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Interacoustics Affinity 2.0 Additional Information

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Equinox
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  • Page 1 Science made smarter Additional Information Affinity Equinox...

  • Page 3: Table Of Contents

    Table of Contents AC440 ..........................1 About AC440 module..................... 1 Launching AC440 ......................2 1.2.1 Launching f rom OtoAccess® ..................2 1.2.2 Launching f rom Noah....................2 1.2.3 Using the tone screen ....................3 The speech screen elem ents ..................9 1.3.1 Speech audiometry in graph mode................
  • Page 4 1.9.2 Noah database settings....................120 1.9.3 Tone and speech settings ..................120 1.10 General suite settings and examiner ................121 1.10.1 Start-up .........................121 1.10.2 Examiner settings ....................121 1.10.3 Languages ......................122 1.10.4 PDF print.........................123 1.10.5 NOA H comment ......................124 1.11 Password protection ....................125 1.12 The AC440 menu items....................126 1.13 PC Shortcut manager ....................128 1.14 Standalone database settings ..................129 1.15 View data without license ...................129...
  • Page 5 2.5.15 Comparing curves....................173 2.5.16 Managing multiple curves ..................174 Clinical application of real-ear measurem ents using REM440........176 2.6.1 REUR/RE UG measurements..................176 2.6.2 REAR/REA G measurements ..................180 2.6.3 REIG measurements ....................182 2.6.4 RECD meas urements ....................184 2.6.5 REOR/REOG measurements ...................195 2.6.6 Measuring input/output.....................196 2.6.7 Directionality measurements..................198 2.6.8...
  • Page 6 2.19.1 Signal analysis characteristics ..................270 The f ollowing table summarises the signal analysis characteristics of the Aff inity/Equinox..270 2.20 REM PC shortcuts ......................271 2.21 REM440 software - technical specifi cations ...............272 HIT440 ...........................273 HIT440 quick guide .....................273 About HIT440 ......................275 HIT 440 tests .......................276 Launching the HIT 440 software .................274 3.4.1...
  • Page 7 3.8.7 Changing a test protocol temporarily .................343 General setup ......................345 3.10 The HIT440 menu items ....................348 3.11 HIT440 software - technical specifications ..............350 3.12 Appendix 1 .........................351 3.12.1 The HIT440 test signal characteristics ...............351 3.12.2 Signal analysis characteristics ..................352 The f ollowing table summarises the signal analysis characteristics of the Aff inity/Equinox..352 3.13 Appendix 2: ........................353 3.13.1 Connecting the TBS25 to Aff inity /Equinox...

  • Page 9: Ac440

    1 AC440 About AC440 module AC440 is the PC-based audiometry module f or the Af f inity and Equinox hardware platf orms. The AC440 sof tware is an independent two-channel audiometer. It f eatures tone audiometry f or air and bone, speech testing and a variety of masking and signal types.

  • Page 10: Launching Ac440

    Launching AC440 Ensure that the Af f inity /Equinox is powered on and connected to your PC bef ore opening the sof tware suite. If the hardware is not detected, the Af f inity Suite will open but it will run in Simulation mode. This is identif iable by the below icon in the lef t of the screen.

  • Page 11: Using The Tone Screen

    1.2.3 Using the tone screen The f ollowing section describes the elements of the tone screen. Menu provides access to Print, Edit, View, Tests, Setup, and Help Print allows f or printing the session’s acquired data. Save & New Session saves the current session in Noah or OtoAccess® and opens a new one.
  • Page 12 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 f ound by right tone tesclicking on one of the areas. The visibility of the dif ferent areas as well as the space that they take on the screen is locally saved to the examiner.
  • Page 13 Single audiogram toggles between viewing the inf ormation of both ears in a single graph and two separate graphs. Multi frequencies activate testing with f requencies in between the standard audiometric test f requencies. The f requency resolution can be adjusted in the AC440 setup.
  • Page 14 Af ter saving the session, comment changes can only be made within the same day until the date changes (at midnight). Note: these timef rames are limited by HIMSA and the Noah sof tware and not by Interacoustics. D-0004576-Q – 2022/05 Page 6 Affinity/Equinox2.0 –...
  • Page 15 The Output list f or channel 1 provides the option to test through head phones, bone conductor, f ree f ield speakers or insert phones. Note that the system only shows the calibrated transducers. The Input list f or channel 1 provides the option to select pure tone, warble tone, narrow band noise (NB) and white noise (WN).
  • Page 16 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 lef t mouse click in the Stimuli area will store the threshold at the current position.

  • Page 17: The Speech Screen Elements

    1.3 The speech screen elements The f ollowing section describes the elements of the speech screen in addition to the tone screen: Input levels sliders allow f or adjusting the input level to 0 VU f or the selected input. This ensures that correct calibration is obtained f or Mic1, Mic2, CD1, and CD2.On the VU Meter the dial intensity is achieved when the signal is at the 0 mark.
  • Page 18 The Output list f or channel 1 provides the option to test through head phones, bone conductor, f ree f ield speakers or insert phones. Note that the system only shows the calibrated transducers. The Input list f or channel 1 provides the option to select white noise (WN), speech noise (SN), microphone 1 or 2 (Mic1 and Mic2), AUX1, AUX2 and wave f ile.
  • Page 19 Shuffled wave file testing 1) By clicking on the ‘Shuf f le’ icon you can randomize the order of the wave f iles f or speech test presentation 2) Re-clicking on the ‘shuf f le’ icon will allow you to revert to the non- randomized material 3) When looking through the material you can quickly see which list has been randomized by the highlighted Randomize button and if the...

  • Page 20: Speech Audiometry In Graph Mode

    1.3.1 Speech audiometry in graph mode Graph mode presentation settings in the lower lef t 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 21 1.3.1.1 Dual speech graphs The graphs can be shown as a dual audiogram to show lef t and right (see example below) this can be enabled in the Speech Setup Screen by clicking on the button called ‘Dual Graph’. D-0004576-Q – 2022/05 Page 13 Affinity/Equinox2.0 –...
  • Page 22 1.3.1.2 50% discrimination line The Graph View allows you to add a 50% discrimination line (see above dual audiogram image f or example). This is enabled by checking on the ‘Show 50% Discrimination Line’ setting in the Speech Norm Curves setup (see image below).
  • Page 23 As a note, on changing this setting in General Setup, you will need to close your sof tware f or the setting to apply. Once this setting has been enabled, your Speech graph will show an additional scale at the bottom of the graph indicating the dB HL value.
  • Page 24 1.3.1.4 Bönninghaus & Röser calculation The Bönninghaus & Röser calculation has been implemented f or the German market. This is a marker to recognise the accuracy of the test in relation to the patient’s audiometry and to identif y when the patient is suitable f or compensation/insurance. Settings in the speech setup need Bönninghaus and SRT enabled to show this score.

  • Page 25: Speech Audiometry In Table Mode

    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 MCL and UCL speech testing can be conducted by selecting The WR (Word Recognition) table.
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  • Page 27: Binaural Speech

    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 dif f erent output is chosen. E.g., right ear in channel 1 and lef t ear in channel 2 or vice versa.

  • Page 28: Full 2(4) Channel Speech In Noise

    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 Lef t and right transducer at the same time and vice versa.
  • Page 29 Binaural Stimulus Intensity Binaural Masking Intensity Channel 1 Channel 2 D-0004576-Q – 2022/05 Page 21 Affinity/Equinox2.0 – Additional Information...

  • Page 30: Counselling Tab

    1.6 Counselling tab Under the menu icon there is a tab titled counslling. This is where the counselling f eatures of the sof tware are contained. 1.6.1 SoundStudio The SoundStudio is a counselling tool which allows you to recreate sound environments to simulate real-lif e situations f or use during hearing aid f itting and counselling.

  • Page 31: Clinical Application Of The Ac440 Tests

    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 perf orming the individual tests.
  • Page 32 These f eatures are intended to help the inexperienced clinician when masking is required. Please see section 1.7.2.2 and Appendix 2 f or more inf ormation on this. Explain to the patient that they will hear a number of dif ferent tones through the headphones and that they should press on the response button whenever the tone is audible, even if it is very f aint.

  • Page 33: High Frequency Audiometry

    1.7.1 High frequency audiometry High f requency audiometry (above 8 kHz) is perf ormed 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 f or a range of 125 Hz –...

  • Page 34: Multi Frequency Audiometry

    1.7.2 Multi frequency audiometry Multi f requency audiometry lets the clinician test more f requencies than the traditional audiometric test f requencies. This may be usef ul 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 helpf ul in the evaluation of tinnitus as is provides the option to match the tinnitus.

  • Page 35: Masking

    Test procedure: Open the AC440 module through Noah or OtoAccess®. If needed select a test protocol in the List of Protocols. Prior to bone conduction audiometry, perf orm the Air conduction audiometry, as described in section Place the bone conductor on the mastoid of the worst ear and choose Bone Right or Bone Left f rom the channel 1 output dropdown list and select the desired test signal (typically Tone).

  • Page 36: Speech Audiometry

    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 pref erred masking stimulus pref erred (usually Narrowband NB). Ensure that Rev is ticked making the masking noise continuous.
  • Page 37 Test procedure: Bef ore perf orming the speech audiometry, you may wish to complete tone audiometry. This provides valuable predictive inf ormation usef ul in the speech testing. Furthermore, the PTA level (Pure Tone Average) gives you a basis f or calculating the starting point f or speech testing. Open the AC440 module in the Af f inity Suite through your patient management sof tware, Noah or OtoAccess®...
  • Page 38 Note: The AC440 Setup allows f or selecting whether the speech test is to be perf ormed in Graph or Table Mode (see section 1.7.2.3). This screen shot shows graph mode. In case of mistakes during the test you can right click on the threshold which will prompt a menu with edit options.
  • Page 39 Choose the input f or channel 1 (microphone, CD, or wave f ile). In case of wave f iles, check if the pref erred material, and wordlist are selected. Note: In case of microphone/AUX the speech material can be calibrated by speaking into the microphone/playing the calibration track.
  • Page 40 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 inf ormation about what phonemes the patient has dif f iculty hearing at a particular intensity level. This is helpf ul f or counselling and rehabilitation purposes. The diagnostic value has shown to be f airly low, but it is generally accepted that the word and sentence recognition are least af f ected by conductive and most af f ected by neural loss.
  • Page 41 1.7.5.3 Speech testing with a microphone Affinity 2.0. /Equinox Connect the microphone to the Mic1 or Mic2 input on the on the hardware. Microphone inputs Open the AC440 sof tware, go to the Speech screen Choose Mic1 or Mic2 in the input channel 1 list. Adjust the input levels f or 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 42 Choose AUX1 or AUX2 in the channel 1 list. Play the calibration tone f or your material through the CD player. Then adjust the input levels f or the CD player until you reach an average of approximately 0 dB VU on the VU meter .

  • Page 43: Masking Level Difference (Mld)

    Should you wish to edit your speech score af ter it has been assigned you can right click on the word, and it will allow you to re-score it as shown below. This f eature can be used during testing or af ter the test has completed. 5) Should you wish to choose where to begin your speech testing then you can click on the designated wavef ile ahead of starting the test.
  • Page 44 The MLD is measured by presenting a low f requency pulsed tone with simultaneous presentation of the corresponding narrow band noise, starting at an intensity of 60, or 65 dB to both ears. The f irst condition should be to f ind the threshold f or the homophasic condition (ref erred to as SoNo). The next step is to measure the antiphasic condition, either presenting the tone out of phase or the noise out of phase and the masked threshold is determined again.

  • Page 45: Master Hearing Aid (Mha)

    Do a masked threshold search. Typically, the masked threshold f or the SoNo condition will be equal to the noise level. When you have established a threshold, click in the Stimuli area f or Store or press S on the PC keyboard. Once the SoNo condition has been stored, the cursor will automatically jump to the SπNo condition., in which the signal is out of phase and the noise is still in phase.
  • Page 46 Open the AC440 and enter the MHA screen by selecting Menu | Tests | MHA. Select headphones or inserts in the channel 1 output list. Select CD, Microphone or Wavefile in the channel 1 input list. If using CD press play on the CD player, and if using wave f iles, you can Browse and play them in the bottom of the screen.

  • Page 47: Hearing Loss Simulation (Hls)

    1.7.8 Hearing loss simulation (HLS) The HLS of f ers a simulation of the hearing loss through the audiometric headphones or the high f requency headset and is primarily aimed at the f amily members of the hearing impaired. It is a valuable tool as a hearing loss in many f amilies may result in f rustrations and misunderstandings.

  • Page 48: Short Increment Sensitivity Index

    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 f rom 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 49: Weber

    Explain to the patient that they will now hear a series of tones. If suddenly one tone seems louder that the other ones the response button should immediately be pushed. Select the pref erred type of SISI test. Setting the system to 1 dB increments is the classical SISI. If the patient can hear these increments and scores high, cochlea damage is likely.

  • Page 50: Knaster

    Test procedure: Open the AC440 and enter the Weber screen by selecting Menu | Tests | Weber Input and Output selections f or channel 1/channel 2 are f ixed Tone and Bone. Place the bone conductor on the patient’s f orehead and instruct them to tell you if the tones presented are heard better to the Right, Left, Centre or if it is Not heard at all.
  • Page 51 Test procedure: To perf orm the Knaster test, you need to know the level of maximum speech understanding. The test should theref ore be perf ormed af ter the speech audiometry which will provide you with this inf ormation. Do the Speech Audiometry as described in section 1.6.5.5.

  • Page 52: Ablb/Fowler

    Note: If you wish to switch between right and lef t during the Knaster training without the intensity returning to the original start level, please be sure to enter the Common settings in the AC440 setup (Menu/setup/AC440 setup, see section 1.7.2.1) and select “OFF” in the Default intensity when changing output dropdown list like illustrated below: 1.7.12 ABLB/Fowler ABLB (Alternate Binaural Loudness Balancing) is a test to detect perceived loudness dif ferences between...

  • Page 53: Stenger Test

    Clarif y the test procedure to the patient. Explain that he/she will now hear tones in both ears. The assignment is to determine when the two tones sound equal in intensity/loudness The ABLB is perf ormed at f requencies where recruitment is assumed. Set the intensity level on the impaired ear to 20 dB above the pure tone threshold using channel 2.
  • Page 54 Present the tones to both ears simultaneously. Keep the intensity level of the better ear f ixed and increase the intensity f or the worse ear in 5 dB steps. If the hearing loss in the worse ear is genuine the patient will keep responding to the signal presented to the better ear (Negative Stenger).

  • Page 55: Ten Test

    1.7.14 TEN test Until recently, the TEN(HL) test f or 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 Af f inity /Equinox Suites.
  • Page 56 Test procedure 1) Open the AC440 and enter the QuickSIN screen by selecting Menu | Tests | QuickSIN 2) Select the output level. For most of the tracks the channels are synchronised to ensure that the correct SNR level is achieved. Note: the ‘Speech and Babble’ Lists are not synchronised and will require the user to manually alter these to ensure the correct SNR setting f or the test.

  • Page 57: Tone Decay

    The QuickSIN is perf ormed according to the methods described in the QuickSIN manual. 1.7.16 Tone decay This is a test to help identif y 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 deaf ness.
  • Page 58 But if the subject indicates that they no longer hear the tone bef ore 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 59 The tone is continued to be raised in 5 dB steps until an intensity is reached that allows the subject to perceive the tone f or f ull minute. The amount of decay occurring at each level suggests/indicates the amount of decay the subject is showing. As a time saving measure, Carhart (1957) suggested that the test should be terminated when the subject f ails to respond 30 dB above threshold.

  • Page 60: Anl Test

    The Equinox and Af f inity systems can perf orm the test binaurally via the R+L f eature. The ANL Test can use any of the materials you have already ripped into your Interacoustics Suite sof tware. When should I perform the ANL test? The ANL test is typically perf ormed bef ore the patient is given any f orm of amplif ication as a rehabilitative action f or their hearing loss.
  • Page 61 It is not essential to perf orm MCL High and MCL Low f or the ANL test, but these are also good indicators of the patients’ comf ortable hearing range. Instructions f or the patient will always be displayed at the bottom of the screen. The ANL Test requires an additional license.
  • Page 62 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 63 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 to f ind a level of competing noise which the patient would be comf ortable to listen to alongside their target material.
  • Page 64 What does my ANL value mean? On perf orming the ANL test you will obtain an ANL value (in dB) and a percentage. The percentage gives a likelihood of success with amplif ication (Nabalek et al., 2006) and the ANL value is the outcome of the f ollowing calculation: ANL = MCL -BNL For response categories the f ollowing outcome criteria was determined as an ef f ect of the Nabalek et al.

  • Page 65: 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 sof tware. However, the Stimulus intensity is maintained automatically by the sof tware f ollowing a correct or incorrect response to the stimulus, this helps to speed up the test time.
  • Page 66 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. 7. On the patients’ response, score the words correct or incorrect according to their response. The system will automatically increase the next stimulus intensity f or an incorrect response and decrease the next stimulus intensity f or a correct response.

  • Page 67: 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 sof tware. However, the Signal-to-Noise Ratio is maintained automatically by the sof tware f ollowing a correct or incorrect response to the stimulus, this helps to speed up the test time.
  • Page 68 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 f rom Man to Rev. The masking will need to be turned on manually, this is because you may want to perf orm an initial f amiliarization test with the patient without the noise to begin.

  • Page 69: Vdb-Express

    1.7.20 VDB-express Dif f iculty with hearing in background noise is a common complaint among hearing aid users. Theref ore, 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 f rom the pure tone audiogram. The VDB-Express test was developed to provide a quick estimate of SNR loss f or French listeners.
  • Page 70 2) Select the output level. The channels are synchronised f or this material to ensure that the correct SNR level is achieved. 3) Select a list in the corresponding dropdown. e.g., “Liste 2”. 4) Instruct the patient to repeat the sentences and try to ignore the noise that they will also hear through the headphones.
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  • Page 72: Working With Individual Setups (Test Protocols)

    1.8 Working with individual setups (test protocols) There are many dif f erent demands and wishes regarding how an audiometer should both f unction and appear depending on the specif ic situation and national standards. One of the greatest advantages of the AC440 module is the f lexibility enabling you to tailor the system according to your specif ic pref erences in the so-called “test protocols”.

  • Page 73: Creating New Protocols

    Clicking Cancel will close the AC440 setup without saving any changes made. 1.8.2 Creating new protocols Click Menu | Setup | AC440 setup to enter the Main setup. Click New to create a new test protocol and f ill in the Name f ield (e.g., “Joan Jones”). 1.8.2.1 Common setup The specif ics of the test can be selected starting in the Common screen shown below:...
  • Page 74 Note: Some tests are purchased as additional licences f or 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’ of the protocol settings (at number 1 in the above f igure). Select the def ault start Intensity (Tone, Speech, SISI, Weber).
  • Page 75 Mandatory Comments allow you to enable a setting which f orces the user to comment on the test session when saving the session. This is to ensure relevant session comments are provoked to be stored alongside the session data. D-0004576-Q – 2022/05 Page 67 Affinity/Equinox2.0 –...
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  • Page 77 1.8.2.2 Tone testing setup Start-up 1) To enter the Start-up options f or tone testing unf old the Tone options and click Start-up. Def ault Output of Channel 1 and Channel 2 can be selected in the two dropdown lists. The selection will dif f er depending on which transducers are calibrated.
  • Page 78 Common: To enter the Common options f or tone testing unf old the Tone options and click Common. Here you can adjust some of the more f requent tone audiometry settings stating with the General settings. Note: This screen contains f our tabs (General, Tone audiometry, Overlays, Masking). D-0004576-Q –...
  • Page 79 Def ault input f or Channel 1 and Channel 2 can be set using the dropdown lists. Select between Tone, Warble tone, NB (Narrow Band noise), and WN (White Noise) f or both channels. In addition, TEN Noise can be selected f or channel 2 (if purchased). See more inf ormation about the TEN test in Appendix 2.
  • Page 80 Tick Show Ch1 and Ch2 in a single audiogram to show a single audiogram by def ault Choose Swap intensity keys on PC keyboard and Swap arrows on intensity buttons to change the direction when adjusting intensity and f requency. Hide unmasked threshold where masked exist will only display the masked (i.e., real) thresholds by def ault.
  • Page 81 The Hearing loss index on audiogram allows f or ticking Show European CPT-AMA index, Show AC PTA index or Show BC PTA index. The European CPT-AMA is calculated using the values f rom the table below which ensures that the dif f erent f requencies are weighted to display a correct quantif ication of impairment due to the hearing loss.
  • Page 82 If selecting the PTA index, you can choose the f requencies that should be included in the calculation. The def ault setting will be 500, 1000, 2000, and 4000 Hz (Fletcher index). In this calculation method all f requencies are equally weighted and averaged to give the f igure. A f urther example of the Fletcher index is as f ollows: 500Hz Threshold + 1kHz Threshold + 2kHz Threshold + 4kHz Threshold = PTA Score Should one of the f requencies have a double emphasis then the f ollowing calculation will be applied.
  • Page 83 Note: The PTA is calculated f or insert phones and headset. However, if values f or both are stored no PTA value is calculated. Since the speech banana is language dependent the AC440 allows f or entering individual speech banana values. Enter your values f or the upper and lower margin of the speech banana under Top part of banana and Bottom part of banana.
  • Page 84 A Severity indication can be set up by def ining the label, minimum and maximum dB, and colour f or each indication in the audiogram. For counselling purposes, you can tick Show severity in the Severity tab. This allows f or severity indications in the audiogram screen.
  • Page 85 The Phonemes to be shown in an audiogram can be set up by def ining the labels and positions of all phonemes. Indicate the f ont size as how they must appear on screen. For counselling purposes, you can tick Show phonemes in the Phonemes tab. This allows f or phonemes in the audiogram screen.
  • Page 86 The Sound examples to be shown in an audiogram can be set up by def ining the positions of all examples. When adding a new picture, you are asked to point out where the picture can be f ound. Note that the f ile type must be *.png to allow transparent background colours. For counselling purposes, you can tick Show sound examples in the Sound examples tab.
  • Page 87 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 dif f erences as well as the def ault values f or over masking. a. Auto masking on masking will start automatically where required b.
  • Page 88 Pressing the lef t rotating dial will enable/disable ‘Talk f orward f unction.’ Pressing the right rotating dial will enable/disable the ‘Talk back’ option. The audiometer keyboard has an LED light indicator which changes status during dif f erent operations. These dif f erent colours and their statuses are listed and shown below.
  • Page 89 Tick Set multi frequencies as default enabled to set the f unction to be def ault as on (f or f urther description of multi f requency testing please see section 1.6.2) Note: High frequency Add on tab is currently not in use (f or f urther description of high f requency testing please see section 1.6.1).
  • Page 90 1.8.2.3 Speech testing setup Start-up To enter the Start-up options f or speech testing, unf old the Speech options and click Start-up. Select the def ault output of Channel 1 and Channel 2 in the two dropdown lists. The selection will dif f er depending on which transducers are calibrated.
  • Page 91 Common To enter the Common options f or speech testing unf old the Speech options and click Common. Note: This screen contains f our 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 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 f rom the point where the norm curve crosses 50% to the point where the speech curve crosses 50%) like shown below.
  • Page 93 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 f or each WR can be selected in the Link stimulus types to WR curves (see later in this section). Under Graph mode settings you can decide whether the testing should start with WR1, WR2, WR3, MCL, or UCL.
  • Page 94 Settings – controls include the f ollowing options: Ignore mouse over touch switch: The AC440 will ignore the mouse touching the stimuli area.  The f unction is embedded to avoid accidentally presenting a stimulus. Incorrect button deactivated: The incorrect button will be greyed, and only correct answers are ...
  • Page 95 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 f or example always uses multi syllabic numbers f or WR1 and single syllabic words f or WR2, you can link these materials to the curves and corresponding buttons in the f ront screen.
  • Page 96 19) For Phone norm curves both Multi syllabic and Single syllabic norm values f or speech tests obtained with head phone can be edited or replaced with other norm material. The def ault norm material is in accordance with the DIN 45 626 standard. 20) For FF norm curves both Multi syllabic and Single syllabic norm values f or speech tests obtained in f ree f ield can be edited or replaced with other norm material.
  • Page 97 Add-ons 21) To enter the Add-on options f or speech testing unf old the Speech options and click Add-ons. In this screen the AC440 can be setup to do speech testing using wave f iles . Upload the wave f iles to the PC (as described in Appendix 1).
  • Page 98 1.8.2.4 MLD testing setup Start-up To enter the Start-up options f or MLD testing unf old the MLD options and click Start-up. Talk back can be enabled by ticking the check box. Use the slider to set the def ault Talk back level. Masking Level Difference (MLD) requires an additional license and is only available for the Affinity /Equionox D-0004576-Q –...
  • Page 99 Common To enter the Common options f or MLD testing unf old 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. This means that the Ch1 output will decide the output of Ch2. Use the Ch1 Output dropdown list to select the input f or Phone right or Insert right.
  • Page 100 Keyboard To enter the Keyboard options f or MLD testing unf old the MLD options and click Keyboard. This is, however, only relevant if using the dedicated audiometry keyboard. Since the procedure f or setting up the keyboard buttons f or MLD testing is identical to the procedure f or the setting up keyboard buttons f or tone audiometry, please see section 1.7.2.2 f or a description.
  • Page 101 Under Monitor one or both channels may be ticked if monitoring is pref erred. The level of the monitoring can be set using the slider If Wave files are chosen as input, you can browse f or them by clicking Browse. If a group of wave f iles are already chosen and you wish to browse f or new ones, click Clear.
  • Page 102 1.8.2.6 Knaster testing setup Start-up To enter the Start-up options f or Knaster testing unf old the Knaster options and click Start-up. The def ault Talk back level can set using the check box (as described in section 1.7.2.4). Common To enter the Common options f or Knaster testing unf old the Knaster options and click Common.
  • Page 103 Select the def ault start Low pass filters and/or High pass filters: no f iltering -12 per octave Medium low/high pass f iltering -24 per octave Major low/high pass f iltering In Normal hearing level for gain calculation, you can select a certain dB level which should normally be like the level of real speech (typically 60 dB).
  • Page 104 1.8.2.7 HLS counselling setup Start-up To enter the Start-up options f or HLS counselling unf old the HLS options and click Start-up. Determine the Talk back level using the check box to set the Talk back def ault (as described in section 1.7.2.4). Common To enter the Common options f or HLS counselling unf old the HLS options and click Common.
  • Page 105 Under Monitor one or both channels may be ticked if monitoring is pref erred. The level of the monitoring can be set using the slider. If Wave files are chosen as input, you can browse f or them by pressing Browse. If a group of wave f iles are already chosen and you wish to browse f or new ones, press Clear.
  • Page 106 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 that Mic 2 transducer is chosen 4. Go to Counselling Overlays window and click on the Patient Monitor Text button 5.
  • Page 107 Keyboard To enter the Keyboard options f or HLS testing unf old the HLS options and click Keyboard. Since the procedure f or setting up the keyboard buttons f or HLS testing is identical to the procedure f or the setting up keyboard buttons f or tone audiometry, please see section 1.7.2.2 f or a description.
  • Page 108 2) Under Monitor one or both channels may be ticked if monitoring is pref erred. The level of the monitoring can be set using the slider Keyboard To enter the Keyboard options f or SISI testing unf old the SISI options and click Keyboard. Since the procedure f or setting up the audiometry keyboard buttons f or SISI testing is identical to the procedure f or the setting up keyboard buttons f or tone audiometry, please see section 1.7.2.2 f or a description.
  • Page 109 1.8.2.10 QuickSIN setup Start-up To enter the Start-up options f or QuickSIN testing unf old the QuickSIN options and click Start-up. Select the def ault output f or 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 Common To enter the Common options f or QuickSIN testing unf old the QuickSIN options and click Common. Select Monitor f or channel 1 (Ch1) and channel 2 (Ch2) using the check boxes and adjust the level using the slider. Keyboard To enter the Keyboard options f or QuickSIN testing unf old the QuickSIN options and click Keyboard.
  • Page 111 1.8.2.11 QuickSIN additional features setup Adding a fourth column to the SNR loss def initions table: Go to: Menu │Setup │AC440 │Main Setup │QuickSIN │Common Insert a checkmark in the “show f ourth 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 D-0004576-Q –...
  • Page 112 Aided QuickSIN is now possible when selecting the f ree f ield transducer. To activate Aided QuickSIN: Ensure you are in the QuickSIN screen Select Free Field as the Transducer; this will activate the “Aided” f unction. Click on the Aided button; this will add an extra column on to the QuickSIN scoring table Comparing aided and unaided QuickSIN scores over time: Clinicians are now able to compare the Unaided and Aided SNR scores.
  • Page 113 1.8.2.12 ABLB/Fowler and Stenger setup ABLB/Fowler and Stenger can be perf ormed by adjusting the Tone or Speech settings in the f ront 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-def ined test protocol which is made according to the methods of Brian Moore (see Appendix 1).
  • Page 114 1.8.2.14 ANL test setup Start-up To enter the Start-up options f or ANL testing unf old the ANL options and click Start-up. 1) Select the def ault output f or Channel 1 f rom the dropdown list. 2) The Talk back level can be determined using the check box. D-0004576-Q –...
  • Page 115 Common To enter the Common options f or ANL testing unf old 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 1.8.2.15 SIQ Test setup Start-up To enter the Start-up options f or SIQ testing unf old the SIQ options and click Start-up. 1) Select the def ault output f or Channel 1 f rom the dropdown list. 2) Select the def ault output f or Channel 2 f rom the dropdown list. 3) The Talk back level can be determined using the check box.
  • Page 117 Common To enter the Common options f or SIQ testing unf old the SIQ options and click Common. D-0004576-Q – 2022/05 Page 109 Affinity/Equinox2.0 – Additional Information...
  • Page 118 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. The CD chosen corresponds to material which is already available in your Speech Audiometry test screen.
  • Page 119 1.8.2.16 SIN test setup Start-up To enter the Start-up options f or SIN testing unf old the SIN options and click Start-up. 1) Select the def ault output f or Channel 1 f rom the dropdown list. 2) Select the def ault output f or Channel 2 f rom the dropdown list. 3) The Talk back level can be determined using the check box.
  • Page 120 Common To enter the Common options f or SIN testing unf old the SIN options and click Common. D-0004576-Q – 2022/05 Page 112 Affinity/Equinox2.0 – Additional Information...
  • Page 121 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. The CD chosen corresponds to material which is already available in your Speech Audiometry test screen.

  • Page 122: Finishing The Test Protocol

    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 f ound in the Protocols and sessions dropdown list in the f ront 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 123: Changing A Test Protocol Temporarily

    1.8.5 Changing a test protocol temporarily You may f rom time to time run into a patient with special needs requiring advanced or dif f erent testing parameters. In this situation the Temporary Setup can be helpf ul. The setup changes made here will be specif ic to the session.

  • Page 124: Importing And Exporting Test Protocols

    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 f ile has been saved. Click Open.
  • Page 125 1.8.6.2 Exporting a test protocol: Go to the AC440 Setup (Menu | Setup | AC440 setup). Click on Export. Select if the f ile 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 126: General Setup

    1.9 General setup In the General Setup you can select overall settings which are valid f or all tests and protocols. To enter the General setup, select Menu | Setup | General Setup. D-0004576-Q – 2022/05 Page 118 Affinity/Equinox2.0 – Additional Information...

  • Page 127: Symbol Editor

    1.9.1 Symbol editor You enter the symbol editor by either pressing Edit on an existing symbol scheme or by pressing New af ter which you are asked to type a name and select which of the existing symbol schemes is your starting point f or the new set.

  • Page 128: Noah Database Settings

    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 specif ic manner f or third party EMR systems to read and display the speech test data as SRT thresholds. The setting to ‘Save IP measurements as AC’...

  • Page 129: General Suite Settings And Examiner

    1.10 General suite settings and examiner In General suite settings you f ind 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 Start-up Choose which module will be visible on starting up the Suite: AUD, REM, HIT or VO 1.10.2 Examiner settings At start-up the Suite by def ault sets the examiner identical to the user of the database through which the Suite was opened.

  • Page 130: Languages

    Note that locally, on the pc you are working, f or each examiner a log f ile is created that contains pref erences 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 def ault start protocol.

  • Page 131: Pdf Print

    This is a benef it f or paperless documenting of patients test data and f or sharing data with people who do not have the Interacoustics Suites. This f eature is present f or all modules of the Callisto, and Af f inity Suites once enabled.

  • Page 132: Noah Comment

    1.10.5 NOAH comment The NOAH Comment f eature allows you add comments to the NOAH tag against the associated action/session you are saving. This can, f or example, allow you to store the users initials so that the actions in a patients journey can be recognized as to who perf ormed them. If you enable this setting, then this pop up will show when you try to save the session alerting the user to comment.

  • Page 133: Password Protection

    1.11 Password protection When password protection is enabled the f ollowing 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 conf irm your password.

  • Page 134: The Ac440 Menu Items

    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)  Menu | Print | Print preview prompts a print preview of the current protocol using the print template ...
  • Page 135 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. Menu | Setup | Language opens the language selection. The system must be restarted f or a new ...

  • Page 136: Pc Shortcut Manager

    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 sof tware.

  • Page 137: Standalone Database Settings

    This can be changed by going to the f ollowing location, C:\Program Files (x86)\Interacoustics\Af f inity Suite, and launching the application titled FolderSetupAf finity.exe. On doing this the below window will be shown.
  • Page 138 When you enter a test which is unavailable the HUD will be completely greyed out and the data is only permitted to be viewed and not interacted with. D-0004576-Q – 2022/05 Page 130 Affinity/Equinox2.0 – Additional Information...

  • Page 139: Faq

    1.16 FAQ When I open my AC440 it shows that I am in Simulation mode on the left of the screen. What could be the cause of this? Ensure that the Af f inity /Equinox hardware is connected properly. This will be indicated by the picture of the instrument in the lower lef t corner of the screen.
  • Page 140 Can I upload my own speech material? Yes, but a special tool is needed f or this. Contact Interacoustics or the local distributor to acquire this sof tware. You will need to have purchased the Speech f rom Hard Drive (SFH440) license to use wave f ile materials.

  • Page 141: 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 f or 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 142 Implementation of the TEN(HL) test in Interacoustics audiometers The implementation of the TEN(HL) test in the Af f inity 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 143 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 of f while the appropriate level is selected.
  • Page 144 For people with low-f requency dead regions, as can occur, f or example, in cases of Ménière’s syndrome, there appears to be some benef it of amplif ying f requencies above 0.57f e, but not of amplif ying frequencies below 0.57f e. 20,21 Amplif ication of frequencies below 0.57f e can actually lead to reduced speech intelligibility.
  • Page 145 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 f or f eedback of outer hair cells upon the basilar membrane.
  • Page 146 Figure 1: Cochlea f rom a 25-year-old man who had been exposed to gunshots. The dark lines show auditory neurons. There are no neurons coming f rom 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 f requency in Hz, using a f requency- to-place map of the cochlea.
  • Page 147 Figure 3: Spectrum (top) and a segment of the wavef orm (bottom) of the noise used f or the TEN(HL) test. Figure 4. Screen shot f rom the Af f inity 2.0 system. The open circles show the audiometric (absolute) thresholds.

  • Page 148: 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 saf e and correct masking intensity. When masking help is activated, a status light on channel 2 indicates if masking is applied correctly.
  • Page 149 Recommendations Be aware that patients require proper instructions bef ore audiometry with masking is undertaken. • The switching on and of f the masking noise may be uncomf ortable to some patients and cause them to become more f atigued. In some cases (when testing young children, some elderly patients or dif f icult to test patients), it is recommended not to use masking because conf usion about the application of masking noise may lead to f alse responses.
  • Page 150 The recommended masking level is adjusted f or values that cannot be reached by the masking transducer due to maximum values. When the auto masking f eature is used, masking intensities are set to the recommended intensity. Of course, if “extended range” is not switched on, the masking intensities are thereby limited accordingly. Frequency specific inter-aural attenuation The def ault inter-aural attenuations used by the masking help are f requency specif ic and can be customized in the setup.

  • Page 151: Technical Specifications Of The Ac440 Software

    1.19 Technical specifications of the AC440 software Medical CE-mark: The CE-mark in combination with MD symbol indicates that Interacoustics A/S meets the requirements of the Medical Device Regulation (EU) 2017/745 Annex I Approval of the quality system is made by TÜV – identif ication no. 0123.
  • Page 152 Signal indicator (VU) Time weighting: 350mS Dynamic range: -20dB to +3dB Rectif ier characteristics: Selectable inputs are provided with an attenuator by which the level can be adjusted to the indicator ref erence position(0dB) Storing capability: Tone audiogram: dB HL, MCL, UCL, Tinnitus, R+L Speech Audiogram: WR1, WR2, WR3, MCL, UCL, Aided, Unaided, Binaural, R+L.

  • Page 153: Rem440

    2 REM440 2.1 About REM440 The REM440 is a user-f riendly and intuitive Real-Ear Measurement sof tware which enables you to satisf y your Hearing Aid verif ication requirements. A great advantage is the f lexibility which permits the creation of an unlimited number of personalized test f lows or “test protocols”...

  • Page 154: Launching Rem440

    2.3 Launching REM440 The REM440 module can be launched and operated under Noah and OtoAccess® databases. It is also compatible with other patient management systems which have Noah embedded. Ensure that the Af f inity/Equinox is powered on and connected to your PC bef ore opening the sof tware suite. If the hardware is not detected, the Af f inity Suite will open but it will run in Simulation mode.

  • Page 155: The Rem Screen Elements

    The REM screen elements The f ollowing 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 156 List of Protocols allows you to select a test protocol (def ault or user def ined) to use in the current test session. Temporary Setup button allows f or making temporary changes to the selected test protocol. The changes will be valid f or the current session only.
  • Page 157 To return to the original REM440 press the red cross in the upper right- hand corner. Tube calibration button activates the tube calibration. Bef ore measuring it is recommended to calibrate the probe tube. This is done by pressing the calibration button.
  • Page 158 Normal and Reversed Coordinate System buttons enable you to toggle between reversed and normal graph displays. This may be helpf ul f or counselling purposes since the reversed view look more like the audiogram and may theref ore be easier f or the client to comprehend when explaining his/her results.
  • Page 159 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 160 Current Protocol is listed in the lower lef t-hand corner. This highlights the test which you are currently perf orming and the other tests in the battery. The checkmarks indicates that a curve has been measured. Test protocols can be created and adjusted in the REM440 setup. Colour on each test button indicates the colour selected f or each curve.
  • Page 161 A Curve Comment f or 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. The comment will then appear in the comment section whenever the curve is selected.

  • Page 162: Background On Real-Ear Measurements Using Rem440

    2.5 Background on real-ear measurements using REM440 When perf orming real-ear measurements there a certain things you should keep in mind to obtain the best possible result. Some of these will inevitably also inf luence 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 163 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 164: Calibration

    4) The ref erence microphone on the headset monitors the amplitude of the signal reaching the hearing aid f rom the loudspeaker. If the input level is louder or sof ter than the desired level the ref erence microphone will turn the volume up or down accordingly.

  • Page 165: Gain Versus Response View

    • Follow the instructions appearing on the screen: Note: If using an Af f inity place the in-situ headset in f ront of the internal loudspeaker (as shown above f or the Equinox external loudspeaker) and press OK. 2.5.3 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 166: Real-Ear Measurements On Open Fittings

    The REM440 allows f or showing real-ear measurements as both gain and response curves. The gain curve is automatically generated f rom the response curve which allows you to choose which view you pref er using the Gain and Response radio buttons below the graph: 2.5.4 Real-ear measurements on open fittings The increasingly popular open f it hearing instruments have many advantages relating to comf ort, sound...
  • Page 167 2.5.4.1 Calibrate for open fit Calibrate f or open f it is the best way to cope with open f ittings. Calibrate f or open f it is done with the hearing aid in place muted or switched of f . During a stimulus presentation the ref erence microphone supervises the amplitude of the signal.

  • Page 168: Probe Placement

    In this example when going to REIG/REAR the system will show Warble Tone and ISTS in the stimulus dropdown. 2.5.5 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 28 mm past the inter-tragal notch...
  • Page 169 2.5.6.2 Speech stimuli/ISTS Speech is likely to be the most important signal to the hearing aid user in his or her daily lif e. Theref ore, if you wish to verif y 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, f requency, and phase.
  • Page 170 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. 2.5.6.5 Presenting a stimulus The REM440 stimuli can be selected f rom the main screen using the stimuli selection dropdown For continuous stimulus presentation, click the continuous button.

  • Page 171: Referencing

    2.5.7 Referencing Ref erencing is the term used to describe the communication between the REM speaker and the Insitu REM headset ref erence microphone. This communication ensures that the stimulus level specif ied in the REM sof tware is the correct stimulus level achieved at the patients’ ear. As an example, if the level specif ied in the sof tware is set to 65dB and the REM speaker is playing at 55dB then the Insitu ref erence microphone will detect this and communicate to the speaker that it needs to increase the stimulus level by +10dB to achieve the specif ied stimulus level.

  • Page 172: Vocal Effort

    This method is applied to the f ollowing signals: International Speech Test Signal (ISTS) ICRA stimuli IF Noise Male Speech Female Speech Custom REM sound f iles 2.5.8 Vocal effort We apply a vocal ef f ort transf orm to our stimuli to result in a more lif e-like stimulation. When we apply these transf orms, they are being supplied by the DSL algorithm.
  • Page 173 2.5.9.2 Choosing a fitting prescription Fitting targets can be selected in the Fitting Prescription dropdown list. A f itting target can be described as a recipe f or how to f it the hearing aids. Today, the most used generic f itting targets f or non-linear hearing aids are the DSL m[i/o] developed at the University of Western Ontario in Canada and the NAL-NL1/NAL-NL2 developed by National Acoustics Laboratories in Australia.
  • Page 174 SPL conversion f rom the REM440 module does not include a transducer correction. When the hearing aid f itting 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 175 Note: Remember to indicate the correct coupler type bef ore perf orming the RECD based 2 cc coupler measures. (For more inf ormation about the DSL mi/o v5.0a please ref er to www.dslio.com) s D-0004576-Q – 2022/05 Page 167 Affinity/Equinox2.0 – Additional Information...
  • Page 176 2.5.9.4 NAL-NL1/NAL-NL2 options Name: Select the NAL-NL1 or NAL-NL2.  Age: Select the age on your client. Research on children’s  perf ormance and pref erence leads us to inf er that children on average pref er a f ew dB more gain than what NAL- NL1 prescribes (Ching et al.

  • Page 177: Comparing To The Hearing Aid Fitting Software

    2.5.10 Comparing to the hearing aid fitting software Real-ear measures are of ten compared to the hearing aid manuf acturer’s sof tware. You can run the REM440 and f itting software simultaneously within Noah4. If real-ear measures reveal too little or too much gain in some f requency areas, enter the f itting software and adjust gain using the relevant gain controls.
  • Page 178 2.5.10.2 Table mode If graph comparisons are not pref erred, 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 manuf acturer’s f itting sof tware.

  • Page 179: Speech Intelligibility Index (Sii)

    2.5.11 Speech intelligibility index (SII) The Speech Intelligibility Index (SII) is a quality indicator of your hearing aid’s f itting 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 f or REUR, REUG, REAR, REAG and REIG in the bottom right corner.

  • Page 180: Display Peaks And Valleys

    2.5.12 Display peaks and valleys If Display peaks and valleys is ticked f or the REM test in the REM440 Setup you will have the view illustrated below. The peaks and valleys are shaped according to the LTASS. Peaks Valleys 2.5.13 Preconditioning and sweep delay Preconditioning and sweep delay can be set f or each test in the REM440 settings (see section 2.6.2) 2.5.13.1 Preconditioning...

  • Page 181: Smoothing A Curve

    2.5.14 Smoothing a curve Smoothing is a technique where small details in the curve appear to be ironed out. As these details sometimes have a noisy character, smoothing may be pref erred. The individual tests can be designed to have smoothing applied in the REM440 setup. Smoothing is applied according to a n/12 octave smoothing method.

  • Page 182: Managing Multiple Curves

    The two curves are now shown Target Historical curve Curve f rom current session Note: To avoid error through incorrect comparison, only curves of the same type can be compared! This f unction is embedded into the system so that you do not need to f ocus on this and to prevent comparing mistakes.
  • Page 183 2.5.16.2 Deleting curves To delete one or all curves right click on the input level marking in the curve display options box. Select Delete to remove the selected curve or Delete all to remove all curves displayed in the graph. 2.5.16.3 Combined screen view If a combined screen is setup you may want to compare to other curves obtained.

  • Page 184: Clinical Application Of Real-Ear Measurements Using Rem440

    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. 2.6.1 REUR/REUG measurements REUR (Real-Ear Unaided Response): The REUR accounts f or the SPL across f requencies measured in the open/unaided ear canal f or a given input signal at specif ic measurement point.
  • Page 185 7) Ensure that the correct Ear is selected 8) Choose the pref erred Stimulus in the corresponding dropdown list 9) Select input level using the Input level slider 10) Click START and the REUR/REUG will be perf ormed. Ensure that the room is quiet whilst the curve is obtained 11) If you wish to use the REUG/REUR f or both ears, right click on the curve tag in the Curve display options and select Transfer to left/right ear.
  • Page 186 2.6.1.1 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 helpf ul 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 187 2.6.1.2 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 f or 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 188: Rear/Reag Measurements

    2.6.2 REAR/REAG measurements REAR (Real-Ear Aided Response): The REAR accounts f or the SPL across f requencies f or 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 f or the gain across f requencies f or a given input signal measured in the ear canal.
  • Page 189 9) Check that the inf ormation about client, f itting prescription and hearing aid parameters to the right are correct. 10) Ensure that the correct Ear is selected 11) Choose the pref erred Stimulus in the corresponding dropdown list If you have done Calibrate f or open f it only the signals used f or this calibration are available in the stimulus selection dropdown (see section 0).

  • Page 190: Reig Measurements

    2.6.3 REIG measurements REIG (Real-Ear Insertion Gain): The REIG accounts f or the gain across f requencies provided by the hearing aid alone. This is obtained by subtracting the REUR f rom the REAR or the REUG f rom the REAG. REAR –...
  • Page 191 A predicted REUR may be selected if the REUR is a part of the individual test protocol (see section 2.6.2.1). 7) Caref ully insert the hearing aid without moving the probe tube. Ensure that the instruments are switched on. 8) If f itting an open hearing aid; perf orm Calibrate for open fit (see section 0). 9) Click on the REIG button if it is not already marked automatically.

  • Page 192: Recd Measurements

    2.6.4 RECD measurements RECD (Real-Ear to Coupler Difference): The RECD accounts f or the dif f erence in decibels (dB) across f requencies, between the SPL measured in the real-ear and in a 2cc coupler, produced by a transducer generating the same signal. Example at 1000 Hz: Coupler SPL –...
  • Page 193 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 f or the RECD.
  • Page 194 2.6.4.1 RECD using the client’s own ear mould Additional required items: An ear mould  A 2 cc coupler connected to an adaptor f or the BTE. These click easily together.  Ear Curve Coupler Curve Real-ear to Coupler Dif f erence 1) Open the REM440 module by selecting the REM tab.
  • Page 195 6) Connect the tube to the BTE adapter as shown on the picture and click OK. The coupler curve will be perf ormed f ollowed by a new instruction screen. 7) Disconnect the sound tube f rom the BTE adapter and connect it to the ear mould. Perf orm otoscopy and insert the REM probe and ear mould as shown on the picture.
  • Page 196 2.6.4.2 RECD using the SPL probe Ear Curve Coupler Curve Real-ear to Coupler Dif f erence Additional required items: An SPL probe and ear tips.  A 2 cc coupler connected to an adapter f or the SPL probe. These click easily together. ...
  • Page 197 1) Open the REM440 module by selecting the REM tab. 2) Select a test in the List of Protocols. 3) The RECD is most of ten used with children, so you will need to explain the procedure to the parents. 4) Click START and the screen below will appear.
  • Page 198 Below see two RECD measured in the same ear using the SPL probe and own ear mould respectively. Note: the dif f erences between the two ways of measuring. As can be seen above the curve measured with the client’s own ear mould is below 0 in the low f requencies. This may be due to ear mould ef f ects such as the tightness of the f it and venting and in the insertion depth of the SPL probe or ear mould.
  • Page 199 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 f or the test box verif ication (simulated REM).
  • Page 200 2.6.4.7 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 f or 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 201 3) Close the lid. 4) Press START to conduct your measurement in the 2 cc coupler. D-0004576-Q – 2022/05 Page 193 Affinity/Equinox2.0 – Additional Information...
  • Page 202 2.6.4.10 The “real-ear approach” 1) If you pref er verif ication in the Real-ear select Ear mode 2) Press START to conduct your measurement in the real-ear as described in the previous sections. 2.6.4.11 Importing the RECD into the hearing aid manufacturers software Some hearing aid manuf acturers allow f or importing the measured RECD curve into the sof tware via Noah and/or write the measured values into a RECD screen.

  • Page 203: Reor/Reog Measurements

    2.6.5 REOR/REOG measurements REOR (Real-Ear Occluded Response): The REOR accounts f or the SPL across f requencies measured in the ear canal with the hearing aid in place and turned of f . REOG (Real-Ear Occluded Gain): The REOG accounts f or the gain across f requencies measured in the ear canal with the hearing aid in place turned of f .

  • Page 204: Measuring Input/Output

    7) Click on the REOG/REOR button if it is not already marked automatically. A right click on the REOG/REOR button allows you to enter the Settings menu or Change colour of the curve. 8) Ensure that the correct Ear is selected 9) Choose the pref erred Stimulus in the corresponding dropdown list 10) Select input level using the Input level slider 11) Click START and the REOG/REOR will be perf ormed.
  • Page 205 Test procedure: 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. 4) Perf orm otoscopic examination.

  • Page 206: Directionality Measurements

    2.6.7 Directionality measurements Unwanted noise will inevitably turn up in daily lif e situations. Fortunately, many digital hearing aids have directional microphones that suppress noise coming f rom some directions while maintaining a good sensitivity to sounds coming f rom another direction. This ef f ect can be measured in the real-ear. Place the client in f ront the REM loudspeaker.

  • Page 207: Binaural Rem Measurements

    10) Ensure that the correct Ear is selected 11) Choose the pref erred Stimulus in the corresponding dropdown list . If you have calibrated f or open f it only the signals used f or this calibration are available in the stimulus selection dropdown (see section 0).
  • Page 208 Required items: • The Af f inity hardware Licensed Af f inity hardware with REM440 REM module • • Calibrated REM headset REM protocol • D-0004576-Q – 2022/05 Page 200 Affinity/Equinox2.0 – Additional Information...
  • Page 209 Procedure 1. Enter/Select an audiogram f rom Noah or f rom the AUD module. If no audiogram is entered or selected, no targets will be displayed. 2. To enable Binaural REM measurements in the REM module you will need to Right click on the ear selector icon.
  • Page 210 Note: For this example, an Insertion Gain method has been used to demonstrate the Binaural REM f eature, however the f eature is also compatible with protocols which perf orm this measurement in an Aided Response method. 9. Once you have chosen your protocol, please conf igure your f itting prescription settings as per your f itting.
  • Page 211 11. Begin by running the REUR measurement, this is looking at the natural acoustics of your patients ear canals, it is perf ormed with nothing in the patients ear canals apart f rom the probe tubes. Your response should peak around 2-3kHz f or a normal adult response (BSA, 2007). The shape of this measurement can also be used as a quality criterion f or your probe placement, the measurement should intersect the Horizontal axis (x-axis) at 6khz and must not be more negative than -5dB (BSA, 2007 &...
  • Page 212 You will notice that there is a target in these measurements; in the next step it is shown how you can amend the output of the patient’s hearing devices to meet these targets. Note: the def ault view f or the Binaural REM f eature is to have the lef t and right aided measure displayed side-by-side.
  • Page 213 Note: Using this f eature will remove your previous target allocation (i.e., NAL-NL2, DSLmi/o etc) f rom the opposite ear side, which you have not provided custom values f or, because we cannot allow dif ferent prescription methods to be used on dif f erent ears independently. 15.
  • Page 214 16. Once you have f ine-tuned your hearing devices so that the patient is happy and have counselled them involving their opinions in the amplif ication of their hearing devices you can save and close the Suite and f inish the session. This is done by pressing the ‘Save and Exit’ button Note: Binaural REM can also be used when f itting Open Fit type hearing aids.

  • Page 215: Fm System Verification

    2.7 FM system verification 2.7.1 FM transparency FM Transparency can be def ined as “The condition in which equal inputs to the FM and hearing aid The verif ication method is according to the AAA microphones produce equal outputs from the hearing aid.” Clinical Practice Guidelines f or Remote Microphone Hearing Assistance Technologies f or Children and Youth Birth to 21 Years.
  • Page 216 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 217 Step 3: FM Mic + HA 1. Remove the hearing aid, still attached to the coupler, f rom the test box 2. Position the FM microphone inside the test box, in f ront of the ref erence microphone 3. Measure the output of the hearing aid f rom the FM microphone (green curve) NOTE: if a significant difference is already seen between the Green curve and the Red curve, one can presume that there is a problem with the FM microphone...

  • Page 218: Ear Level, Fm Only

    Example 2 HA + Receiver FM Mic + HA Difference 750 Hz 1000 Hz 2000 Hz Average *Average dif ference is less than 2 dB, theref ore transparency is achieved 2.7.2 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 219 3. Once in the REM screen, select the “FM only, Ear level” protocol f rom the drop-down list 4. Place the FM transmitter microphone inside the test chamber, f acing the ref erence 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 220 7. Measure the REAR Select the appropriate FM-specif ic target: FM Boom or  FM Chest  the choice should ref lect 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 221: Working With Individual Setups (Test Protocols)

    2.8 Working with individual setups (test protocols) The REM440 module is pre-programmed with standard protocols ready f or use which can be selected f rom the f ront screen. However, you may wish to create an individual test protocol accommodating for personal pref erences and test methods.

  • Page 222: Creating New Test Protocols

    2.8.2 Creating new test protocols The f ollowing sections describe how to setup your own protocol in the REM440 setup. All setup options f or all tests will be described even though you most likely will only need a f ew. This section is theref ore to be seen as a work of ref erence where single f unctions can be looked up rather than a step-by-step guide where all steps need to be explored.
  • Page 223 4) Once this new protocol has been created it will show in your protocol lists where you can then modif y/change it. 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 f or the protocol using this procedure.
  • Page 224 Below the selection list f our check boxes are f ound: Display combined screen allows f or comparing dif ferent curves in the same display. Which curves to compare can be setup individually (see section 0). Use audiogram for UCL provides you with the option to adjust UCLs transf erred f rom the audiogram screen. When using the NAL-NL1, NAL-NL2 or DSL m[i/o] f itting prescriptions UCLs f rom the audiogram screen will automatically be transf erred to the REM440 screen where they are indicated in shading.
  • Page 225 2.8.2.1 REUG/REUR settings 1) Ensure that REUR/REUG is marked in the lef t-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 f or the test in this section (e.g., “REUR/REUG 70 dB input”) 2) Stimulus selection: Input Level: Set the input level using the slider.
  • Page 226 Sweep delays: This is relevant if Continuous measurement is selected f or Pure Tone or Warble  Tone. In this case sweep delays (in milliseconds) may be entered between the individual sweeps. Measurement time (in seconds): Duration f or the measurement can be set using the slider. This ...
  • Page 227 2.8.2.2 REAR/REAG settings ide of the screen. The name of the test will then Ensure that REAR/REAG is marked in the left-hand s appear in the Name of selected test section Note the option to write a new name f or the test in this section (e.g., “REAR/REAG 70 dB input”) 2) Stimulus selection Input Level: Set the input level using the slider.
  • Page 228 Start Frequency and Stop Frequency: Select the pref erred f requencies using the sliders.  These may f or 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 f requency). To avoid low f requency noise, you may wish to set the slider to a start f requency of 200Hz.
  • Page 229 2.8.2.3 REIG settings 1) Ensure that REIG is marked in the lef t-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 f or the test in this section (e.g., “REIG 70 dB input”) 2) Stimulus selection: Input Level: Set the input level using the slider.
  • Page 230 Note: Preconditioning, Stimulus type, Start/Stop frequency, and Sweep delay are all greyed out f or REIG. This is because the REIG is a calculation and not a measurement (REAR/REAG – REUR/REUG = REIG). The stimulus characteristics theref ore are tied to the REUR settings. If other stimulus settings are pref erred these should be changed in the REUR/REUG test (see section 2.6.2.1).
  • Page 231 2.8.2.4 RECD settings 1) Ensure that RECD is marked in the lef t-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 f or the test in this section (e.g., “RECD with SPL probe”) 2) Select the pref erred Coupler type.
  • Page 232  Stimulus type: Select a stimulus using the dropdown list. Note that only Pure Tone, Warble Tone, and Pink Noise are available f or RECD. Note: The input level f or RECD is f ixed at 70 dB. This cannot be changed by the user. 4) Recording method: Use RECD for both ears: Select if one RECD measurement is to be used f or both ears.
  • Page 233 2.8.2.5 REOR/REOG settings Ensure that REOR/REOG is marked in the lef t-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 f or the test in this section (e.g., “REOR/REOG 70 dB input”) Stimulus selection Input Level: Set the input level using the slider.
  • Page 234 Start Frequency and Stop Frequency: Select the pref erred f requencies using the sliders.  These may f or 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 f requency).
  • Page 235 2.8.2.6 Input/output settings Ensure that Input/Output is marked in the lef t-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 f or the test in this section (e.g., “Input/Output 1600 Hz”) Stimulus selection ...
  • Page 236  Preconditioning: This is relevant when using broadband signals such as ICRA. Select a time using the slider.  Sweep delays: This is relevant if Continuous measurement is selected f or Pure Tone or Warble Tone. In this case sweep delays (in milliseconds) may be entered between the individual sweeps.
  • Page 237 2.8.2.7 Directionality settings Ensure that Directionality is marked in the lef t-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 f or the test in this section (e.g., “Directionality check”) •...
  • Page 238 Color:  Select a color f or the Right and Left curve (see section 2.6.2.1 regarding REUR/REUG f or details). Back speaker setup:  Select which speaker should be used f or the back microphone measure. You have the option to select a f ree f ield loud speaker instead of the Af f inity loudspeaker. In this case the client does not need to be turned around af ter measuring the f ront microphone.
  • Page 239 2.8.2.8 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 lef t-hand side of the screen. The name of the test will then appear in the Name of selected test section.

  • Page 240: Combined Screen Setup

    2.8.3 Combined Screen Setup REM440 can be setup f or def ault 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. 2) Click on the Combined screen button.

  • Page 241: Fitting Prescription Setup

    2.8.4 Fitting prescription setup REM440 can be setup to use a specif ic f itting prescription by def ault. 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 242 2.8.4.1 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 f or 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 243 2.8.4.2 NAL-NL2 settings 1) Default prescription: • NAL-NL2. 2) Transducer: • Choose the type of transducer used f or the audiometry. Select between Head phone, Insert, Insert + mould, Sound field 0 deg., and sound field 45 deg. This will af f ect the threshold indications and thereby the target calculation.
  • Page 244 8) Orientation for REUR/REUG: • If using a predicted REUR/REUG select the orientation. Choose between 0 Deg, 45 Deg. using the check boxes. 90 Deg is not available f or NAL-NL2 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.
  • Page 245 1. Default prescription: NAL-NL1.  2. Transducer: Choose the type of transducer used f or the audiometry. Select between Head phone, Insert,  Insert + mould, Sound field 0 deg., and sound field 45 deg. This will af f ect the threshold indications and thereby the target calculation.

  • Page 246: Finishing The Test Protocol

    2.8.5 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 f ound in the List of Protocols dropdown list on the f ront screen. 2.8.6 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 247: Changing A Test Protocol Temporarily

    Choose your test protocol in the Selected protocol dropdown list. Browse the setup options as if creating a test protocol (see section 2.6.2). When f inished click OK (or Apply) to save the changes. 2.8.7 Changing a test protocol temporarily You may f rom time to time run into a client with special requirements f or advanced or dif f erent testing parameters.
  • Page 248 2.8.8.2 Exporting a test protocol Go to REM440 setup (Menu/Setup/REM440 setup). Click on Export. Select if the f ile 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. Browse f or the location on the PC or USB where the test protocol is to be placed.

  • Page 249: General Setup

    2.9 General setup In the General Setup you can select overall settings which are valid f or all tests. To enter the General setup, select Menu/Setup/General Setup  In-situ loudspeaker:  Select the speaker output through which the stimuli f or the real-ear measurements are presented. FF2 or FF1: If using the Af f inity /Equinox with one or multiple external f ree f ield...
  • Page 250  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 f rom happening accidently. Note: Prior to password activation a password must be selected under Menu/setup/Password protection (see section 0) ...

  • Page 251: The Rem 440 Menu Items

    2.10 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)  Menu/File/Print Preview prompts a print preview of the current protocol using the print template which is linked to the current protocol.
  • Page 252 Menu/Setup  Menu/Setup/REM440 setup opens the REM440 where you can setup customised test protocols (see section 2.6 f or details)  Menu/Setup/General setup opens the General setup where settings valid f or all tests can be selected (see section 2.7 f or details) ...
  • Page 253 Menu/Help  Menu/Help/About REM440 prompts a message box showing inf ormation regarding the Suite version, Hardware version, and Firmware version. Please note that if experiencing problems with the system this inf ormation should be sent to the manuf acturer along with the description of the issue.

  • Page 254: Visible Speech Mapping (Vspm440)

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

  • Page 255: The Visible Speech Mapping Screen

    2.13 The visible speech mapping screen Menu provides access to File, Edit, View, Mode, Setup, and Help (see section 0) Print button allows f or printing the sessions acquired data (see section 4.1) Save & New Session button saves the current session in Noah4 or OtoAccess®...
  • Page 256 Freeze curve allows f or taking a snapshot of a REM curve when testing with broadband signals. In other words, the curve f reezes at a particular moment while the test continues. Note that if too many curves are f rozen on the screen not all will be saved in Noah4 due to imposed limitations.
  • Page 257 Normal and reversed coordinate system buttons enable you to toggle between reversed and normal graphs. This may be helpf ul f or counselling purposes since the reversed curves look more like the audiogram and may theref ore be easier f or the client to comprehend.
  • Page 258 Note that the sound f rom the monitor may be very sof t (compared to the audiometry monitoring). It is louder f or 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 259 The ear/coupler mode indicates which side is being tested next to a label showing whether the test is perf ormed in an aided or unaided ear. SII (Speech Intelligibility Index) of the current input signal is expressed in a percentage. UCL (Uncomfortable Levels) will be shown in shading at the top of the graph if entered in the audiogram screen.
  • Page 260 Curve comment f or 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. The comment will then appear in the comment section whenever the curve is selected.

  • Page 261: Verification With Visible Speech Mapping

    2.14 Verification with visible speech mapping 2.14.1 Considerations before you begin Visible Speech Mapping can be run side by side with the relevant f itting software. Af ter f itting the hearing aid, Visible Speech Mapping can be used to verif y if the client’s speech area is amplif ied suf f iciently using these stimuli: ISTS, Male Speech, or Female Speech.

  • Page 262: Visible Speech Mapping (In Coupler Mode/Test Box Mode)

    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 pref erred Stimulus in the corresponding dropdown list . Male Speech, Female, Speech, and ISTS are recommended. Note the option to use Live Voice.
  • Page 263 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 inf ormation about client, f itting prescription and hearing aid to the right are correct by pressing Show fitting prescription and test information.
  • Page 264 13) Verif y and f ine-tune to your chosen f itting prescription. DSL mi/o or NAL-NL1/NAL-NL2. Use On top mode to compare to the hearing aid manuf acturers’ sof tware D-0004576-Q – 2022/05 Page 256 Affinity/Equinox2.0 – Additional Information...

  • Page 265: Visual Tools For Counseling And Verification

    2.15 Visual tools for counseling and verification 2.15.1 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 def ault, the 30th, 65 , and 99th percentile are selected.

  • Page 266: Display Peaks And Valleys

    2.15.2 Display peaks and valleys Display peaks and valleys can be added in the REM440 setup (see section 0) When Display peaks 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 described in section 0.

  • Page 267: Speech Intelligibility Index

    2.15.4 Speech intelligibility index As a supporting f eature the SII (Speech Intelligibility Index) indicates improved audibility expressed in a percent on the aided display. SII is a method f or computing a physical measure of the intelligibility of speech. The method is based on results of the speech perception tests in each group of talkers and listeners.

  • Page 268: Dynamic Range View

    2.15.6 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 uncomf ortably loud).

  • Page 269: Visible Speech Mapping Settings

    2.16 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 270  Measurement time (in seconds): Duration f or the measurement can be set using the slider. This is only relevant f or broad band signals. A number of seconds can f reely be selected between 1 and 1200. By def ault, the measurement time is the same f or all signals. ...

  • Page 271: Faq

    2.17 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 sof tware suite should be restarted. Otherwise, the connection may be af f ected, and testing may be compromised. Question: There is no target on my screen.
  • Page 272 Question: What kind of stimulus does Interacoustics recommend being used and in different situations? Answer: ISTS is the best stimulus to use when verif ying hearings aids with the hearing aid on f or the measurement. This stimulus does not require the hearing aid to have specif ic f eatures disabled and should be used as the hearing aid will be in a real-lif e situation (Holube et al.
  • Page 273 Warble Tone Pink Noise ICRA 6pbl ISTS Ref erences: 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 f or Hearing Aid Verif ication. Hearing Review, August 2003.
  • Page 274 Question: When I do the REUR with an ICRA or ISTS I get a 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 275 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 Af f inity you don’t have to do the REAG/REAR to see the REIG.
  • Page 276 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 def ault, the 30th, 65 , and 99th percentile are selected. These percentiles are calculated based on an FFT analysis of 100 measurements.

  • Page 277: The Rem440 Test Signal Characteristics

    2.18 Appendix 1 2.19 The REM440 test signal characteristics Pure Tone f requency accuracy is ±1%. Crest f actor is 3 dB. Warble Tone f requency accuracy is ±1%, warble f requency 0100 Hz and intensity 010%, sine wave f requency modulation. Crest f actor is 3 dB. Random Noise is a noise with a linear spectrum measured with an FFT or a 3 dB drop per octave measured with a 1/3 octave f ilter.

  • Page 278: Signal Analysis Characteristics

    ICRA: 3bsmnmn 3 Band speech modulated noise (3bSMN) - Male weighted - Normal ef f ort - Level Ref . Crest f actor = 27 dB. ICRA: 2pb1f1mn 2 persons babble, 1f emale 3bSMN + 1 male 2bSMN - Idealized - Normal ef f ort - Level Ref + 3dB. Crest f actor = 24 dB.

  • Page 279: Rem Pc Shortcuts

    2.20 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 Of f set Y axis PgUp/PgDn Of f set Y axis Arrow up/down Change input level Control + R Right ear...

  • Page 280: Rem440 Software - Technical Specifications

    2.21 REM440 software - technical specifications Medical CE-mark: The CE-mark in combination with MD symbol indicates that Interacoustics A/S meets the requirements of the Medical Device Regulation (EU) 2017/745 Annex I Approval of the quality system is made by TÜV – identif ication no. 0123.

  • Page 281: Hit440

    3 HIT440 3.1 HIT440 quick guide 1) Open Noah and select the patient you want to work with: 2) Select the Af f inity module f rom 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 to compare the results to the hearing aid manuf acturers’...
  • Page 282 Position the Hearing Aid in the test box: BTE: Connect the 2 cc coupler to the BTE adaptor. Place the coupler tube pointing straight f orward, 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 f acing f orward with the microphone at the cross.

  • Page 283: About Hit440

    6) Select the desired test protocol in the List of Protocols Select Test Ear 8) Select START 9) Please wait f or all tests of the selected protocol to be perf ormed: Save by clicking “Save” icon 3.2 About HIT440 The HIT440 is a straightf orward Hearing Instrument Testing system suited f or all types of hearing aids.

  • Page 284: Hit 440 Tests

    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 Ref erence test gain    Input/output Attack/recovery time Frequency response...

  • Page 285: Launching The Hit 440 Software

    3.4 Launching the HIT 440 software The HIT440 module can be launched and operated under Noah and OtoAccess® databases. It is also compatible with other patient management systems which have Noah embedded. Ensure that the Af f inity Compact is powered on and connected to your PC bef ore opening the sof tware suite. If the hardware is not detected, the Af f inity Suite will open but it will run in Simulation mode.

  • Page 286: The Hit440 Screen

    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 287 Select protocol to use from the list allows you to select a test protocol the current test session (see section 0 f or more inf ormation about test protocols). Temporary Setup button allows f or making temporary changes to the selected test protocol.
  • Page 288 Normal and reversed coordinate system buttons enable you to toggle between reversed and normal graph. This may be helpf ul f or counselling purposes since the reversed curves look more like the audiogram and may theref ore be easier f or the patient to comprehend.
  • Page 289 Current Protocol is listed in the lower lef t-hand corner. indicates the test is a part of an automatic test f low (Auto Run). When pressing START all tests with the tick mark will be perf ormed. If you wish to perf orm one test only, mark it using the mouse by clicking on it.
  • Page 290 Measurement details: In this table the curve details can always be viewed. This way the prof essional always has an overview of what is being measured, f or example, inf ormation such as Input Level, Max SPL, Curve Type, Stimulus, and Curve type. A Curve Comment f or each curve can be typed into the comment section on the right-hand side.

  • Page 291: Hearing Instrument Testing Using Hit440

    3.6 Hearing instrument testing using HIT440 Hearing Instrument Testing (HIT) is perf ormed to verif y that the hearing aids are technically f unctioning as they should. It is usually perf ormed af ter f itting the hearing aid or during a repair appointment. When perf orming HIT there are certain things you should keep in mind to get the best possible result.

  • Page 292: 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 perf orm technical measurements of bone anchored devices. For more inf ormation on the setup and test procedures, please ref er to the Quick Guide at the end of this document.

  • Page 293: Installing The Skull Simulator License In The Hit440 Software

    How to receive a new HIT license 1- Af ter purchasing the SKS10 and the license, please send Interacoustics (Service@interacoustics.com) the serial number. You can f ind out by going to the Af f inity software and going to Menu/Help/About  License  “Copy s/n”...
  • Page 294 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 sof tware. If this is the case; it is necessary to activate it: 1- Go to HIT/Menu/Setup/HIT440 setup 2- Choose “Skull Simulator”...
  • Page 295 3.6.3.3 Using the skull simulator protocol A def ault protocol for the Skull Simulator is available f rom the protocol drop down menu. Since a standard ANSI or IEC protocol does NOT exist f or bone anchored devices, the Skull Simulator def ault protocol was created as a starting point and to give inspiration to create your own protocol, according to user needs.
  • Page 296 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 297 3- Snap on the bone anchored device onto the abutment of the skull simulator. NOTE: For more inf ormation on how to setup the Af f inity 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 298: Running Pre-Programmed Test Protocols

    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 f unction will ensure that all test in the protocol is perf ormed automatically. The tests included automatic test f low will be marked with a 3.6.5 Automatic testing (auto run)

  • Page 299: Preconditioning And Sweep Delay

    Auto Run can be setup in the HIT440 setup (Menu/setup/HIT440 setup). Next to each test you will f ind a Play symbol (Auto Run) or a Stop symbol (Manual Run) Click on the Play/Stop symbols f or each test to toggle between Auto and Manual Run. See more inf ormation about protocol setup in section 0.

  • Page 300: Show Cursor On The Graph

    Examples: Smoothing index 0 Smoothing index 10 Smoothing index 5 Note: Numerically reported MAX OSPL90 Level is determined f rom a non-smoothed curve, and as such not af f ected by smoothing level, even though the smoothed wavef orm may appear to have a reduced peak around the MAX SPL area.
  • Page 301 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. Un-ticked curves will be hidden ensuring a less conf using screen view.

  • Page 302: Comparing Curves

    3.6.9 Comparing curves The HIT440 also allows f or comparing either two historical curves (e.g., two OSPL90 curves) or comparing a historical curve to a currently recorded curve. This is done f ollowing the procedure described below: Find the f irst curve in the Session list. Historical HIT measures are listed by date and time of saving.

  • Page 303: Comparing To The Manufacturer's Specification Sheets

    3.6.10 Comparing to the manufacturer’s specification sheets When comparing a measurement to the hearing aid manuf acturer’s specif ication 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 304 As an add-on the Af f inity test boxes also includes a TMFS coil shown below. TMFS is short f or Telephone Magnetic Field Simulator. It is a transducer that produces a magnetic f ield like the signal coming out of traditional telephones. In other words, the TMFS coil attempts to simulate a telecoil f or 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 305: Application Of The Hit440 Tests

    Application of the HIT440 tests 3.7.1 Frequency response The f requency response equals the absolute sound level delivered by the hearing aid at each f requency expressed in dB SPL. This may be measured f or both microphone and telecoil. Prior to the measurement remember to perf orm the Ref erence Test Gain and set the volume control to the correct position.

  • Page 306: Gain Curve

    3.7.2 Gain curve The gain curve is identical to the f requency response described above. The only dif f erence is that the input level is subtracted f rom the f requency response providing you with pure hearing aid gain. The gain curve can be measured f or both coil and microphone.

  • Page 307: Harmonic Distortion

    3.7.3 Harmonic distortion The pure tone components are called harmonics and occur at integer multiples of the f undamental f requency. The output of a hearing aid, however, is rarely a pure tone and the signal will inevitably contain elements at dif ferent f requencies not included in the input. These components are def ined as distortion products.

  • Page 308: Input/Output

    3.7.4 Input/output The Input/Output curve displays the output of the hearing aid as a f unction of the input f or one f requency (or broadband signal). The Input/Output f unction provides inf ormation about the compression characteristics of the hearing aid such as f or example expansion, knee-point, and compression limiting Below is an example: View test inf ormation...

  • Page 309: Intermodulation Distortion

    3.7.5 Intermodulation distortion Distortion in moderate -severe amounts will inevitably have a negative ef f ect 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: one at the selected f requency dif f erence (f 1) and one at the selected f requency (f 2).

  • Page 310: Attack/Recovery Time

    3.7.6 Attack/recovery time The Attack time is the time it takes f or the hearing aid compressor to react to an increase in input signal. As the output will gradually move towards the f inal gain value it has been decided to def ine 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 311: Battery Current Drain/Battery Life Time

    3.7.7 Battery current drain/battery life time HIT440 measures the battery current at the ref erence f requency 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 312 Below is an example: View test details Battery current drain viewed as a f unction of f requency. Select test Note: Some hearing aids will show higher battery consumption in the higher f requency range due to the conf iguration of the audiogram D-0004576-Q –...

  • Page 313: Equivalent Input Noise

    3.7.8 Equivalent input noise Every amplif ier and microphone will generate noise to some extent. The internal noise of a hearing device is expressed as the Equivalent Input Noise. More specif ically this term covers the amount of noise that would need to be added to the input of a noiseless hearing aid with the same f requency response if the noise coming out is to be the same as the tested hearing aid.

  • Page 314: Reference Test Gain

    3.7.9 Reference test gain Ref erence Test Gain is a control position which is usually set af ter doing the high-level measures such as OSPL90 and Full-on gain. If this is the case the result is a basic f requency response (IEC 118-0) or f requency response curve (ANSI S3.22).

  • Page 315: Microphone Directionality

    3.7.10 Microphone directionality Unwanted noise is provided by many dif f erent sources in many daily lif e situations. They can come f rom dif f erent directions due to position or ref lection f rom the walls in the environment. Fortunately, many digital hearing aids have directional microphones that suppress noise coming f rom some directions while maintaining a good sensitivity to sounds coming from another direction.

  • Page 316: Single Frequency

    3.7.11 Single frequency Single Frequency tests the hearing aid at a single selected f requency using a given stimulus. This allows you to get an impression of the hearing aid at specif ic important f requencies. If selecting a pure tone or warble tone stimulus a bar representing the f undamental f requency together with harmonics will appear on the graph.

  • Page 317: Response/Gain/Input/Output

    3.7.12 Response/gain/input/output The Response/Gain/Input/Output is a combination screen showing the f requency curve, gain curve (one or both) and input/output curves. Response/Gain/Input/Output is perf ormed as described in section 3.7.11. Below is an example: Floating curve display options window Frequency response Input/Output Curve Select test Select f requency...

  • Page 318: Delay

    3.7.13 Delay The Delay test measures the hearing aid delay in milliseconds across f requency using a chirp stimulus. To obtain the best possible result, it is recommended to use a TBS25 external test box. However, the Af f inity build-in test may be used if kept partly open to avoid ref lection of sound.

  • Page 319: Ospl90

    3.7.14 OSPL90 The OSPL90 is def ined as the maximum output level of the hearing aid measured at an input level of 90 dB. This 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 320: Full-On Gain

    3.7.15 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 comf ortable level (MCL). When measuring the f ull-on gain, you thereby can check that even at a high output the gain stays below the uncomf ortable level (UCL).

  • Page 321: Working With Individual Setups (Test Protocols)

    Working with individual setups (test protocols) The HIT440 module is pre-programmed with standard test protocols (IEC and ANSI) ready f or use which can be selected f rom the f ront screen. However, you may wish to create an individual test protocol accommodating f or personal pref erences and test methods.

  • Page 322: Designing A Customized Test Protocol

    3.8.2 Designing a customized test protocol The f ollowing sections describe how to setup your own test protocol in the HIT440 setup. All setup options f or all tests will be described even though you most likely will only need a f ew. This section is theref ore to be seen as a work of ref erence where single f unctions can be looked up rather than a step-by-step guide where all steps need to be explored.
  • Page 323 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 f or the test protocol using this procedure. 6) To remove a test selected by mistake, mark it under Selected tests and press Remove.
  • Page 324 example wish to create a new protocol based on elements f rom the ANSI or IEC standard. In this case the dropdown list can be used to select an ANSI or IEC standard bef ore clicking New. When asked if the new protocol should be based on a copy of the currently selected protocol, click yes.
  • Page 325 Averaging time: Decide the number of FFTs shall be used f or 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. Continuous: This check box allows you to make the measurement ongoing rather than a single ...
  • Page 326 Note: In the General Setup it is possible to set a warning, which will pause the test and prompt the user if a recording f alls outside tolerance limits. 7) Recording method: 8) Resolution (of f requency): Select the pref erred resolution in the dropdown. The higher the resolution the slower the measurement.
  • Page 327 3.8.2.2 Gain curve settings Settings f or Gain Curve are identical to the settings described above f or Frequency Response. Please ref er to section 0. D-0004576-Q – 2022/05 Page 316 Affinity/Equinox2.0 – Additional Information...
  • Page 328 3.8.2.3 Harmonic distortion settings 1) Ensure that Harmonic Distortion is marked in the lef t-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 f or the test in this section (e.g., “Harmonic Distortion 500 and 1000 Hz”) 2) Frequency list: Frequency dropdown lists: Select the f requencies to be included in the distortion measure.
  • Page 329 3) Tolerance limits:  Set limits: Press the button to def ine individually pref erred 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 f requency specif ic values.
  • Page 330 5) Input selection:  Choose whether the Harmonic Distortion measurement should be perf ormed through the Speaker 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 lef t-hand side of the screen.
  • Page 331 Sweep delays: This is relevant if Continuous measurement is selected f or 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 f or details). Stimulus Frequency: Select the f requency of the input stimulus using the slider. ...
  • Page 332 3.8.2.5 Intermodulation distortion settings Ensure that Intermodulation Distortion is marked in the lef t-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 f or the test in this section (e.g., “Intermodulation Distortion 500, 1000 &...
  • Page 333 Display Tolerance Limits: Tick the box to activate the tolerances which will then be shown  on the graph in the f ront screen. Note: In the General Setup it is possible to set a warning, which will pause the test and prompt the user if a recording f alls outside tolerance limits.
  • Page 334 3.8.2.6 Attack/recovery time settings 1) Ensure that Attack/recovery time is marked in the lef t-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 f or the test in this section (e.g., “Attack/Recovery low 50, high 90”).
  • Page 335 4) Sweeps: Number of sweeps: Select a number of sweeps using the slider. To average out noise which  may inf luence 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 336 3.8.2.7 Battery current drain settings Settings f or Battery Current Drain are identical to the settings described above f or Frequency Response. Please ref er to section 0. D-0004576-Q – 2022/05 Page 325 Affinity/Equinox2.0 – Additional Information...
  • Page 337 3.8.2.8 Equivalent input noise settings 1) Ensure that Equivalent input noise is marked in the lef t-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 f or the test in this section (e.g., “Equiv.
  • Page 338 3) Reference frequency: Ref f: Tick this option to select a single ref erence f requency using the slider. Af ter measuring  the curve, the level at the ref erence f requency will be displayed in the measurement details table.
  • Page 339 Recording method: Resolution (of f requency): Select the pref erred 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 manuf acturers sof tware. If the curve is to be compared to this, you may consider choosing this resolution.
  • Page 340 Note the option to Define Custom Colors to get a more extensive selection. When having f ound the exact colour, press Add to Custom Colors. 6) Eq input noise display Curve: Select this option to see the measurement as a curve. ...
  • Page 341 3.8.2.9 Reference test gain settings 1) Ensure that Reference Test Gain is marked in the lef t-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 f or the test in this section (e.g., “Equiv.
  • Page 342 HFA/SPA: Tick this option to select three f requencies at a f ixed distance using the slider. Af ter  measuring the curve, the ref erence f requency average will be displayed in the in the measurement details table. 4) .Test settings: Battery simulator: Select the correct battery type f or the hearing aid to be used under the test.
  • Page 343 3.8.2.10 Directionality settings Settings f or Directionality are identical to the settings described above f or Frequency Response with the exceptions listed below. Please ref er to section 0 f or details regarding the additional test settings. 1) Display result as: Response: Tick this option to have the measurement displayed in dB SPL.
  • Page 344 3.8.2.11 Single frequency settings 1) Ensure that Single Frequency is marked in the lef t-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 f or the test in this section (e.g., “Single Frequency 1000 Hz”) 2) Stimulus selection: Input Level: Set the input level using the slider.
  • Page 345 3) Test settings: Battery simulator: Select the correct battery type f or 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. If a Zinc-air battery type is selected, then an estimated battery lif etime is calculated as part of the Battery Current Drain test.
  • Page 346 3.8.2.12 Response/gain/input/output settings Settings f or Response/Gain/Input/Output are identical to the settings described above f or Frequency Response (or Gain Curve) and Input/Output respectively. Please ref er to section 0 and 0. Note: This screen contains two tabs: Response/gain and Input/output. D-0004576-Q –...
  • Page 347 3.8.2.13 Delay settings 1) Ensure that Delay is marked in the lef t-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 f or the test in this section (e.g., “Delay 70 dB input”).
  • Page 348 Note the option to Define Custom Colors to get a more extensive selection. When having f ound the exact color, press Add to Custom Colors. D-0004576-Q – 2022/05 Page 337 Affinity/Equinox2.0 – Additional Information...
  • Page 349 3.8.2.14 Pause settings 1) Ensure that Pause is marked in the lef t-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 f or the test in this section (e.g., “Check Volume Control Setting”).

  • Page 350: Combined Screen Setup

    3.8.3 Combined screen setup HIT440 can be setup f or def ault 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. 2) Click on the Setup combined screen button.

  • Page 351: Print Layout Settings

    Note: Bef ore closing the setup remember to tick the Display combined screen check box f or 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 f ront 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 352: Finishing The Test Protocol

    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 f ound in the List of Protocols dropdown list on the f ront screen. D-0004576-Q –...

  • Page 353: Changing A Test Protocol Permanently

    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 354: Changing A Test Protocol Temporarily

    3.8.7 Changing a test protocol temporarily You may f rom time to time run into a client with special needs requiring advanced or dif f erent testing parameters. In this situation the Temporary Setup can be helpf ul. The setup changes made here will be specif ic to the session.
  • Page 355 3.8.7.3 Exporting a test protocol Go to HIT440 setup (Menu/Setup/HIT440 setup) Click on Export. Select if the f ile is to be saved as “Read Only”. In this case the test protocol f ile is locked and the clinician receiving it will not be able to make changes to it. Browse f or the location on the PC or USB where the test protocol is to be placed.

  • Page 356: General Setup

    General setup In the General Setup you can select overall settings which are valid f or all tests. To enter the To enter the General setup, select Menu/Setup/General Setup D-0004576-Q – 2022/05 Page 345 Affinity/Equinox2.0 – Additional Information...
  • Page 357 Ref and coupler: Specif y which ref erence 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 pref erred test box: Internal: This option ref ers to the Af f inity built-in test box.
  • Page 358 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 f rom the f ront screen. D-0004576-Q – 2022/05 Page 347 Affinity/Equinox2.0 – Additional Information...

  • Page 359: The Hit440 Menu Items

    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).  Menu/Print/Print Preview prompts a print preview of the current test protocol using the print template which is linked to the current protocol.
  • Page 360 Menu/Help  Menu/Help/About HIT440 prompts a message box showing inf ormation regarding the Suite version, Hardware version, and Firmware version. Please note that if experiencing problems with the system this inf ormation should be sent to the manuf acturer along with the description of the issue.

  • Page 361: Hit440 Software - Technical Specifications

    3.11 HIT440 software - technical specifications Medical CE-mark: The CE-mark in combination with MD symbol indicates that Interacoustics A/S meets the requirements of the Medical Device Regulation (EU) 2017/745 Annex I Approval of the quality system is made by TÜV – identif ication no.

  • Page 362: The Hit440 Test Signal Characteristics

    3.12 Appendix 1 3.12.1 The HIT440 test signal characteristics Pure Tone f requency accuracy is ±1%. Crest f actor is 3 dB. Warble Tone f requency accuracy is ±1%, warble f requency 0100 Hz and intensity 010%, sine wave f requency modulation. Crest f actor is 3 dB. Random Noise is a noise with a linear spectrum measured with an FFT or a 3 dB drop per octave measured with a 1/3 octave f ilter.

  • Page 363: Signal Analysis Characteristics

    3.12.2 Signal analysis characteristics The f ollowing table summarises the signal analysis characteristics of the Af f inity/Equinox. Broadband analysis Measurement bandwidth: 43Hz Integration time: 1 – 1200 sec. Spectrum analysis, sweep filtered Filter bandwidth: 1/3 octave Skirt slope: 12dB pr. Octave Spectrum analysis, digital means Sampling rate 44100Hz...

  • Page 364: Connecting The Tbs25 To Affinity 2.0 /Equinox

    3.13 Appendix 2: 3.13.1 Connecting the TBS25 to Affinity /Equinox Description: The f ollowing items are included with the Cable kit f or TBS25 – Af f inity /Equinox and TBS25: 1) Base f or ref erence microphone 2) Test box connection cable f or speaker (green connector) 3) Cable f or test box loop (beige connector) 4) Cable ref erence mic.

  • Page 365: Printing And Making Reports

    4 Printing and making reports 4.1 The print wizard In the Print Wizard you have the option to create customized print templates which can be linked to individual protocols f or quick printing. The Print Wizard can be accessed in two ways. a.
  • Page 366 3. Factory def ault 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 pref erences 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 f rom the drop-down list.

  • Page 367: Designing A Customized Print Template

    4.1.1 Designing a customized print template Af ter 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 368: Design Elements

    4.1.2 Design elements Template elements are added to the template page using the select, drag, and drop f unction. Click on the desired element and drag it onto the template page. The element will appear as a small box in the upper lef t-hand corner.
  • Page 369 2 Clinic information. a. Select fields pops up the Select fields window where you select which items are to be shown in the clinic inf ormation element. You can change the order of the items by selecting one and pressing the or down arrows .
  • Page 370 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 f ormat in which the date and/or time appears in the template.You can also choose the f ont type, size and f ormatting. b.
  • Page 371 d. Selecting Rotate makes the element rotate 90 degrees clockwise. 6. Hardware – Here you can include inf ormation about the hardware such as Hardware name, modules used, version number, last calibration date and next calibraton due. a. Select fields pops up the Select fields window where you select which items are to be shown in the Hardware element.
  • Page 372 b. Format… Here you can change the the f ont, f ont size and f ormatting, and the appearance (borders) of the Hardware area c. Selecting Modules gives the opportunity to def ine which modules’ session dates will be shown d.

  • Page 373: Creating Reports

    Creating reports The Af f inity 2.0/Equinox 2.0 Suite allows electronically generated reports through the Report editor. This allows reports to be saved in the module f or 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 test inf ormation in one customized piece of paper.
  • Page 374 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. Change the Font type of the current selection. 6.
  • Page 375 1. New Template enables you to create a new customized report template. Enter a template name (e.g., “Standard Report”) bef ore 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.
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  • Page 377: Recovery Manager

    5 Recovery manager In the unlikely event that your sof tware 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 f ile on your PC.
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  • Page 379: Crash Reports

    If the Af f inity Suite crashes, and the details can be logged by the system, the Crash Report window will appear on the test screen (as shown below). The crash report provides inf ormation to Interacoustics about the error message and extra inf ormation can be added by the user outlining what they were doing bef ore the crash occurred to assist in f ixing the problem.
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  • Page 381 7 Quick guides Several quick guides have been developed to support the users of the Af f inity and Equinox, these can be f ound in your sof tware by navigating to ‘Manuals and Guides’ in all modules of the sof tware. These quick guides involve the f ollowing topics: Introduction to Quick Guides •...
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  • Page 383 8 References British Society of Audiology Recommended Procedure: Pure tone air and bone conduction threshold audiometry with and without masking and determination of uncomf ortable loudness levels (2004). Uploaded f rom www.thebsa.org.uk/docs/bsapta.doc : Clinical determination of abnormal auditory adaptation. In: Archives of Carhart.
  • Page 384 Mehta and Singh. (2000). Screening Tests f or 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 f or Individuals with Hearing Impairments; Dobie RA, Van Hemel S, editors. Hearing Loss: Determining Eligibility f or Social Security Benef its.

This manual is also suitable for:

Equinox 2.0

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