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MedRx AVANT ARC Training Manual
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MedRx AVANT ARC Training Manual

Audiometry & binaural rem/lsm in one system, m studio
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A V A N T A R C
AUDIOMETRY & BINAURAL
REM/LSM IN ONE SYSTEM
Studio Software AVANT ARC Training Manual
1
D-0126019-B

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Summary of Contents for MedRx AVANT ARC

  • Page 1 A V A N T A R C AUDIOMETRY & BINAURAL REM/LSM IN ONE SYSTEM Studio Software AVANT ARC Training Manual D-0126019-B...
  • Page 2 1200 Starkey Rd., #105, Largo, FL 33771 U.S.A. Toll Free: (888) 392-1234 • (727) 584-9600 Fax: (727) 584-9602 • Email: medrx@medrx-usa.com www.medrx-usa.com MedRx's Authorized Representative in Europe DGS Diagnostics A/S Audiometer Alle 1 • 5500 Middelfart • Denmark Distributor: MedRx International c/o MAICO Diagnostics GmbH Sickingenstr.

  • Page 3: Table Of Contents

    Contents Getting to Know Your AVANT ARC ..............4 Speaker Calibration ..................49 Alternate Speaker Option AVANT ARC ...............5 Probe Tube Calibration ..................50 Transducers and Accessories ................6 Step-by-Step Guide to Live Speech Mapping ........... 51 Probe Mic Hanger Installation ................7 Speech Mapping with Recorded Inputs ............

  • Page 4: Getting To Know Your Avant Arc

    Please refer to the Studio Software Installation Manual for assistance. The Installation manual is included in the original AVANT ARC packaging in PDF format. The scope of this manual is to get you “up and running” with your AVANT ARC System. Please consult the interactive Help System within the software for more detailed information of features and functionality.

  • Page 5: Alternate Speaker Option Avant Arc

    Alternate Speaker Option AVANT ARC Notice! The Red & Blue adapters are included and must be removed to attach 18 gage (1.0mm) Free Field speaker wires and then reinstalled. To Install Free Field Speaker Wires: Screw Screw Driver Driver Unplug both the Red & Blue connectors.

  • Page 6: Transducers And Accessories

    Make sure that the correct transducers are set in the software by right clicking any transducer button on the audiometry screen and left-clicking to change the transducer. Use the accessories provided with your AVANT ARC. Use of unapproved accessories is not recommended.

  • Page 7: Probe Mic Hanger Installation

    Probe Mic Hanger Installation 4. Gently press clip into place. 1. You will need the two Probe Mics, the Probe Mic Hanger and the clip. 2. Install the hook on the back side of the probe mic. Pull hook down to seat on the post. 5.

  • Page 8: Loading Calibration Files

    Audiometer device. • Click Load (choose *.set or *.cal files). 1. With the MedRx USB Flash Drive connected, open the MedRx Studio software, enter the module you will be loading calibration files into and click: •...

  • Page 9: Audiometer Module Studio Software Overview

    AUDIOMETER MODULE Studio Software Overview Basic Software Options The MedRx Studio software can run stand-alone or from NOAH System or the TIMS NOAH-Compatible Office System.  Several options are available which allow the user to customize the MedRx Launching the MedRx Studio Software Studio Software to meet their needs.

  • Page 10: Audiometry

    Show Help More Options The More Options icons have the following functions: If you have more than one MedRx product you can show/hide modules in 1. Save the Current Session to a File the Main Screen settings. 2. Open session from a file NOTE: Remember, more information is always available in the Interactive 3.

  • Page 11: Assign Transducers

    Configuring the AUD Software Assign Transducers It is important to note that each module will have different Option 1: On the General Options settings available for customization. screen click Outputs to assign specific transducers to the audiometer outputs. Enter the module and click the settings wheel to customize. Option 2: You can change transducers by Right-Clicking on any transducer icon on the Audiometry...

  • Page 12: Preparing For Testing

    Preparing for Testing Use the accessories provided with your Avant Audiometer. Typical acceptable transducers are shown on page 6. Operator headsets for use with the Avant Audiometer should have 32 ohms impedance and the speaker power should be at least 50 watts. Air conduction transducers for use with this device should have an impedance of 10 ohms.
  • Page 13 Tinnometer and are part of an upgrade option for the AVANT Stealth Audiometer. If you need to test frequencies beyond 8000 Hz, you must notify MedRx. This option carries a price differential which will be detailed at the time of order.

  • Page 14: Sound Field Testing

    Sound Field Testing The Sound Field speakers (Free Field) should be connected using optional or Repeat until all the speaker wires are secured then plug both connectors into user supplied amplifier and speakers. They should be calibrated annually as the device as indicated above. per ISO 8253-2, located at least 1 meter from the patient ear and at the same DC Power supply must be used when using passive Free Field speakers or height.

  • Page 15: Performing Audiometric Testing

    Performing Audiometric Testing The screen shot below shows the controls which are available from the Audiometer main window. The sections of the manual that follow explain how to use these tools to perform hearing evaluations using your Audiometer. 1. Test Selection Tool Bar 2.

  • Page 16: Pure Tone Audiometry

    These thresholds are plotted on a standard graph called an also say “even if it seems very far away”. audiogram. The MedRx Studio software controls the hardware, stores the 5. Begin at 1000 Hz in the Right ear (unless the patient reports better data (if running within NOAH or TIMS) and prints a standard or custom hearing in the left ear).
  • Page 17 Pure Tone Audiometry via the Bone Conductor 1. Following the instructions on page Error! Bookmark not defined., place the Bone 2. Use your mouse or hold control and use the up Conductor on the mastoid and down arrow keys to adjust the Masking process behind the ear with Level Slider to the appropriate level based on better air conduction...

  • Page 18: Speech Audiometry

    3. Click the W tab on the bottom right. 4. Use the folder icon and drop-down list to select Spondee Word Lists A&B or Child Spondee from the The following sections detail how to perform these tests in MedRx Studio. list. D-0126019-B...
  • Page 19 Word Recognition (WR). the test slider or masking slider. NOTE: *CD function will only be 1. From the MedRx Studio main screen, Click the displayed if you have a disc drive AUD button.
  • Page 20 6. To Input & Calibrate the Rainbow Passage in WR for MCL: c. The Rainbow Passage is now part of the MedRx Studio Audio Files for future use. a. Press the small file folder on the top right of media player.
  • Page 21 Repeat steps d - f for the remaining channel. The VU meter is just below the Test button in MedRx Studio Note: This calibration also needs to be done with any and will become active once you press Test.

  • Page 22: Word Recognition (Wr)

    The test is complete when all words in the list have been presented. The software automatically plots the score on the WR graph. 1. From the MedRx Studio main screen, click the AUD 8. Click the Advance button >> or press the F10 key button.

  • Page 23: Quicksin

    QuickSIN The primary complaint of hearing-impaired persons is difficulty hearing in background noise. The measurement of SNR loss (signal-to-noise ratio loss) is important because speech understanding in noise cannot be reliably predicted from the pure tone audiogram (Killion & Niquette, 2000). The QuickSIN test was developed to: Provide a one-minute estimate of SNR loss.
  • Page 24 Performing the QuickSIN Test 2. Play the first sentence in the list by clicking the Play button. Ask the 1. From the MedRx Studio main screen, Click the AUD patient to repeat the sentence. button. 2. Click the QuickSIN button located on the toolbar on the top of the screen.

  • Page 25: Vra Module (Optional)

    The VRA module is a Visual Reinforced Audiometry (VRA) module available VRA Setup in the MedRx Studio software. This is an optional module which must be The VRA system will require initial setup in order to begin licensed to activate. Contact your MedRx representative if you have performing hearing tests.
  • Page 26 If the primary screen is not being used for reward presentation this screen child’s left and right ear. may keep the MedRx Studio software present or it may be hidden with If the primary screen is not being used for reward presentation this screen Primary Screen Blackout.
  • Page 27 Reward Length, and Rewards Randomized are greyed out. These are to be adjusted within the iVRA App. If you would like to recover a deleted MedRx video, they can be Default Output, Default Signal, Default Pulse Type, dB Weighting, can be restored in the MedRx Video Folder selected in this section.
  • Page 28 Connecting MedRx Studio and iVRA App found in the Studio settings. The Computer To connect MedRx Studio and the iVRA app you will need to connect to the Name or IP address will remain the same same wireless network. This can be a local network or a network with unless you change wireless networks or internet access.
  • Page 29 Type of tone (i.e. warble, pure tone, narrowband, continuous, pulsed) is also through the iOS device set up in MedRx Studio software prior to beginning the VRA testing. headphones The settings for the VRA system are found in the iOS app. You can find these...
  • Page 30 The iVRA conditioning is initiated through the iOS app. The iOS app and MedRx Studio must be connected for the testing to begin. Once the iOS app You may select presentation ear, and MedRx Studio are connected, navigate to the conditioning tab.
  • Page 31 MedRx Studio must be connected for the testing to begin. You may select presentation ear, frequency, level, and video reward. Once the iOS app and MedRx Studio are connected, navigate to the Tests tab. Note: You have the option in the Studio settings to fix presentation ear to binaural during free field testing.
  • Page 32 Once the automatic test mode has begun, iVRA Automatic Test Mode the iOS app will look like the left image. To begin automatic testing, click the select presentation ear, Automatic button in the Test tab. frequency, starting level, and video reward.
  • Page 33 VRA MedRx Studio Logging video reward on the center screen. Logging of test sessions are available through MedRx Studio. To access the logs, click the Log tab in the MedRx Studio VRA sidebar. Be sure to click Send in the top right of the iOS app when testing is complete.

  • Page 34: Tinnometer Module (Optional)

    Purpose of the Tinnometer Tinnitus is experienced by millions of people worldwide. The Tinnometer is 1. From the MedRx Studio main screen, Click the designed to mimic the sounds of tinnitus in order to provide an accurate and Tinnometer button.
  • Page 35 Key features of the Tinnometer Main Screen: 1. Toggle Switch to Start/Stop stimulus 2. Sliders to control frequency, bandwidth, slope and tempo of the stimulus 3. Slider to control the intensity of the stimulus 4. Buttons used in determining tinnitus match, threshold and minimum masking level 5.
  • Page 36 Interactions with the Patient are Controlled as Follows: Step 1: Identify Patient’s Tinnitus 1. Patient Response Switch Indicator 2. Patient Monitor Microphone 3. Talk Forward 4. Undo 5. Toggle Help Section 1. Start by selecting the tinnitus type that has been described by the 6.
  • Page 37 Step 2: Find Identified Tinnitus Threshold 1. Use down arrow on your keyboard to lower stimulus until patient states they are no longer able to hear the tinnitus. 3. Use frequency slider to match the pitch of the patient’s perceived tinnitus.
  • Page 38 Tinnometer Modulation Tab The Tinnometer modulation tab is designed to simulate sound generators when hearing aid demonstrations cannot be performed. The following are controls used in Modulation. 2. Enter the modulation tab on the right side of Tinnometer software. 1. Type of Modulation Sound 2.
  • Page 39 A complete tinnitus assessment must be performed prior to performing Tinnometer Audiometry Scan testing in the RI tab. Once tinnitus assessment testing is completed, optional residual inhibition testing can be performed with the following steps: The Tinnometer Scan tab is designed for various forms of air conduction audiometry.
  • Page 40 4. Click the stop watch to begin the masking stimulus Tinnometer Report Printing (stimulus to play for 60 seconds). The Tinnometer has four reports available for printing: • Tinnitus Assessment Report. • Manufacturer Guidance Report. • Questionnaire Report. • Channel Report. The following are common features found across reports: 1.
  • Page 41 Tinnitus Assessment Report Tinnitus assessment reports are able to be generated after completing the three steps to tinnitus assessment. Once all steps are complete you are able 3. Use the drop down box to to print a report select a diagnosis for the patient.
  • Page 42 Manufacturer Guidance Report Manufacturer guidance reports are designed to provide hearing aid sound therapy guidance to a clinician based on tinnitus assessment results. Sound 3. Select “Hearing Aid Guidance” from therapy is an option to tinnitus treatment. We encourage all clinics to the list of reports develop a tinnitus treatment protocol that is in line with their tinnitus treatment goals.
  • Page 43 Graph Channel Report Questionnaire Report Graph channel reports will print a patient report which displays an image of Questionnaire reports will only show as an option once the questionnaire has the patient’s tinnitus with QR codes for YouTube videos that play a wind been completed.

  • Page 44: Rem / Lsm Module Studio Software Overview

    REM / LSM MODULE Studio Software Overview Basic Software Options The MedRx Studio software can run stand-alone, from NOAH System or the TIMS NOAH-Compatible Office System.  Several options are available which allow the user to customize the MedRx Studio Software to meet their needs.

  • Page 45: Live Speech Mapping

    9. Show Help 10. More Options The More Options icons have the following functions: If you have more than one MedRx product you can show/hide modules in 1. Save the current session to a file the Main Screen settings. 2. Open session from a file NOTE: Remember, more information is always available in the Interactive 3.

  • Page 46: Bottom Tool Bar

    Bottom Tool Bar The Bottom Tool Bar icons have the following functions: ___________________________________________________________________________ The Wrench icon displays The Target Selection icon The Display icon sets up options for: sets up: which target lines to 1. Ear Selection 1. Target type display on the 2.

  • Page 47: General Lsm Options

    General LSM Options The Fitting tab sets the default fitting rule, client information, output and hearing aid parameters. Click the settings wheel in the top right menu bar. The LSM tab sets your default view and default target levels. The Fitting tab also sets default NAL or DSL default settings. The General tab defines the default appearance of the Live Speech...
  • Page 48 The Signal tab sets the signals displayed on the Live Speech The REUR tab sets the view options. Mapping Screen. The REOR tab sets the view options. The Shown Tests tab sets the tests displayed in the Live Speech Mapping module. The Percentiles tab sets the view options.

  • Page 49: Positioning The Speakers

    Preparing for Testing Positioning the Speakers The speaker should be positioned in such a way that nothing blocks the path Proper positioning of the loudspeakers relative to the patient’s hearing aids of the emanated sound in front and on the sides of the speaker. For example, is critical for making accurate and repeatable measurements.

  • Page 50: Probe Tube Calibration

    Calibration top menu icon. Click the More Options icon (3 dots) then click the Calibration icon. Return Probe Microphones to MedRx for annual re-calibration. Annual re-calibration of the Avant REM+ Probe Microphones is recommended. There are no user repairable components on this device.

  • Page 51: Step-By-Step Guide To Live Speech Mapping

    Before making Live Speech Mapping measurements, the patient’s pure tone audiogram must be available to the software. This can occur several ways: 1. The audiogram was automatically entered by MedRx Studio software when testing. 2. The audiogram was manually entered into the NOAH audiogram module or Noah 4 software and saved.

  • Page 52: Speech Mapping With Recorded Inputs

    It is also possible to use an audio CD, such as the patient’s favorite music to Speech Mapping with perform Speech Mapping. Recorded Inputs Select CD as an option under General and Signal. Select the CD button and then select a track. The Studio software provides several digital audio files to use as a repeatable Use the sound level meter on screen to check stimulus for Speech Mapping.

  • Page 53: Speech Mapping With Live Voice Inputs

    67. 8. Tools Tab, Target Selection Tab, and Display Tab NOTE: The screen shot above shows the MedRx Modified Speech Spectrum (Canoe). 9. Legend It is also possible to use DSL IO or NAL-NL2 targets on this screen. Click the Setting 10.

  • Page 54: Running Speech Mapping "On-Top

    Live Speech Mapping in a way that complements their practice style rather than compromising it. In order to get you “up and running” with the AVANT REM+ system, MedRx From the MedRx Studio LSM main screen, click the On-Top has developed the following protocol.

  • Page 55: Real Ear Measurements

    ISTS or file input conventional Real Ear Measurements (REM). All these tests are accessed b. Peak Measures from the main REM screen. c. 1/3 Octave resolution To begin, click the REM icon on the MedRx Studio main screen. D-0126019-B...

  • Page 56: Medrx Real Ear Measures Protocol

    1. Complete a careful otoscopic examination as instructed by the manufacturer of your otoscope. a. For MedRx Video Otoscopes, refer to the Help system within the software by pressing the F1 key or clicking the Help icon or text menu.
  • Page 57 4. Calibrate Probe Tube as described Stimulus Signal Types earlier in this manual on page 48. Pure Tone: A pure sine wave. Crest Factor = 1.41 (3.0dB) 5. Measure and place the probe tube in Broadband Noise (BBN): Uniform random noise with normal (Gaussian) the ear canal.
  • Page 58 To activate specific REM tests, click the buttons as follows: White-weighted noise can be used mostly for testing of equipment. It is not recommended to use it for hearing aid fitting, unless specified by the Opens the audiometry data entry screen. Use this if manufacturer.

  • Page 59: Additional Tests & Features

    “difficult” to fit patients. RECD measurements can be conducted outside measurement curve, the corresponding REOG curve is calculated and of a Hearing Instrument Test Box when using the optional MedRx RECD automatically plotted to the REOG screen. The REOG function is useful in Coupler.

  • Page 60: How To Perform The Recd Task

    in the uncooperative client’s ear. This is particularly important in the case of How to Perform the children, whose small volume ear canals enhance high frequency amplification more so than in average adults. This is an essential RECD Task consideration in determining the maximum output of the hearing instrument.

  • Page 61: Measuring Acoustic Feedback

    Coupler Response Measuring Acoustic Feedback When the REAR measurement is complete, you are prompted to perform a coupler response. Feedback (whistling, howling) is one of the most common complaints of hearing instrument users. Even though many modern hearing instruments Attach the hearing instrument or the insert •...

  • Page 62: Hearing Loss Simulator

    If a more specific frequency analysis of the person would perceive the sound. Toggle between these selections feedback is desired, change the resolution of as necessary. the system to 1/24 octave and adjust the 5. The Reset option restores the audiogram to the original state. Use smoothing in the General LSM or REM this option if you have modified the audiogram while in the simulate settings menu.
  • Page 63 File allows the user to play sound files. The program supports MP3 and WAV edit the other ear, click the appropriate test ear icon on the control files and comes with a preset MedRx Sounds Sensations set of files. After the panel first.

  • Page 64: Printing

    PRINTING To Use an Existing Print Template Printing within the MedRx Studio software. You can use the templates provided at installation or create your own templates to suit your needs. 1. Click the print icon in the top tool bar or hold down the Ctrl key Icons in the Print Window and click the P key on your keyboard.
  • Page 65 8. Drag and drop elements onto the page to Create New Print Templates create your template. 1. Select the printer icon. a. You can combine data from multiple modules into a single template. b. Elements may overlap and will 2. Select the + icon to create a new stack/cover previously added...

  • Page 66: Rainbow Passage

    Rainbow Passage When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above and its two ends apparently beyond the horizon.

  • Page 67: Emc Precautions

    • The Avant ARC should not be used adjacent to or stacked with other equipment and if adjacent or stacked use is necessary, the Avant ARC should be observed to verify normal operation in the configuration in which it will be used.
  • Page 68 The Avant ARC is intended for use in electromagnetic environment specific below. The customer or the user of the Avant ARC should assure that it is below. The customer or the user of the Avant ARC should assure that it is used in such an environment.
  • Page 69 Guidance and manufacturer’s declaration – electromagnetic immunity The Avant ARC is intended for use in electromagnetic environment specific below. The customer or the user of the Avant ARC should assure that it is used in such an environment. Immunity test...
  • Page 70 Portable and mobile RF communications equipment and the Avant ARC The Avant ARC is intended to use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the Avant ARC can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the Avant ARC as recommended below, according to the maximum output power of the communications equipment.

  • Page 71: Safety

    • The device warm-up time is less than 5 minutes. recycling. • Use only the 15 VDC, 2A medical power supply supplied with your Avant ARC, CUI ETMA150200UD-P5P-IC. • All repairs should be sent to MedRx for evaluation and / or repair. However, necessary •...

  • Page 72: Symbols That May Be Used

    Read the instruction manuals Indicates that the Type B applied part. Manufacturer Authorized for safe usage of the device device serial number (Type B equipment) (MedRx) Representative in (operating instructions) will follow Europe Non-ionizing electromagnetic Special Disposal Humidity Limitation Caution, General...

  • Page 73: Recommended Procedures For Cleaning And Disinfection

    Recommended Procedures for Cleaning and Disinfection 1. Foam ear tips and probe tubes are single use components, and should not be re-used by another patient. 2. It is recommended that 70% Isopropyl Alcohol should be applied to a soft clean cloth or tissue, not directly on the component to be cleaned. The cloth should never be wet, just damp.

  • Page 74: Permissions (Optional)

    Avant REM and Avant AUD uses the default windows user accounts to control access to the software. The default user settings are typically sufficient for regulatory bodies. These settings can be also adjusted if needed to comply with country requirements. MedRx Avant software does not store private information. Data control is performed by the office management system or patient management system (i.e. Noah, Blueprint, Sycle).
  • Page 75 Adjusting log out time period Create user settings to lock the computer when not in use. Navigate to local security policy and adjust the Amount of idle time required before suspending session. Adjusting this setting will prevent unintended access to the computer and health records. Setting maximum password age Local Security Policy will also identify the required password expiration timeframe.

  • Page 76: Technical Information

    Technical Information The Avant ARC Audiometer/REM Combination is an active, diagnostic Class IIa Medical Device according to the EU medical directive 93/42/EEC. Standards: IEC 60601-1: 2012 Class II Modulation: Connection Sockets: Specification IEC 60601-1-2 Class A Pulse tone: 0.25/0.5 s on time. Warble tone: 5% sinus frequency...
  • Page 77 Calibration values and Calibration values and Calibration values: Calibration values: Calibration values: Calibration values: Max Levels: Max Levels: Headphone DD45 Headphone TDH39 Insert phone Eartone 3A Insert phone IP30 Bone conductor Sound field (0 degree NBS-9A acoustic coupler NBS-9A acoustic coupler HA-2 acoustic coupler HA-2 acoustic coupler Radioear B71 Force: 4.9...
  • Page 78 Maximum Sound Levels: Frequency Inserts Supra-aural Sound Field Bone Conduction 1000 1500 2000 3000 4000 6000 8000 Routine checking and subjective tests The user of the instrument should perform a subjective instrument check once a week. The purpose of routine checking is to ensure, as far as possible, that the equipment is working properly, that its calibration has not noticeably altered and that its attachments, leads and accessories are free from any defect that might adversely affect the test result.

  • Page 79: Limited Warranty

    Limited Warranty MedRx warrants this product to be free from defects in material and workmanship for two years from the time of purchase. If this system fails to perform as specified during this period, the purchaser is responsible for calling MedRx at +49 30 70 71 46 43. The company's representative will advise the owner to either...