Amplivox Otosure User manual

Otosure

Operating Manual

D-0116492-B (OM022) –Otosure Operating Manual

ABOUT THIS MANUAL

READ THIS OPERATING MANUAL BEFORE ATTEMPTING TO USE THE INSTRUMENT.

This manual is valid for the Otosure (applies from serial number 58000 and Audibase version 5.5 onwards).

This product is manufactured by:

Amplivox Ltd.

10393 West 70th Street

Eden Prairie

MN 55344

United States

Amplivox Ltd.

3800 Parkside, Solihull Parkway,

Birmingham Business Park,

Birmingham, West Midlands,

B37 7YG

United Kingdom

www.amplivox.com

For all enquiries please contact us under:

Tel: 888 941 4208

Fax: 952 903 4100

[email protected]

Tel: +44 (0)1865 880846

[email protected]

 
 
 
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D-0116492-B (OM022) –Otosure Operating Manual 
TABLE OF CONTENTS
INTRODUCTION.................................................................................................................................................. 4 
1. THANK YOU...........................................................................................................................................................4 
2. INTENDED APPLICATIONS .........................................................................................................................................4 
3. CONTRADICTIONS................................................................................................................................................... 4 
4. STANDARD AND OPTIONAL COMPONENTS....................................................................................................................4 
5. WARNINGS ...........................................................................................................................................................5 
PRINCIPLES OF OPERATION ................................................................................................................................ 6 
1. OTOSCOPIC EXAMINATION .......................................................................................................................................6 
2. PRINCIPALS OF PURE TONE AUDIOMETRY ...................................................................................................................6 
3. AUDIOMETRY PREPARATION .....................................................................................................................................6 
UNPACKING AND INSTALLATION........................................................................................................................ 8 
1. GENERAL..............................................................................................................................................................8 
2. MARKINGS............................................................................................................................................................8 
3. SAFETY INSTRUCTIONS............................................................................................................................................. 9 
3.1. General ..................................................................................................................................................... 9 
3.2. Cautions –General ................................................................................................................................... 9 
3.3. Environmental factors ............................................................................................................................ 10 
3.4. Electrical and electrostatic safety........................................................................................................... 10 
3.5. Electromagnetic compatibility (EMC) ..................................................................................................... 11 
3.6. Explosion hazards ................................................................................................................................... 11 
3.7. Measuring Security ................................................................................................................................. 11 
3.8. Miscellaneous ......................................................................................................................................... 11 
3.9. Use of equipment after transport and storage....................................................................................... 12 
4. CONNECTIONS .....................................................................................................................................................12 
5. HARDWARE INSTALLATION .....................................................................................................................................12 
INSTALLING SOFTWARE & OPERATIONAL CHECK ..............................................................................................13 
1. GENERAL ............................................................................................................................................................13 
2. INSTALLATION...................................................................................................................................................... 13 
3. UNINSTALLING THE OTOSURE PROGRAM ..................................................................................................................13 
4. OPERATIONAL CHECK............................................................................................................................................13 
USING THE OTOSURE ........................................................................................................................................15 
1. EQUIPMENT PREPARATION ..................................................................................................................................... 15 
2. STARTING THE SOFTWARE.......................................................................................................................................15 
3. AVAILABLE TEST MODES ........................................................................................................................................15 
3.1. Manual Testing....................................................................................................................................... 15 
3.2. Computer Testing ................................................................................................................................... 15 
3.3. Mixed Testing ......................................................................................................................................... 16 
4. INITIATING A TEST ................................................................................................................................................16 
5. CONTROL BUTTONS..............................................................................................................................................17 
6. CONTROL -PC KEYBOARD AND MOUSE...................................................................................................................17 
7. MANUAL TESTING................................................................................................................................................17 
8. COMPUTER TESTING .............................................................................................................................................19 
9. SINGLE-FREQUENCY TESTING ..................................................................................................................................20 

 
 
 
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D-0116492-B (OM022) –Otosure Operating Manual 
10. MIXED-MODE TESTING..........................................................................................................................................20 
OPTIONS AVAILABLE TO SET-UP........................................................................................................................21 
1. GENERAL ............................................................................................................................................................21 
2. MENU COMMANDS..............................................................................................................................................21 
TROUBLESHOOTING ..........................................................................................................................................22 
1. GENERAL ............................................................................................................................................................22 
2. NO INSTRUMENT FOUND....................................................................................................................................... 22 
3. NO RESPONSE FROM PATIENT ................................................................................................................................ 22 
4. RESPONSE SWITCH HELD ON..................................................................................................................................23 
5. ERRATIC PATIENT RESPONSE...................................................................................................................................24 
6. EXIT OTOSURE WITH NO RESULTS........................................................................................................................... 24 
7. USB LEAD DISCONNECTED.....................................................................................................................................25 
ROUTINE MAINTENANCE...................................................................................................................................26 
1. GENERAL MAINTENANCE PROCEDURES ....................................................................................................................26 
2. AUDIOMETER MAINTENANCE..................................................................................................................................26 
3. HEADSET MAINTENANCE ....................................................................................................................................... 27 
4. ACCESSORIES/REPLACEMENT PARTS .........................................................................................................................27 
5. REPAIR...............................................................................................................................................................27 
6. WARRANTY.........................................................................................................................................................28 
7. CALIBRATION AND RETURN OF THE INSTRUMENT........................................................................................................28 
8. GUARANTEE........................................................................................................................................................ 29 
TECHNICAL SPECIFICATIONS..............................................................................................................................30 
1. STANDARDS AND REGULATORY................................................................................................................................ 30 
2. INPUT/OUTPUT ...................................................................................................................................................30 
3. AUDIOMETRIC .....................................................................................................................................................30 
4. EARPHONE SOUND ATTENUATION CHARACTERISTICS ..................................................................................................30 
5. PHYSICAL &ENVIRONMENTAL.................................................................................................................................30 
EMC GUIDANCE & MANUFACTURER’S DECLARATION...................................................................................32 
USE WITH NON-MEDICAL ELECTRICAL EQUIPMENT ......................................................................................37 

D-0116492-B (OM022) –Otosure Operating Manual

1.INTRODUCTION

1.1. THANK YOU

Thank you for purchasing an Amplivox audiometer. The Otosure is a compact, automatic air-conduction

screening audiometer, driven and controlled by a computer (PC). It provides a cost-effective solution for

today's health care environment.

The Otosure is used with the Amplivox Audibase software, which allows electronic storage of audiometric

test records on a PC, application of audiogram categorisation schemes, printing of audiograms and data

exchange with other PC applications.

This operator's manual enables you to take full and safe advantage of the features offered by the Otosure

audiometer. Therefore, PLEASE READ IT THOROUGHLY before using the audiometer.

1.2. INTENDED APPLICATIONS

This instrument is designed for use by trained personnel only, such as audiologists, ENT surgeons, doctors,

general practitioners, hearing aid dispensers, child health professionals and hearing healthcare professionals

with a similar level of education. It is not recommended to utilize the equipment without the necessary

knowledge and training.

1.3. CONTRADICTIONS

Always visually inspect the outer ear and the external auditory canal for abnormalities before testing. Testing

should not be performed on patients in the following items is applicable.

1. The presence of other sensitivity to loud sounds may contraindicate testing when high intensity stimuli

are used.

2. Recent outer ear surgery.

1.4. STANDARD AND OPTIONAL COMPONENTS

Shipping documentation will reference the stock number quoted above, and images of the parts alongside the

relevant stock number are available on the Amplivox website (www.amplivox.com). The required fitting

instructions are supplied with each part.

STANDARD COMPONENTS

Otosure audiometer

8508019

Audiometric headset (DD45)

8509615

Patient response switch

8011155

HBA audiometric headband

8010882

Cable USB A to USB B (2.0 m)

8011241

Carrying case

8004651

Calibration certificate

USB with Audibase Software and

manuals

D-0116492-B (OM022) –Otosure Operating Manual

OTHER COMPONENTS TO REORDER

Audiocups (noise reducing earphone enclosures)

8010855

Headband (standard

headphone)

8010840

Audiocup ear cushion

8010835

Earphone cushion

8010857

Audiocup headband

8507381

Earphones DD45 *

8010876

Audiocup headband cover

8010834

Headset lead

8010822

Booth Leads

851095

Accessories marked * require calibration with the specific audiometer to be used. Do not attempt to

use these accessories until the audiometer has been calibrated to match their characteristics.

Shipping documentation will reference the stock number quoted above, and images of the parts alongside

the relevant stock number are available on the Amplivox website (www.amplivox.com). The required fitting

instructions are supplied with each part.

1.5. WARNINGS

Throughout this manual, the following meanings of warnings and cautions apply:

The WARNING label identifies conditions or practices that may present danger

to the patient and/or user.

The CAUTION label identifies conditions or practices that could result in damage

to the equipment.

WARNING

CAUTION

D-0116492-B (OM022) –Otosure Operating Manual

2.PRINCIPLES OF OPERATION

2.1. OTOSCOPIC EXAMINATION

A suitably-qualified health care professional should perform a thorough otoscopic examination to establish that

the condition of the ear is suitable for the test options selected and that no contraindications are present. The

latter would include obstruction of the external ear canal due to excessive wax and/or hairs, both of which

would need to be removed. This is required to ensure that the probe tone delivered by the probe are able to

reach the ear drum and are not reflected by cerumen or debris and thereby alter the test result.

2.2. PRINCIPALS OF PURE TONE AUDIOMETRY

Ideally, hearing tests are conducted in a soundproof room. The purpose of pure tone audiometry is to measure

the patient’s hearing threshold which is then compared to the hearing threshold of an average normal hearing

person. The examination starts with air conduction on the ear with better hearing, or if not specified differently,

on the right ear. The BSA (British Society of Audiology) recommends starting the test at 1000 Hz to then next

measure the higher frequencies. When done with the high frequencies 1000 Hz shall be retested and to then

continue with the lower frequencies.

2.3. AUDIOMETRY PREPARATION

Refer to the various audiometric standards and other relevant publications for guidance on audiometric testing.

Ambient Conditions

Audiometric testing should always be performed in quiet conditions (e.g. a quiet room or an acoustic booth).

The optional Audiocups can provide an additional level of isolation from ambient noise. For further

explanation on permissible ambient noise levels, please refer to the audiometry standard ISO 6189.

Test System Arrangement

The schematic diagram below shows a typical example of the use of audiometric test equipment. The

audiometer is located on the desk of a seated operator as shown.

The patient is seated in front of the desk facing away from the operator. The patient wears a headset (see

below) and responds to test stimuli by use of a hand-held switch which is also connected to the instrument.

Operator

Otosure

Audiometer

Computer (e.g. Tablet/Laptop)

Patient, wearing headset

Headset lead

Response switch & lead

D-0116492-B (OM022) –Otosure Operating Manual

Headset

The headset must be fitted by a qualified person to ensure a proper seal and comfortable fit. The leads from

the headset are connected to the instrument and the headset is then fitted to the patient.

Patient Instructions

The patient is given the following instructions: “Press and then release the response switch when a tone is

heard”.

D-0116492-B (OM022) –Otosure Operating Manual

3.UNPACKING AND INSTALLATION

3.1. GENERAL

Please check the contents of the shipping carton against the delivery note to make sure that all items ordered

have been included. If anything is missing, please contact the distributor who supplied the audiometer or

Amplivox if purchased directly.

Please retain the carton and packaging as the instrument will need calibrating on an annual basis and should

be returned to Amplivox in its original shipping carton.

For supply in US only: Federal Law restricts this device to sale by or on the order of a licensed medical

professional.

3.2. MARKINGS

The following markings can be found:

Symbol

Explanation

Type B applied parts. According to IEC 60601-1.

Patient applied parts that are not conductive and can be immediately released from the

patient.

Refer to instruction manual.

WEEE (EU-directive)

This symbol indicates that when the end-user wishes to discard this product, it must be

sent to separate collection facilities for recovery and recycling. Failing to do so may

endanger the environment.

The CE-mark indicates that Amplivox Ltd. meets the requirements of Annex II of the

Medical Device Directive 93/42/EEC. TÜV Product Service, Identification No. 0123,

has approved the quality system.

Serial number.

Date of manufacture.

Manufacturer.

Keep dry.

Transport and storage humidity range.

CAUTION

D-0116492-B (OM022) –Otosure Operating Manual

Transport and storage temperature range.

Logo.

3.3. SAFETY INSTRUCTIONS

3.3.1. GENERAL

The following safety precautions must be observed at all times. General safety precautions must be followed

when operating electrical equipment. Failure to observe these precautions could result in damage to the

equipment and injury to the operator or patient.

The employer should instruct each employee in the recognition and avoidance of unsafe conditions and the

regulations applicable to his or her work environment to control or eliminate any hazards or other exposure to

illness or injury.

Amplivox Ltd. is aware that safety rules within individual organizations vary. If a conflict exists between the

instructions in this manual and the rules of the organization using this instrument, the more stringent rules

should take precedence.

The Otosure is intended to be used by hearing healthcare professionals (i.e. ENT doctors, audiologists), nurses

or technicians who have been trained in the proper use of the device.

3.3.2. CAUTIONS –GENERAL

If the system is not functioning properly, do not operate it until all necessary repairs are made and the unit is

tested and calibrated for proper functioning in accordance with Amplivox’s specifications.

Do not drop or in any other way cause undue impact to this device. If the instrument is damaged, return it to

the manufacturer for repair and/or calibration. Do not use the instrument if any damage is suspected.

This product and its components will perform reliably only when operated and maintained in accordance with

the instructions contained in this manual, accompanying labels, and/or inserts. A defective product should not

be used. Make sure all connections to external accessories are secured properly. Parts which may be broken

or missing or are visibly worn, distorted, or contaminated should be replaced immediately with clean, genuine

replacement parts manufactured by or available from Amplivox Ltd.

Equipment is not user repairable. Repairs must be performed by an authorized service representative only.

No modifications of the equipment are allowed by anyone other than a qualified Amplivox Ltd. representative.

Modification of the equipment could be hazardous.

Amplivox Ltd. will make available on request circuit diagrams, component part lists, descriptions, calibrations

instructions, or other information that will assist authorized service personnel to repair those parts of this

instrument that are designated by Amplivox Ltd. as repairable by service personnel.

CAUTION

D-0116492-B (OM022) –Otosure Operating Manual

No parts of the equipment can be serviced or maintained while in use with the patient.

Connect only accessories purchased from Amplivox Ltd. to the Otosure. Only accessories which have been

stated by Amplivox Ltd. to be compatible are allowed to be connected to the device or cradle.

3.3.3. ENVIRONMENTAL FACTORS

Use and store the instrument indoors only. It is recommended that the instrument

be operated within an ambient temperature range of 15 °C / 59 °F to 35 °C / 95 °F

and in relative humidity between 30 % and 90 % (non-condensing).

Do not use the device in the presence of fluid that can come into contact with any of the electronic components

or wiring. Should the user suspect fluids have contacted the system components or accessories, the unit

should not be used until deemed safe by an authorized service technician.

3.3.4. ELECTRICAL AND ELECTROSTATIC SAFETY

Before performing any service to the insert earphones you must uncouple the

Otosure transducers from the patient.

Do not touch the contacts on the back of the instrument and the patient at the

same time. The consequence could be a too high leakage current to the patient.

Do not open the case of the instrument. Refer servicing to qualified personnel.

This equipment is intended to be connected to other equipment thus forming a Medical Electrical System.

External equipment intended for connection to signal input, signal output or other connectors must comply with

the relevant product standard e.g. IEC 60950-1 for IT equipment and the IEC 60601-series for medical

electrical equipment. In addition, all such combinations –Medical Electrical Systems –must comply with the

safety requirements stated in the general standard IEC 60601-1, (edition 3.1), clause 16. Any equipment not

complying with the leakage current requirements in IEC 60601-1 must be kept outside the patient environment

i.e. at least 1.5m from the patient support or must be supplied via a separation transformer to reduce the

leakage currents. Any person who connects external equipment to signal input, signal output or other

connectors has formed a Medical Electrical System and is therefore responsible for the system to comply with

these requirements. If in doubt, contact a qualified medical technician or your local representative. When the

instrument is connected to a PC, or other similar items, beware of not touching the PC and patient

simultaneously.

A Separation Device (isolation device) is needed to isolate the equipment located outside the patient

environment from the equipment located inside the patient environment. In particular such a Separation Device

is required when a network connection is made. The requirement for the Separation Device is defined in IEC

60601-1 clause 16.

CAUTION

WARNING

CAUTION

D-0116492-B (OM022) –Otosure Operating Manual

3.3.5. ELECTROMAGNETIC COMPATIBILITY (EMC)

Although the instrument fulfills the relevant EMC requirements, precautions

should be taken to avoid unnecessary exposure to electromagnetic fields, e.g.,

from mobile phones, etc. If the device is used adjacent to other equipment it

must be observed that no mutual disturbance appears. Please also refer to the

appendix regarding EMC.

3.3.6. EXPLOSION HAZARDS

Risk of explosion.

Do not use in the presence of flammable anesthetics or other gases.

Do NOT use in the presence of flammable gaseous mixtures. Users should

consider the possibility of explosions or fire when using this device in close

proximity to flammable anesthetic gases.

Do NOT use the Otosure in a highly oxygen-enriched environment, such as a

hyperbaric chamber, oxygen tent, etc.

3.3.7. MEASURING SECURITY

To guarantee that the Otosure works properly, the instrument should be checked and calibrated at least once

a year. The transducers supplied with the audiometer are specifically calibrated with it; if these transducers

are changed recalibration will be required.

The service and calibration must be performed by an authorized service technician. If these checks are not

performed, EU Medical Device Directive (MDD) and other regulations may be violated and warranties may be

void.

The use of non-calibrated devices can lead to incorrect test results and is not advisable.

3.3.8. MISCELLANEOUS

Please note: DO NOT connect the Otosure hardware to the computer before the software has been installed!

Storage in temperatures below 0C /32F and above 50C /122F may cause permanent damage to the

instrument and its accessories.

Do not place the instrument next to a heat source of any kind.

Great care should be exercised when handling transducers, as rough handling, for example dropping onto a

hard surface may break or damage the parts.

Within the European Union it is illegal to dispose of electrical and electronic waste as unsorted

municipal waste. Electrical and electronic waste may contain hazardous substances and

therefore have to be disposed of separately. Such products will be marked with the crossed-

out wheelie-bin image shown to the left. User cooperation is important in order to ensure a

high level of reuse and recycling of electrical and electronic waste. Failure to recycle such

waste products in an appropriate way may endanger the environment and consequently the

health of human beings.

Outside the European Union, local regulations should be followed when disposing of the product after its end

of life.

CAUTION

WARNING

D-0116492-B (OM022) –Otosure Operating Manual

3.3.9. USE OF EQUIPMENT AFTER TRANSPORT AND STORAGE

Please make sure that the instrument is functioning correctly before use. If the instrument has been stored in

a cold environment (even for short period of time), please allow the instrument to become acclimatized. This

can take long time depending on the conditions (such as environmental humidity). You can reduce the

condensation by storing the instrument in its original packaging. If the instrument is stored under warmer

conditions than the actual use conditions no special precaution is required before use. Always ensure proper

operation of the instrument by following routine check procedures for audiometric equipment.

3.4. CONNECTIONS

The accessory terminals and connections are labelled to ensure correct identification and connection as

follows:

SOCKET TYPE

COLOUR CODE

CONNECTED PART

6.3mm jack

Blue

Air conduction headset (Left) *

6.3mm jack

Red

Air conduction headset (Right) *

6.3mm jack

Black

Patient response Switch *

USB Connector

N/a

Computer (via USB port)

Please note: Only connect the accessories supplied with the instrument or supplied by Amplivox or an

Amplivox distributor. These parts have been tested for use with the Amplivox Otosure audiometer for

compliance with the standards IEC 60601-1 and IEC 60601-1-2. The use of accessories other than those

specified may compromise compliance with these standards.

3.5. HARDWARE INSTALLATION

Refer to Section 11 for important information regarding the connection of non-medical electrical

equipment to medical electrical equipment.

The audiometer is powered and controlled by a computer (PC) using software supplied for this

purpose. This software must be installed before the audiometer is connected to the PC.

All other connections should be made before connecting the audiometer to the PC.

A USB cable is provided to connect the Otosure to a PC. The connected port on the PC must be to USB

specification 1.0 or 2.0. Connect the headset and the patient response switch to the Otosure and then make

the connection from the Otosure to the PC. No specific warm-up time is required although the device

registration to the PC might take a short time to complete.

Please note: Please refer to Section 4 for instructions on how to install the software and drivers, how to

carry out the first-time connection to a PC, and how to undertake a basic operational check to ensure the

audiometer is functioning correctly.

D-0116492-B (OM022) –Otosure Operating Manual

4.INSTALLING SOFTWARE & OPERATIONAL CHECK

4.1. GENERAL

This section describes the procedure for installing the Otosure operating software & associated device

drivers, undertaking the first-time connection of the Otosure audiometer and performing a basic operational

check to ensure that the instrument is working.

4.2. INSTALLATION

Installation is a two-stage process (please ensure both are completed):

1. Install the Otosure software on the PC

2. Install the device drivers to enable USB communication between the PC and the Otosure audiometer

Step 1: Install the Amplivox Otosure Software

The installation of the Otosure software is seamless and is installed as part of Audibase. Please refer to the

Audibase5.x user guide for step by step installation instructions.

Step 2: Install the USB Device Drivers

Please refer to “D-0115682”Guide to Installing Amplivox USB Drivers

4.3. UNINSTALLING THE OTOSURE PROGRAM

Uninstalling the Otosure program is achieved simply by navigating to the location where the software was

originally installed and deleting the file named “Otosure.exe”. There is no need to use the “Add or Remove

Programs” utility.

This will leave Audibase installed.

Please note: If more information about the uninstallation of the Audibase are required, please refer to

the Audibase5.x user guide.

4.4. OPERATIONAL CHECK

Connect the headphones and patient response switch to the Otosure audiometer, and connect the Otosure

audiometer to the PC via a USB cable. Start the Audibase application on the PC and enter new patient

details (refer to the Audibase user manual).

Start a test using the Launch Test button in the Audibase toolbar

Close any dialogue boxes in the Otosure window and select the Manual Test option:

Move the mouse pointer over the “Present” icon in the Otosure window and ensure a tone is heard from an

earphone. Use the arrow keys on the PC keyboard to change the level and frequency of the tone. Use the

“L” and “R” keys on the PC keyboard to switch between earphones.

Press the patient response switch and ensure that the “Response” icon in the Otosure window changes

colour to light green and returns to dark green when the switch is released.

D-0116492-B (OM022) –Otosure Operating Manual

The above will demonstrate the basic functionality of the audiometer. When closing the Otosure window

remember to use the “Edit > Cancel Insert/Edit” option or cancel toolbar button in Audibase to cancel the test

operation.

D-0116492-B (OM022) –Otosure Operating Manual

5.USING THE OTOSURE

5.1. EQUIPMENT PREPARATION

Connect the headset and the patient response switch to the Otosure and then make the connection from the

Otosure to the PC. No specific warm-up time is required although the device registration to the PC might

take a short time to complete.

5.2. STARTING THE SOFTWARE

Start the Audibase application, and with reference to the user manual either establish a new a patient, or

access and display details of an existing patient.

Use the left mouse button to click on the Launch Test icon in the Audibase toolbar.

Alternatively use the “Test > Launch Test” drop-down menu selection at the top of the Audibase window.

A new window will open for the Otosure software. If the patient has more than one set of audiometric results

stored in Audibase the most recent audiogram is transferred and displayed in the Otosure window.

The serial number and calibration date of the connected Otosure audiometer is shown at the bottom right of

the Otosure window along with the test type currently selected.

The test type last used is remembered; if this was a manual test the procedures may be followed; if this was

an automatic test the following dialogue box will be displayed:

To run the same automatic test using the same options (as last used)

simply click the “Start test” button and the test will commence.

If a manual test is required, or if the test options are to be modified,

click the “Modify” button which will close the dialogue box.

5.3. AVAILABLE TEST MODES

5.3.1. MANUAL TESTING

This allows the operator to use the Otosure to record hearing level thresholds using the computer’s keyboard

and mouse. The resulting audiometric data may then be transferred to the Audibase application.

5.3.2. COMPUTER TESTING

This is a method of automatic audiometry based on the Hughson and Westlake method and undertaken

automatically by the instrument. The level is increased in 5dB steps until a response is obtained from the

patient and decreased in 10 dB steps until no response occurs. The process is repeated until, depending

upon the criteria selected for recording a threshold, the instrument will record a threshold at that particular

frequency. The Otosure then continues to the next test frequency and so on to complete the test on both

ears.

D-0116492-B (OM022) –Otosure Operating Manual

The Otosure provides the facility to run this test at specified single frequencies and add the results into the

overall audiogram result. This feature is useful for situations where one particular

frequency has proved problematic.

5.3.3. MIXED TESTING

This is typically used when the automatic test has been unable to yield a threshold at one or more

frequencies. It is possible to perform a manual test (normally at just a few selected frequencies) to complete

an audiogram by adding thresholds to those already established.

5.4. INITIATING A TEST