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Interacoustics Affinity 2.0 Additional Information

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Additional Information

2.0
2.0
Affinity
/ Equinox
Hearing Aid Analyzer
D-0004576-I – 2017/11

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  • Page 1: Additional Information

    Additional Information Affinity / Equinox Hearing Aid Analyzer D-0004576-I – 2017/11...

  • Page 3: Table Of Contents

    Table of Contents AC440 ..........................1 About AC440 Module ..................... 1 Launching AC440 with Databases ................. 2 1.2.1 Launching from OtoAccess™ ..................2 1.2.2 Launching AC440 from Noah..................3 1.2.3 Using the Tone Screen....................4 The Speech Screen Elements ..................10 1.3.1 Speech Audiometry in Graph Mode................
  • Page 4 Working with Individual Setups (Te st Protocol s)............65 1.8.1 Selecting a Test Protocol: ..................65 1.8.2 Creating new Protocols ..................... 66 1.8.2.1 Common Setup ..................66 1.8.2.2 Tone Testing Setup..................68 1.8.2.3 Speech Testing Setup ................. 80 1.8.2.4 MLD testing Setup ..................88 1.8.2.5 MHA Counselling Setup ................
  • Page 5 REM440 ........................144 Quick Guide ........................144 About REM440 ......................146 REM440 Te sts ......................146 Launching REM440 with Database s ................147 2.4.1 Launching REM440 from Noah4: ................147 2.4.2 Launching REM440 from OtoAccess™: ..............147 The REM Screen Elements ..................149 Background on Real-Ear Measurements using REM440 ..........156 2.6.1 Required Items ......................156 2.6.2...
  • Page 6 2.7.4.1 RECD using the client’s own ear mould ............184 2.7.4.2 RECD using the SPL Probe................187 2.7.4.3 Own Mould versus SPL Probe ..............189 2.7.4.4 Predicted RECD Curve ................189 2.7.4.5 Measured RECD compared to a predicted RECD ........189 2.7.4.6 Re-using a Coupler Curve ................190 2.7.4.7 RECD from a previous Session ..............191 2.7.4.8...
  • Page 7 2.11.3 Visible Speech Mapping (in coupler mode/test box mode) ..........253 2.12 Visual Tool s for Counseling and Verification .............256 2.12.1 Percentile Analysis ....................256 2.12.2 Display Peaks and V alleys ..................257 2.12.3 Show Examples .......................257 2.12.4 Speech Intelligibility Index ..................258 2.12.5 Speech Spectrum ....................258 2.12.6 Dynamic Range View....................259 2.12.7 Aided versus Unaided ....................259 2.13 2.13 Vi sible Speech Mapping Settings................259...
  • Page 8 3.6.10 Comparing to the manufacturers specification sheets ..........274 3.6.10.1 Telecoil Testing ..................274 Application of the HIT440 Te sts..................276 3.7.1 Frequency Response ....................276 3.7.2 Gain Curve ......................277 3.7.3 Harmonic Distortion ....................278 3.7.4 Intermodulation Distortion..................280 3.7.5 Attack/Recovery Time ....................280 3.7.6 Battery Current Drain/Battery Life Time ..............282 3.7.7 Equivalent Input Noise .....................284 3.7.8...
  • Page 9 PRINTING AND MAKING REPORTS ..............337 The Print Wizard ......................337 4.1.1 Designing a Customized Print Template ..............339 4.1.2 Design Elements .....................340 4.1.2.1 General Elements ..................340 4.1.2.2 Taskbar 343 Creating Reports ......................344 4.2.1 Operation of the Report Editor ..................344 4.2.1.1 The Report Editor ..................344 4.2.1.2 The Template Editor ..................346 RECOVERY MANAGER...

  • Page 11: Ac440

    Affinity Additional Information Page 1 1 AC440 About AC440 Module AC440 is the PC-based audiometry module for the Affinity and Equinox hardware platforms. The AC440 software is an independent two-channel audiometer. It features tone audiometry for air and bone, speech testing and a variety of masking and signal types. Stimuli are presented using the PC keyboard, mouse or a dedicated audiometry keyboard.

  • Page 12: Launching Ac440 With Databases

    Affinity Additional Information Page 2 Launching AC440 with Databases 1.2.1 Launching from OtoAccess™ Ensure that the Affinity is switched on and connected before opening the software suite. If the hardware is not detected, a dialog box will appear asking if you want to run the Affinity Suite in Simulation mode, similar to the following: To start the Affinity Suite from OtoAccess™: 1.

  • Page 13: Launching Ac440 From Noah

    Affinity Additional Information Page 3 1.2.2 Launching AC440 from Noah Ensure that the Affinity is switched on and connected before opening the software module. If the hardware is not detected, a dialog box will appear asking if you want to run the Affinity Suite in Simulation mode. To start the Affinity Suite from Noah 4: 1.

  • Page 14: Using The Tone Screen

    Affinity Additional Information Page 4 1.2.3 Using the Tone Screen The following section describes the elements of the tone screen. Menu provides access to Print, Edit, View, Tests, Setup, and Help Print allows for printing the session’s acquired data. Save & New Session saves the current session in Noah or OtoAccess™ and opens a new one.
  • Page 15 Affinity Additional Information Page 5 Fold an area so that it only shows the label or the buttons of that area. Unfold an area so that all buttons and labels are visible Show/hide areas can be found by right mouse clicking on one of the areas. The visibility of the different areas as well as the space that they take on the screen is locally saved to the examiner.
  • Page 16 Affinity Additional Information Page 6 High Frequency shows frequencies on the audiogram (up to 20 kHz for the Affinity /Equinox ). However, you will only be able to test in the frequency range the selected headset is calibrated for. High Frequency Zoom activates high frequency testing and zooms in on the high frequency range.
  • Page 17 Affinity Additional Information Page 7 Selecting the Monitor Ch1 and/or Ch2 check boxes allow you to monitor one or both channels through an external loudspeaker/headset connected to the monitor input. The monitor intensity is adjusted by the arrow keys. The Talk back check box enables you to listen to the patient. Note that you need to be equipped with a microphone connected to the talk back input and an external loudspeaker/headset connected to the monitor input.
  • Page 18 Affinity Additional Information Page 8 The Output list for channel 1 provides the option to test through head phones, bone conductor, free field speakers or insert phones. Note that the system only shows the calibrated transducers. The Input list for channel 1 provides the option to select pure tone, warble tone, narrow band noise (NB) and white noise (WN).
  • Page 19 Affinity Additional Information Page 9 Stimuli buttons will light up when hovering the mouse over it. This indicates the presentation of a stimulus. A right mouse click in the Stimuli area will store a no response threshold. A left mouse click in the Stimuli area will store the threshold at the current position.

  • Page 20: The Speech Screen Elements

    Affinity Additional Information Page 10 1.3 The Speech Screen Elements The following section describes the elements of the speech screen in addition to the tone screen: Input levels sliders allow for adjusting the input level to 0 VU for the selected input.
  • Page 21 Affinity Additional Information Page 11 The Output list for channel 2 provides the option to test through head phones, free field speakers, insert phones or insert masking phone. Note that the system only shows the calibrated transducers. The Input list for channel 2 provides the option to select white noise (WN), speech noise (SN), microphone (Mic1 and Mic2), CD1, CD2 and wave file.
  • Page 22 Affinity Additional Information Page 12 This feature gives much more flexibility and control when Speech testing. This feature is also implemented in other areas of the software where we are using speech wave files, for example in the SIN and SIQ tests. There is a setting within the protocol configuration to enable this feature to be defaulted on...

  • Page 23: Speech Audiometry In Graph Mode

    Affinity Additional Information Page 13 1.3.1 Speech Audiometry in Graph Mode Graph mode presentation settings in the lower left corner and in the presentation options (Ch1 and Ch2) in the upper part of the screen you can adjust the test parameters during the test. 1) The graph: The curves of the recorded speech graph will be displayed on your screen.

  • Page 24: Dual Speech Graphs

    Affinity Additional Information Page 14 1.3.1.1 Dual Speech Graphs The graphs can be shown as a dual audiogram to show left and right (see example below) this can be enabled in the Speech Setup Screen by clicking on the button called ‘Dual Graph’. 1.3.1.2 50% Discrimination Line The Graph View allows you to add a 50% discrimination line (see above dual audiogram image for example).

  • Page 25: Bönninghaus & Röser Calculation

    Affinity Additional Information Page 15 1.3.1.3 Bönninghaus & Röser calculation The Bönninghaus & Röser calculation has been implemented for the German market. This is a marker to recognise the accuracy of the test in relation to the patients audiometry and also to identify when the patient is suitable for compensation/insurance.

  • Page 26: Speech Audiometry In Table Mode

    Affinity Additional Information Page 16 1.3.2 Speech Audiometry in Table Mode The AC440 Table Mode consists of two tables: The SRT (Speech Reception Threshold) table. When the SRT test is active, it is indicated in orange The WR (Word Recognition) table. When WR1, WR2, or WR3 is active the corresponding label will be orange 1.3.2.1 The SRT table...

  • Page 27: The Wr Table

    Affinity Additional Information Page 17 1.3.2.2 The WR Table The word recognition (WR) table allows for measuring multiple WR scores using different parameters (e.g. Transducer, Test Type, Intensity, Mask ing, Binaural and Aided). Upon changing Transducer, Masking, Binaural and/or Aided re-testing an additional WR entry will appear in the WR table.

  • Page 28: Binaural Speech

    Affinity Additional Information Page 18 1.4 Binaural speech It is only possible to test Speech binaurally in the Speech audiometry screen. This can be done if channel 1 and channel 2 are using the same air conduction transducer and only when a different output is chosen. E.g. right ear in channel 1 and left ear in channel 2 or vice versa.

  • Page 29: Full 2(4) Channel Speech In Noise

    Affinity Additional Information Page 19 1.5 Full 2(4) channel Speech in noise The ability to test via Full 2(4) Channel Speech in noise allows the ability to test whilst stimulating speech and noise in both channels at the same time. If the R+L is chosen in channel 1 the level presented in Channel 1 will be equal in both Left and right transducer at the same time and vice versa.
  • Page 30 Affinity Additional Information Page 20 Binaural Stimulus Intensity Binaural Masking Intensity Channel 1 Channel 2...

  • Page 31: Counselling Tab

    Affinity Additional Information Page 21 1.6 Counselling Tab Under the menu icon there is a tab titled counslling. This is where the counselling features of the software are contained. 1.6.1 Sound Studio The SoundStudio is a counselling tool which allows you to recreate sound environments to simulate real-life situations for use during hearing aid fitting and counselling.

  • Page 32: Clinical Application Of The Ac440 Tests

    Affinity Additional Information Page 22 1.7 Clinical Application of the AC440 Tests This section will give a short introduction to the clinical applications of the AC440 module. The methods described here primarily based on the textbooks by Stach (1998) and Katz (2002) and describes one way of performing the individual tests.
  • Page 33 Affinity Additional Information Page 23 These features are intended to help the inexperienced clinician when masking is required. Please see section 1.7.2.2 and Appendix 4 for more information on this. Explain to the patient that they will hear a number of different tones through the headphones and that they should press on the response button whenever the tone is audible, even if it is very faint..

  • Page 34: High Frequency Audiometry

    Affinity Additional Information Page 24 1.7.1 High Frequency Audiometry High frequency audiometry (above 8 kHz) is performed using the same procedure as normal air conduction audiometry. Note, however, that you are only allowed to test within the range of the headset calibration That is, if the headset is only calibrated for a range of 125 Hz –...

  • Page 35: Multi Frequency Audiometry

    Affinity Additional Information Page 25 1.7.2 Multi Frequency Audiometry Multi frequency audiometry lets the clinician test more frequencies than the traditional audiometric test frequencies. This may be useful when dealing with steeply sloping hearing impairments as it becomes possible to obtain a more precise measure of the slope of the hearing loss. It is also helpful in the evaluation of tinnitus as is provides the option to match the tinnitus.

  • Page 36: Bone Conduction Audiometry

    Affinity Additional Information Page 26 1.7.3 Bone Conduction Audiometry In bone conduction audiometry, the test signal is presented by a bone vibrator placed on the mastoid. The bone vibrator uses the skull to transfer the vibrations to the cochlear and bypasses the outer and middle ears.

  • Page 37: Masking

    Affinity Additional Information Page 27 1.7.4 Masking In cases where a symmetrical hearing loss is detected, traditional audiometry without masking is usually sufficient. However, be aware that in cases of asymmetrical hearing loss, one cannot be certain that the test ear is the one actually detecting the sound.

  • Page 38: Speech Audiometry

    Affinity Additional Information Page 28 There are many ways of applying clinical masking. Which method to use is your decision. Regardless of the masking method channel 2 is used to occupy the better ear. In the example above channel 2 should be set to Right (non-test ear) using the preferred masking stimulus preferred (usually Narrowband NB).
  • Page 39 Affinity Additional Information Page 29 Correct, Incorrect, and Store Number of correct Phonemes and Store The speech score will be displayed in the black bar: Note: The AC440 Setup allows for selecting whether the speech test is to be performed in Graph or Table Mode (see section 1.7.2.3).

  • Page 40: Speech Reception Threshold (Srt) In Table Mode

    Affinity Additional Information Page 30 1.7.5.1 Speech Reception Threshold (SRT) in Table Mode The SRT examines at which level 50% of the speech material (usually numbers or spondaic words) is repeated correctly. The SRT can be used as a cross check of the air conduction audiometry and should closely agree with the PTA (Pure Tone Average).

  • Page 41: Word Recognition (Wr) In Table Mode

    Affinity Additional Information Page 31 1.7.5.2 Word Recognition (WR) in table mode The Word Recognition score determines the patient’s discrimination ability expressed in a percentage. It provides information about what phonemes the patient has difficulty hearing at a particular intensity level. This is helpful for counselling and rehabilitation purposes.

  • Page 42: Speech Testing With A Microphone

    Affinity Additional Information Page 32 1.7.5.3 Speech Testing with a Microphone 2.0. Affinity /Equinox Connect the microphone to the Mic1 or Mic2 input on the on the hardware. Microphone inputs Open the AC440 software, go to the Speech screen Choose Mic1 or Mic2 in the input channel 1 list. Adjust the input levels for the Mic1 or Mic2 until you reach an average of approximately 0 dB VU on the VU meter while speaking into the microphone at a normal conversation level.

  • Page 43: Speech Testing With An External Cd Player

    Affinity Additional Information Page 33 1.7.5.4 Speech Testing with an external CD Player Connect the CD player to the CD1 or CD2 input under the hardware (the below illustration shows the Affinity hardware). CD inputs Open the AC440 software, go to the Speech screen Choose CD1 or CD2 in the channel 1 list.

  • Page 44: Speech Testing With Wave Files

    Affinity Additional Information Page 34 1.7.5.5 Speech testing with Wave Files The AC440 also allows for testing with wave files if installed on the PC. The default speech material can be selected in the AC440 setup (see section 1.7.2.3). To use wave files choose them in the channel 1 list. The speech material can be selected from the four dropdown lists.
  • Page 45 Affinity Additional Information Page 35 5) Should you wish to choose where to begin your speech testing then you can click on the designated wavefile ahead of starting the test. Clicking on it will highlight it with a bolder outline. The material will then play from her on clicking the ’play’...

  • Page 46: Masking Level Difference (Mld)

    Affinity Additional Information Page 36 1.7.6 Masking Level Difference (MLD) Masking Level Difference refers to the improvement in detecting a tone or speech in noise when the phase of the tone or the noise is reversed by 180 degrees. It aims to assess central auditory function and is specifically sensitive to brainstem lesions, but peripheral changes (like a hearing loss) may also affect the MLD.
  • Page 47 Affinity Additional Information Page 37 Test Procedure: Open the AC440 and enter the MLD screen by selecting Menu | Tests | MLD. Select headset or inserts in the channel 1 output list. Before mounting the headphones on the patient, explain to them that they will now hear both tones (identical to the ones from the air conduction audiometry) and noise through the headphones.

  • Page 48: Master Hearing Aid (Mha)

    Affinity Additional Information Page 38 1.7.7 Master Hearing Aid (MHA) MHA is a hearing aid fitting procedure consisting of three hearing aid simulated high pass filters of -6 dB, -12 dB, -18 dB per octave and a HFE filter (High Frequency Emphasis) equivalent to -24 dB per octave through the audiometric headphones.
  • Page 49 Affinity Additional Information Page 39 what a hearing aid might sound like. Perhaps let him or her listen to the signal with their natural hearing as it is (without manipulating the sound). Explain that they are now listening to the CD, wave file or live voice with their own natural hearing.

  • Page 50: Hearing Loss Simulation (Hls)

    Affinity Additional Information Page 40 1.7.8 Hearing Loss Simulation (HLS) The HLS offers a simulation of the hearing loss through the audiometric headphones or the high frequency headset and is primarily aimed at the family members of the hearing impaired. It is a valuable tool as a hearing loss in many families may result in frustrations and misunderstandings.
  • Page 51 Affinity Additional Information Page 41 Start simulating by clicking the Right and/or Left buttons corresponding to the ear to be simulated. The text above each button will then change from Normal to ON. During the simulation it is possible to adjust the volume of the signal using the dB HL Decrease/Increase channel 1/channel 2 buttons.

  • Page 52: Short Increment Sensitivity Index

    Affinity Additional Information Page 42 1.7.9 Short Increment Sensitivity Index SISI is designed to test the ability to recognise 1 dB increase in intensity during a series of bursts of pure tones presented 20 dB above the pure tone threshold for the test frequency. It can be used to differentiate between cochlear and retrocochlear disorders as a patient with a cochlear disorder will be able to perceive the increments of 1 dB, as where a patient with a retrocochlear disorder will not.
  • Page 53 Affinity Additional Information Page 43 Start the test by pressing START. During the testing the frequency and intensity can be adjusted manually (see illustration). The system will automatically count the number of reactions from the patient. Note that the system needs 20 presentations to calculate a SISI score. Press STOP to end the test.

  • Page 54: Weber

    Affinity Additional Information Page 44 1.7.10 Weber Originally the Weber test distinguished between conductive and sensorineural hearing loss through use of a tuning fork. The fork was softly struck and placed in the middle of the patient’s forehead. If the patient heard the tone better in the poorer ear the hearing loss was conductive, and if the tone was heard better in the better ear the hearing loss was sensorineural at the given frequency.

  • Page 55: Knaster

    Affinity Additional Information Page 45 1.7.11 Knaster Knaster is a speech in noise training tool. Modified speech noise (Knaster Noise) is presented to one or both ears (binaurally) as this is believed to initiate a state of "alertness" in the sensorineural cells and thereby also affect the auditory pathways and centres.
  • Page 56 Affinity Additional Information Page 46 Select microphone, CD, or wave file in the channel 1 input list. The Knaster test can be performed on left, right or both ears. This is selected in the channel 1 output list. Set the level of the input to the level of maximum speech understanding using the dB HL Decrease/Increase channel 1 buttons.

  • Page 57: Ablb/Fowler

    Affinity Additional Information Page 47 1.7.12 ABLB/Fowler ABLB (Alternate Binaural Loudness Balancing) is a test to detect perceived loudness differences between the ears designed for people with unilateral hearing loss. It serves as a possible test for recruitment. The test is performed at frequencies where recruitment is presumed. The same tone is presented alternatively to both ears.

  • Page 58: Stenger Test

    Affinity Additional Information Page 48 1.7.13 Stenger Test The Stenger test is applied when a patient is suspected of feigning/faking a hearing loss and is based on the auditory phenomenon, “The Stenger Principle” which states that only the louder of two similar tones presented to both ears at the same time will be perceived.
  • Page 59 Affinity Additional Information Page 49 Note: Rev (Reverse) and if preferred Multi Pulse should be selected for channel 1 and Rev (Reverse) or Sim (Simultaneous) for channel 2. Clarify the test procedure to the patient. Explain that he/she will now hear speech and the assignment is to repeat the presented words or numbers.

  • Page 60: Ten Test

    Affinity Additional Information Page 50 1.7.14 TEN Test Until recently, the TEN(HL) test for diagnosing dead regions in the cochlea could only be conducted by use of a compact disc player connected to an audiometer. Now, the test has been implemented within the Affinity /Equinox Suites.

  • Page 61: Quicksin

    Affinity Additional Information Page 51 1.7.15 QuickSIN Difficulty with hearing in background noise is a common complaint among hearing aid users. Therefore, the measurement of SNR loss (signal-to-noise ratio loss) is important because a person’s ability to understand speech in noise cannot be reliably predicted from the pure tone audiogram. The QuickSIN test was developed to provide a quick estimate of SNR loss.
  • Page 62 Affinity Additional Information Page 52 6) The number of words in bold the patient repeats correctly should be scored by clicking on the score buttons. 7) When 6 sentences are scored a total score will be calculated. Note that if you press Stop before the 6 sentences of the list have been played and scored, no total score will be calculated.

  • Page 63: Tone Decay

    Affinity Additional Information Page 53 1.7.16 Tone Decay This is a test to help identify the adaptation of the auditory system (Carhart, 1957). It involves measuring the perceptual reduction in a continuous tone over time. This can indicate towards a cochlear or neural cause of deafness.
  • Page 64 Affinity Additional Information Page 54 But if the subject indicates that they no longer hear the tone before the minute criteria is reached, then the intensity of tone is increased by 5 dB without interrupting the tone, but the timing at the top of the screen is reset.
  • Page 65 Affinity Additional Information Page 55...

  • Page 66: Anl Test

    The Equinox and Affinity systems can perform the test binaurally via the R+L feature. The ANL Test can use any of the materials you have already ripped into your Interacoustics Suite software. When should I perform the ANL test? The ANL test is typically performed before the patient is given any form of amplification as a rehabilitative action for their hearing loss.
  • Page 67 Affinity Additional Information Page 57 It is not essential to perform MCL High and MCL Low for the ANL test, but these are also good indicators of the patients’ comfortable hearing range. Instructions for the patient will always be displayed at the bottom of the screen. The ANL Test requires an additional license.
  • Page 68 Affinity Additional Information Page 58 6. MCL Low Click on the MCL Low Icon and click play. This will loop your speech material. Increase and decrease the stimulus intensity to match the patients lowest MCL. The display will change within the icon but also a predicted MCL Real will be generated as a midpoint between the MCL High and MCL Low.
  • Page 69 Affinity Additional Information Page 59 8. BNL Click on the BNL Icon and click Play. This will loop the same speech material but also introduce the background masking noise. Increase/decrease Channel 2 in order to find a level of competing noise which the patient would be comfortable to listen to alongside their target material.
  • Page 70 Affinity Additional Information Page 60 What does my ANL value mean? On performing the ANL test you will obtain an ANL value (in dB) and a percentage. The percentage gives a likelihood of success with amplification (Nabalek et al., 2006) and the ANL value is the outcome of the following calculation: ANL = MCL -BNL For response categories the following outcome criteria was determined as an effect of the Nabalek et al.

  • Page 71: Siq Test

    The SIQ test is very similar to Speech Audiometry and can use any of the materials you have already ripped into your Interacoustics Suite software. However the Stimulus intensity is maintained automatically by the software following a correct or incorrect response to the stimulus, this helps to speed up the test time.
  • Page 72 Affinity Additional Information Page 62 5. Ensure that your speech material is correct and the relevant list has been chosen. 6. Instruct the patient to respond by repeating the words that they hear. Press the play icon to begin the test.

  • Page 73: Sin Test

    The SIN test is very similar to Speech Audiometry and can use any of the materials you have already ripped into your Interacoustics Suite software. However the Signal-to-Noise Ratio is maintained automatically by the software following a correct or incorrect response to the stimulus, this helps to speed up the test time.
  • Page 74 Affinity Additional Information Page 64 5. Ensure that your speech material is correct and the relevant list has been chosen. 6. Turn on the masking in Channel 2 by clicking from Man to Rev. The masking will need to be turned on manually, this is because you may want to perform an initial familiarization test with the patient without the noise to begin.

  • Page 75: Working With Individual Setups (Test Protocols)

    Affinity Additional Information Page 65 1.8 Working with Individual Setups (Test Protocols) There are many different demands and wishes regarding how an audiometer should both function and appear depending on the specific situation and national standards. One of the greatest advantages of the AC440 module is the flexibility enabling you to tailor the system according to your specific preferences in the so-called “test protocols”.

  • Page 76: Creating New Protocols

    Affinity Additional Information Page 66 In each setup screen you will find three buttons in the lower right corner: Clicking OK will close the AC440 setup and save all changes. Clicking Apply will save changes but without closing the AC440 Setup. The change will, however, immediately be active and visible on the screen behind the setup dialog.
  • Page 77 Affinity Additional Information Page 67 Note: Some tests are purchased as additional licences for the AC440. If a license has not been purchased, the test will be greyed out in the start screen selection and it will not be shown in the ‘test tree’...

  • Page 78: Tone Testing Setup

    Affinity Additional Information Page 68 1.8.2.2 Tone Testing Setup Startup 1) To enter the Startup options for tone testing unfold the Tone options and click Startup. Default Output of Channel 1 and Channel 2 can be selected in the two dropdown lists. The selection will differ depending on which transducers are calibrated.
  • Page 79 Affinity Additional Information Page 69 Common: To enter the Common options for tone testing unfold the Tone options and click Common. Here you can adjust some of the more frequent tone audiometry settings stating with the General settings. Note: This screen contains three tabs (General, Tone audiometry and Overlays). Default input for Channel 1 and Channel 2 can be set using the dropdown lists.
  • Page 80 Affinity Additional Information Page 70 Settings – a. Ignore mouse over touch switch which will make AC440 ignore the cursor touching the stimuli area in the front screen. Instead you will need to present the stimulus manually using the PC keyboard or the dedicated audiometer keyboard.
  • Page 81 Affinity Additional Information Page 71 Under the Tone audiometry tab you can select the desired test frequencies for HL/MCL and UCL by ticking the preferred frequencies. Use the Check all or Uncheck all buttons to help if needed. If the unselected frequencies are not to be visible on the graph then also tick Hide unselected HL, MCL and UCL frequencies.
  • Page 82 Affinity Additional Information Page 72 If selecting the PTA (Fletcher) index you can choose the frequencies that should be included in the calculation. The default setting will be 500, 1000, 2000, and 4000 Hz. In this calculation method all frequencies are equally weighted and averaged to give the figure. The PTA index also provides the option to add a certain level to the result using the dropdown list.
  • Page 83 Affinity Additional Information Page 73 Since the speech banana is language dependent the AC440 allows for entering individual speech banana values. Enter your values for the upper and lower margin of the speech banana under Top part of banana and Bottom part of banana. For counselling purposes you can tick Show speech banana in the Speech Banana tab.
  • Page 84 Affinity Additional Information Page 74 A Severity indication can be set up by defining the label, minimum and maximum dB and colour for each indication in the audiogram. For counselling purposes you can tick Show severity in the Severity tab. This allows for severity indications in the audiogram screen.
  • Page 85 Affinity Additional Information Page 75 The Phonemes to be shown in an audiogram can be set up by defining the labels and positions of all phonemes. Indicate the font size as how they must appear on screen. For counselling purposes you can tick Show phonemes in the Phonemes tab. This allows for phonemes in the audiogram screen.
  • Page 86 Affinity Additional Information Page 76 The Sound examples to be shown in an audiogram can be set up by defining the positions of all examples. When adding a new picture you are asked to point out where the picture can be found. Note that the file type must be *.png to allow transparent background colours.
  • Page 87 Affinity Additional Information Page 77 Masking Tab: In this section, the tester can decide if Automasking or Masking Help should be turned on. The user can also change the interaural differences as well as the default values for over masking. a.
  • Page 88 Affinity Additional Information Page 78 The example below walks you through an example of how to set up one keyboard button. Press the unfold icon to make all command under Ch1 input available. Make sure the Output channel 1 under key is selected and press the plus icon to add the Ch1 next output to Output Channel 1.
  • Page 89 Affinity Additional Information Page 79 Unfold the newly added command to see its options. Select or deselect the options as you prefer to use them. Delete a command from a keyboard button by clicking the white cross. Add-ons: To enter the Add-on options for tone testing unfold the Tone options and click the plus in front of Add- on.

  • Page 90: Speech Testing Setup

    Affinity Additional Information Page 80 1.8.2.3 Speech Testing Setup Startup To enter the Startup options for speech testing, unfold the Speech options and click Startup. Select the default output of Channel 1 and Channel 2 in the two dropdown lists. The selection will differ depending on which transducers are calibrated.
  • Page 91 Affinity Additional Information Page 81 Common To enter the Common options for speech testing unfold the Speech options and click Common. Note: This screen contains four tabs (General, Other, Link stimulus type to WR curves, and Norm curves). Set the Channel 1 and Channel 2. You have the option to tick Manual so that the stimulus is only presented when manually activated.
  • Page 92 Affinity Additional Information Page 82 Channel 1 Channel 2 In Settings – representation you can choose between Table Mode and Graph Mode.  Graph Mode: If selecting Graph Mode the results are displayed in a graph. Show SRT on speech audiogram calculates the SRT value based on the norm curve (the distance in dB from the point where the norm curve crosses 50% to the point where the speech curve crosses 50%) like shown below.
  • Page 93 Affinity Additional Information Page 83 Under Table mode settings you can decide whether the testing should start with SRT, WR1, WR2, WR3, HL, MCL, or UCL. The type of speech material for each WR can be selected in the Link stimulus types to WR curves (see later in this section).
  • Page 94 Affinity Additional Information Page 84 Settings – controls includes the following options:  Ignore mouse over touch switch: The AC440 will ignore the mouse touching the stimuli area. The function is embedded to avoid accidentally presenting a stimulus.  Incorrect button deactivated: The incorrect button will be greyed and only correct answers are counted.
  • Page 95 Affinity Additional Information Page 85 Linking a type speech material to a WR curve: Under the Link stimulus to WR curve tab a certain type of speech material can be linked to the individual WR curves. If a clinic for example always uses multi syllabic numbers for WR1 and single syllabic words for WR2, you can link these materials to the curves and corresponding buttons in the front screen.
  • Page 96 Affinity Additional Information Page 86 19) For Phone norm curves both Multi syllabic and Single syllabic norm values for speech tests obtained with head phone can be edited or replaced with other norm material. The default norm material is in accordance with the DIN 45 626 standard. 20) For FF norm curves both Multi syllabic and Single syllabic norm values for speech tests obtained in free field can be edited or replaced with other norm material.
  • Page 97 Affinity Additional Information Page 87 Add-ons 21) To enter the Add-on options for speech testing unfold the Speech options and click Add-ons. In this screen the AC440 can be setup to do speech testing using wave files . Upload the wave files to the PC (as described in Appendix 1).

  • Page 98: Mld Testing Setup

    Affinity Additional Information Page 88 1.8.2.4 MLD testing Setup Startup To enter the Startup options for MLD testing unfold the MLD options and click Startup. Talk back can be enabled by ticking the check box. Use the slider to set the default Talk back level. Masking Level Difference (MLD) requires an additional license and is only available for the Affinity /Equionox...
  • Page 99 Affinity Additional Information Page 89 Common To enter the Common options for MLD testing unfold the MLD options and click Common. The Channel 1 Output and Channel 2 Output are tied together as tones are presented to the ears in and out of phase respectively.

  • Page 100: Mha Counselling Setup

    Affinity Additional Information Page 90 Keyboard To enter the Keyboard options for MLD testing unfold the MLD options and click Keyboard. This is, however, only relevant if using the dedicated audiometry keyboard. Since the procedure for setting up the keyboard buttons for MLD testing is identical to the procedure for the setting up keyboard buttons for tone audiometry, please see section 1.7.2.2 for a description.
  • Page 101 Affinity Additional Information Page 91 Under Monitor one or both of the channels may be ticked if monitoring is preferred. The level of the monitoring can be set using the slider If Wave files are chosen as input you can browse for them by clicking Browse. If a group of wave files are already chosen and you wish to browse for new ones, click Clear.

  • Page 102: Knaster Testing Setup

    Affinity Additional Information Page 92 1.8.2.6 Knaster Testing Setup Startup To enter the Startup options for Knaster testing unfold the Knaster options and click Startup. The default Talk back level can set using the check box (as described in section 1.7.2.4). Common To enter the Common options for Knaster testing unfold the Knaster options and click Common.
  • Page 103 Affinity Additional Information Page 93 Select the default start Low pass filters and/or High pass filters: no filtering -12 per octave Medium low/high pass filtering -24 per octave Major low/high pass filtering In Normal hearing level for gain calculation you can select a certain dB level which should normally be similar to the level of real speech (typically 60 dB).

  • Page 104: Hls Counselling Setup

    Affinity Additional Information Page 94 1.8.2.7 HLS Counselling Setup Startup To enter the Startup options for HLS counselling unfold the HLS options and click Startup. Determine the Talk back level using the check box to set the Talk back default (as described in section 1.7.2.4). Common To enter the Common options for HLS counselling unfold the HLS options and click Common.
  • Page 105 Affinity Additional Information Page 95 If Wave files are chosen as input you can browse for them by pressing Browse. If a group of wave files are already chosen and you wish to browse for new ones, press Clear. The Input level of the wave files can be adjusted to the left using the slider.
  • Page 106 Affinity Additional Information Page 96 Deleting an entry Using the Patient Monitor Text feature: 1. Choose the protocol in which the Patient Monitor Text has been activated 2. Go to the Menu│Tests │ HLS 3. Ensure the that Mic 2 transducer is chosen 4.

  • Page 107: Sisi Testing Setup

    Affinity Additional Information Page 97 Keyboard To enter the Keyboard options for HLS testing unfold the HLS options and click Keyboard. Since the procedure for setting up the keyboard buttons for HLS testing is identical to the procedure for the setting up keyboard buttons for tone audiometry, please see section 1.7.2.2 for a description.

  • Page 108: Weber Testing Setup

    Affinity Additional Information Page 98 Keyboard To enter the Keyboard options for SISI testing unfold the SISI options and click Keyboard. Since the procedure for setting up the audiometry keyboard buttons for SISI testing is identical to the procedure for the setting up keyboard buttons for tone audiometry, please see section 1.7.2.2 for a description.

  • Page 109: Quicksin Setup

    Affinity Additional Information Page 99 1.8.2.10 QuickSIN Setup Startup To enter the Startup options for QuickSIN testing unfold the QuickSIN options and click Startup. Select the default output for Channel 1 and Channel 2 using the dropdown lists. The Talk back level can be determined using the check box. QuickSIN requires an additional software license.
  • Page 110 Affinity Additional Information Page 100 Common To enter the Common options for QuickSIN testing unfold the QuickSIN options and click Common. Select Monitor for channel 1 (Ch1) and channel 2 (Ch2) using the check boxes and adjust the level using the slider. Keyboard To enter the Keyboard options for QuickSIN testing unfold the QuickSIN options and click Keyboard.

  • Page 111: Quicksin Additional Features Setup

    Affinity Additional Information Page 101 1.8.2.11 QuickSIN Additional Features Setup Adding a fourth column to the SNR loss definitions table: Go to: Menu │Setup │AC440 │Main Setup │QuickSIN │Common Insert a checkmark in the “show fourth column” box Click on the pencil icon to enter text in the text box Click on the dropper icon to add colour to the text box...
  • Page 112 Affinity Additional Information Page 102 Aided QuickSIN is now possible when selecting the free field transducer. To activate Aided QuickSIN: Ensure you are in the QuickSIN screen Select Free Field as the Transducer; this will activate the “Aided” function. Click on the Aided button; this will add an extra column on to the QuickSIN scoring table Comparing Aided and Undaided QuickSIN scores over time: Clinicians are now able to compare the Unaided and Aided SNR scores.

  • Page 113: Ablb/Fowler And Stenger Setup

    Affinity Additional Information Page 103 1.8.2.12 ABLB/Fowler and Stenger Setup ABLB/Fowler and Stenger can be performed by adjusting the Tone or Speech settings in the front screen. (see 1.7.2.2 section and 1.7.2.3). 1.8.2.13 TEN test Setup For your convenience, the TEN test can be selected as a pre-defined test protocol which is made according to the methods of Brian Moore (see Appendix 3).

  • Page 114: Anl Test Setup

    Affinity Additional Information Page 104 1.8.2.1 ANL Test Setup Startup To enter the Startup options for ANL testing unfold the ANL options and click Startup. 1) Select the default output for Channel 1 from the dropdown list. 2) The Talk back level can be determined using the check box.
  • Page 115 Affinity Additional Information Page 105 Common To enter the Common options for ANL testing unfold the ANL options and click Common. 1) Select your desired Channel 1 input via the Input dropdown list. 2) Select your desired Channel 2 input via the Input dropdown list. 3) Choose your Speech Material via this section.

  • Page 116: Siq Test Setup

    Affinity Additional Information Page 106 1.8.2.2 SIQ Test Setup Startup To enter the Startup options for SIQ testing unfold the SIQ options and click Startup. 1) Select the default output for Channel 1 from the dropdown list. 2) Select the default output for Channel 2 from the dropdown list. 3) The Talk back level can be determined using the check box.
  • Page 117 Affinity Additional Information Page 107 Common To enter the Common options for SIQ testing unfold the SIQ options and click Common. 1) Select your desired Channel 1 input via the Input dropdown list. 2) Select your desired Channel 2 input via the Input dropdown list. 3) Choose your Speech Material via this section.

  • Page 118: Sin Test Setup

    Affinity Additional Information Page 108 1.8.2.3 SIN Test Setup Startup To enter the Startup options for SIN testing unfold the SIN options and click Startup. 1) Select the default output for Channel 1 from the dropdown list. 2) Select the default output for Channel 2 from the dropdown list. 3) The Talk back level can be determined using the check box.
  • Page 119 Affinity Additional Information Page 109 Common To enter the Common options for SIN testing unfold the SIN options and click Common. 1) Select your desired Channel 1 input via the Input dropdown list. 2) Select your desired Channel 2 input via the Input dropdown list. 3) Choose your Speech Material via this section.

  • Page 120: Finishing The Test Protocol

    Affinity Additional Information Page 110 1.8.3 Finishing the Test Protocol Press OK in the lower right hand corner of the AC440 setup screen to save the customized test protocol. The test protocol can then be found in the Protocols and sessions dropdown list in the front screen. 1.8.4 Changing a Test Protocol Permanently You can at any time make changes to an individual test protocol by entering the AC440 setup again as when...

  • Page 121: Changing A Test Protocol Temporarily

    Affinity Additional Information Page 111 1.8.5 Changing a Test Protocol Temporarily You may from time to time run into a patient with special needs requiring advanced or different testing parameters. In this situation the Temporary Setup can be helpful. The setup changes made here will be specific to the particular session.

  • Page 122: Importing And Exporting Test Protocols

    Affinity Additional Information Page 112 1.8.6 Importing and Exporting Test Protocols The AC440 also allows you to import and export test protocols to other AC440 users. 1.8.6.1 Importing a Test Protocol: Go to the AC440 Setup (Menu | Setup | AC440 setup). Click Import and browse to the location on the PC or USB where the test protocol file has been saved.

  • Page 123: Exporting A Test Protocol

    Affinity Additional Information Page 113 1.8.6.2 Exporting a Test Protocol: Go to the AC440 Setup (Menu | Setup | AC440 setup). Click on Export. Select if the file is to be saved as “read only”. In this case the protocol file is locked and the clinician receiving it will not be able to make changes to it.

  • Page 124: General Setup

    Affinity Additional Information Page 114 1.9 General Setup In the General Setup you can select overall settings which are valid for all tests and protocols. To enter the General setup, select Menu | Setup | General Setup.

  • Page 125: Symbol Editor

    Affinity Additional Information Page 115 1.9.1 Symbol editor You enter the symbol editor by either pressing Edit on an existing symbol scheme or by pressing New after which you are asked to type a name and select which of the existing symbol schemes is your starting point for the new set.

  • Page 126: Noah Database Settings

    Affinity Additional Information Page 116 1.9.2 Noah database settings The option to ‘Use WR1 as SRT measurement (German User Scenario)’ enables the data to be stored in a specific manner for third party EMR systems to read and display the speech test data as SRT thresholds. The setting to ‘Save IP measurements as AC’...

  • Page 127: General Suite Settings And Examiner

    Affinity Additional Information Page 117 1.10 General Suite Settings and Examiner In General suite settings you find setup items that apply to all modules of the suite. To enter the General Suite settings enter Menu | Setup | General suite settings. 1.10.1 Startup Choose which module will be visible on starting up the Suite: AUD, REM, HIT or VO 1.10.2 Examiner settings...

  • Page 128: Language

    Affinity Additional Information Page 118 Note that locally, on the pc you are working, for each examiner a log file is created that contains preferences with regards to how the visuals of the Suite are being used. It is remembered which protocol was used last or which protocol is set as default start protocol.

  • Page 129: Pdf Print

    This is a benefit for paperless documenting of patients test data and also for sharing data with people who do not have the Interacoustics Suites. This feature is present for all modules of the Callisto and Affinity Suites once enabled.

  • Page 130: Password Protection

    Affinity Additional Information Page 120 1.11 Password protection When password protection is enabled the following menu items are greyed out and thereby make it impossible to permanently change settings. To activate or change a password, select Menu | Setup | Password protection and enter and confirm your password.

  • Page 131: The Ac440 Menu Items

    Affinity Additional Information Page 121 1.12 The AC440 Menu Items The AC440 Menu gives you access to Print, Edit, View, Tests, Setup, and Help.  Menu | Print | Print will prompt the system to print using the selected print template (see section 4.1) ...
  • Page 132 Affinity Additional Information Page 122  Menu | Setup | Show/hide protocols prompts a screen allowing you to tick test protocols which are to be shown in the List of defined protocols and untick the test protocols which are to be hidden. ...

  • Page 133: Pc Shortcut Manager

    Affinity Additional Information Page 123 1.13 PC Shortcut Manager The PC Shortcut Manager allows the user to personalize PC keyboard shortcuts in the AC440 Module. To access the PC Shortcut Manager go to Menu │ Setup │PC Shortcut Keys in the AUD module. It can also be accessed by pressing Ctrl + Alt + Shift + S simultaneously when in the AUD module of the software.

  • Page 134: Standalone Database Settings

    This can be changed by going to the following location, C:\Program Files (x86)\Interacoustics\Affinity Suite, and launching the application titled FolderSetupAffinity.exe. On doing this the below window will be shown.

  • Page 135: Faq

    Affinity Additional Information Page 125 1.15 FAQ When I open my AC440 a screen appears saying that my hardware is not connected. What could be the cause of this? Ensure that the Affinity /Equinox hardware is connected properly. This will be indicated by the picture of the instrument in the lower left corner of the screen.
  • Page 136 Can I upload my own speech material? Yes, but a special tool is needed for this. Contact Interacoustics or the local distributor in order to acquire this software (see section Appendix 1 for a description of the indexing process). You will need to have purchased...

  • Page 137: Importing Wave Files - Speech From Hard Drive (Isf440)

    Affinity Additional Information Page 127 1.16 Appendix 1 1.16.1 Importing Wave Files – Speech from Hard Drive (ISF440) The AC440 allows for implementing individual speech material via the Speech from Hard drive function (ISF440) if purchased. Using a special indexing tool you have the ability to upload speech material to the PC and divide it into the preferred lists.
  • Page 138 Affinity Additional Information Page 128 Choose C:\Documents and Settings\All Users\Application Data\Interacoustics\Affinity Equinox Suite\AUD\WaveFiles in the dropdown. This will make the files selectable in the AC440 Setup (see section 1.7.2.3). Mark the calibration track in the wave file list. If uncertain which one this is, click Play to listen to each track.
  • Page 139 Affinity Additional Information Page 129 Fill the list with the desired tracks into the first list. Choose the sound files in the dropdown such as for example Track No02.wav in the example below. Click on Stereo if the track includes a noise signal. This way you will be able to see both the speech signal and the noise below.
  • Page 140 Affinity Additional Information Page 130 The word is now added to the speech list. Repeat procedure for all required words. When having filled the first list with words click Back and mark the next list to be filled. Repeat this procedure for the rest of the speech material.
  • Page 141 You do not have to send the created lists back to Interacoustics for calibration. However, the material may be sent to the manufacturer with the purpose of being wrapped up in an installation package if it is to be distributed to a large number of end users.

  • Page 142: Audiometer Implementation Of The Ten(Hl) Test For Diagnosing Cochlear Dead Regions

    (1) What is meant by a dead region in the cochlear; (2) The basis of the TEN(HL) test for diagnosing dead regions in the cochlea; (3) The implementation of the TEN(HL) test in the Interacoustics audiometers; (4) The clinical value of diagnosing dead regions.
  • Page 143 Implementation of the TEN(HL) Test in Interacoustics Audiometers The implementation of the TEN(HL) test in the Affinity 2.0 and Equinox 2.0 PC-based Interacoustics audiometers makes it easy and simple to administer the TEN(HL) test. There is no need to have any equipment external to the audiometer.
  • Page 144 Affinity Additional Information Page 134 The level of the TEN in dB HL can be set using the computer mouse, by clicking the appropriate point on the screen, or by using the appropriate knob on the optional dedicated keyboard. Initially, the TEN is turned off while the appropriate level is selected.
  • Page 145 Affinity Additional Information Page 135 For people with low-frequency dead regions, as can occur, for example, in cases of Ménière’s syndrome, there appears to be some benefit of amplifying frequencies above 0.57fe, but not of amplifying frequencies 20,21 below 0.57fe. Amplification of frequencies below 0.57fe can actually lead to reduced speech intelligibility.
  • Page 146 Affinity Additional Information Page 136 References Moore BCJ, Cochlear Hearing Loss: Physiological, Psychological and Technical Issues, 2nd Ed., Chichester: Wiley; 2007. Schuknecht HF, Pathology of the Ear, 2nd Ed., Philadelphia: Lea and Febiger; 1993. Ruggero MA, Rich NC. Furosemide alters organ of Corti mechanics: Evidence for feedback of outer hair cells upon the basilar membrane.
  • Page 147 Affinity Additional Information Page 137 Figure 1: Cochlea from a 25-year old man who had been exposed to gunshots. The dark lines show auditory neurons. There are no neurons coming from the basal part of the cochlea, indicating a dead region. Dead Figure 2: Illustration of how the edge of a dead region can be related to frequency in Hz, using a frequency- to-place map of the cochlea.
  • Page 148 Figure 3: Spectrum (top) and a segment of the waveform (bottom) of the noise used for the TEN(HL) test. Figure 4. Screen shot from the Affinity 2.0 system. The open circles show the audiometric (absolute) thresholds. The “TEN” symbols show masked thresholds measured for TEN with a level of 80 dB HL. The TEN(HL)-test criteria for a dead region are met at 1.5, 3, and 4 kHz.

  • Page 149: Masking Help/Automasking Quick Guide

    1.18.1 Masking Help/Automasking Quick Guide Masking Help Interacoustics masking help is available to make it easier to decide on a safe and correct masking intensity. When masking help is activated, a status light on channel 2 indicates if masking is applied correctly.
  • Page 150 Affinity Additional Information Page 140 Recommendations • Be aware that patients require proper instructions before audiometry with masking is undertaken. The switching on and off of the masking noise may be uncomfortable to some patients and cause them to become more fatigued. In some cases (when testing young children, some elderly patients or difficult to test patients), it is recommended not to use masking because confusion about the application of masking noise may lead to false responses.
  • Page 151 Affinity Additional Information Page 141 Recommended masking intensity The masking help can indicate a recommended masking intensity. If masking is indeed required and also possible, the recommended masking intensity is given by the minimum required masking level plus a fixed preferred amount: Recommended Dial = Dial –...
  • Page 152 Technical Specifications of the AC440 Software Medical CE-m ark: The CE-mark indicates that Interacoustics A/S meets the requirements of Annex II of the Medical Device Directive 93/42/EEC. Approval of the quality system is made by TÜV – identification no. 0123.
  • Page 153 Affinity Additional Information Page 143...

  • Page 154: Rem440

    Affinity Additional Information Page 144 2 REM440 Quick Guide Open Noah and double click on any client: Select the Affinity icon from the menu bar To view an audiogram, you can select an older audiogram from a previous session or you can manually enter an audiogram.
  • Page 155 Affinity Additional Information Page 145 Choose the Test Ear in the upper left corner Choose the test you wish to perform by clicking on it in the protocol list: Select Stimulus in the stimulus dropdown list If needed adjust the Input Level using the slider to the right: Click START to perform real-ear measures.

  • Page 156: About Rem440

    Affinity Additional Information Page 146 2.2 About REM440 The REM440 is a user-friendly and intuitive Real-Ear Measurement software which enables you to satisfy your Hearing Aid verification requirements. A great advantage is the flexibility which permits the creation of an unlimited number of personalized test flows or “test protocols”...

  • Page 157: Launching Rem440 With Databases

    Affinity Additional Information Page 147 2.4 Launching REM440 with Databases The REM440 module can be launched and operated under Noah4, Noah3 and OtoAccess™ databases as described in the following sections. It is also compatible with other patient management systems which have Noah embedded.
  • Page 158 Affinity Additional Information Page 148 Open OtoAccess™ Select the client you want to work with. If the client is not yet listed:  press the New client button  fill in at least the mandatory fields, marked with a red asterisk*. ...

  • Page 159: The Rem Screen Elements

    Affinity Additional Information Page 149 The REM Screen Elements The following section describes the elements of the REM screen: Menu provides access to File, Edit, View, Mode, Setup, and Help. Print button will print the test results using the selected print template. If no print template is selected the results currently displayed on the screen will be printed.
  • Page 160 Affinity Additional Information Page 150 List of Protocols allows you to select a test protocol (default or user defined) to use in the current test session. Temporary Setup button allows for making temporary changes to the selected test protocol. The changes will be valid for the current session only.
  • Page 161 Affinity Additional Information Page 151 To return to the original REM440 press the red cross in the upper right hand corner. Tube calibration button activates the tube calibration. Before measuring it is recommended to calibrate the probe tube. This is done by pressing the calibration button.
  • Page 162 Affinity Additional Information Page 152 Normal and Reversed Coordinate System buttons enable you to toggle between reversed and normal graph displays. This may be helful for counselling purposes since the reversed view look more similar to the audiogram and may therefore be easier for the client to comprehend when explaining his/her results.
  • Page 163 1. Connect a monitor headset to the monitor output on the hardware. It is recommended to use only a monitor headset which is approved by Interacoustics. 2. Tick the Monitor check box. 3. Use the slider to turn the sound level up and down.
  • Page 164 Affinity Additional Information Page 154 Fitting Prescription and related details can be adjusted on the right hand side of the screen. Select your preferred fitting prescription in the upper dropdown list. Choose between Berger, DSL m[i/o], Half Gain, NAL-NL1, NAL-NL2, NAL-R, NAL-RP, POGO1, POGO2, Third Gain, or ’Custom’...
  • Page 165 Affinity Additional Information Page 155 Enable/Disable Icons This feature lets the fitter customize which buttons appear on the front of the main REM440 screen. When all the items are selected with the checkmark, all buttons will be displayed on the front screen.

  • Page 166: Background On Real-Ear Measurements Using Rem440

    Affinity Additional Information Page 156 Background on Real-Ear Measurements using REM440 When performing real-ear measurements there a certain things you should keep in mind in order to obtain the best possible result. Some of these will inevitably also influence the precision of the curve obtained. This section will walk through some important tips and tricks to remember when doing real-ear measurements using the REM440.
  • Page 167 Affinity Additional Information Page 157 Mount the probe tube on the small microphone on the in-situ headset and place it on the ear of the client using either the plastic headband or slide-on ear loop. Plastic headband (click it on the plastic headband and hang it over the ears of the client). Attach the probe tube here Slide-on ear loop (slide on as shown below and hang it on the ear of the client).

  • Page 168: Calibration

    Affinity Additional Information Page 158 4) The reference microphone on the headset monitors the amplitude of the signal reaching the hearing aid from the loudspeaker. If the input level is louder or softer than the desired level the reference microphone will turn the volume up or down accordingly.

  • Page 169: Gain Versus Response View

    Affinity Additional Information Page 159 • Follow the instructions appearing on the screen: Note: If using an Affinity place the in-situ headset in front of the internal loudspeaker (as shown above for the Equinox external loudspeaker) and press OK. 2.6.3 Gain versus Response View To understand the various real-ear measurement terms you should be aware of the way the real-ear acronyms are constructed.

  • Page 170: Real-Ear Measurements On Open Fittings

    Affinity Additional Information Page 160 The REM440 allows for showing real-ear measurements as both gain and response curves. The gain curve is automatically generated from the response curve which allows you to choose which view you prefer using the Gain and Response radio buttons below the graph: 2.6.4 Real-ear Measurements on Open Fittings The increasingly popular open fit hearing instruments have many advantages relating to comfort, sound...

  • Page 171: Calibrate For Open Fit

    Affinity Additional Information Page 161 2.6.4.1 Calibrate for Open Fit Calibrate for open fit is the best way to cope with open fittings. Calibrate for open fit is done with the hearing aid in place muted or switched off. During a stimulus presentation the reference microphone supervises the amplitude of the signal. It records how much of the signal leaks out of the ear canal at each frequency and adjusts the input level accordingly.

  • Page 172: Probe Placement

    Affinity Additional Information Page 162 In this example when going to REIG/REAR the system will show Warble Tone and ISTS in the stimulus dropdown. 2.6.5 Probe Placement It is important that the probe is placed correctly in the ear of the client (e.g. within 5 mm of the eardrum). Approximate insertion depths Females 27 mm past the inter-tragal notch...

  • Page 173: Speech Stimuli/Ists

    Affinity Additional Information Page 163 2.6.6.2 Speech Stimuli/ISTS Speech is likely to be the most important signal to the hearing aid user in his or her daily life. Therefore, if you wish to verify if speech sounds are audible there is no better stimulus than speech. Furthermore, speech signals challenge the hearing aid since they have quick change in amplitude, frequency, and phase.

  • Page 174: Presenting A Stimulus

    Affinity Additional Information Page 164 Note that your choice has an impact on your result as illustrated below: Warble ICRA Pink Note: The signals Male Speech, Female Speech, and ISTS are shaped according to LTASS standards. Vocal efforts are included which results in the input level range being limited depending on the start level. If the measurement is set to start at for example a normal input level (e.g.

  • Page 175: Working With Fitting Targets

    Affinity Additional Information Page 165 Note: If you have done Calibrate for open fit, only the signals used for this calibration are available in the stimulus selection dropdown for aided measures (e.g. REIG, REAR) 2.6.7 Working with Fitting Targets The REM440 includes many possibilities ensuring a precise target calculation based on the data available on the individual client.

  • Page 176: Dsl M[I/O] Options

    SPL conversion from the REM440 module does not include a transducer correction. When the hearing aid fitting is based on an audiogram obtained with the Interacoustics ASSR, ensure that “IA ASSR eHL” is selected. this will ensure that double compensation is avoided.
  • Page 177 Affinity Additional Information Page 167 • HA1 – Mold refers using an RECD measured using the client’s own ear mold followed by 2cc coupler measures with an ITE adaptor. • HA1 – Tip refers using an RECD measured using a foam tip or SPL probe followed by 2cc coupler measures with an ITE adaptor.

  • Page 178: Nal-Nl1/Nal-Nl2 Options

    Affinity Additional Information Page 168 2.6.7.4 NAL-NL1/NAL-NL2 options  Name: Select the NAL-NL1 or NAL-NL2.  Age: Select the age on your client. Research on children’s performance and preference leads us to infer that children on average prefer a few dB more gain than what NAL- NL1 prescribes (Ching et al.

  • Page 179: Comparing To The Hearing Aid Fitting Software

    Affinity Additional Information Page 169 2.6.8 Comparing to the Hearing Aid Fitting Software Real-ear measures are often compared to the hearing aid manufacturer’s software. You can run the REM440 and fitting software simultaneously within Noah4. If real-ear measures reveal too little or too much gain in some frequency areas, enter the fitting software and adjust gain using the relevant gain controls.

  • Page 180: Show Cursor On The Graph

    Affinity Additional Information Page 170 2.6.8.2 Table Mode If graph comparisons are not preferred, you can choose the Table mode button . This may make it easier to compare the measured numerical values and the values in the hearing aid manufacturer’s fitting software.

  • Page 181: Speech Intelligibility Index (Sii)

    Affinity Additional Information Page 171 2.4.1 Speech Intelligibility Index (SII) The Speech Intelligibility Index (SII) is a quality indicator of your hearing aid’s fitting regarding the audibility it can provide. The SII calculation will show the SII value as a percentage against the curve tag of every completed measurement for REUR, REUG, REAR, REAG and REIG in the bottom right corner.

  • Page 182: Preconditioning And Sweep Delay

    Affinity Additional Information Page 172 2.6.10 Preconditioning and Sweep Delay Preconditioning and sweep delay can be set for each test in the REM440 settings (see section 2.6.2) 2.6.10.1 Preconditioning Preconditioning is relevant when using broadband signals for example ISTS/ICRA. It consists of a wideband signal followed by a pure tone just before the selected stimulus is presented.

  • Page 183: Comparing Curves

    Affinity Additional Information Page 173 2.6.12 Comparing Curves The REM440 also allows for comparing either two historical curves (e.g. two REIG curves) or comparing a historical curve to a currently recorded curve. This may be helpful when having made adjustments to a hearing aid to see if the new setting is closer to the target.

  • Page 184: Curve Display Options

    Affinity Additional Information Page 174 2.6.13.1 Curve Display Options In the curve display options box all curves are listed by input level and colour. If many of the same curve type (e.g. REIGs) have been measured tick only the ones that you wish to display on the graph.

  • Page 185: Clinical Application Of Real-Ear Measurements Using Rem440

    Affinity Additional Information Page 175 Clinical application of Real-Ear Measurements using REM440 This section describes all the REM440 real-ear tests. For all measures please reduce ambient noise as much as possible. 2.7.1 REUR/REUG Measurements REUR (Real-Ear Unaided Response): The REUR accounts for the SPL across frequencies measured in the open/unaided ear canal for a given input signal at specific measurement point.
  • Page 186 Affinity Additional Information Page 176 7) Ensure that the correct Ear is selected 8) Choose the preferred Stimulus in the corresponding dropdown list 9) Select input level using the Input level slider 10) Click START and the REUR/REUG will be performed. Ensure that the room is quiet whilst the curve is obtained 11) If you wish to use the REUG/REUR for both ears, right click on the curve tag in the Curve display options and select Transfer to left/right ear.

  • Page 187: Predicted Reur

    Affinity Additional Information Page 177 2.7.1.1 Predicted REUR When right clicking on the REUG/REUR as described in point 6 above you may choose to use a predicted curve. This may be helpful if having to deal with challenging clients. When clicking Show predicted curve the screen below will appear: Choose Age and Azimuth angle and click OK.

  • Page 188: Reug/Reur From A Previous Session

    Affinity Additional Information Page 178 2.7.1.2 REUG/REUR from a previous Session If you have measured the REUG/REUR at an earlier session with the client, the REM440 provides the option to use this historical curve in the current session. 1) Browse for the historical REUG/REUR curve in the session browser: 2) Right click on the curve tag in the Curve display options: 3) Select Transfer to current session.

  • Page 189: Rear/Reag Measurements

    Affinity Additional Information Page 179 2.7.2 REAR/REAG Measurements REAR (Real-Ear Aided Response): The REAR accounts for the SPL across frequencies for a given signal measured in the ear canal with the hearing aid in place and turned on. REAG (Real-Ear Aided Gain): The REAG accounts for the gain across frequencies for a given input signal measured in the ear canal.
  • Page 190 Affinity Additional Information Page 180 9) Check that the information about client, fitting prescription and hearing aid parameters to the right are correct. 10) Ensure that the correct Ear is selected 11) Choose the preferred Stimulus in the corresponding dropdown list If you have done Calibrate for open fit only the signals used for this calibration are available in the stimulus selection dropdown (see section 0).

  • Page 191: Reig Measurements

    Affinity Additional Information Page 181 2.7.3 REIG Measurements REIG (Real-Ear Insertion Gain): The REIG accounts for the gain across frequencies provided by the hearing aid alone. This is obtained by subtracting the REUR from the REAR or the REUG from the REAG. REAR –...
  • Page 192 Affinity Additional Information Page 182 A predicted REUR may be selected if the REUR is a part of the individual test protocol (see section 2.6.2.1). 7) Carefully insert the hearing aid without moving the probe tube. Ensure that the instruments are switched on.

  • Page 193: Recd Measurements

    Affinity Additional Information Page 183 2.7.4 RECD Measurements RECD (Real-Ear to Coupler Difference): The RECD accounts for the difference in decibels (dB) across frequencies, between the SPL measured in the real-ear and in a 2cc coupler, produced by a transducer generating the same signal.
  • Page 194 Affinity Additional Information Page 184 There are two ways to measure RECD which will be described in this section: a) RECD with the client’s own ear mould b) RECD with an SPL probe Right click on the RECD test in the protocol list and select Settings to check if the system is setup to use the client’s own ear mould or SPL probe for the RECD.

  • Page 195: Recd Using The Client's Own Ear Mould

    Affinity Additional Information Page 185 2.7.4.1 RECD using the client’s own ear mould Additional required items:  An ear mould  A 2 cc coupler connected to an adaptor for the BTE. These click easily together. Ear Curve Coupler Curve Real-ear to Coupler Difference 1) Open the REM440 module by selecting the REM tab.
  • Page 196 Affinity Additional Information Page 186 6) Connect the tube to the BTE adapter as shown on the picture and click OK. The coupler curve will be performed followed by a new instruction screen. 7) Disconnect the sound tube from the BTE adapter and connect it to the ear mould. Perform otoscopy and insert the REM probe and ear mould as shown on the picture.

  • Page 197: Recd Using The Spl Probe

    Affinity Additional Information Page 187 2.7.4.2 RECD using the SPL Probe Ear Curve Coupler Curve Real-ear to Coupler Difference Additional required items:  An SPL probe and ear tips.  A 2 cc coupler connected to an adapter for the SPL probe. These click easily together. Note: Remember to calibrate the SPL probe.
  • Page 198 Affinity Additional Information Page 188 1) Open the REM440 module by selecting the REM tab. 2) Select a test in the List of Protocols. 3) The RECD is most often used with children, so you will need to explain the procedure to the parents. 4) Click START and the screen below will appear.

  • Page 199: Own Mould Versus Spl Probe

    Affinity Additional Information Page 189 2.7.4.3 Own Mould versus SPL Probe Whether the RECD is performed using the client’s own ear mould or the SPL probe may have an effect on the result. The benefit of using the client’s own ear mould is that the measurement will reflect your client’s actual residual volume when wearing their hearing device whereas the SPL probe only provides an estimate.

  • Page 200: Measured Recd Compared To A Predicted Recd

    Affinity Additional Information Page 190 2.7.4.5 Measured RECD compared to a predicted RECD You can at any time select a predicted RECD as described in section 0 and view it alongside a measured RECD. Note that when both a measured and a predicted RECD are displayed the system will always prioritize the measured RECD for the test box verification (simulated REM).

  • Page 201: Recd From A Previous Session

    Affinity Additional Information Page 191 2.7.4.7 RECD from a previous Session If you have measured the RECD at an earlier session with the client, the REM440 provides the option to use this historical curve in the current session. 1) Browse for the historical RECD curve in the session browser: 2) Right click on the curve tag in the Curve display options 3) Select Transfer to current session.
  • Page 202 Affinity Additional Information Page 192 3) Close the lid. 4) Press START to conduct your measurement in the 2 cc coupler.

  • Page 203: The "Real-Ear Approach

    Affinity Additional Information Page 193 2.7.4.10 The “Real-ear approach” 1) If you prefer verification in the Real-ear select Ear mode 2) Press START to conduct your measurement in the real-ear as described in the previous sections. 2.7.4.11 Importing the RECD into the Hearing Aid Manufacturers Software Some hearing aid manufacturers allow for importing the measured RECD curve into the software via Noah and/or write the measured values into a RECD screen.

  • Page 204: Reor/Reog Measurements

    Affinity Additional Information Page 194 2.7.5 REOR/REOG measurements REOR (Real-Ear Occluded Response): The REOR accounts for the SPL across frequencies measured in the ear canal with the hearing aid in place and turned off. REOG (Real-Ear Occluded Gain): The REOG accounts for the gain across frequencies measured in the ear canal with the hearing aid in place turned off.

  • Page 205: Measuring Input/Output

    Affinity Additional Information Page 195 8) Ensure that the correct Ear is selected 9) Choose the preferred Stimulus in the corresponding dropdown list 10) Select input level using the Input level slider 11) Click START and the REOG/REOR will be performed. Note: If the curve falls below the graph area use the arrow buttons in the left side of the screen to adjust the graph as illustrated below: 2.7.6...
  • Page 206 Affinity Additional Information Page 196 1) Open the REM440 module by selecting the REM tab. 2) If needed select a test protocol in the List of Protocols. If you do not select a protocol the system will automatically select a standard protocol. 3) Explain the procedure to the client.

  • Page 207: Directionality Measurements

    Affinity Additional Information Page 197 2.7.7 Directionality Measurements Unwanted noise will inevitably turn up in daily life situations. Fortunately, many digital hearing aids have directional microphones that suppress noise coming from some directions while maintaining a good sensitivity to sounds coming from another direction. This effect can be measured in the real-ear. Place the client in front the REM loudspeaker.

  • Page 208: Binaural Rem Measurements

    Affinity Additional Information Page 198 If you have calibrated for open fit only the signals used for this calibration are available in the stimulus selection dropdown (see section 0). 12) Select input level using the Input level slider 13) Click START and follow the instructions on screen. 14) Place the client in front of the loudspeaker as shown on the picture.
  • Page 209 Affinity Additional Information Page 199 Required Items: • The Affinity hardware • Licensed Affinity hardware with REM440 REM module • Calibrated REM headset • REM protocol Procedure 1. Enter/Select an audiogram from Noah or from the AUD module. If no audiogram is entered or selected, no targets will be displayed.
  • Page 210 Affinity Additional Information Page 200 Due to the way in which this feature has been implemented you will not need to recreate new protocols to use this function. It uses the settings you already have in your existing protocols. Please note: when running measurements of this type you will only be using one reference microphone to monitor the signal from the speaker.
  • Page 211 Affinity Additional Information Page 201 9. Once you have chosen your protocol please configure your fitting prescription settings as per your fitting. 10. Place the REM tubes inside the patient’s ears and aim to use a marker of roughly 27mm on the probe tubes.
  • Page 212 Affinity Additional Information Page 202 Horizontal axis (x-axis) at 6khz and must not be more negative than -5dB (BSA, 2007 & ISO, 2003). 12. You can now proceed to running the REIG measurements, there are 3 different intensity measurements in this protocol but the main focus should be to fit the 65dB curve as this is the intensity for speech. Please place the hearing devices into your patient’s ears along with the probe tubes for the following measurements.
  • Page 213 Affinity Additional Information Page 203 13. You will now begin fine tuning in the hearing aid fitting software to amend the output of the device to meet the prescription target. 14. Should you wish to edit the targets when performing a binaural measurement then you should click on this icon .
  • Page 214 Affinity Additional Information Page 204 15. A nice feature in the Affinity and Callisto™ Suites is the On top mode. This feature allows you to minimize the suite so that it can be placed on top of the fitting software to make it easier to fine tune and compare the output following your changes.
  • Page 215 Affinity Additional Information Page 205 16. Once you have fine-tuned your hearing devices so that the patient is happy and have counselled them involving their opinions in the amplification of their hearing devices you can save and close the Suite and finish the session.

  • Page 216: Fm System Verification

    Affinity Additional Information Page 206 2.5 FM System Verification 2.5.1 FM Transparency FM Transparency can be defined as “The condition in which equal inputs to the FM and hearing aid microphones produce equal outputs from the hearing aid.” The verification method is according to the AAA Clinical Practice Guidelines for Remote Microphone Hearing Assistance Technologies for Children and Youth Birth to 21 Years.
  • Page 217 Affinity Additional Information Page 207 Step 1: HA Alone 1. Select the HA Alone test 2. Attach the hearing aid to the coupler/coupler microphone 3. Position the hearing aid in the test chamber 4. Click START to measure the output of the hearing aid (red curve) Step 2: HA + Receiver 1.
  • Page 218 Affinity Additional Information Page 208 Step 3: FM Mic + HA 1. Remove the hearing aid, still attached to the coupler, from the test box 2. Position the FM microphone inside the test box, in front of the reference microphone 3.

  • Page 219: Ear Level, Fm Only

    Affinity Additional Information Page 209 Example 2 HA + Receiver FM Mic + HA Difference 750 Hz 1000 Hz 2000 Hz Average *Average difference is less than 2 dB, therefore transparency is achieved 2.5.2 Ear Level, FM only Ear Level FM systems are intended to be used by patients who have normal or near-normal hearing and help increase the signal to noise ratio.
  • Page 220 Affinity Additional Information Page 210 3. Once in the REM screen, select the “FM only, Ear level” protocol from the drop down list 4. Place the FM transmitter microphone inside the test chamber, facing the reference microphone 5. Close the lid of the test chamber NOTE: The test box reference microphone is the active microphone, even if we are doing a real ear measurement 6.
  • Page 221 Affinity Additional Information Page 211 7. Measure the REAR Select the appropriate FM-specific target:  FM Boom or  FM Chest  the choice should reflect what is used with the system in question Measure the REAR by clicking the start button Adjust volume control on the FM receiver to match the targets between 1kHz and 4kHz 8.

  • Page 222: Working With Individual Setups (Test Protocols)

    Affinity Additional Information Page 212 Working with Individual Setups (Test Protocols) The REM440 module is pre-programmed with standard protocols ready for use which can be selected from the front screen. However, you may wish to create an individual test protocol accommodating for personal preferences and test methods.

  • Page 223: Creating New Test Protocols

    Affinity Additional Information Page 213 2.6.2 Creating new Test Protocols The following sections describe how to setup your own protocol in the REM440 setup. All setup options for all tests will be described even though you most likely will only need a few. This section is therefore to be seen as a work of reference where single functions can be looked up rather than a step-by-step guide where all steps need to be explored.
  • Page 224 Affinity Additional Information Page 214 Yes: The system will create a copy of the current test and allow you to add new tests, make changes, and save it under a new name. The Selected tests section will be blank and you can create a new test from scratch. 4) Name the protocol setup in the Selected protocol section.
  • Page 225 Affinity Additional Information Page 215 6) If the order of the tests is to be changed, use the two Move arrow buttons. Mark the test to be moved and press one of the arrow buttons. Depending on the direction of the selected arrow, the test will then jump up or down.

  • Page 226: Reug/Reur Settings

    Affinity Additional Information Page 216 2.6.2.1 REUG/REUR Settings 1) Ensure that REUR/REUG is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 227 Affinity Additional Information Page 217  Sweep delays: This is relevant if Continuous measurement is selected for Pure Tone or Warble Tone. In this case sweep delays (in milliseconds) may be entered between the individual sweeps (see section 0 for details). ...

  • Page 228: Rear/Reag Settings

    Affinity Additional Information Page 218 2.6.2.2 REAR/REAG Settings Ensure that REAR/REAG is marked in the left hand s ide of the screen. The name of the test will then appear in the Name of selected test section Note the option to write a new name for the test in this section (e.g. “REAR/REAG 70 dB input”) 2) Stimulus selection ...
  • Page 229 Affinity Additional Information Page 219  Start Frequency and Stop Frequency: Select the preferred frequencies using the sliders. These may for example be set so that they correspond with the hearing aid gain handles (e.g. if the hearing aid goes up to 8000 Hz there is no reason to measure beyond this frequency). To avoid low frequency noise you may wish to set the slider to a start frequency of 200Hz.

  • Page 230: Reig Settings

    Affinity Additional Information Page 220 2.6.2.3 REIG Settings 1) Ensure that REIG is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g. “REIG 70 dB input”) 2) Stimulus Selection: ...
  • Page 231 Affinity Additional Information Page 221 Note: Preconditioning, Stimulus type, Start/Stop frequency, and Sweep delay are all greyed out for REIG. This is because the REIG is a calculation and not a measurement (REAR/REAG – REUR/REUG = REIG). The stimulus characteristics therefore are tied to the REUR settings. If other stimulus settings are preferred these should be changed in the REUR/REUG test (see section 2.6.2.1).

  • Page 232: Recd Settings

    Affinity Additional Information Page 222 2.6.2.4 RECD Settings 1) Ensure that RECD is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g. “RECD with SPL probe”) 2) Select the preferred Coupler type.
  • Page 233 Affinity Additional Information Page 223  Stimulus type: Select a stimulus using the dropdown list. Note that only Pure Tone, Warble Tone, and Pink Noise are available for RECD. Note: The input level for RECD is fixed at 70 dB. This cannot be changed by the user. 4) Recording Method: ...

  • Page 234: Reor/Reog Settings

    Affinity Additional Information Page 224 2.6.2.5 REOR/REOG Settings Ensure that REOR/REOG is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g. “REOR/REOG 70 dB input”) Stimulus Selection ...
  • Page 235 Affinity Additional Information Page 225  Start Frequency and Stop Frequency: Select the preferred frequencies using the sliders. These may for example be set so that they correspond with the hearing aid gain handles (e.g. if the hearing aid goes up to 8000 Hz there is no reason to measure beyond this frequency).

  • Page 236: Input/Output Settings

    Affinity Additional Information Page 226 2.6.2.6 Input/Output Settings Ensure that Input/Output is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g. “Input/Output 1600 Hz”) Stimulus Selection ...
  • Page 237 Affinity Additional Information Page 227  Preconditioning: This is relevant when using broadband signals such as ICRA (see section 0 for details). Select a time using the slider.  Sweep delays: This is relevant if Continuous measurement is selected for Pure Tone or Warble Tone.

  • Page 238: Directionality Settings

    Affinity Additional Information Page 228 2.6.2.7 Directionality Settings • Ensure that Directionality is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g. “Directionality check”) •...
  • Page 239 Affinity Additional Information Page 229 Color:  Select a colour for the Right and Left curve (see section 2.6.2.1 regarding REUR/REUG for details). Back Speaker Setup:  Select which speaker should be used for the back microphone measure. You have the option to select a free field loud speaker instead of the Affinity loudspeaker. In this case the client does not need to be turned around after measuring the front microphone.

  • Page 240: Pause Settings

    Affinity Additional Information Page 230 2.6.2.8 Pause Settings You have the option to implement a pause in your individual test protocol. This way you can create a reminder if needed during the testing. Ensure that Pause is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section.

  • Page 241: Combined Screen Setup

    Affinity Additional Information Page 231 2.6.3 Combined Screen Setup REM440 can be setup for default curve comparisons. This is done in the Combined screen settings menu. 1) To enter the Combined screen settings menu, select your protocol in the Select protocol dropdown list in the main setup.

  • Page 242: Fitting Prescription Setup

    Affinity Additional Information Page 232 2.6.4 Fitting Prescription Setup REM440 can be setup to use a specific fitting prescription by default. 1) To enter the Fitting prescription settings menu, select your protocol in the Select protocol dropdown list in the main setup. 2) Click on the Fitting prescription button.

  • Page 243: Dsl

    Affinity Additional Information Page 233 2.6.4.1 DSLm[i/o] Settings Default Prescription:  Select DSL mi/o. Note that it is version implemented is DSL mi/o v5.0a. Transducer:  Choose the type of transducer used for the audiometry. Select between Head phone, Insert, Insert + mould, Sound field 0 deg., Sound field 45 deg., Sound field 90 deg., and ABR estimated hearing level.

  • Page 244: Nal-Nl2 Settings

    Affinity Additional Information Page 234 2.6.4.2 NAL-NL2 Settings 1) Default Prescription:  NAL-NL2. 2) Transducer:  Choose the type of transducer used for the audiometry. Select between Head phone, Insert, Insert + mould, Sound field 0 deg., and sound field 45 deg. This will affect the threshold indications and thereby the target calculation.

  • Page 245: Nal-Nl1 Settings

    Affinity Additional Information Page 235 9) Vent Size:  Set the vent size of the hearing aid using the dropdown. Select between Tight, Occluded, 1 mm, 2 mm, 3 mm, and Open. 10) Number of Hearing Aids:  Set whether the fitting is Monaural or Binaural using the tick boxes 11) Threshold (dB) ...

  • Page 246: Print Layout Settings

    Affinity Additional Information Page 236 3. Hearing Instrument Style:  Select the type of hearing aid the client is fitted with. Choose between Behind the ear, In the canal, In the ear, and Completely in the canal. This will add a correction to the measurement during RECD based verification in the test box.

  • Page 247: Finishing The Test Protocol

    Affinity Additional Information Page 237 2.6.5 Finishing the Test Protocol Press OK in the lower right hand corner of the AC440 setup screen to save the customized test protocol. The test protocol can then be found in the List of Protocols dropdown list on the front screen. 2.6.6 Changing a Test Protocol Permanently You can at any time make changes to an individual test protocol by entering the REM440 setup again as...

  • Page 248: Changing A Test Protocol Temporarily

    Affinity Additional Information Page 238 Browse the setup options as if creating a test protocol (see section 2.6.2). When finished click OK (or Apply) to save the changes. 2.6.7 Changing a Test Protocol temporarily You may from time to time run into a client with special requirements for advanced or different testing parameters.

  • Page 249: Exporting A Test Protocol

    Affinity Additional Information Page 239 After saving it by clicking OK the test protocol can be selected in the List of Protocols on the front screen. 2.6.8.2 Exporting a Test Protocol Go to REM440 setup (Menu/Setup/REM440 setup). Click on Export. Select if the file is to be saved as “read only”.

  • Page 250: General Setup

    Affinity Additional Information Page 240 General Setup In the General Setup you can select overall settings which are valid for all tests.  To enter the General setup, select Menu/Setup/General Setup  In-situ Loudspeaker: Select the speaker output through which the stimuli for the real-ear measurements are presented. ...
  • Page 251 Affinity Additional Information Page 241  Protected Settings:  To activate password protection of the REM440 write the password selected under Menu/setup/Password protection and tick Protect settings. All options will then be greyed out in the REM440 setup. This prevents protocol changes from happening accidently. Note: Prior to password activation a password must be selected under Menu/setup/Password protection (see section 0) ...

  • Page 252: The Rem 440 Menu Items

    Affinity Additional Information Page 242 2.8 The REM 440 Menu Items The REM440 Menu gives you access to File, Edit, View, Mode, Setup, and Help. Menu/File  Menu/File/Print will prompt the system to print using the selected print template (see section 4.1) ...
  • Page 253 Affinity Additional Information Page 243 Menu/Setup  Menu/Setup/REM440 setup opens the REM440 where you can setup customised test protocols (see section 2.6 for details)  Menu/Setup/General setup opens the General setup where settings valid for all tests can be selected (see section 2.7 for details) ...
  • Page 254 Affinity Additional Information Page 244 Menu/Help  Menu/Help/About REM440 prompts a message box showing information regarding the Suite version, Hardware version, and Firmware version. Please note that if experiencing problems with the system this information should be sent to the manufacturer along with the description of the issue.

  • Page 255: Visible Speech Mapping (Vspm440)

    Interacoustics Visible Speech Mapping is designed to assist you in the important process of fitting and counselling. The system merges verification and counselling into one screen display visualizing the SPL at the ear drum with and without hearing aids respectively.

  • Page 256: The Visible Speech Mapping Screen

    Affinity Additional Information Page 246 2.10 The Visible Speech Mapping Screen Menu provides access to File, Edit, View, Mode, Setup, and Help (see section 0) Print button allows for printing the sessions acquired data (see section 4.1) Save & New Session button saves the current session in Noah4 or OtoAccess™...
  • Page 257 Affinity Additional Information Page 247 Freeze curve allows for taking a snapshot of a REM curve when testing with broadband signals. In other words the curve freezes at a particular moment while the test continues. Note that if too many curves are frozen on the screen not all will be saved in Noah4 due to imposed limitations.
  • Page 258 Affinity Additional Information Page 248 Normal and reversed coordinate system buttons enable you to toggle between reversed and normal graphs. This may be helpful for counselling purposes since the reversed curves look more similar to the audiogram and may therefore be easier for the client to comprehend.
  • Page 259 Affinity Additional Information Page 249 Note that the sound from the monitor may be very soft (compared to the audiometry monitoring). It is louder for audiometry because the audiometric equipment is producing the signal that is monitored. In REM440 the hearing instrument produces the monitored signal meaning that it cannot be controlled by the equipment.
  • Page 260 Affinity Additional Information Page 250 The ear/coupler mode indicates which side is being tested next to a label showing whether the test is performed in an aided or unaided ear. SII (Speech Intelligibility Index) of the current input signal is expressed in a percentage.
  • Page 261 Affinity Additional Information Page 251 Curve comment for each curve can be typed into the comment section on the right hand side. Select a curve using the curve tag boxes under Curve display options and write a comment in the comment section.

  • Page 262: Verification With Visible Speech Mapping

    Affinity Additional Information Page 252 2.11 Verification with Visible Speech Mapping 2.11.1 Considerations before you begin Visible Speech Mapping can be run side by side with the relevant fitting software. After fitting the hearing aid, Visible Speech Mapping can be used to verify if the client’s speech area is amplified sufficiently using these stimuli: ISTS, Male Speech, or Female Speech.

  • Page 263: Visible Speech Mapping (In Coupler Mode/Test Box Mode)

    Affinity Additional Information Page 253 10) Ensure that the correct Ear is selected If you wish to measure on both ears right click on the ear icon 11) Choose the preferred Stimulus in the corresponding dropdown list Male Speech, Female, Speech, and ISTS are recommended. Note the option to use Live Voice.
  • Page 264 Affinity Additional Information Page 254 7) Click on the Visible Speech Mapping button if it is not already marked automatically. Note: A right click on Visible Speech Mapping button allows you to enter the Settings menu or Change colour of the curve. 8) Check that the information about client, fitting prescription and hearing aid to the right are correct by pressing Show fitting prescription and test information.
  • Page 265 Affinity Additional Information Page 255 12) Click START and the Visible Speech Mapping will be performed. Ensure that the hearing aids are switched on and that the room is quiet while the curve is obtained. 13) Verify and fine-tune to your chosen fitting prescription. DSL mi/o or NAL-NL1/NAL-NL2. Use On top mode to compare to the hearing aid manufacturers’...

  • Page 266: Visual Tools For Counseling And Verification

    Affinity Additional Information Page 256 2.12 Visual Tools for Counseling and Verification 2.12.1 Percentile Analysis The Percentile Analysis can be added in the REM440 setup (see section 0.1) The Percentile Analysis is implemented according to the IEC 60118-15 standard. By default the 30th, 65 , and 99th percentile are selected.

  • Page 267: Display Peaks And Valleys

    Affinity Additional Information Page 257 2.12.2 Display Peaks and Valleys Display peaks and valleys can be added in the REM440 setup (see section 0) When Display peak s and valleys is ticked you will have the view illustrated below. The peaks and valleys are shaped according to the LTASS and are the same as the 30 and 99 percentile in the Percentile Analysis...

  • Page 268: Speech Intelligibility Index

    Affinity Additional Information Page 258 2.12.4 Speech Intelligibility Index As a supporting feature the SII (Speech Intelligibility Index) indicates improved audibility expressed in a percent on the aided display. SII is a method for computing a physical measure of the intelligibility of speech. The method is based on results of the speech perception tests in a given group of talkers and listeners.

  • Page 269: Dynamic Range View

    Affinity Additional Information Page 259 2.12.6 Dynamic Range View The hearing thresholds converted to SPL and the UCLs provide a dynamic range view. This provides the option to show that speech sounds are above thresholds and are within the area where the client can hear (but without being uncomfortably loud).

  • Page 270: Visible Speech Mapping Settings

    Affinity Additional Information Page 260 2.13 Visible Speech Mapping Settings Visible Speech Mapping with individual settings can be added to a test protocol the same way as other REM tests (see section 2.6.2) 1) Enter the REM440 setup (Menu/Setup/REM440 setup) and add Visible Speech Mapping to the test protocol.
  • Page 271 Affinity Additional Information Page 261  Measurement time (in seconds): Duration for the measurement can be set using the slider. This is only relevant for broad band signals. A number of seconds can freely be selected between 1 and 1200. By default the measurement time is the same for all signals. ...

  • Page 272: Faq

    Affinity Additional Information Page 262 2.14 FAQ Question: After I accidently disconnected the USB my system behaves strangely – what could be the cause? Answer: If the USB is disconnected during testing the software suite should be restarted. Otherwise the connection may be affected and testing may be compromised.
  • Page 273 Additional Information Page 263 Question: What kind of stimulus does Interacoustics recommend to be used and in different situations? Answer: Choosing the correct stimuli for the purpose is extremely important as it is the basis of a good measurement with a valid result. Digital hearing aids automatically adjust the amplification depending on the input. This capacity, however, cannot be reflected in a real-ear measurement unless a realistic and dynamic test stimulus like speech is used (Fabry 2004).
  • Page 274 Affinity Additional Information Page 264 Warble Tone Pink Noise ICRA 6pbl ISTS References: Fabry D. (2004) Real Ear Measurements and Digital Hearing Aids: Realities, Myths, and Measurement Techniques. Phonak Focus no. 32. (www.phonak.com) Kuk, F & Ludvigsen, C. (2003) Changing with Times: Choice of Stimuli for Hearing Aid Verification. Hearing Review, August 2003.
  • Page 275 Affinity Additional Information Page 265 Question: When I do the REUR with an ICRA or ISTS I get a pretty flat curve: When I do the REUR with a warble tone I get, what I think is a correct curve: What is the reason for this difference? Answer: With response measurements you are measuring the ear canal + the signal you are using.
  • Page 276 Affinity Additional Information Page 266 Question: When I do the REUG I have to do the REAG and then I don’t see the REIG. That means that I’m not going to use this setup. I can’t choose the REIG without the REUR according to the program. Answer: In the Affinity you don’t have to do the REAG/REAR to see the REIG.
  • Page 277 Affinity Additional Information Page 267 Question: In Visible Speech Mapping what is the purpose of percentile analysis? Answer: The Percentile Analysis implemented according to the IEC 60118-15 standard. By default the 30th, 65 , and 99th percentile are selected. These percentiles are calculated based on an FFT analysis of 100 measurements.

  • Page 278: The Rem440 Test Signal Characteristics

    Affinity Additional Information Page 268 2.15 Appendix 1 2.16 The REM440 Test Signal Characteristics Pure Tone frequency accuracy is ±1%. Crest factor is 3 dB. Warble Tone frequency accuracy is ±1%, warble frequency 0100 Hz and intensity 010%, sine wave frequency modulation.
  • Page 279 Affinity Additional Information Page 269 ICRA: 6pbr 6 persons babble, 1f+1m+2f(-6db)+2m(-6dB), all 3bSMN - Idealized - Raised effort - Level Ref + 10.7dB. Crest factor = 24 dB. Speech Dialog Crest factor = 24 dB. Speech Female Crest factor = 20 dB. Speech Male Crest factor = 25 dB.

  • Page 280: Rem Pc Shortcuts

    Affinity Additional Information Page 270 2.17 REM PC Shortcuts Quick Keys REM/HIT Next test Shift + Tab Previous test Shift + Mouse scroll or Shift + Arrow up/down Curve smoothing increase/decrease Mouse Scroll Offset Y axis PgUp/PgDn Offset Y axis Arrow up/down Change input level Control + R...

  • Page 281: Technical Specifications Of The Rem440 Software

    2.18 Technical Specifications of the REM440 Software REM440 Software - Technical Specifications Medical CE-m ark: The CE-mark indicates that Interacoustics A/S meets the requirements of Annex II of the Medical Device Directive 93/42/EEC. Approval of the quality system is made by TÜV – identification no. 0123.

  • Page 282: Hit440

    Affinity Additional Information Page 272 3 HIT440 HIT440 Quick Guide 1) Open Noah and select the patient you want to work with: 2) Select the Affinity module from the Noah Module menu 3) Select the HIT Icon in the upper right corner of the screen: IMPORTANT NOTE: The hearing instrument needs to be in FULL ON GAIN MODE/TEST MODE in order to compare the results to the hearing aid manufacturers’...
  • Page 283 Affinity Additional Information Page 273 Position the Hearing Aid in the test box: BTE: Connect the 2 cc coupler to the BTE adaptor. Place the coupler tube pointing straight forward, and the microphone at the cross. ITE: Connect the ITE adaptor to the 2 cc coupler and attach the hearing aid using blue putty. Place coupler at the back with hearing aid facing forward with the microphone at the cross.

  • Page 284: About Hit440

    Affinity Additional Information Page 274 6) Select the desired test protocol in the List of Protocols Select Test Ear 8) Select START 9) Please wait for all tests of the selected protocol to be performed: Save by clicking “Save” icon About HIT440 The HIT440 is a straightforward Hearing Instrument Testing system suited for all types of hearing aids.

  • Page 285: Hit 440 Tests

    Affinity Additional Information Page 275 HIT 440 Tests Custom selectable tests: The IEC standard tests: The ANSI standard tests:    Frequency response OSPL90 OSPL90    Gain curve Full-on gain Full-on gain    Harmonic distortion Input/output Reference test gain ...

  • Page 286: Launching The Hit 440 Software From Databases

    Affinity Additional Information Page 255 Launching the HIT 440 Software from Databases 3.4.1 Launching HIT440 from Noah 1) Open Noah and select the patient you want to work with. 2) Select the Affinity module from the Noah Module menu The selected suite will now open and automatically search for the hardware. If t does not detect hardware a dialog box pops up and asks if you want to run in Simulation mode.
  • Page 287 Affinity Additional Information Page 256 Double click on Affinity Suite icon in the Select Instrument box 4) The selected suite will now open and automatically search for the hardware. If it does not detect the hardware a dialog box pops up and asks if you want to run in Simulation mode. To continue with the use of hardware.

  • Page 288: The Hit440 Screen

    Affinity Additional Information Page 257 3.5 The HIT440 Screen Menu provides access to File, Edit, View, Mode, Setup, and Help. Print button allows you to will print the test results currently displayed on the screen. Save & New Session button saves the current session in Noah or OtoAccess™...
  • Page 289 Affinity Additional Information Page 258 Select protocol to use from the list allows you to select a test protocol the current test session (see section 0 for more information about test protocols). Temporary Setup button allows for making temporary changes to the selected test protocol.
  • Page 290 Affinity Additional Information Page 259 Normal and reversed coordinate system buttons enable you to toggle between reversed and normal graph. This may be helpful for counselling purposes since the reversed curves look more similar to the audiogram and may therefore be easier for the patient to comprehend.
  • Page 291 Affinity Additional Information Page 260 Current Protocol is listed in the lower left hand corner. indicates the test is a part of an automatic test flow (Auto Run). When pressing START all tests with the tick mark will be performed. If you wish to perform one test only, mark it using the mouse by clicking on it.
  • Page 292 Affinity Additional Information Page 261 Measurement details: In this table the curve details can always be viewed. This way the professional always has an overview of what is being measured, for example, information such as Input Level, Max SPL, Curve Type, Stimulus, and Curve type. A Curve Comment for each curve can be typed into the comment section on the right hand side.

  • Page 293: Hearing Instrument Testing Using Hit440

    Affinity Additional Information Page 262 Hearing Instrument Testing using HIT440 Hearing Instrument Testing (HIT) is performed in order to verify that the hearing aids are technically functioning as they should. It is usually performed after fitting the hearing aid or during a repair appointment. When performing HIT there are certain things you should keep in mind in order to get the best possible result.

  • Page 294: Testing Bone Anchored Device Using The Sks10 Skull Simulator

    Testing bone anchored device using the SKS10 Skull Simulator With the Interacoustics SKS10 Skull Simulator, it is now possible to perform technical measurements of bone anchored devices. For more information on the setup and test procedures, please refer to the Quick Guide at the end of this document.

  • Page 295: Installing The Skull Simulator License In The Hit440 Software

    (Service@interacoustics.com) the serial number. You can find out by going to the Affinity software and going to Menu/Help/About  License  “Copy s/n” 2- Paste the serial number in the body of an email and send it to Interacoustics 3- Interacoustics will then email a new HIT license...

  • Page 296: Activating The New Hit License

    Affinity Additional Information Page 265 3.6.3.2 Activating the new HIT license 1- Go to HIT module/Menu/Help/About 2- Click on License 3- Paste the new license number under HIT (New license) The Skull protocol might be hidden in the software. If this is the case; it is necessary to activate it: 1- Go to HIT/Menu/Setup/HIT440 setup 2- Choose “Skull Simulator”...

  • Page 297: Using The Skull Simulator Protocol

    Affinity Additional Information Page 266 3.6.3.3 Using the Skull Simulator protocol A default protocol for the Skull Simulator is available from the protocol drop down menu. Since a standard ANSI or IEC protocol does NOT exist for bone anchored devices, the Skull Simulator default protocol was created as a starting point and to give inspiration to create your own protocol, according to user needs.

  • Page 298: Setup Of Sks10 In The Affinity Test Chamber

    Affinity Additional Information Page 267 3.6.3.4 Setup of SKS10 in the Affinity test chamber Since the SKS10 contains an accelerometer, it needs to be powered by an external power source. Please ensure that the SKS10 is connected to the power supply and the power supply is connected to a power source.
  • Page 299 Affinity Additional Information Page 268 3- Snap on the bone anchored device onto the abutment of the skull simulator. NOTE: For more information on how to setup the Affinity and test bone anchored devices, please see the Quick Guide for testing bone anchored devices with the SKS10, this can be accessed via the link mentioned at the end of this document.

  • Page 300: Running Pre-Programmed Test Protocols

    Affinity Additional Information Page 269 3.6.4 Running Pre-programmed Test Protocols 1) Place the hearing aid in the test box (as described in section 0) 2) Select the appropriate ear 3) Select a test protocol Select START to run the test automatically The Auto Run function will ensures that all test in the protocol are performed automatically.

  • Page 301: Preconditioning And Sweep Delay

    Affinity Additional Information Page 270 Auto Run can be setup in the HIT440 setup (Menu/setup/HIT440 setup). Next to each test you will find a Play symbol (Auto Run) or a Stop symbol (Manual Run) Click on the Play/Stop symbols for each test to toggle between Auto and Manual Run. See more information about protocol setup in section 0.

  • Page 302: Show Cursor On The Graph

    Affinity Additional Information Page 271 Examples: Smoothing index 0 Smoothing index 10 Smoothing index 5 Note: Numerically reported MAX OSPL90 Level is determined from a non-smoothed curve, and as such not affected by smoothing level, even though the smoothed waveform may appear to have a reduced peak around the MAX SPL area.

  • Page 303: Curve Display Options

    Affinity Additional Information Page 272 3.6.8.2 Curve Display Options In the curve display options box all curves are listed by input level and color. If many of the same curve type (e.g. Frequency Responses) have been measured tick only the ones that you wish to display on the graph.

  • Page 304: Comparing Curves

    Affinity Additional Information Page 273 3.6.9 Comparing Curves The HIT440 also allows for comparing either two historical curves (e.g. two OSPL90 curves) or comparing a historical curve to a currently recorded curve. This is done following the procedure described below: Find the first curve in the Session list.

  • Page 305: Comparing To The Manufacturers Specification Sheets

    Affinity Additional Information Page 274 3.6.10 Comparing to the manufacturers specification sheets When comparing a measurement to the hearing aid manufacturer’s specification sheet it is important keep in mind that the same hearing aid settings that were used in the specification measures should also be used for the HIT440 measures! If the parameters are not accordance with each other the comparison will not be valid.
  • Page 306 Affinity Additional Information Page 275 As an add-on the Affinity test boxes also includes a TMFS coil shown below. TMFS is short for Telephone Magnetic Field Simulator. It is a transducer that produces a magnetic field similar to the signal coming out of traditional telephones. In other words the TMFS coil attempts to simulate a telecoil for the purpose of calibrating hearing aids with inductive coils according to ANSI S3.22:2003 Place the hearing aid on top of the TMFS coil as shown on the illustration below.

  • Page 307: Application Of The Hit440 Tests

    Affinity Additional Information Page 276 Application of the HIT440 Tests 3.7.1 Frequency Response The frequency response equals the absolute sound level delivered by the hearing aid at each frequency expressed in dB SPL. This may be measured for both microphone and telecoil. Prior to the measurement remember to perform the Reference Test Gain and set the volume control to the correct position.

  • Page 308: Gain Curve

    Affinity Additional Information Page 277 3.7.2 Gain Curve The gain curve is identical to the frequency response described above. The only difference is that the input level is subtracted from the frequency response providing you with pure hearing aid gain. The gain curve can be measured for both coil and microphone.

  • Page 309: Harmonic Distortion

    Affinity Additional Information Page 278 3.7.3 Harmonic Distortion The pure tone components are called harmonics and occur at integer multiples of the fundamental frequency. The output of a hearing aid, however, is rarely a pure tone and the signal will inevitably contain elements at different frequencies not included in the input.
  • Page 310 Affinity Additional Information Page 279 Input/Output The Input/Output curve displays the output of the hearing aid as a function of the input for one frequency (or broadband signal). The Input/Output function provides information about the compression characteristics of the hearing aid such as for example expansion, knee-point, and compression limiting Below is an example: View test information...

  • Page 311: Intermodulation Distortion

    Affinity Additional Information Page 280 3.7.4 Intermodulation Distortion Distortion in moderate -severe amounts will inevitably have a negative effect on the quality of speech and speech intelligibility. To assess the distortion product generated by the hearing aid, intermodulation distortion is measured. Two tones equal in amplitude are presented to the hearing aid;...

  • Page 312: Attack/Recovery Time

    Affinity Additional Information Page 281 3.7.5 Attack/Recovery Time The Attack time is the time it takes for the hearing aid compressor to react to an increase in input signal. As the output will gradually move towards the final gain value it has been decided to define the attack time as the time it takes the hearing aid to stabilize the output within 2 or 3 dB according to the IEC 6018-2 and ANSI S3.22 respectively.

  • Page 313: Battery Current Drain/Battery Life Time

    Affinity Additional Information Page 282 3.7.6 Battery Current Drain/Battery Life Time HIT440 measures the battery current at the reference frequency with an input of 60 dB SPL. The battery pill is placed in the hearing aid battery compartment and connected to the test box using the corresponding plug as illustrated below.
  • Page 314 Affinity Additional Information Page 283 Below is an example: View test details Battery current drain viewed as a function of frequency. Select test Note: Some hearing aids will show higher battery consumption in the higher frequency range due to the configuration of the audiogram...

  • Page 315: Equivalent Input Noise

    Affinity Additional Information Page 284 3.7.7 Equivalent Input Noise Every amplifier and microphone will generate noise to some extent. The internal noise of a hearing device is expressed as the Equivalent Input Noise. More specifically this term covers the amount of noise that would need to be added to the input of a noiseless hearing aid with the same frequency response if the noise coming out is to be the same as the tested hearing aid.

  • Page 316: Reference Test Gain

    Affinity Additional Information Page 285 3.7.8 Reference Test Gain Reference Test Gain is a control position which is usually set after doing the high level measures such as OSPL90 and Full-on gain. If this is the case the result is a basic frequency response (IEC 118-0) or frequency response curve (ANSI S3.22).

  • Page 317: Microphone Directionality

    Affinity Additional Information Page 286 3.7.9 Microphone Directionality Unwanted noise is provided by many different sources in many daily life situations. They can come from different directions due to position or reflection from the walls in the environment. Fortunately many digital hearing aids have directional microphones that suppress noise coming from some directions while maintaining a good sensitivity to sounds coming from another direction.

  • Page 318: Single Frequency

    Affinity Additional Information Page 287 3.7.10 Single Frequency Single Frequency tests the hearing aid at a single selected frequency using a given stimulus. This allows you to get an impression of the hearing aid at specific important frequencies. If selecting a pure tone or warble tone stimulus a bar representing the fundamental frequency together with harmonics will appear on the graph.

  • Page 319: Response/Gain/Input/Output

    Affinity Additional Information Page 288 3.7.11 Response/Gain/Input/Output The Response/Gain/Input/Output is a combination screen showing the frequency curve, gain curve (one or both) and input/output curves. Response/Gain/Input/Output is performed as described in section 3.7.11. Below is an example: Floating curve display options window Frequency response Input/Output Curve Select test...

  • Page 320: Delay

    Affinity Additional Information Page 289 3.7.12 Delay The Delay test measures the hearing aid delay in milliseconds across frequency using a chirp stimulus. In order to obtain the best possible result it is recommended to use a TBS25 external test box. However, the Affinity build-in test may be used if kept partly open to avoid reflection of sound.

  • Page 321: Ospl90

    Affinity Additional Information Page 290 3.7.13 OSPL90 The OSPL90 is defined as the maximum output level of the hearing aid measured at an input level of 90 dB. This particular input level has been chosen as standard as it is enough to saturate the hearing aid in most cases except if the volume control is set to an extremely low level.

  • Page 322: Full-On Gain

    Affinity Additional Information Page 291 3.7.14 Full-on Gain Full-on Gain is the amount of gain measured in a hearing aid with volume control set to its maximum. It usually measured at an input level of 60 dB which is a common most comfortable level (MCL). When measuring the full-on gain you thereby have the opportunity to check that even at a high output the gain stays below the uncomfortable level (UCL).

  • Page 323: Working With Individual Setups (Test Protocols)

    Affinity Additional Information Page 292 Working with Individual Setups (Test Protocols) The HIT440 module is pre-programmed with standard test protocols (IEC and ANSI) ready for use which can be selected from the front screen. However, you may wish to create an individual test protocol accommodating for personal preferences and test methods.

  • Page 324: Designing A Customized Test Protocol

    Affinity Additional Information Page 293 3.8.2 Designing a Customized Test Protocol The following sections describe how to setup your own test protocol in the HIT440 setup. All setup options for all tests will be described even though you most likely will only need a few. This section is therefore to be seen as a work of reference where single functions can be looked up rather than a step-by-step guide where all steps need to be explored.
  • Page 325 Affinity Additional Information Page 294 4) Name the test protocol setup in the Selected protocol section. 5) Select the tests to be included in the test protocol. Mark a test by clicking on it and press the Add. Double clicking on a test will also select it. Choose all the tests for the test protocol using this procedure.

  • Page 326: Frequency Response Settings

    Affinity Additional Information Page 295 Note: Prior to creating a new test protocol you may wish to select a protocol type in the Protocols to view dropdown list. This function is practical if you for example wish to create a new protocol based on elements from the ANSI or IEC standard.
  • Page 327 Affinity Additional Information Page 296  Averaging time: Decide the number of FFTs shall be used for the averaging of non-linear stimuli like ICRA noise, real speech or other wave based stimuli. The longer average the more reproducible test results will be. ...
  • Page 328 Affinity Additional Information Page 297 Note: In the General Setup it is possible to set a warning, which will pause the test and prompt the user if a recording falls outside tolerance limits. 7) Recording Method:  Resolution (of frequency): Select the preferred resolution in the dropdown. The higher the resolution the slower the measurement.

  • Page 329: Gain Curve Settings

    Affinity Additional Information Page 298 3.8.2.2 Gain Curve settings Settings for Gain Curve are identical to the settings described above for Frequency Response. Please refer to section 0.

  • Page 330: Harmonic Distortion Settings

    Affinity Additional Information Page 299 3.8.2.3 Harmonic Distortion Settings 1) Ensure that Harmonic Distortion is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 331 Affinity Additional Information Page 300 3) Tolorance Limits:  Set limits: Press the button to define individually preferred tolerance limit values. By applying tolerance limits to the recording, it will be possible to easily document whether a curve is inside tolerances or not. In the tolerance limits screen the upper limits may be entered as numerical frequency specific values.

  • Page 332: Input/Output Settings

    Affinity Additional Information Page 301 5) Input Selection:  Choose whether the Harmonic Distortion measurement should be performed through the Speak er or Coil. TMFS coil may also be selected. If measuring through the coil, please ensure that the telecoil in the hearing aid is activated. 3.8.2.4 Input/Output Settings 1) Ensure that Input/Output is marked in the left hand side of the screen.
  • Page 333 Affinity Additional Information Page 302  Sweep delays: This is relevant if Continuous measurement is selected for Pure Tone or Warble Tone. In this case sweep delays (in milliseconds) may be entered between the individual sweeps (see section 3.6.6.2 for details). ...

  • Page 334: Intermodulation Distortion Settings

    Affinity Additional Information Page 303 3.8.2.5 Intermodulation Distortion Settings Ensure that Intermodulation Distortion is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 335 Affinity Additional Information Page 304 Note: In the General Setup it is possible to set a warning, which will pause the test and prompt the user if a recording falls outside tolerance limits. 5) Test Settings:  Battery simulator: Select the correct battery type for the hearing aid to be used under the test.

  • Page 336: Attack/Recovery Time Settings

    Affinity Additional Information Page 305 3.8.2.6 Attack/Recovery Time Settings 1) Ensure that Attack/Recovery Time is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 337 Affinity Additional Information Page 306 4) Sweeps:  Number of sweeps: Select a number of sweeps using the slider. To average out noise which may influence particularly low level recordings, you may select to do multiple recordings (sweeps) which are then averaged together to reduce noise. Only the averaged curve will be displayed.

  • Page 338: Battery Current Drain Settings

    Affinity Additional Information Page 307 3.8.2.7 Battery Current Drain Settings Settings for Battery Current Drain are identical to the settings described above for Frequency Response. Please refer to section 0.

  • Page 339: Equivalent Input Noise Settings

    Affinity Additional Information Page 308 3.8.2.8 Equivalent Input Noise Settings 1) Ensure that Equivalent Input Noise is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 340 Affinity Additional Information Page 309 3) Reference Frequency:  Ref f: Tick this option to select a single reference frequency using the slider. After measuring the curve the level at the reference frequency will be displayed in the measurement details table.
  • Page 341 Affinity Additional Information Page 310 Recording Method:  Resolution (of frequency): Select the preferred resolution in the dropdown. The higher the resolution the slower the measurement. Keep in mind that 1/3 is what is used in many hearing aid manufacturers software. If the curve is to be compared to this you may consider choosing this resolution.
  • Page 342 Affinity Additional Information Page 311  Color: Select a colour for the Right and Left curve. Press each of the buttons to have the custom colour selection below. Choose the desired colour by clicking on it and press OK. Note the option to Define Custom Colours to get a more extensive selection. When having found the exact colour, press Add to Custom Colors.

  • Page 343: Reference Test Gain Settings

    Affinity Additional Information Page 312 3.8.2.9 Reference Test Gain Settings 1) Ensure that Reference Test Gain is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 344 Affinity Additional Information Page 313  HFA/SPA: Tick this option in order to select three frequencies at a fixed distance using the slider. After measuring the curve the reference frequency average will be displayed in the in the measurement details table. 4) .Test Settings: ...

  • Page 345: Directionality Settings

    Affinity Additional Information Page 314 3.8.2.10 Directionality Settings Settings for Directionality are identical to the settings described above for Frequency Response with the exceptions listed below. Please refer to section 0 for details regarding the additional test settings. 1) Display result as: ...

  • Page 346: Single Frequency Settings

    Affinity Additional Information Page 315 3.8.2.11 Single Frequency Settings 1) Ensure that Single Frequency is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 347 Affinity Additional Information Page 316 3) Test Settings:  Battery simulator: Select the correct battery type for the hearing aid to be used under the test. In general Zinc-air types will give best results, particularly on power hearing aids, as this battery type is best at providing current.

  • Page 348: Response/Gain/Input/Output Settings

    Affinity Additional Information Page 317 3.8.2.12 Response/Gain/Input/Output Settings Settings for Response/Gain/Input/Output are identical to the settings described above for Frequency Response (or Gain Curve) and Input/Output respectively. Please refer to section 0 and 0. Note: This screen contains two tabs: Response/gain and Input/output.

  • Page 349: Delay Settings

    Affinity Additional Information Page 318 3.8.2.13 Delay Settings 1) Ensure that Delay is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.
  • Page 350 Affinity Additional Information Page 319 Note the option to Define Custom Colours to get a more extensive selection. When having found the exact colour, press Add to Custom Colors.

  • Page 351: Pause Settings

    Affinity Additional Information Page 320 3.8.2.14 Pause Settings 1) Ensure that Pause is marked in the left hand side of the screen. The name of the test will then appear in the Name of selected test section. Note the option to write a new name for the test in this section (e.g.

  • Page 352: Combined Screen Setup

    Affinity Additional Information Page 321 3.8.3 Combined Screen Setup HIT440 can be setup for default curve comparisons. This is done in the Setup combined screen menu. 1) To enter the Setup combined screen menu, select your test protocol in the Selected protocol dropdown list in the main setup.

  • Page 353: Print Layout Settings

    Affinity Additional Information Page 322 Note: Before closing the setup remember to tick the Display combined screen check box for the combined screen settings to be active. When a combined screen view is setup you can click on the Toggle between single and combined screen button in the front screen to view the desired curves together: If no combined screen view is setup Toggle between single and combined screen will show all measured curves.

  • Page 354: Finishing The Test Protocol

    Affinity Additional Information Page 323 3.8.5 Finishing the Test Protocol Press OK in the lower right hand corner of the HIT440 setup screen to save the customized test protocol. The test protocol can then be found in the List of Protocols dropdown list on the front screen.

  • Page 355: Changing A Test Protocol Permanently

    Affinity Additional Information Page 324 3.8.6 Changing a Test Protocol Permanently You can at any time make changes to an individual test protocol by entering the HIT440 setup again as when creating the test (Menu/Setup/HIT440 setup). Choose your test protocol in the Selected protocol dropdown list. Browse the setup options as if creating a test protocol (see section 0) and amend as desired.

  • Page 356: Changing A Test Protocol Temporarily

    Affinity Additional Information Page 325 3.8.7 Changing a Test Protocol Temporarily You may from time to time run into a client with special needs requiring advanced or different testing parameters. In this situation the Temporary Setup can be helpful. The setup changes made here will be specific to the particular session.

  • Page 357: Exporting A Test Protocol

    Affinity Additional Information Page 326 3.8.7.3 Exporting a Test Protocol Go to HIT440 setup (Menu/Setup/HIT440 setup) Click on Export. Select if the file is to be saved as “Read Only”. In this case the test protocol file is locked and the clinician receiving it will not be able to make changes to it.

  • Page 358: General Setup

    Affinity Additional Information Page 327 General Setup In the General Setup you can select overall settings which are valid for all tests. To enter the General setup, select Menu/Setup/General Setup...
  • Page 359 Ref and Coupler:  Specify which reference microphone and couplers are used. If using the ones provided by Interacoustics tick Normal and if using Brüel & Kjær tick B_K type. Test box: Select the preferred test box: ...
  • Page 360 Affinity Additional Information Page 329 11) Show/Hide icons button: Press the button to customize the test screen. Use the tick boxes to decide which buttons and dropdown lists should be available from the front screen.

  • Page 361: The Hit440 Menu Items

    Affinity Additional Information Page 330 3.10 The HIT440 Menu Items The HIT440 Menu gives you access to File, Edit, View, Mode, Setup, and Help. Menu/Print  Menu/Print/Print will prompt the system to print using the selected print template (see section 4). ...
  • Page 362 Affinity Additional Information Page 331  Menu/Setup/General Suite Settings launches a screen where the user can choose which module should start up, the examiner options and the choice to change the language. Please note that changing something in this screen will affect all active modules, not just the HIT module. Menu/Help ...

  • Page 363: Hit440 Software - Technical Specifications

    HIT440 Software – Technical Specifications HIT440 Software - Technical Specifications Medical CE-m ark: The CE-mark indicates that Interacoustics A/S meets the requirements of Annex II of the Medical Device Directive 93/42/EEC. Approval of the quality system is made by TÜV – identification no. 0123.
  • Page 364 Page 333 HIT440 Software - Technical Specifications Medical CE-m ark: The CE-mark indicates that Interacoustics A/S meets the requirements of Annex II of the Medical Device Directive 93/42/EEC. Approval of the quality system is made by TÜV – identification no. 0123.

  • Page 365: The Hit440 Test Signal Characteristics

    Affinity Additional Information Page 334 3.12 Appendix 1 3.12.1 The HIT440 Test Signal characteristics Pure Tone frequency accuracy is ±1%. Crest factor is 3 dB. Warble Tone frequency accuracy is ±1%, warble frequency 0100 Hz and intensity 010%, sine wave frequency modulation.

  • Page 366: Connecting The Tbs25 To Affinity /Equinox

    Affinity Additional Information Page 335 3.13 Appendix 2: 3.13.1 Connecting the TBS25 to Affinity /Equinox Description: The following items are included with the Cable kit for TBS25 – Affinity /Equinox and TBS25: 1) Base for reference microphone 2) Test box connection cable for speaker (green connector) 3) Cable for test box loop (beige connector) 4) Cable reference mic.

  • Page 367: Printing And Making Reports

    Affinity Additional Information Page 337 4 Printing and making Reports The Print Wizard In the Print Wizard you have the option to create customized print templates which can be linked to individual protocols for quick printing. The Print Wizard can be accessed in two ways. a.
  • Page 368 Affinity Additional Information Page 338 3. Factory default templates are recognized by the lock icon. They ensure that you always have a standard template and do not need to create a customized one. However, they cannot be edited according to personal preferences without resaving with a new name. User defined/created templates can be set to Read-only (showing the lock icon), by right clicking on the template and selecting Read-only from the drop down list.

  • Page 369: Designing A Customized Print Template

    Affinity Additional Information Page 339 4.1.1 Designing a Customized Print Template After clicking on the New Template (or Edit Template) button the design window shows as below. 1. Upon opening, a short description about how to create a template will show on the screen. Press Close to close the message box.

  • Page 370: Design Elements

    Affinity Additional Information Page 340 4.1.2 Design Elements Template elements are added to the template page using the select, drag and drop function. Click on the desired element and drag it onto the template page. The element will appear as a small box in the upper left hand corner.
  • Page 371 Affinity Additional Information Page 341 2 Clinic information. a. Select fields pops up the Select fields window where you select which items are to be shown in the clinic information element. You can change the order of the items by selecting one and pressing the or down arrows .
  • Page 372 Affinity Additional Information Page 342 4. Date Time. This element allows you to put in a stamp on the template showing date and/or time of printing. a. Enter setup…opens the Date Time setup window. Here you choose the format in which the date and/or time appears in the template.You can also choose the font type, size and formatting.

  • Page 373: Taskbar

    Affinity Additional Information Page 343 d. Selecting Rotate makes the element rotate 90 degrees clockwise. 4.1.2.2 Taskbar 1. Add page to make a template of more than one page. 2. Remove page. You will be prompted if you are sure you want to delete the page and all its contents. 3.

  • Page 374: Creating Reports

    Page 344 4.2 Creating Reports The Affinity 2.0/Equinox 2.0 Suite allows electronically generated reports through the Report editor. This allows reports to be saved in the module for each session and they can be retrieved at any time. The reports can also be implemented in the patient’s printout, which gives you the opportunity to have all the relevant...
  • Page 375 Affinity Additional Information Page 345 1. Write your reports and observations in the report page. 2. Increase the Font size of the current selection. 3. Decrease Font size of the current selection. 4. Change the Font size of the current selection. 5.

  • Page 376: The Template Editor

    Affinity Additional Information Page 346 4.2.1.2 The Template Editor To enter the Template editor press 1. New Template enables you to create a new customized report template. Enter a template name (e.g. “Standard Report”) before pressing New Template. The name of the template will then appear on the tool bar and you can type in your report template details like in the example below.

  • Page 377: Recovery Manager

    Affinity Additional Information Page 347 5 Recovery manager In the unlikely event that your software is not shut down properly, the recovery manager will ensure that no data is lost. During testing each threshold or measurement that is stored on screen is also saved in a log file on your PC.
  • Page 378 Affinity Additional Information Page 348...

  • Page 379: Crash Reports

    (as shown below). The crash report provides information to Interacoustics about the error message and extra information can be added by the user outlining what they were doing before the crash occurred to assist in fixing the problem. A screen shot of the software can also be sent.
  • Page 380 Affinity Additional Information Page 350...

  • Page 381: Quick Guides

    Page 351 7 Quick Guides Several quick guides have been developed to support the users of the Affinty/Equinox, these can be found on the Interacoustics.com website in this link: http://www.interacoustics.com/affinity/resources#quick-guides These quick guides involve the following topics: • Introduction to Quick Guides •...
  • Page 382 Affinity Additional Information Page 352...

  • Page 383: References

    Affinity Additional Information Page 353 8 References British Society of Audiology Recommended Procedure: Pure tone air and bone conduction threshold audiometry with and without masking and determination of uncomfortable loudness levels (2004). Uploaded from www.thebsa.org.uk/docs/bsapta.doc : Clinical determination of abnormal auditory adaptation. In: Archives of Carhart.
  • Page 384 Affinity Additional Information Page 354 Mehta and Singh. (2000). Screening Tests for Non-Organic Hearing Loss. [online] Available at: http://medind.nic.in/maa/t00/i1/maat00i1p79.pdf [Accessed 8 Mar. 2017]. National Research Council (US) Committee on Disability Determination for Individuals with Hearing Impairments; Dobie RA, Van Hemel S, editors. Hearing Loss: Determining Eligibility for Social Security Benefits.

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