresholds.
Channel 2 s hould be muted or switc hed off in the beginning of the eval uation. If preferred, Aut o
Masking or M aski ng Hel p can be t urned on.
Affinity
2.0
Additional I nforma tion Page 23
These features are intended to hel p t he inex peri enced c l i ni cian when m aski ng i s required. P l ease see
section 1.7.2.2 and Appendix 4 for more informat ion on t his .
5) Explain to the pat i ent t hat they wil l hear a number of different tones through t he headphones and that
they should press on the response button whenever the tone is audible, even if it is ve r y fain t..
6) P lac e t he headphones over t he pat ient ’s ears and begi n t he audi ometry tes t. If one ear is as sum ed to
have worse hearing c om pared to t he other, start t he audi om et ry on t he better ear. If the heari ng level
is as sum ed to be equal on bot h ears, start on the right.
7) Us e the arrow buttons on the PC k eyboard or t he audiometer keyboard t o set t he frequenc y and
int ensity. You may al s o choose Mouse controlled audi om e try
t o do the audiomet ry us ing only
the mouse. Left click to stimulate and right click to store the threshold.
8) B egi n t he t esti ng at 1000 Hz at an intensi t y whic h you think t he patient should hear. A normal s tart
level would be approx imat ely 40 dB for a person as sum ed to have norm al hearing and 30 dB above
presumed threshold if hearing loss i s present . However, the s t art int ens i ty should never exc eed 70-80
dB.
9) P resent the sti m ul us for approx i m at el y 2 seconds and wait for the pat i ent t o respond. The St i m ul i area
will li ght up whil e pres ent i ng, visuall y indi cati ng that the s timul us is presented. T he stimuli can be
present ed three way s :
a. Pres sing on the space bar
b. Hovering t he m ouse over the St i m ul i button
c. Using the sti m uli button on the Audiometry keyboard (additional accessory)
10) If no reac ti on is obt ained, increase the i ntensi t y by 10dB s teps until the pati ent responds. If t he pat i ent
has a severe hearing los s you m ay want to press the Extended Range +20 dB button
, which
allows act ivat ion above a 55 dBHL int ensit y of c ompati ble trans ducers .
11) You may now begin the threshol d search usi ng the Hughson West l ake procedure, k nown as the “10
down, 5 up” method: P resent the stim uli. If t he pati ent hears it , decreas e by 10 dB . If the patient does
not hear it , increase by 5 dB. The threshold is set at the intensity where the patient is able t o perceive
the t one 50% of the t i m e during the ascendi ng port ion of the threshold s earch (when inc reasing by 5
dB). Typically, the tone s hould be heard 2 out of 3 t i m es to be consi dered the t hreshold. .
12) In c ase of m i s takes during the test you c an right click on the threshold which wil l prom pt a menu wit h
edit opt i ons: Add unmaske d threshold, Add no response, Add masked threshold, Add masked-
no response threshold, Copy bone thresholds to other ear, Delet e thr esho l d , Del et e cur ve and
Hide unm a sked thresholds wher e mask ed exist .
13) If t he di fference between the two ears exceeds 40 dB (55 dB i f using insert phones) t here will be a ris k
of cross hearing (e.g. the good ear is responding to t he t one pres ented to the worse ear). In this c ase
you m ay consider retes ting the worse ear whi l e mas king t he better ear. Mas king c an be ac tivated
usi ng the Ch2 input and output dropdown list s i n t he upper part of t he s creen.
14) If y ou have other audi ograms on the patient saved in Noah or Ot oAc ces s™ y ou c an com pare the new
audiogram to a previ ous one using t he s essi on l ist. This i s done by usi ng the c heckboxes of the
his toric sessions that you like to overlay.
15) To s ave the audi ogram press Save
or Sav e an d Exit .
Affinity
2.0
Additional I nforma tion Page 24
1.7.1 High Freque ncy Audiom etry4
High frequency audiometry (above 8 kHz) i s performed using t he s am e procedure as normal ai r conduct i on
audiometry. Note, however, t hat you are only al l owed to t est within t he range of t he headset cal i bration That
is, if t he headset is onl y calibrat ed for a range of 125 Hz – 8 kHz you will not be allowed to pres ent t ones at
higher frequencies .
High frequency audiometry is helpful when testing hearing impairments caused by ototoxicity, noise
exposure and acousti c traumas as these m ai nl y affect the hi gh frequencies. This frequency area i s more
sus cepti bl e t o the effect s of ex ternal fac t ors such as m edi cati ons and loud nois es than the l ow and m i ddl e
frequencies.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware wit h High Frequency functi onality
• A calibrated hi gh frequency audiom etric headset (Koss R/80 or HDA200)
• A res ponse button
Test Procedure :
1) Open t he AC440 modul e t hrough your pat ient m anagement s ys tem, Noah or Ot oA ccess™ .
2) If needed s el ect a t est protocol in the Protocols and sessions
3) To perform a hi gh frequency audiom et ry, press the HF button
or HFz button in the front
screen.
4) Conduct high frequenc y audi ometry usi ng t he normal air c onducti on audiom et ry m et hod (s ee sec ti on
1.6 above for details), ensuring that you are us i ng proper headsets. The following headsets are
available:
4
Kos s R/ 80 can be calibrat ed for 8 kHz t o 20 k Hz
HDA 200 c an be c alibrat ed for 125 Hz to 20 kHz
4
Koss R/80 is only available for the Affinity
2.0
/Equinox
2.0
Affinity
2.0
Additional I nforma tion Page 25
1.7.2 Multi Fre que ncy Audiome try5
Multi frequency audiom et ry lets the clinician test more frequencies than the traditional audiometric test
frequencies. This m ay be useful when deal ing wit h st eeply slopi ng hearing i mpairment s as it becom es
possible to obtain a more preci se meas ure of the slope of the hearing loss . It is al s o hel pful in t he evaluation
of t i nni tus as is provides the opti on to m atch the tinni tus.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware wit h Mult i Frequenc y funct ionalit y
• Headphones or Insert phones
• A patient response button
Note: If doing Multi Frequenc y t esti ng i n the high frequenc i es (8-20 kHz) a high frequency heads et must be
used.
Test Procedure :
1) Open t he Affinity Suite through y our pati ent managem ent sy st em, Noah or OtoAccess™.
2) S el ect the AUD Tab and If needed s elect a prot ocol from the List of Protocols.
3) To perform a m ul ti frequency audiom et ry, cl i ck the MF button
in the front screen. You m ay want t o
check that t he m ul ti frequency s et tings are in ac cordance wit h y our preference in the AC440 set up
(see s ect ion 1.7.2.2).
4) Conduc t high frequenc y audiomet ry us ing the normal air conduct ion audiom etry m ethod (see s ect ion
1.6 above for details). The cursor will jum p i n small frequenc y s t eps during the test providing you with
mult iple t hreshol ds and a detailed c urve.
Note: Evaluation of ti nni tus can be used for both t he purpose of identifying the nature of the s ound the
pati ent is ex perienc ing and the purpos e of mask ing the sound. Instruc t the pat ient that y ou wil l now try t o
reproduce the exac t sound that they are experienc i ng as precis ely as possi bl e. St art by finding the frequency
and subs equentl y finding t he ampli tude usi ng 5 dB s teps . This way the pat ient only needs t o c oncent rate on
one thi ng at the t ime. A fter replic ati ng t he t innit us, present a noi se (NB) t o t he ear where t he s ound is
experi enced. Increase t he noise i n 5 dB steps unti l t he patient cl ai m s that the tinnit us is mas ked (Niels en &
Carver 1997).
5
M ulti frequency audiom etry is only available on the Affinity
purchased, the button is greyed out.
2.0
/Equinox
2.0
. The test requires an additi onal feature for the AC440. I f not
Affinity
2.0
Additional I nforma tion Page 26
1.7.3 Bone Conduction Audiometry
In bone conduction audiometry, the test signal i s presented by a bone vi brator plac ed on t he mastoid. The
bone vibrator uses the skul l to transfer the vibrations to the cochl ear and bypasses t he outer and mi ddl e
ears. B one conduc tion t hreshol ds thereby provide a meas ure of the coc hlear and retroc ochl ear function
regardles s of the outer and m iddle ear funct ion, t herefore it allows y ou t o di sti ngui sh between conduc tive,
sensorineural and mixed hearing thresholds detected through Air conduction Audiometry. The difference
whic h is det ect ed between the bone and air c onduc tion is cal l ed t he air-bone gap. It i s recom m ended to s t art
a hearing assessm ent first with ai r-conduction measurements , followed by bone conduction measurements.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• A calibrated bone c onduct or (B81)
• A patient response button
Test Procedure :
1) Open t he AC440 modul e t hrough Noah or Ot oAc ces s™ .
2) If needed s el ect a t est protocol in the List of Protocols.
3) P rior to bone conduc tion audi ometry, perform the Air c onducti on audiometry, as descri bed in s ection
0.
4) P l ace the bone conductor on the mas toid of the worst ear and c hoose B one Right or B one Left from
the channel 1 output dropdown l is t, and sel ect t he desired tes t signal (t ypic al l y Tone). In the channel
2 input and output dropdown lis ts y ou can dec ide whet her or not mas king is to be em ployed. If s o you
will need to place the headset on the pati ent as well .
Conduct high frequency audiom etry using t he norm al air c onduct ion audiom etry m ethod (s ee sec tion 0
above for details).
Note: W i thout appropriate maski ng appl i ed where nec essary y ou cannot know whi c h c ochlea is responding,
as there is a l w a ys no int eraural at tenuat ion in bone c onduct ion audiomet ry. W e will al way s assum e that it i s
the better ear t hat is res ponding. In the c ase of asy mmet rical hearing loss es, bone conduc ti on m ask ing
shoul d always be c ons idered.
Affinity
2.0
Additional I nforma tion Page 27
1.7.4 Masking
In cas es where a sy mmet rical hearing los s i s detec ted, tradit ional audiom etry without mask ing is usually
suffic ient. However, be aware t hat in c ases of as ymm etrical hearing loss , one c annot be c ertain that the test
ear is t he one act ually det ect ing the s ound. For exam ple, when m easuring an audi ogram on a patient wit h
hearing wi t hi n t he normal range on one ear but a moderate to severe hearing los s on the other, there is a
potent ial ris k that the bett er ear is the one responding, even if it i s not t he ear being tes ted. That is because
the sound vibrat ion may travel through the head and be heard by the oppos it e ear when the vibrat ions of t he
si gnal are of s uffic ient magni tude. Therefore, you are act ually m easuring t he thresholds from the wrong ear.
To prevent t hi s phenomenon in c ausing an erroneous m easurement , maski ng noi se can be used to occupy
the better ear (non-tes t ear) while t est ing the ot her one (St ach 1998, Katz 2002 and Brit is h S ociet y of
Audi ology 2004). M aski ng can be appl i ed to air conduction, bone conduction and s peech audiometry. The
need to mask the bett er hearing ear i s link ed to the interaural att enuati on whic h equals the amount of
attenuation the s ound is exposed to on its way through the skull. Even though the interaural attenuation is
very individual and varies with frequency it can, on average be esti m ated to a m i nim um of 40 dB for supraaural headphones and 55 dB for i nserts. Regarding bone conducti on, t he i nt eraural att enuation i s a mini m um
of 0 dB whic h means that c ross ing over of t he st imul us may oc cur all t he tim e.
Require d I te m s:
• The Affinit y hardware
2.0
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
• Calibrated Headphones or insert phones
• A calibrated bone c onduct or (B81)
• A patient response button
Test Procedure :
1) Open t he AC440 modul e t hrough Noah or Ot oAc ces s™ .
2) S el ect a test protoc ol in t he list of Prot ocols and ses sions if needed.
3) Perform the Ai r c onducti on audiometry as described in sect i on 1.6.
4) Perform B one conduc tion audi ometry as described in section 1.6.3
5) If the difference between the air conduc tion t hreshold of t he wors e ear and t he bone c onduct ion
thres hol d of the better ear exc eeds 10 dB , masking is needed.
Affinity
2.0
Additional I nforma tion Page 28
There are many ways of apply i ng cl i ni cal maski ng. Whi ch method to use is your deci sion. Regardl ess of the
mas king method channel 2 i s used to occupy the better ear. In t he exampl e above channel 2 should be s et
to Right (non-tes t ear) us ing the preferred mas ki ng st imulus preferred (usuall y Narrowband NB). Ensure that
Rev is tic k ed mak i ng the m aski ng noise cont i nuous. Channel 1 should be set to Left (test ear) usi ng t he
preferred stimulus (usually Tone). You c an set t he m aski ng and tone level us i ng the buttons on t he screen,
the P C keyboard, or the dedicated keyboard. W hi l e t rying t o establi sh the true threshol d of the l eft ear the
right ear i s now dis trac ted wit h noi se.
W hen storing a threshold while the m as king is enabled, the used m aski ng l evel is st ored i n the m aski ng table
under the ear that is being tested. The terms ‘E ffective maski ng’ i n this situation refers to t he narrow band
nois e level that was loud enough to effectively mask a pure tone of the indicated level heard by the
unmas ked ear.
1.7.5 Speech Audiometry
Mos t people acquire hearing ai ds because they or thei r rel at i ves report t hat they have trouble hearing
speech. S peech audi om etry has t he advantage of uti l i sing speech signals and i s used to quantify the
pati ent ’ s abili ty t o understand everyday comm unicati on. It ex am i nes the pati ent’s proc essi ng abil i t y in
relat ion to their degree and ty pe of hearing loss whi ch can vary greatly between pati ents with the same
hearing l oss configuration.
Speec h audiomet ry can be performed using a number of test s. F or exampl e, SRT (Speech Reception
Threshol d) refers t o the level at whi ch t he patient can repeat 50% of the pres ented words correc tly . It serves
as a confirmation of the pure tone audiogram , gives an i ndex of hearing sensi tivit y for speech and hel ps
determ ine t he s tarti ng point for other supra-thres hol d measures s uch as WR (Word Recognit i on). WR is
som etimes als o referred to as SDS (Speech Discrimination Sc ores) and repres ents t he num ber of words
correctly repeated, then ex pressed as a perc entage.
Note t hat there is a predict able relations hip between the pat ient ’s pure tone t hreshold and s peech reception
thres hol d. S peech audi om et ry m ay therefore be us eful as a cross-chec k of the pure t one audiogram.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• Headphones, insert phones, or free field s peak ers
• A m i c rophone, CD pl ayer or wave files
Test Procedure :
Before performing the speech audi om etry you m ay wis h to complete t one audiometry. This provides valuable
predic t i ve informati on us eful in the speech t esting. Furthermore, the PTA level (Pure Tone Average) gives
you a bas is for cal culat ing t he s tart ing point for speec h tes ti ng.
1) Open t he AC440 module i n t he Affinity S uite through y our patient managem ent s oft ware, Noah or
OtoAccess™
2) Go t o s peec h test ing by press ing t he Sp eec h S creen button
3) If needed s el ect a t est protocol in the List of Protocols.
4) S el ect the input and output sti m ul i and int ensity levels for channel 1.
If maski ng i s needed, configure channel 2 also.
5) E xplain to the pati ent that he/she will now hear s om e words/num bers /sent ences though the ear
phones/free field speakers. Inst ruct him /her t o repeat what is said even though i t m ay be very faint.
Pat i ents m ay als o be enc ouraged to guess if they are unsure about the word/ num ber/sentence. If
performing the s peech test in noi se do not forget t o i nstruc t the pati ent not to foc us on t he noi se but on
the speech.
6) S tart pres enting the words, numbers, or sent ences . Depending on t he s etup for speec h tes ti ng (s ee
section 1.7.2.3) the tes t c an be s cored us ing the following butt ons:
Affinity
Mode (s ee sec tion 1.7.2.3). This s creen shot shows graph mode.
The speech score wi l l be display ed in t he bl ack bar:
2.0
Additional I nforma tion Page 29
Correct, I ncorrect, a nd S tore
Number of correct Phoneme s a nd Store
Note: The AC440 S etup all ows for s elect ing whether t he s peec h test is t o be performed i n Graph or Table
In case of m i stakes during t he test you can right cl i ck on the t hreshol d which wil l prom pt a m enu with edit
opti ons. B esides delet ing si ngle thres holds or whole curves it al so provides the option t o Add no re sponse,
Add m a sked threshol d and Add ma ske d-no response thre shold.
Note: If performing s peec h audiomet ry in free field and c alibrat ion is done at one l ocat ion, please be aware
that free field calibrat i on values are li kely to be incorrect at other l oc ations because of acous tic al
ci rcums tanc es. The differences c an easil y differ up to 10 dB.
Affinity
2.0
Additional I nforma tion Page 30
1.7.5.1 Speec h Receptio n Threshol d (SRT) in Table Mode
The SRT exam ines at whic h level 50% of the speec h mat erial (usual ly num bers or s pondaic words ) i s
repeated correctly. The SRT can be used as a cros s c heck of t he ai r c onduct ion audiomet ry and s hould
closely agree with the PT A (Pure Tone Average). The P TA can be calc ulated in different ways but is us ually
the average of thres holds obtained at 500, 1000, 2000 and 4000 Hz . It is general l y accept ed t hat i f the P TA
and t he SRT i s withi n ± 6 dB of each other t he accordanc e is good, i f it i s ±7 to 12 dB i t is adequate, and i f it
±13 or more it is poor.
1) Perform air and b one c onduct ion audiom etry as described in s ection 0 and 1.6.3 i n order to obt ain the
PTA.
2) Open t he Sp eech Screen
3) E nsure t hat the SRT t est i s ac tive. This is shown by t he SRT label being orange
4) Choos e the i nput for channel 1 (mi c rophone, CD, or wave file). In case of wave fil es, c heck if t he
preferred m aterial , and wordlis t are s elec ted.
Note: In case of microphone/CD the s peech mat erial c an be c ali brated by speaki ng int o the
mic rophone/pl aying the c alibrat ion trac k. A djus t the corres ponding arrow keys to 0 VU (s ee det ai l s in s ec tion
1.6.5).
5) S tart with the bett er heari ng ear ac cording to the audi ogram and s et the i ntensi ty to 15 dB above Pure
Tone Average.
6) B egi n pres ent i ng the speech material and reduc i ng the i ntensi ty i n 5 dB steps for every correctl y
repeated word. Use the Store button to st ore t he S RT.
7) Upon changing Transducer, Mask ing, and/ or Aided and re-t est ing an addit ional SRT entry will appear
in the S RT tabl e (s ee ill ustrat ion above). This all ows for mult iple S RT m easurement s to be s hown in
the S RT t abl e.
If the SRT i s not i n accordanc e wit h the ai r conduction threshol ds , t he ai r conduction audi ogram shoul d be
chec ked and the proc edure repeat ed (Niels en & Carver 1997; Katz 2002).
Affinity
2.0
Additional I nforma tion Page 31
1.7.5.2 Word Recognition (WR) in table mode
The W ord Rec ogniti on s core det ermines the pat ient’ s disc rimi nation abil ity express ed in a percentage. It
provides i nformat i on about what phonemes t he patient has di ffic ul t y heari ng at a part i cular i ntensi t y level.
This is helpful for c ounsell ing and rehabili tat ion purpos es. The di agnost ic value has s hown to be fairly low
but i t i s generally ac cepted that the word and s entence rec ognition are l east affect ed by c onducti ve and m ost
affected by neural loss.
There are numerous ways of performing the WR. The procedure described bel ow is a suggestion.
1) Perform air and b one conduct ion audiom etry as described in s ection 0 and 1.6.3 i n order to obt ai n
the P TA.
2) Open the Speech S c reen
3) Ensure that WR test is activ e.
In table mode, thi s is shown by t he correspondi ng WR label being orange
4) Choose the input for channel 1 (Mi c rophone, CD or wave fil e). In case of wave files, selec t the
preferred material and wordlist (see bel ow). Note t hat calibrat ion is t he sam e for SRT (s ee section
1.6.5.1 above).
5) Start in the better hearing ear accordi ng to t he audi ogram and s et the int ensity to approximately 30
or 40 dB above PTA (m inimum 55 dB). In cases where rec ruitm ent is pres ent s tart lower at about 20
dB above P TA and ask t he pat ient if the level is c omfortabl e after 2-3 words.
6) Begin pres enting t he s peech m aterial. Use the scori ng buttons to s core and s tore the resul ts . The
current s core (i n percent) will appear in t he blac k bar.
7) Upon changing Transducer, Mask ing, and/or Aided re-testing an addit ional W R entry wil l appear in
the WR tabl e. This al l ows for m ul tiple W R m easurements to be shown in the WR tabl e
8) If y ou have other speech audiograms on the pati ent s aved in Noah or OtoAc cess™ y ou can
com pare the new audiogram to a previ ous one usi ng the session li st. This i s done by usi ng t he
checkboxes of the histori c sessi ons that you like to overlay.
To s ave the audiogram press Save
or Sav e an d Exit .
Affinity
Microphone inputs
2.0
Additional I nforma tion Page 32
1.7.5.3 Speech Tes t ing with a Microphone
1) Affinity
2.0.
/Equinox
2.0
Connec t the m i crophone t o the Mic1 or Mic2 input on t he on the hardware.
2) Open t he AC440 s oftware, go t o the S peech sc reen .
3) Choose Mic1 or Mic2 in the input channel 1 list.
4) Adjust the input levels for the Mic1 or Mic2 until you reac h an average of approx i m at el y 0 dB VU on
the V U meter while speaking into the microphone at a norm al conversati on level.
5) W hen the VU meter is adj ust ed the mi crophone input i s ready for use. Perform the speec h audiometry
as descri bed in s ecti on 1.6.5.5.
Affinity
CD inputs
2.0
Additional I nforma tion Page 33
1.7.5.4 Speech Tes t ing with an external CD Player
1) Connec t t he CD player t o t he CD1 or CD2 input under t he hardware (t he below ill ust ration s hows t he
2.0
Affinity
hardware).
2) Open t he AC440 s oftware, go t o the S peech sc reen
.
3) Choose CD1 or CD2 in the channel 1 list.
4) P l ay the calibrat i on t one for your m aterial through the CD play er. Then adjust the i nput levels for t he
6
CD pl ayer until you reach an average of approxi m at el y 0 dB VU on the VU meter
. You may al so us e
the CD play er’s volume control to adjus t the V U m et er, shoul d the control i n t he Suite not be s uffici ent.
5) W hen the VU meter is adj ust ed the CD input is ready for us e. Perform t he s peech audi ometry as
described i n section 1.6.5.5.
6
This function ensures that the VU m eter is not adjusted by accident.
Affinity
2.0
Additional I nforma tion Page 34
1.7.5.5 Speech t es t ing with Wave Files7
The AC440 al so allows for tes ti ng wit h wave files if ins tal l ed on the PC. The default speec h mat erial c an be
sel ected i n t he AC440 s et up (see secti on 1.7.2.3).
1) To use wave files choose them in the channel 1 list.
2) The s peech mat eri al can be selec t ed from the four dropdown lists.
3) P lay, Stop, or Pa use t he s peech t est on t he t hree buttons on the right side.
Note: Appendi x 1 explains how to import own wave files .
4) By cli cki ng t he button indicated in t he i m age below, y ou c an random i se t he order in whic h y our
materials are presented. Note: thi s setti ng wil l be reflected when the play button i s pushed as the
word order wil l then shuffle.
Shoul d you wis h to edit your speec h sc ore after it has been ass igned y ou c an right cli ck on the word and it
will all ow you to re-score it as shown below.
This feature can be used during t est ing or aft er the t est has c ompl eted.
7
Speech audiometry with wave files requires an additional software license.
Affinity
2.0
Additional I nforma tion Page 35
5) Should you wi sh t o choose where to begin y our s peech test i ng then you can click on the designat ed
wavefile ahead of start i ng t he test. Clicking on it will highlight it wit h a bolder outli ne. The materi al will
then pl ay from her on cli ck ing the ’play ’ ic on.
Affinity
2.0
Additional I nforma tion Page 36
1.7.6 Maski n g Level D i ff er en ce ( M L D)8
Mas king Level Di fference refers t o the improvement in det ecti ng a tone or speech i n noi se when the phase
of the tone or the noise is reversed by 180 degrees . It ai m s to assess cent ral auditory funct i on and is
specific al l y sensiti ve to brai nstem lesions , but peripheral changes (like a hearing loss) m ay als o affect the
MLD.
The MLD is a low frequency phenom enon, related to the audit ory s ystem’s abi l i t y to perceive differences in
ti m i ng of a sound reaching the two ears. This helps t o l ocalize low frequenc y s ounds that reach t he ears at
different t imes due to the longer wave lengt h.
The MLD is usually referred to as t he di fference of i m provement, in dB, bet ween an “hom ophas i c” (in-phase)
condi tion and an “ant iphasi c” (out of phase) condi tion. Homophas ic m eans that both the si gnal and the
nois e are in phas e wit h eac h other when reachi ng t he two ears. A ntiphas ic m eans t hat either the signal or
the noise (not both) are out of phase wit h eac h other when reaching t he two ears. The three tes t c onditi ons
for t he MLD in the AC40 are:
• SoNo: Signal and Nois e are IN PHASE when reaching the two ears. (Hom ophasic condi tion)
• SπNo: Si gnal is OUT OF PHASE, nois e i s IN PHASE when reaching the two ears (A nt i phasic
condition)
• SoNπ: Signal is IN PHASE, nois e i s OUT OF PHASE when reac hi ng the two ears (Ant i phasic
condition)
The MLD is measured by presenting a low frequency pulsed t one wit h s imult aneous pres entat ion of the
corresponding narrow band nois e, starting at an i nt ensit i y of 60 or 65 dB dB t o both ears . The first condit i on
shoul d be to find the threshol d for the hom ophasic c ondi t i on (referred to as SoNo). The next st ep is to
meas ure t he ant iphas ic c ondit ion, either present ing the tone out of phase or the noise out of phas e and the
mas ked threshold i s determined again. If the brai nstem is func tioning normall y, there will be an im provement
in t he m asked threshold from t he hom ophasic condi t i on t o t he antiphas i c condit i on. The condit i on that will
yield the greatest MLD is the SπNo condition, that is, the condition where the signal is out of phase when
reachi ng the t wo ears but the nois e i s still in phase. .
Example: If the m ask ed thres hold for t he S oNo condit ion is 60 dB , then we revers e t he phase of the s ignal
by 180 degrees. The t hreshol d for thi s phas e reversed condit ion, call ed SπNo, improves to 44 dB. The
masking level difference from SoNo to SπNo is therefore 16 dB.
Mos t researc h t hat has been done on the MLD i ndi cates that i n general , if the MLD i s les s than 7 dB , thi s will
indicate a problem wit h t he brai nstem and bi naural int eracti on. There wi l l also be a decrease in t he heari ng
MLD i f t here is a peri pheral hearing los s or i f the hearing aid as ymmetric al . Norm al res ults for MLD i s usual l y
around 12 dB (Brown & Mus iek , Hearing Journal, Jan 2013).
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware with MLD func tional ity
• Calibrated Headphones or insert phones
• A patient response button
8
MLD requires an additional software license and is only available as an additional feature for the Affinity
2.0
/Equinox
2.0
Affinity
2.0
Additional I nforma tion Page 37
Test Procedure :
1) Open t he AC440 and ent er the MLD screen by selec ting Menu | Tests | MLD.
2) S el ect headset or i nserts i n the channel 1 output lis t.
3) Before mounting the headphones on the pat i ent, ex pl ai n to them t hat they wi l l now hear both tones
(identi cal to the ones from the air conduc tion audi ometry ) and noise t hrough t he headphones.
Em phasiz e that they should only foc us on t he tones and press the respons e but t on whenever it is
audible.
4) S el ect the frequency y ou would lik e to test; 250 Hz or 500 Hz i s a good starti ng point
5) S et the i nt ensit y level to be the sam e level in bot h ears (50, 60 or 65 dB).
6) Press START and the signal wi ll be presented to bot h ears i n phas e (SoNo c onditi on)
7) Do a mas ked threshold search. Typic al l y, the m asked threshol d for t he S oNo c ondi t i on will be equal to
the noi se l evel. When you have establ i shed a t hreshold, cl i ck in the Stim ul i area for Store or pres s S
on t he PC key board. Once t he SoNo condit ion has been stored, t he curs or wi ll aut omati call y jump to
the SπNo condition., in which t he signal i s out of phase and the noi se i s sti l l in phase. Note that
frequency adj ust ments als o c an be performed manuall y (s ee illus trat ion)
8) Leaving t he intens ity of the noi se at the s am e l evel, perform a thres hold again, pres s Store, and the
cursor wi l l s wi tch t o SoNπ. Where the s i gnal is in phas e and the noi se in reversed phas e.
9) E stabl i sh the t hreshold once more.
10) Press STOP to end t he t est.
11) The MLD will be t he di fferenc e bet ween t he t hreshol d of t he t he hom ophasic condit ion (SoNo) and the
threshold of one of the antephasic conditions (SoNπ or SπNo)
12) Save the M LD t es t by clicki ng Save
Note: In the setup for MLD (see s ect ion 1.7.2.4) you can choose whether you woul d like MLD to be
calculated using SoNo minus SoNπ or SoNo minus SπNo.
Affinity
Sel ec t Fil t ers
2.0
Additional I nforma tion Page 38
1.7.7 Master Hearing Aid (MHA)9
MHA i s a hearing ai d fit t i ng procedure c onsis t i ng of three hearing ai d s i m ul at ed hi gh pas s filters of -6 dB, -12
dB, -18 dB per octave and a HFE filt er (High Frequenc y E mphas is) equi valent to -24 dB per oct ave through
the audiometric headphones. This gives a rough sens e of the benefits of a hearing aid and what could
event ual l y be gained by get ting properly fitted hearing aids. The filt ers can be act i vated i ndi vidually on bot h
channel s enabl ing t he audiometer t o serve as a 2 channel m aster hearing aid.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware with MHA func tionali t y
• Headphones or insert phones
10
• A m i c rophone, CD pl ayer
or wave files
Test Procedure :
W hen havi ng performed the hearing as sessment you may want to start discussi ng a possi bl e hearing aid
sol ution. However, there i s no guarantee that the pat i ent i s posi t i ve t owards s uc h a solut i on. He/s he mi ght
not even have acknowledged their hearing impairment and may therefore not be motivated or prepared for
thi s prospec t. In this s it uation M HA may be useful.
1) Open t he AC440 and ent er the MHA screen by selecting Menu | Te sts | MHA.
2) S el ect headphones or inserts i n the channel 1 output l ist .
3) Select CD, Mi cr ophone or Wavefile in the channel 1 input list.
4) In this exampl e the s i m ul at i on start s in t he -12 dB filter. It may, however, be adv isable to start in Lin
5) B efore mounting the headsets on t he patient describe to t hem t hat this tool can give an impres sion of
9
10
If using CD press play on the CD player, and if us ing wave files you can Browse and play t hem i n t he
bott om of t he sc reen.
(no filtering) as listi ng t o the input signal wit h one’ s own hearing for a moment is l i kely to have a s trong
effect when having to compare wi th the filt ered input. The procedure is, however, up t o you and t he
defaults can be set up in t he AC440 s etup (s ee section 1.7.2.5).
M H A requires an additional software license
MHA using a CD player is only available on the Affinity
2.0
/Equinox
2.0
Affinity
6) The s el ected M HA fil t er c an be vi sualized i n t he graph. Toggle bet ween the filters and see the effect .
7) During the simul ation i t i s possible to adjus t the vol um e of t he s i gnal using the dB HL
2.0
Additional I nforma tion Page 39
what a hearing ai d mi ght sound like. P erhaps l et hi m or her listen to the signal with their natural
hearing as it is (without mani pulating the sound). E x pl ai n that t hey are now listeni ng to the CD, wave
fil e or live voi ce with their own natural heari ng. In a m i nute, t hough, t he sound wil l be c hanged trying to
give t hem an im pressi on of what it could sound li k e i f t hey acqui red hearing ai ds. Not e that it may, be
necessary t o point out t hat a hearing ai d wil l sound even bett er than what t hey are about to hear whic h
is an approx imat ion. A hearing aid will be fit ted more ac curat ely bas ed on the individual hearing l oss .
The MHA i s m eant t o gi ve them an idea as to how the ampli ficati on can provide them much more
audibili ty and thereby improve t heir qualit y of life signific antl y.
Decrease/Increase channel 1/channel 2 buttons.
Affinity
2.0
Additional I nforma tion Page 40
1.7.8 Hearing Loss Simulation (H LS)11
The HLS offers a s i m ulation of t he heari ng loss through t he audi om et ri c headphones or t he hi gh frequency
headset and is prim arily ai med at t he family m embers of the heari ng i mpaired. It is a valuabl e tool as a
hearing l oss i n m any famili es m ay result in frust rations and m i sunderst andi ngs. Knowing what the heari ng
los s ac tuall y sounds l ike gives an i mpress ion of what t he hearing im paired goes t hrough every day.
Require d I tems:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
Hardware
2.0
hardware with HLS func tionali t y
• Headphones or a free field s peaker
12
• A m i c rophone, CD pl ayer
, or wave fi l es
Test Procedure :
1) Open t he AC440. To perform the HLS couns ell ing, an audiogram i s needed. Y ou should t herefore
start by performing Air Conduc tion Audiomet ry (as desc ribed in sect ion 1.6) or ret rievi ng an old
audiogram in the List of historical se ssi ons.
2) W hen an audiogram is present , ent er the HLS sc reen by selec ti ng Menu | Tests | HLS.
3) S el ect headphones or inserts i n the channel 1 output dropdown lis t.
4) Select CD, Mic rophone or Wave f iles in t he channel 1 i nput dropdown l ist .
If using CD press play on the CD player, and if us ing wave files you can Browse and play t hem i n t he
bott om of t he sc reen.
5) B efore mounting the headset on the friend or relat i ve expl ai n the audi ogram . Use ex am pl es of what
the hearing im pai red may not be able t o hear anym ore such as som e speech sounds and other
sounds t hat are li kely to oc cur in everyday s urroundings.
6) It may be advi sable to start the si m ul at i on s essi on by let t i ng the relati ve lis ten to t he i nput signal with
his or her natural hearing for a m om ent. This is lik el y to have a strong effect when having to compare
with the simul at i on. The procedure is, however, up t o you and the defaults c an be setup in t he AC440
setup (s ee sec tion 1.7.2.7).
11
H LS requires an additional software l icense.
12
HLS using a CD player is only available on the Affinity
2.0
/Equinox
2.0
Affinity
2.0
Additional I nforma tion Page 41
St art si m ul at i ng by cli cki ng t he Right and/or Left buttons correspondi ng to the ear to be s i m ul ated.
The tex t above each button will then change from Normal to ON.
During t he sim ulation it is possi ble to adjus t t he volume of the si gnal using the d B HL
Decrease/Increase channel 1/channel 2 buttons.
Patient Monitor Text with HLS
Now clini cians can input tex t in the pat ient monitor, whic h can then be read by out loud while si mulat ing the
hearing l oss. This is to help with counsel l i ng and addi ng text which can be read out l oud can m ake i t easier
than as k i ng someone to spontaneously s ay som et hi ng. Pleas e s ee sect i on 1.7.2.7 for more information on
how to setup the Pat i ent Monitor.
Affinity
2.0
Additional I nforma tion Page 42
1.7.9 Short Increme nt Se nsi tivity I ndex13
SISI is designed to test the abil i ty t o recognis e 1 dB i ncrease in intensi t y during a s eri es of bursts of pure
tones present ed 20 dB above the pure t one t hreshold for t he t est frequenc y . It can be used to di fferentiate
between coc hlear and ret rococ hlear dis orders as a patient with a coc hlear dis order wil l be able t o perc eive
the i ncrements of 1 dB, as where a patient with a retroc ochlear di sorder will not.
Require d I te m s:
• The Affinit y hardware
2.0
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware wit h SISI funct ionalit y
• Calibrated Headphones or insert phones
• A patient response button
Test Procedure :
1) Open t he AC440 and ent er the SISI sc reen by selec ting Menu | Tests | SISI.
2) S el ect Tone or Warble Tone in the channel 1 input lis t. If needed m aski ng can be selec ted in the
channel 2 input dropdown lis t.
3) S el ect headphones or inserts i n t he channel 1/channel 2 out put li st s
4) S et the i nput level t o 20 dB above thres hol d usi ng the dB HL Decrease/Increase channel 1/channel
2 butt ons or arrow keys on t he P C k eyboard.
5) E xplain to the pati ent that they wil l now hear a series of tones . If s uddenl y one t one s eem s louder that
the other ones t he respons e butt on should i mmediat ely be pus hed.
6) S el ect the preferred t ype of S IS I test. Setting the sy s tem to 1 dB increm ent s i s consi dered to be the
cl ass ical S ISI. If the patient i s able t o hear t hese i ncrement s and s cores hi gh, cochl ea damage is
likely . Y ou may als o c hoose 0 dB, 2 dB , or 5 dB i ncrement s .
If the patient does not m anage to get a high score on the SISI test this could indi c ative of ret rococ hlear damage.
13
SI SI requires an additional software license.
Affinity
2.0
Additional I nforma tion Page 43
7) S tart t he test by pres sing START. During the tes ting t he frequency and i ntensi t y can be adj usted
manuall y (s ee illus trat ion). The sy st em will automat ic ally c ount the number of reac ti ons from the
pati ent . Note that the system needs 20 presentations to c al culat e a S IS I score.
8) Press STOP to end the t est.
9) S ave the S IS I tes t by cl i cki ng Save
Affinity
2.0
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1.7.10 Weber
Original ly t he W eber test dis tingui shed bet ween c onduct ive and sens orineural hearing los s through us e of a
tuni ng fork. The fork was s oftly s truc k and pl aced in the middle of the patient ’s forehead. If the patient heard
the tone bett er in the poorer ear the heari ng l oss was conduc tive, and if t he t one was heard bet ter in the
bett er ear the hearing l oss was sensorineural at the gi ven frequenc y. Today t he Weber i s most oft en
performed using a bone c onduct or becaus e the tuning fork met hod only allows t est ing at one frequency,
unles s you have mul tiple t uning forks . The bone c onduct ion osc ill ator is pl aced in the m idline and as a
st imul us is mos tl y a signal of 250, 500, and 1000 Hz chosen whi ch s hould be cl early audible to t he patient .
Usi ng an audiom eter t ogether wit h a bone conduc tor to do t he W eber is m ore reliable and flex ible t han t he
tuni ng fork m ethod and has t herefore becom e wides pread.
Require d I te m s:
2.0
• The Affinity
hardware
• The AC440 s oftware
• A bone conduc tor (B81)
Test Procedure :
1) Open t he AC440 and ent er the Weber sc reen by selec ti ng Menu | Te sts | Weber
2) Input and O utput s elec tions for cha nnel 1/channel 2 are fix ed Tone and Bone.
3) P l ace the bone conductor on the patient’s forehead and i nstruct them to tell you if the tones present ed
are heard bet ter t o t he Right, Left , Centre or if it is Not heard at all.
4) P resent a tone at a level of 10 dB above the worst BC t hreshold using t he dB HL Decrease/Increase
butt ons or t he PC keyboard. Y ou can sel ect whet her you want a Tone or Warble stimulus.
5) A wait respons e from t he patient and c lic k on the corres ponding but ton above the graph.
If the pat ient hears the tone bet ter in the poorer ear t he hearing los s i s conduct ive, and t he t one is heard
better i n t he better ear t he heari ng los s is sens ori neural at the gi ven frequenc y.
6) During t he t est ing t he frequency and i ntens ity c an be adjusted m anually (see il lus trati on).
7) S ave the Weber test by clicki ng Save
Affinity
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Additional I nforma tion Page 45
1.7.11 Knaster14
Knas ter is a s peec h in noi se t raining t ool. Modified speech noise (Knas ter Nois e) is presented to one or both
ears (bi naurally) as this is believed to init i ate a stat e of " alertness" i n t he s ensorineural cel ls and thereby als o
affect t he auditory pathway s and c entres . After apply ing the noise for a certai n amount of ti me (in sec onds)
dis crim inati on problems should disappear temporarily.
The t raining shoul d be performed subsequent to doi ng the speech audiom etry si nce you need to pres ent t he
Knaster speech at t he poi nt of max i m um speech unders tanding which wi ll be detect ed in the speech
audiometry. The level the Knast er noise should be presented at i s 5 or 10 dB lower t han t he pres ented
speec h mat erial.
The patient is asked to repeat the speech presented. If m i stak es between sounds are m ade the noi s e i s
inc reased for a few sec onds i n at tempt t o "awak en" t he s ensorineural c ells . The nois e is t hen turned down
to its original level and the patient is prompted to try and correct the mistake and the repeat the word again.
If the noi se is mut ed at the same t i m e as the m i stak en word i s repeated for the second t i m e it is believed to
be easi er for the pat ient t o percei ve i t. W hen succeeding i n repeating the word c orrec tly t he patient shoul d
be made aware of the di fference between t he sound t hey emi t ted and the correc t sound.
If patients undergo half hour K nast er ses sions on cons ecut ive or alt ernati ng day s their dis cri minat ion abili ties
are believed to improve (Appendix 2).
Require d I te m s:
2
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware with K naster functionali t y
• Headphones
Test Procedure :
In order t o perform the Knast er tes t y ou need to know the level of max imum s peech unders tanding. The tes t
shoul d therefore be performed s ubsequent to the speech audi om etry whic h will provide you wit h this
informat ion. Do the Speech A udiomet ry as described in section 1.6.5.5.
1) Open t he AC440 and ent er the Knast er sc reen by selec ting Menu | Tests | Knaster
14
Knaster is only available on the Affinity
2.0
/Equinox
2.0
Affinity
2.0
Additional I nforma tion Page 46
2) Sel ec t microphone, CD, or wave fil e in t he channel 1 input lis t. The Knast er tes t c an be performed
on left, ri ght or both ears . Thi s is sel ect ed in t he c hannel 1 output lis t.
3) Set the level of t he i nput t o t he l evel of m aximum speech understanding using the d B HL
Decrease/Increase channel 1 buttons.
Channel 2 present s t he Knas ter nois e which s hould be set to a level of 5 -10 dB below the l evel of
the speech input us i ng t he dB HL Decrease/Increase channel 2 buttons.
4) Set the desi red filt er for the l ow and hi gh frequenc i es respec tivel y bel ow the graph. The filter applied
can be vis ual i zed in the graph.
5) Explain t o the pat i ent, t hat they wi l l now hear bot h speech and noi se t hrough the headphones. They
shoul d, however, c oncent rate on the speec h and t ry to repeat what they hear. If t hey mak e a mi st ake
the noi se wi l l be a lit tle l ouder for jus t a s econd and t hey will have another chanc e to repeat the word
correctly.
6) St art present i ng the speech material. If mi st akes bet ween s ounds are m ade the noise is i ncreas ed
for a few s econds in attem pt t o "awaken" t he sensori neural cel ls. The noise is then t urned down t o its
original level and the patient is prompted to t ry and c orrect the mi stak e and t he repeat the word
again. If t he noi se is mut ed at the s ame t ime as t he mis tak en word i s repeated for t he s econd t ime it
will be eas ier for the patient to percei ve i t. This is done by touching the channel 2 St i m ul i area wit h
the m ouse. W hen succeeding to repeat the word correc t l y the patient shoul d be m ade aware of
the difference bet ween the sound t hey emitted and the c orrec t sound.
Note: If you wis h to s witc h bet ween right and left during the Knast er training wit hout t he i ntensi ty
returning to the original st art level, pleas e be sure to enter the Common set tings in the AC440 s etup
(Menu/ s etup/A C440 setup, see s ecti on 1.7.2.1) and s el ect “OFF” in the Defaul t intensi t y when
changing output dropdown list lik e i l l ustrat ed bel ow:
Affinity
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Additional I nforma tion Page 47
1.7.12 ABLB/Fowler
AB LB (Alternate Binaural Loudness B al ancing) i s a test to detect perceived loudness differences between
the ears designed for people with unilateral hearing los s. It serves as a possible test for recruitment.
The test is performed at frequencies where recruitment is presumed. The same tone is presented
alt ernat i vely to both ears. The int ensit y is fix ed in the impai red ear (20 dB above pure tone t hreshold). The
task of the patient is to adjust the l evel of the bett er ear unt i l the si gnal in t he two ears is of equal int ens i ty.
Note however that the t est may al so be performed by fixing t he intensi ty in the norm al hearing ear and
havi ng the pati ent s et the t one for the impaired ear.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• Calibrated Headphones or insert phones
• A patient response button
Test Procedure :
1) Open t he AC440 modul e t hrough your pat ient m anagement s ys tem, Noah or Ot oAccess™.
2) Choos e s ett ings for ABLB /F owler using t he i nput and out put for channel 1 and channel 2 as
ill ust rated below:
Note: Man (Manual) and Multi Pulse should be s el ected for c hannel 1 and Alt (Alternate) for channel 2.
3) Clari fy the test procedure to the pat i ent. E xplain that he/she will now hear tones i n bot h ears. The
ass ignment is t o det ermine when the two t ones s ound equal in intens it y/l oudness
4) The ABLB is performed at frequenci es where recruitm ent i s assumed. S et the intensi ty l evel on the
impai red ear t o 20 dB above the pure t one thres hold usi ng channel 2.
5) A dj ust the intensit y level i n the bett er ear until t he perceived l oudnes s i s i dentic al to the impaired ear
using channel 1.
6) Us e the arrow buttons on the PC k eyboard or t he dedic ated audiometry k eyboard t o set the frequency
and int ensit y. If preferred c hoos e Mouse operate d audiometry
and perform t he t est us ing only
the mouse. Left click to stimulat e and right c li ck t o s tore t he t hreshold.
7) The ABLB /Fowl er test cannot be saved. Result s must t herefore be not ed manuall y. The reporting/
comment func t i on in the AC440 software m ay als o be of help.
Affinity
Ch1 output :
Right
Ch1 input:
Mic, CD, or Wave file
Ch2 output :
Left
Ch2 input:
Mic, CD, or Wave file
2.0
Additional I nforma tion Page 48
1.7.13 Stenger Test
The Stenger test is applied when a pat i ent is s uspec ted of feigning/ faking a heari ng los s and i s based on t he
audit ory phenomenon, “The St enger Princ iple” which states that onl y the louder of t wo si m i l ar t ones
present ed to both ears at t he same time will be perceived. As a general rule it i s has been recommended t o
perform the Stenger test i n c ases of unil ateral heari ng los ses or significant asymmetries .
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• Calibrated Headphones or insert phones
• A patient response button
Test Proce dure for Tone Stenge r:
1) Open t he AC440 modul e.
2) Choos e s ett ings for Stenger us ing t he i nput and output for channel 1 and channel 2 as ill ustrat ed
below:
Note: Man (Manual) and if preferred Multi Pulse s houl d be s el ect ed for channel 1 and Sim
(Simultaneous) for channel 2.
3) Typi cally the ins truct i on to the pat i ent i s not di fferent than with normal audiom et ry. The pati ent does
not need to be i nformed that stim ul i are presented at bot h ears sim ultaneousl y.
4) Use channel 2 for presenting tones to the bet ter ear and set the int ens i ty l evel t o 20 dB above the
threshold.
5) Use cha nnel 1 for the poorer ear and set the intens it y level 20 dB below the level of the good ear.
6) P resent the tones to both ears simul t aneously . K eep t he int ensi ty l evel of the better ear fix ed and
inc rease the int ensity for the wors e ear in 5 dB st eps. If the heari ng los s in the worse ear i s genuine
the pat i ent wil l keep res pondi ng to the signal presented to t he better ear (Negative Stenger). If t he
pati ent is feigni ng the hearing impai rm ent he will stop res pondi ng when the l evel of t he wors e ear
exceeds the s i gnal presented to t he good ear (P osi tive S tenger).
7) Us e the arrow buttons on the PC k eyboard or t he dedic ated audiometry k eyboard t o set the frequency
and int ensit y. If preferred c hoos e Mouse operate d audiometry
and perform t he t est us ing only
the mouse. Left c lic k to s ti mulat e and right cl ick to s tore t he t hreshold.
Test Proce dure for Spee ch Stenger:
1) Open t he AC440 modul e.
2) To perform s peech t est s go to the Speech scr een
.
3) Choos e s ett ings for Stenger us ing t he i nput and output for channel 1 and channel 2 as ill ustrat ed
below:
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Note: Rev (Reverse) and if preferred Multi Pulse s houl d be sel ected for c hannel 1 and Rev
(Reverse) or Sim (Simultaneous ) for channel 2.
4) Clari fy the test procedure to the pat i ent. E xplain that he/she will now hear s peec h and the assi gnm ent
is to repeat the presented words or numbers.
5) Use cha nnel 2 for present ing speec h to the bet ter ear and s et t he int ensi ty l evel to 20 dB above the
threshold.
6) Use cha nnel 1 for the poorer ear and set the intens it y level 20 dB below the level of the good ear.
7) P resent the speech m aterial to both ears si mult aneously . K eep t he int ensit y level of the bett er ear
fixed and i ncrease the i ntensi ty for the worse ear i n 5 dB steps. If the hearing los s in the worse ear is
genuine the pati ent wil l k eep repeat ing c orrec tly t o the speech signal presented t o the bett er ear
(Negative Stenger). If the pat ient is feigning the hearing im pairment he will st op repeat ing correct ly
when t he level of the worse ear exc eeds the signal pres ented to t he good ear (Pos iti ve Stenger).
8) Us e the arrow buttons on the P C k eyboard or t he dedicated keyboard t o set the frequency and
intensity. You also choose Mouse opera ted audiometry
and perform the test using only t he
mous e. Left click to s timul at e and right c l i ck to store t he t hres hol d.
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1.7.14 TEN Te st15
Until recentl y , the TEN(HL) test for diagnos i ng dead regions i n t he cochl ea c oul d onl y be conduc t ed by use
of a compac t di sc pl ayer connect ed t o an audi om et er. Now, t he test has been impl em ent ed within the
Affinity
2.0
/Equinox
2.0
Suites.
If dead regions are present it may have im portant i mplic ati ons for fitt ing hearing aids and for predic ting the
lik ely benefit of hearing aids . W hen a pat ient has a dead region, there may be lit tl e or no benefit from
hearing aid amplification for frequencies inside the dead region (Moore 2009). For more i nformation
regarding t he TEN tes t pl ease refer to Appendix 3.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware wit h TEN functi onality
• Calibrated Headphones or insert phones
• A pat i ent response but t on
Test Procedure
The TEN Test i s performed ac cording t o t he met hods des cribed by B rian Moore. Pleas e refer to Appendix 3.
15
TE N test requires an additional l icense.
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1.7.15 QuickSIN16
Difficult y wi th hearing in back ground nois e is a comm on com plaint am ong hearing ai d us ers. Therefore, the
meas urement of SNR los s (s ignal-to-noise rat i o loss) i s import ant bec ause a person’s abili ty t o understand
speec h in noise cannot be rel iably predict ed from the pure tone audi ogram. The Quic k SIN tes t was
devel oped t o provide a quick esti m ate of SNR l os s. A lis t of six sent ences wi th five k ey words per sent ence
is presented in four-talk er babbl e noise. The s entences are presented at pre-recorded signal-to-noise ratios
whic h decreas e in 5-dB st eps from 25 (very eas y) t o 0 (ex tremel y diffic ult). The SNRs used are: 25, 20, 15,
10, 5 and 0, encompas sing normal to severely im pai red performance i n noi s e. For more i nformat ion pl ease
TM
refer to Etymotic Research’s QuickSIN
Speech-in-Noise Test manual, vers ion 1. 3. (Appendix 4)
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• Calibrat ed Headphones, i nsert phones or Free-Field Speakers
Test Procedure
1) Open the A C440 and enter the Quick SIN sc reen by sel ecti ng Menu | Te sts | QuickSIN
2) Select t he output level. For t he majori ty of the trac ks t he channels are sy nchroni sed t o ens ure that
the correc t SNR level i s ac hieved. Not e: the ‘Speec h and Babbl e’ Lis ts are not s ync hronised and wi ll
require the user to manually alt er thes e t o ens ure the c orrect SNR set ti ng for the t est .
3) Select a li st in t he corresponding dropdown. e.g. “QuickSIN (List 2)”.
4) Instruc t the pati ent to repeat the sentences and try to ignore the noise that they wi l l als o hear
through the headphones .
5) Press START to begi n t he t est
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QuickSIN requires an additional license.
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6) The number of words in bold the patient repeats correc tly s hould be s cored by c l i c king on t he score
buttons.
7) When 6 sentences are scored a tot al score wi l l be c al culat ed.
Note that i f y ou press Stop before t he 6 sent ences of t he lis t have been play ed and sc ored, no total
score will be c al culat ed.
8) The total s core can be compared t o t he “S NR los s definit i ons ”.
9) Save the Q ui c kSIN test by cli cki ng Save
Comparing Aided and Undaided Qui ckSIN scores over time :
Clini cians are now able to compare t he Unaided and Aided S NR sc ores.
To view t he scores in a graph view, click on the graph icon
To view t he scores in a graph view, but usi ng t he pat i ent m oni tor, cl i ck on Pat ient Monitor
The Quic kS IN is performed ac cordi ng to the m ethods desc ribed in t he Quic kS IN manual. P leas e refer to
Appendi x 4.
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1.7.16 Tone De ca y17
This is a t est to help i dentify the adapt ation of t he auditory sy st em (Carhart, 1957). It i nvolves meas uring the
percept ual reduct ion in a cont inuous tone over ti me. This c an indi cat e towards a coc hlear or neural caus e of
deafness.
The tes t i nvolves l ooking at the pat i ent’s response to t he onset of a supra-t hreshold sound and then their
continuous response t o this as it conti nues over time. For example, i n M eni ere’ s disease this i s detected
correctly on onset but rapi dl y det eriorates due t o dy s functional hai r cell s (Carhart, 1957). A normal res ponse
shoul d be maint ained for a minut e of st imulat ion, s hould a pati ent not be abl e to maintai n this t hen the
stimul us intensit y i s inc reased unt i l a m i nute i s achi eved. This is only inc reased up t o a m aximum 30 dB
supra-threshold.
Previously this test could only be admini stered manually wi t h t he A ffinity
2.0
/Equinox
2.0
Sui t e and a s t opwatch
but now we have added t hi s test to the software for eas e of use.
Require d I te m s:
2.0
• The Affinity
• Lic ensed A C440 A udiomet ry modul e within y our Affinit y
hardware
2.0
hardware
• Calibrated Headphones or insert phones
Test Procedure
1. The patient’s Audiomet ry i s obtained.
2. The patient is then ins truc ted t o cont inuousl y res pond to the t one i f they hear i t and not res pond as the
si gnal fades/ i s absent.
3. The test is administered with a pure tone 5 dB below the subjec t’s es tablished threshold and then
ascended in 5 dB steps without interruption until the subject responds. As soon as the subject
responds , t he sy st em will begin ti ming (t his i s s hown in the im age below). If the t one is heard for a ful l
one m i nut e t hen t he t est is stopped.
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Tone decay requires an additional license
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4. B ut if the s ubjec t indi cat es t hat t hey no longer hear t he tone before the mi nute c riteria is reac hed, then
the int ensit y of tone i s inc reased by 5 dB wit hout i nterrupti ng the tone, but t he ti ming at the top of t he
screen is reset.
5. The t one is c ontinued t o be raised i n 5 dB s teps until a intens ity is reached t hat all ows the s ubjec t t o
perceive the tone for full minute. The amount of decay occurring at each level suggests/indicates the
amount of decay the s ubj ect i s showi ng.
6. As a time saving measure, Carhart (1957) suggested that the test should be terminated when the
subj ect fail s to respond 30 dB above thres hol d.
Once t his meas urement has been finished t he data c an be docum ented as a comm ent t o the s ess ion by t he
‘Transfer result to comments’ on the left of the screen. Alternatively it c an be saved via t he disk or door icon
in t he t op left for review later on.
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1.7.17 ANL T est
18
The Acceptable Nois e Level (ANL) Test is a method of det ermini ng how muc h noi se t he pat ient i s able t o
tol erat e whilst l i stening t o a t arget s i gnal /speaker (Nabal ek et al., 1991). It is used as a predic t or for how well
a pati ent wil l cope wi t h am pl i fication when receiving a hearing aid (Nabalek et al., 2006).
The ANL test i s designed to be performed vi a loudspeaker as it is a free field test . However, i t can be
configured to perform monaural l y via sel ecti on of headphones and routing t he s i gnal t o t he rel evant ear-side.
The Equinox and Affinity systems can perform the test binaurally via the R+L feature.
The ANL Test c an use any of the mat eri al s you have already ripped into your Interacoustic s S ui t e software.
When should I perform the ANL te st?
The ANL t est i s typi cally performed before t he patient is given any form of ampl i fication as a rehabil i tati ve
action for t hei r hearing los s.
Test Procedure
2
1. Launch t he Affinit y
/Call ist o™ Sui te from Noah or OtoA cc ess ™.
2. Clic k on the AUD t ab on t he upper right hand s i de of the screen. Ensure that your Audiom etry has
been performed ahead of advancing i nt o the S IN test as this determines t he start l evel for the tes t.
3. Click on Menu, Te sts and t hen selec t ANL
4. Once in the ANL test screen, y ou wi ll s ee that t here are 4 different c ondi t i ons which you can choose
to m easure.
MCL High – This is the loudes t com fortabl e level the patient can l i sten to without any com peting
noise
MCL Low – This is the lowes t comfortabl e level the patient c an l i sten t o wi t hout any com pet i ng noise
MCL Real – This is t he patient m ost c omfortabl e l evel without any compet ing nois e
BNL – Thi s is the act ual ANL test where the M CL Real is pres ented and the com peting nois e i s
manipul ated to find an ANL val ue
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It is not essential to perform MCL High and MCL Low for t he A NL test, but these are al so good
indicators of t he patient s’ c om fortabl e hearing range.
Inst ructi ons for the patient will always be dis played at t he bott om of t he s creen.
18
The ANL Test requires an additional license.
5. MCL Hi gh
Click on t he M CL High Icon and cl ick play . This will l oop your speec h material.
Increas e and decrease the s t i m ul us i ntensi ty t o m atch the patients l oudest MCL.
There wi l l be no ot her change in the di splay to represent thi s, only the l evel in the MCL Hi gh icon
box.
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6. MCL Low
Additional I nforma tion Page 58
Clic k on t he M CL Low Ic on and c lic k play . Thi s will l oop your s peech material .
Increas e and decrease the s t i m ul us i ntensi ty t o m atch the patients l owest MCL.
The dis play will change within the icon but al s o a predi cted MCL Real will be generated as a
midpoi nt bet ween t he MCL Hi gh and MCL Low.
7. MCL Real
Clic k on t he M CL Real Icon and cl ick play . This will l oop your s peech material.
If you have performed t he MCL High and MCL l ow y ou should al ready have a predicted M CL value
here. If not then inc rease/dec rease t he i nt ensit y to find a sui table level for the patients MCL.
Agai n the display wi ll not c hange, ot her than ins ide the icon for your tes t c onditi on.
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Clic k on t he B NL Icon and cl ick Play . This will loop the same s peech mat erial but al so introduc e the
back ground mask ing nois e.
Increas e/dec rease Channel 2 in order to find a level of com peting noi se whic h the patient would be
com fort able to l i sten to alongs ide t heir target mat erial . Whilst doing this y ou wi l l not i ce the dis pl ay will
change t o reflec t t he patient s ANL val ue and t he predic tion percent age of how wel l they will perform
with am pl i ficati on.
NOTE: You can customise the i nstruc tions di splay ed in t he test sc reen by entering the ANL s etup.
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What does my AN L valu e m ean ?
On performing t he ANL t est y ou wi ll obtai n an A NL value (in dB ) and a percentage. The percent age gives a
lik elihood of s ucc ess wi th amplific ation (Nabalek et al . , 2006) and the A NL value is the outcome of t he
following calculation:
ANL = MCL -BNL
For response c at egori es t he foll owing outcome cri teria was determi ned as an effect of the Nabal ek et al.
(2006) investi gation i nt o ANL outcom es i n relation to ampl i ficati on:
ANL Sc ore 7 dB or l ess: These individuals have a great prognosis for regular us e and acc eptanc e of
hearing ai ds; m ay not need as much follow-up counsel i ng and gui dance as the average patient.
ANL Sc ore 8-12 dB: These are your more c ommon patient s and have a good (8) or bad (12)
prognosi s for regular us e and ac c eptance of hearing aids. These patients m ay need m ore follow-up
couns eling and are ex cel lent c andidat es for nois e reducti on tec hnologies .
ANL Sc ore 13 dB or m ore: These patient s are “at ris k” for reduced uti liz ation of hearing aids and m ay
need addit ional post -fitting counseling, guidanc e, and require nois e reduct ion tec hnologies .
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1.7.18 SIQ T e st
The Speec h in Qui et (SIQ) t est is a m ethod of test i ng a patient ’ s func tional hearing i n the absence of any
com peting s ound. The object ive of thi s is t o ident ify t heir func tional hearing abil ity (Schoepflin, 2012). The
outc ome of thi s investi gation will give a S peech Recogni tion Threshold (SRT).
This ty pe of testi ng is different from Tone Audiom etry as it i nvolves hi gher areas of the Audit ory pathway as
the i nformat i on needs to be heard, proces sed and repeat ed in order to give a correc t response (Nati onal
Researc h Counc il (US ), 2004).
The SIQ test i s designed to be performed vi a louds peaker as i t i s a free field tes t. However i t can be
configured to perform monaurally via selection of headphones and rout i ng the signal t o t he rel evant ear-side.
The SIQ test i s very simi l ar t o Speech Audi om etry and can use any of the materials y ou have already ripped
int o your Int erac ousti cs Sui te soft ware. However the S timul us intensit y is maint ai ned autom atic all y by the
soft ware foll owi ng a correct or i ncorrect res ponse to the stimulus , this helps to speed up the t est tim e.
When should I perform the SIQ test?
It is norm al to perform this following Tone Audi om et ry as it gives a good indicator of the patient s
performance for speec h, it can also be a good indi cator of t he ac curac y of your audiogram (Mehta & S ingh,
2000). It c an also be used before and after the provisi on of hearing aids t o give an ident i fication of t he benefit
achieved through amplification (REF).
Test Procedure
2
1. Launch t he Affinit y
/Callisto™ Suit e from Noah or OtoA cc ess ™.
2. Clic k on the AUD t ab on t he upper right hand si de of the screen. Ensure t hat your A udi om etry has
been performed ahead of advancing i nt o the S IN test as this determines t he start l evel for the tes t.
3. Click on Menu, Te sts and t hen selec t SIQ
4. Once i n t he S IQ tes t s creen, the s tim uli levels shoul d be s et for you. These are based on the patient
audiogram and the PTA sc ore.
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5. Ensure that y our s peech mat erial is correct and the relevant list has been chosen.
6. Inst ruc t the pati ent to res pond by repeating the words that they hear. Pres s the pl ay ic on t o begi n t he
test.
7. On the patients’ respons e, s core t he words correc t or inc orrect ac c ording t o t heir response. The
sy stem will aut om atic al l y i nc rease t he next sti m ul us intensit y for an incorrect response and decrease
the next s timul us int ensity for a correc t response.
8. Repeat thi s procedure unti l your word li st has com pleted. The sys tem wil l aut omat ical ly s tore on
completi on of your word lis t.
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1.7.19 SIN Test
The Speec h in Noise (S IN) test is a method of test i ng a patient ’s func tional hearing i n the presenc e of
com peting s ound (Taylor, 2003). The objec tive of this i s to identi fy thei r functi onal hearing abi lit y and higher
proc ess ing whic h allows t hem to sort bet ween us eful (speec h/s ignal) and irrelevant (nois e/m ask ing)
informat ion (Taylor, 2003). The out come of t his invest igation will gi ve a S peech Rec ogniti on Threshold (SRT)
for a varying S i gnal to Noi se Rat i o (S NR).
Thi s t y pe of t esti ng i s di fferent from Tone Audi om etry as it i nvolves higher areas of the Audi t ory pathway as
the i nformat i on needs to be heard, sort ed and underst ood in order to determ i ne if it i s useful or not (Marrone
et al., 2008).
The SIN test is designed to be performed via l oudspeaker as i t i s a free fiel d test. However it can be
configured to perform monaurall y vi a s elec tion of headphones and routi ng the mask ing to t he sam e out put.
The SIN t est is very s im ilar to Speec h Audiom etry and c an use any of t he m aterial s y ou have already ripped
int o your Int erac ousti cs Sui te soft ware. However the S i gnal -to-Noise Ratio i s mai ntained autom atic ally by the
soft ware foll owi ng a correct or i ncorrect res ponse to the stimulus , this helps to speed up the t est tim e.
When shoul d I perform the SIN test?
It is norm al to perform this following Tone Audi om et ry as it gives a good indicator of the pat i ent s
performance for s peech i n noi se. It can als o be us ed before and aft er the provision of hearing aids to give an
identification of the benefit achieved through amplification (Marrone, Mason and Kidd, 2008).
Test Procedure
2
1. Launch t he Affinit y
/Callisto™ Suit e from Noah or OtoA cc ess ™.
2. Clic k on the AUD t ab on t he upper right hand si de of the screen. Ensure t hat your A udi om etry has
been performed ahead of advancing i nt o the S IN test as this determines t he start l evel for the tes t.
3. Click on Menu, Te sts and t hen selec t SIN
4. Once i n t he S IN test s c reen, the st imuli l evels s hould be s et for you. These are bas ed on the patient
audiogram and the PTA sc ore.
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5. Ensure that y our s peech mat erial is correc t and t he rel evant list has been chosen.
6. Turn on t he m aski ng i n Channel 2 by c l i c king from Man to Rev. The mas king wil l need to be turned
on manuall y, t his is bec ause y ou may want to perform an ini tial fami l iari zati on test wi t h the pat i ent
without t he noi se t o begi n.
7. Inst ruc t the pati ent to res pond by repeating the words that they hear. Pres s the pl ay ic on t o begi n t he
test.
8. On the patients’ respons e, s core t he words correc t or inc orrect acc ording to their response. The
system will autom atic al l y i ncrease t he nex t stimul us int ens i ty for an i ncorrect res ponse and decrease
the next s timul us int ensity for a correc t response.
9. Repeat thi s procedure unti l your word li st has com pleted. The sys tem will aut om atic al l y s tore on
com pleti on of your word lis t.
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1.8 Working with Individual Setups (Test Protocols)
There are many different dem ands and wis hes regarding how an audiomet er s hould bot h functi on and
appear depending on t he speci fic si tuation and nati onal st andards. One of the greatest advant ages of the
AC440 module is the flexi bi l ity enabl i ng you to tai l or t he s y stem acc ordi ng t o y our s pecific preferences in the
so-c alled “t est prot ocol s”. Thes e tes t protoc ols are created i n t he A C440 s etup which wil l be descri bed in t hi s
section.
This manual will c over the use of fact ory/s tandard tes t prot ocols as wel l as how to creat e individual t est
protoc ol s for di fferent purposes or different clini c i ans worki ng in t he s am e fac i l i ty.
The following sections describe the setup opt ions for all t ests even though you m ost l i kely will only need to
set up a few. Thi s c hapter s hould be s een as a work of reference where singl e funct ions can be looked up
rather than a s tep-by-st ep guide
1.8.1 Selecting a Tes t Protocol:
1) Open t he AC440 from y our patient management s ys tem , Noah, OtoAccess™ or via stand-alone.
2) Go t o t he AC440 S etup by followi ng Me nu | Se tup | AC440 Se tup
3) In the List of protocols, both fac tory t est protocol s wi th standard/ fac tory test parameters and
personalized test protocol s can be accessed and selec ted from t he l ist (e.g. ”A C440” and “Joan
Jones”).
Note: Certai n t est prot ocols may be hi dden from t his t est prot ocol s elec tion using t he Show/Hide protocol
funct ion found under Menu | Setup | s how hide protocols
About the AC440 Se tup:
In t he AC440 S et up test s wi l l be li sted t o the left. Unfold each the m enu of t est to ac cess i ts options. Each
test contains the following options:
Startup: These are the set tings for which t he t est will start up
Common: All ows for setting up more general set tings of the s pecific
test
Keyboard: Al lows for set ti ng up mac ros for the dedic ated
Affinity
2.0
/Equinox
2.0
audiometry keyboard (if this is used).
Add-ons: Allows for set ting up add-on features/subtes ts if avai l abl e
for a test. These require a special licence.
Note: Som e s etup s creens c ontai n more than one t ab offering m ulti ple
user c ontrols .
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In each set up s creen y ou wi l l find three buttons in t he l ower right corner:
Clicking OK will c l ose the AC440 s et up and s ave all changes.
Clicking Apply will save c hanges but without cl osing t he A C440 Set up. The change will,
however, im m edi ately be ac t i ve and visibl e on the screen behind the s etup dialog.
Clicking Cancel will clos e the AC440 setup wit hout savi ng any changes made.
1.8.2 Creating new Protocols
1) Click Menu | Setup | AC440 se tup to ent er the M ai n setup.
2) Click New to create a new tes t protocol and fil l i n t he Name field (e.g. “Joan J ones”).
1.8.2.1 Common Setup
1) The s pecific s of the test can be selec ted st arting in the Common screen shown bel ow:
2) Choos e i n whic h tes t t he s ys tem s hould begin under Start Screen. Note that MLD is greyed out since
it can only be performed after obtaini ng the heari ng threshol ds.
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Note: Some tes ts are purchas ed as addi tional licences for t he AC440. If a license has not been
purchased, the t est will be greyed out in t he start screen selec t i on and i t will not be s hown in the ‘tes t
tree’ of the protocol set tings (at num ber 1 in t he above figure).
3) S el ect the default start Intensity (Tone, Speech, SISI, Weber). Use the dropdown lists to select the
preferred settings. Checking S wi tc h extended range on aut omati call y al l ows the user to go to high
int ensit ies wit hout t he need for manual ac tivation of the ex tended range. The ext ended range opens
automatically as soon as the cursor moves into that area of t he audi ogram
4) In the Automa tic output sel ection the Ch 2 oppos ite Ch 1 output can be ti c ked. This way c hannel 2
will aut om atic ally choos e the opposit e output as channel 1 (e.g. if c hannel 1
is set to Right, channel 2 wil l aut om atic al l y selec t Left). At Bone masking: the
user s et s whic h transducer is chosen by default to m ask bone
meas urements . This opt ion will not be ac ti ve if Ch 2 opposi te Ch 1 out put is
not used.
5) A dj ust the Pulse of t he test si gnal . If Multi Pulse or S i ngl e Puls e are tic ked
the pulsat ion lengt h (in mS ) c an be adj ust ed using t he s liders . Note the
opti on to add multi or single pul se in the front sc reen (as shown on the graph).
6) Direct Access But t ons: right clic k on the buttons to dec i de whic h direc t acc ess but tons appear on t he
main A C440 sc reen. Up to 4 but tons c an be dis played.
7) Set Talk forward t o the desi red intensi t y usi ng t he slider. To al l ow talk forward in free field ti ck the
corresponding check box. Tic k Talk forward input calibration to adj ust t al k forward i nput level t o 0 dB
VU. This is helpful i f the t al k forward mi crophone is alway s located at the sam e posit i on.
8) If desi red, allow Monitor on live voic e s peech. This funct ion is rarely neces sary as it i s lik ely t o c aus e
acousti cal feedback. However, if t he test is performed under ci rcums tances where thi s is not t he case,
monit oring of live voice c an be all owed by t ic king t he chec k box .
9) sssssssUnder Settings – representation tick S how m aximum int ensit ies . This will allow for
showing/not showing the transducer maximum intensities in al l t ests. Thi s i s the dark shaded area on
the graph can i n t he t one audi ogram be (de)ac tivated by the dedi cated button under Counselling
overlays
.
10) Use BSA logi c forces the audi om etry to use symbols according to t he standards of the Britis h Soc i et y
of Audiology (BS A).
11) Only show input /out put on m ouseover wil l hide t he not s elec ted input and out put opt ions whi le the
mous e is not over i t and res ul t s thereby in a calmer screen.
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1.8.2.2 Tone Testing Setup
Startup
1) To ent er the Startup options for tone tes ti ng unfold the Tone options and cl ick Startup.
2) Default Output of Channel 1 and Channel 2 c an be s el ected in t he two dropdown l i sts. The s el ection
will differ depending on whic h trans ducers are cali brated.
3) The Talk back can be activated by t i cki ng the check box. The level of the talk back can be adjusted on
the sli der. A norm al audi ble level would be approx imat ely 60 dB .
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Common:
4) To enter the Common options for tone tes ti ng unfold the Tone opt ions and cli ck Common. Here y ou
can adj ust som e of the m ore frequent tone audiomet ry s etti ngs st ating wit h the General settings.
Note: This s creen cont ains t hree tabs (General, Tone audi ometry and Overlays).
5) Default i nput for Channel 1 and Channe l 2 can be set using the dropdown lists. Select between Tone,
W arble t one, NB (Narrow Band noise), and WN (White Noise) for both c hannels.
In additi on, TEN Noise can be s el ected for c hannel 2 (i f purchased). S ee more informat ion about t he
TEN test in Appendix 3.
Channel 1 and Channel 2 Presentation: You have the opti on to tic k Manual s o that t he sti m ul us is
only presented when manually activated. Ticking Reverse will caus e t he s ignal t o be pres ented
cont inuous ly, only dis appearing when the s tim ulus i s activated.
Singl e Pulse and Multi Pulse presentation for channel 1. The durat i on of the stimul us can be
adjus ted i n the com m on opt ions descri bed above. Furt herm ore, you may wis h to have present ation i n
both c hannels and tic k Simultaneous whic h will lock channel 1 and channel 2 together or have the
present ation in the two channel s alt ernating t o eac h other and t ick Alternate.
6) Under Monitor one or bot h of t he channels may be ti c ked if monitoring i s preferred. The level of the
monit oring can be set us ing the slider.
7) In Othe r settings you can tic k Aided if audiograms us ual l y are obt ai ned wit h hearing aids and/ or
Binaural i f both ears are t est ed at the same t ime. B oth ai ded and binaural meas ures are st ored as
separate curves.HL (Hearing Level), MCL (Most Comfortable Level) or UCL (Uncomfortable Levels)
may al so be t i cked depending on your preference. These are also stored as separate curves.
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Butterfly
The curs or wi ll s tart at 1kHz and move upwards in
Bot tom up
The c ursor will st art at 1kHz and move upwards. When t he
None
Frequenc ies are changed manual ly using t he arrow
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8) Settings –
a. Ignore mous e over touch swi tch which wil l m ake AC440 ignore the curs or t ouc hi ng t he stim ul i
area in the front s creen. Ins tead y ou wil l need to present the sti mulus manual ly using the PC
keyboard or the dedicated audiometer keyboard.
b. W hen tic ki ng J um p to 1 kHz by out put change the c ursor wi l l j um p back to test 1 kHz upon
output changes .
9) The Jump strat egy c ontains three different opti ons:
frequency as the thres hol ds are stored. A fter t es ting t he
high frequencies the c urs or will m ove back to re-test 1kHz
and move downwards. W hen jumpi ng back t o 1k Hz the
But terfly strategy can be set to s t art the re-test at either
the default s t art intensit y or t he intensi ty of the first
threshold.
high frequenci es are t est ed t he curs or will jump t o the
lowest test frequency and move upwards t owards 1kHz.
butt ons in the m ai n screen, t he P C keyboard or the
dedicated keyboard.
10) For Intensity decrease when changing frequenc y, choose the l evel t o decrease to when c hanging the
tes t frequency , us ing the drop down menu. .
11) By activating Set ch2 to manual after st ore, you as sure that m aski ng i s autom at i cally swi t ched off
when s tori ng a point and jum ping to the nex t frequency .
12) If t est ing with warble, tones t he frequenc y of t he warbl e tones can be adjus ted i n the Warble
Frequency sl i der. This may for ex am pl e be helpful i f t esting patient s wi t h tinnitus.
13) Under Masking in Settings – representation: Tick Show mask ing information on screen if y ou want
the m aski ng intensity for every threshold t o be visibl e on screen. You m ay choose to see t he m aski ng
informat ion for air c onduct ion (AC), bone c onduct ion (BC), free fiel d (FF) and insert phones (IP).
If t ic k ing Show masking cursor a cursor indi cating t he m aski ng l evel will be visibl e on c hannel 2.
14) Tick Show Ch1 and Ch2 i n a single audi ogram to show a single audi ogram by default
15) Choose Swap int ensity keys on PC keyboard and Swap arrows on intensi t y b uttons to change the
direc tion when adjus ting i ntens ity and frequency.
16) Hide unmasked threshold where masked exist wil l onl y dis pl ay the m as ked (i . e. real) threshol ds by
default. This opt ion c an also be sel ected by ri ght mouse cl i ck on the audiogram .
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17) Under the Tone audiome try tab you can selec t the des i red test frequencies for HL/MCL and UCL by
ti cki ng t he preferred frequencies. Use t he Check all or Uncheck all butt ons t o hel p if needed.
If the unselected frequencies are not t o be visi ble on t he graph then als o tic k Hide unsel ect ed HL,
MCL and UCL frequenc ies . Th is way onl y the selec t ed frequenci es wil l appear on the audi ogram .
18) The Hearing loss index on audiogram allows for tic king Show European CPT-AMA index, Show AC
PT A (Fletch er) index or Show BC P T A (F l et cher) i ndex. The European CP T-AMA is calculated using
the values from t he t able below whic h ensures that t he different frequenc ies are weight ed to dis play a
correct quant i fication of im pai rm ent due to t he heari ng loss . The dropdown menu bel ow thes e set tings
for PTA (Flet cher) index indi cat e the amount of addit ional decibels you wish to add t o the thres hol d
when ent ering s peech for the i nitial sti m ul us l evel.
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If s el ec ting t he PTA (Fl etcher) index you can choose the frequencies that should be inc l uded in t he
cal culat i on. The default s et ting will be 500, 1000, 2000, and 4000 Hz. In this calc ul at i on method al l
frequencies are equall y weight ed and averaged t o gi ve the figure.
The PTA index al so provi des the option to add a c ert ai n level t o t he result usi ng the dropdown l i st.
This is useful s ince t he PTA is oft en used t o det ermine the st art int ensit y for speech t est ing. If you
prefer to start the s peech test at for example15 dB above PTA this can be sel ected in t he dropdown
list:
Note: The PTA is c alcul ated for insert phones and headset . However, if values for both are s tored no PTA
v alue is calculated.
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19) Since the s peech banana is l anguage dependent the AC440 allows for entering individual speech
banana values . Ent er your values for the upper and lower margin of t he s peech banana under Top
part of bana na and Bottom pa rt of banana.
20) For counsel l i ng purpos es y ou can tick Show s peech b anana in t he Speech Banana tab. This allows
for a s peech banana vi ew in shading in the audiogram s creen. In the tone audiomet ry t est s creen t he
dedic ated but t on under Counselling overlays,
, also allows for (de)activating the speech banana.
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21) A Severity indication can be set up by defini ng the label , m i ni m um and m axim um dB and c ol our for
each indi cation in the audiogram.
22) For counsel l i ng purpos es y ou can tick Show severity in t he Severity tab. This all ows for s everity
indic ati ons in the audiogram s creen. In t he t one audiomet ry tes t s creen t he dedic ated but ton under
Counselling overlays,
, al so allows for (de)act i vating the severity indicati ons.
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23) The Phonemes to be shown in an audiogram can be set up by defini ng t he label s and pos iti ons of all
phonemes . Indic ate t he font s ize as how they must appear on sc reen.
24) For counsel l i ng purpos es y ou can tick Show phonemes in the Phonemes tab. This allows for
phonemes in t he audi ogram sc reen. In t he tone audi om etry tes t screen t he dedi c ated but ton under
Counselling overlays,
, al so allows (de)activati ng t he phonem es.
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25) The S ound e xam pl es to be s hown in an audiogram c an be set up by defini ng the pos itions of all
exam pl es. W hen addi ng a new pi cture you are asked to poi nt out where t he picture c an be found.
Note that the file ty pe m ust be *.png to allow trans parent back ground colours.
26) For counsel l i ng purpos es y ou can tick Show s ound examples in the Sound e x amples tab. This all ows
for s ound exam ples i n the audiogram screen. In the t one audiom etry test sc reen the dedi cated butt on
under Counselling overlays,
, al so allows (de)activati ng the s ound exam ples .
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27) Masking Tab: In this s ec tion, t he t est er c an deci de if A utomas ki ng or M ask ing Help s hould be turned
on. The user c an al so change the interaural differences as wel l as the default values for over mas king.
a. Aut o m aski ng on: masking will start automat i c al l y where required
b. Mas king Help on: a l ight in c hannel 2 will indi cate if masking is required and whet her t here is
undermas king or overm ask ing occuring
c. Indicat e suggested mas king level: will suggest t he m aski ng l evel t hat should be used
In this s ect ion the user can c onfigure their Aut om aski ng feat ure by adjusti ng the i nteraural di fference
levels depending on the t ransducer s el ec ted. They can al so adjus t t he l evel at which t he transducer wil l
be overm ask ing.
For more det ails , please refer to the A utomas k ing and Mas king Help Quic k Guide in Appendix 4
Keyboard:
To enter the Keyboard opti ons for tone t est ing unfol d t he Tone opt ions and c lic k Keyboard. Thi s is used s et
up mac ros for t he dedic ated A ffi nity
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audiometry keyboard shown bel ow (if this is used).
The s creen display (shown below) all ows you to set up mos t of t he keyboard buttons according to individual
preferences. Multiple functi ons c an be added to a single but t on and if done s o al l commands are exec uted
when t he keyboard button i s pressed. S ome funct ions have addi tional opti ons aft er they are added t o a
keyboard button; for ex ample t oggling through the avail able out puts .
Note: The k eyboard func t i ons have to be set up for eac h t est indivi dual l y.
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The ex ample below walk s you t hrough an exampl e of how to s et up one k eyboard butt on.
28) Press the unfold ic on to mak e al l command under Ch1 input available.
29) Make sure t he O utput c hannel 1 under key is selected and press the plus i c on to add t he Ch1 next
output to Output Channel 1.
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30) Unfold the newly added com mand to see i ts options .
31) Select or deselec t t he options as y ou prefer to use them.
32) Delete a com m and from a keyboard button by cl i cki ng the white c ros s.
Add-ons:
33) To ent er the Add-on opt ions for tone tes ting unfold t he Tone options and cl ick the plus in front of Add-
on. Then select Mult i Frequency.
34) Here settings for Multi F requenc y can be adapted. A djust the frequency Resolution us i ng the
dropdown list.
Tick S et m ul ti f requenc i es as default enabled t o set the functi on t o be default as on (for further
desc ript ion of mult i frequenc y tes ti ng please s ee s ecti on 1.6.2)
Note: High f requency Add on tab i s currentl y not i n use (for further des cript ion of hi gh frequency
testing pl ease see secti on 1.6.1).
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1.8.2.3 Speech Testing Setup
Startup
1) To ent er the Startup options for speech testing, unfold the Speech options and c l i ck Startup.
2) S el ect the default output of Channel 1 and Channel 2 i n t he two dropdown li st s. The sel ect ion will
differ depending on whic h trans ducers are cali brated.
3) A ct ivat e the Ta l k b ack by ticking the c heck b o x. The talk bac k l evel can be adjus ted usi ng t he sl ider.
A normal audible level would be approximately 60 dB.
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Common
4) To enter t he Common opt ions for speec h tes ti ng unfold the Speech options and click Common.
Note: This s creen contai ns four tabs (General, Ot her, Link sti m ul us type to W R c urves , and Norm
curves).
5) S et the Channel 1 and Channel 2. Y ou have the opt i on to tic k Manual so that the stimul us is only
presented when manually activated. Ticking Reverse will cause t he s i gnal t o be pres ent ed
continuous l y, only di sappearing when t he st imul us is ac ti vated.
You also have t he option t o s elec t between S ingle P uls e and Multi Pulse presentation for channel 1.
The durati on of the st imul us c an be adjus ted i n t he com mon opti ons des cribed above. Furthermore,
you m ay wis h to have present ation in both c hannels and t ic k Simultaneous which will lock c hannel 1
and channel 2 together or have t he presentat ion in the t wo channel s alt ernating t o eac h ot her and tic k
Alternate
6) The default input for Channel 1 and Channel 2 can be s etup usi ng the dropdown lists. Select
between Mic 1, Mic 2, CD1 , CD2 and W ave file as i nput for c hannel 1, and Mic 1, Mic2 , CD1, CD2, W N
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(White Nois e), and SN (Speech Nois e) as i nput for channel 2
.
Note t hat sinc e CD and mi crophone are not automat ical ly c ons idered m asking s i gnal s you can ti ck
Masking below the channel 2 input sel ecti ons . This ensures that t he AC440 c onsiders the CD input
masking.
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Mic2 and speech audiometry using a CD player is only availabl e on the Affinity
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Channel 1 Channel 2
7) In Settings – representation you c an c hoose bet ween T able Mode and Graph Mode.
Graph Mode : If sel ect ing Graph Mode the res ult s are display ed in a graph.
Show SRT on s peec h audiogram c alc ulates t he SRT value based on the norm c urve (the
dis tance i n dB from the point where t he norm c urve c ross es 50% to t he point where t he
speech curve cros ses 50%) like shown below. The result is then an expression of how much
you need to turn up t he l evel c om pared to normal in order for the pat i ent t o be abl e to repeat
50%.
The calc ul ation is based on the m curve if using mul ti sy llabic words and t he s curve if using
single syllabic words.
Note t hat the norm curves c hange bas ed on the s peech materi al. Y ou must therefore ensure
that W R1, WR2 and/or WR3 is l inked to single or mul t i syl l abi c words to show the SRT (see
section
1.7.2.3). If no s t i m ul us is link ed t o t he WR c urves, no SRT wil l be s hown on the
speec h sc reen.
Table Mode: If s el ecting Table Mode the t est res ul ts are dis pl ayed i n a t abl e.
W hen cl i cki ng “st ore” the i nt ensit y level is shown in t he t abl e. Unl i ke Graph mode no
cal culat i on of the SRT t akes pl ace. The t abl e m ode records the level at which you found the
SRT.
W hen changing Transducer, T es t Type (HL, MCL, UCL), and Aided (Aided or Bi naural) a new
SRT i s recorded.
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8) Under Table mode s ettings you can dec ide whet her t he tes ting should s tart wi th SRT, W R1, WR2,
W R3, HL, MCL, or UCL. The t ype of speech m aterial for each W R c an be s elec ted in t he Li nk sti m ul us
types to WR curves (s ee lat er in t his s ect ion).
9) Under Graph mode sett ings you can dec ide whether t he t esti ng should start with WR1, WR2, WR3,
MCL, or UCL. The type of s peech mat eri al for eac h WR c an be sel ected in t he Li nk sti m ul us types t o
WR curves (see later this sect i on).
10) Under O th er settings y ou can tic k Aided i f audiograms us ually are obt ained wi t h heari ng aids and/ or
Binaural i f both ears are tested at the sam e t ime. Thi s wi l l resul t in a s eparat e speech curve. Tic king
Synchrone wil l act ivat e the c orrespondi ng butt on in the front sc reen by defaul t loc king the dist ance in
input level between Ch1 and Ch2 for m ask ing purpos es
.
11) Under Monitor one or both of the channels may be ticked i f moni toring i s preferred. The level of the
monitoring can be set us ing the sli der bar.
12) Adjust t he I nput Le ve ls for t he selec ted input . It m ay be pract i cal to s et a default value in this screen if
you al way s use the same input. Note that the input level can al so be selec ted in the speech s creen by
press ing s hift and adjust ing the input to 0 V U (see section 1.6.5)
13) Under the Othe r ta b addi tional s peech t est func tions are avail able.
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14) Settings – controls includes the following opti ons:
Ignore mouse over t ouch switc h: The AC440 will i gnore the m ouse t ouching the stim ul i area.
The functi on is em bedded to avoi d acc i dentally present i ng a stimul us.
Incorrec t b utt on deactivated: The inc orrect butt on wi ll be greyed and only correct ans wers are
19
counted.
Res et s peech sc ore on i ntens ity c hange: The score wil l ret urn to zero when t he intensi ty i s
changed. Thi s is useful t o avoid ac ci dentally storing a measurement poi nt in the speech graph
whic h was measured over di fferent speec h levels .
Reset s c ore on HL to UCL change: E nsures t hat if the test is toggled from HL to UCL the
scoring wi l l res tart s o that the UCL test does not buil d on t he HL scoring.
Jump t o next t rac k on store m akes sure that a new word l i s t is used for every point m easured. In
case word li sts cont ai n enough words for s everal point s, i t can be di sabled. Not ice that the word
scoring can be revi ewed by hovering the m ouse over meas ured data point s . It however only
shows the words of the lis t in whic h t he poi nt s tarted its measurem ent.
Phoneme sc ore schem e: Al low phoneme sc oring during the speec h tes t. The front sc reen wil l
allow you to specify i f 0, 1, 2, 3 or 4 phonemes are correctly repeated as illustrated below.
First word(s) for famil i arizati on: Set a num ber of “pract is e words” usi ng the dropdown l ist (i f
Phonem e score scheme is t ic ked). If for example s et to 3, the firs t three words will not be c alc ulated
in t he final score as t hese are trial words.
Number of words: Type in a number of words for t he ac tual sc ored tes t. Not e that this will be ignored
when us i ng wave fil es si nce the number of words i n t hi s case wi l l be dependent on the s el ec ted
speec h mat erial.
St op when number of words has b een reached automat ic ally st ores the poi nt after reac hing the
number of words that i s indi cat ed at number of words.
Always show wavefile presentation as sures that y our preferred wave files are al so shown on screen
when s el ecti ng m i crophone or CD as i nput.
19
Thi s m ay be useful if testing w ith wave files. In the wave file settings you can set time lim its so that after a certain period of tim e the
word wil l be scored as incorrect. In this case the incorrect button is not needed
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15) Link i ng a type speech m aterial to a WR curve:
Under the Link stim ul us to WR curve t ab a certai n type of speec h material can be li nked to the
individual WR curves. If a c l ini c for example alway s uses multi s yllabi c numbers for W R1 and s i ngle
syllabi c words for WR2, y ou can link these m at eri al s to t he curves and corres pondi ng but tons i n the
front sc reen.
Mark the type of material in t he s el ecti on l i st
Click on t he arrow pointi ng towards the WR curve to whic h t he material shoul d be linked
The mat erial will then jump to t he selec t ed WR
16) Unlink i ng a type of speec h material from a WR curve:
Mark the type of material
Click on t he arrow pointi ng bac k to the selec t i on
The mat erial will then jump back to t he selec tion l i st
17) User de fined WR labels allow you to name or label the speech m aterial which wil l t hen be sel ect able
for t he print l ayout (s ee 0 for how to m ake a personal print layout). A dditi onally for table mode t est ing
the check boxes indicate whic h labels are avai lable as but tons in the t est sc reen.
18) Under the Norm curve s t ab t he norm values appearing in the speec h graph can be changed.
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19) For Phone norm curves both Multi syllabic and Single syllabic norm values for speec h tes ts
obtained with head phone can be edi ted or replac ed wit h other norm m aterial . The default norm
mat erial is i n acc ordance wit h the DIN 45 626 standard.
20) For FF norm curves both M u lti syllabic and Single syllabic norm values for speec h test s obt ained in
free field can be edi ted or replac ed wit h other norm material . The default norm mat erial is in
accordance with the DIN 45 626 s tandard.
Keyboard
To enter the Keyboard opti ons for speec h test i ng unfold the Speech opt ions and click Keyboard. This is,
however, only relevant if using t he dedi cated audiometry keyboard (shown in section 1.7.2.2). S ince the
procedure for sett ing up the key board butt ons for speec h audiomet ry is ident ical to the proc edure for set ting
up the key board butt ons for tone audiom etry , pleas e see sec tion 1.7.2.2 for a des cri ption.
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Add-ons
21) To enter t he Add-on opti ons for speec h tes ti ng unfold the Speech options and click Add-ons. In this
20
sc reen the AC440 can be set up to do s peech t esti ng us ing wave files
. Upload the wave files to the
PC (as descri bed in Appendi x 1).
22) Selec t your speech m aterial in t he Speec h CD name dropdown list. Sel ecting the dash ‘-‘results in
not having word li sts av ailable in the test screen.
23) Word scoring inc l udes the following opti ons:
Manual: Full m anual c ontrol over the speec h test whic h is init iated, s topped and s cored
manually.
Continue t o next word aft er manual s coring: P res ents the next word, number, or sentence
imm ediatel y after y ou have s cored t he previous word t o be ei ther correct or i ncorrect .
Continue t o next word and sc ore automat ic ally: The AC440 c an be t imed to wai t for a c ertai n
number of sec onds before cont i nui ng wit h the next word, number or sentence regardles s of
whether it the previous word was repeat ed correc tly or inc orrectly. Additi onal l y, you can
deci de whether the word, number, or sent ence s hould be ass umed Correct or Incorrect when
continuing the t est if no score has been ent ered.
In the whit e sec tion below you c an specify t he exact durati on of t he pause between c l icki ng the correc t
butt on and present ing the next word, number or sent ence by ent ering the des ired number of sec onds.
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Speech testing w ith wave files is an additional license (I SF 440)
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1.8.2.4 M LD te sti ng21 Setup
Startup
To enter the Startup options for MLD tes ting unfold t he MLD options and c lic k Startup.
1) Talk back can be enabled by t i cki ng the check box. Use the sl i der to set the default Talk back level.
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Common
To enter the Common options for MLD tes ting unfold t he MLD opti ons and c lic k Common.
2) The Channel 1 Output and Channel 2 Output are t i ed together as t ones are pres ented t o the ears in
and out of phase respec ti vely . This means that the Ch1 output wi ll decide t he out put of Ch2. Us e t he
Ch1 O ut put dropdown l i st to s elect the input for P hone right or Ins ert ri ght .
Under Monitor one or both of the channel s m ay be ti cked i f moni toring i s preferred. The level of t he
monitoring can be set using the slider.
3) In MLD differe nce you c an decide whether the M LD is preferred t o equal S0 - SΠ or S0 – NΠ using
the check boxes.
4) The MLD Test freque ncies may be user defined. You have the possi bi li ty to c hoose t he four
preferred t est frequencies us ing the dropdown lis ts that al l allow for sel ect ing between t he frequencies
125 – 8000 Hz. A s MLD is primaril y a low frequency tes t, 125, 250, 500, and 1000 Hz woul d be the
mos t com m on choic e.
Affinity
Lin
no filt ering
-6 per oc tave
Minor hi gh pass filt ering
-12 per octave
Minor - M edium high pas s filteri ng
-18 per octave
Medium – Major high pas s filt ering
HFE (-24 per oc tave)
Major hi gh pass filt ering
2.0
Additional I nforma tion Page 90
Keyboard
To enter the Keyboard opti ons for MLD tes ti ng unfold the MLD options and cl ick Keyboard. T his is, howev er,
only relevant i f using the dedic ated audiom etry keyboard. Si nc e the procedure for setting up the k eyboard
butt ons for MLD tes ting is ident ic al to t he procedure for t he s ett ing up key board butt ons for tone audi ometry ,
pleas e s ee sect i on 1.7.2.2 for a description.
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1.8.2.5 MHA Counselling
Setup
Startup
To enter the Startup options for MHA c ounsell ing unfold the MHA options and c l ick Startup. Tal k b ack can
be enabl ed by tic king the chec k box (as described i n section 1.7.2.4 above).
Common
To enter the Common options for MHA c ounsell ing unfold the MHA options and cl i ck Common.
1) S et the out put and input for c hannel 1 and the input for channel 2 under Channel 1 and Channel 2
Input using the dropdown lists. The output c hosen for channel 1 will aut om atic al l y also apply for
channel 2.
2) S el ect the default st art fil t er. The different fi l ters are ill ustrat ed below:
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M aster Hearing Aid (MH A) requires an additional software l icense.
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