Interacoustics AA222 Installation manual

Additional Information
AA222
Impedance Audiometer
D-0115567-C – 2017/11

Table of contents
1About the AA222.............................................................................................................................. 1
2General operation of the tympanometry module ....................................................................... 3
2.1 Preparing for the tympanometry test .................................................................................. 3
2.1.1 Tympanometry patient instruction.......................................................................... 3
2.1.2 Visual inspection of the ear canal.......................................................................... 3
2.1.3 Placement of the contralateral phone.................................................................... 4
2.1.4 Selecting the correct ear tip ................................................................................... 4
2.2 Tympanometry.................................................................................................................... 5
2.3 Reflex.................................................................................................................................. 7
2.4 Reflex decay....................................................................................................................... 9
2.5 Reflex latency ................................................................................................................... 10
2.6 Eustachian tube function – non-perforated eardrum ........................................................ 11
2.8 Eustachian tube function – perforated eardrum ............................................................... 12
2.9 Eustachian tube function – patulous eustachian tube...................................................... 13
3General operation of the Audiometry module.......................................................................... 15
3.1 Pure tone audiometry........................................................................................................ 15
3.1.1 Masking................................................................................................................ 15
3.2 Weber................................................................................................................................ 15
3.3 Stenger ............................................................................................................................. 15
3.4 Auto – Hughson-Westlake................................................................................................ 15
3.5 Alternate binaural loudness balancing (ABLB) – Fowler Test.......................................... 15
3.6 Speech audiometry........................................................................................................... 15
3.7 QuickSIN – Quick signal in noise testing.......................................................................... 15
3.8 Short increment sensitivity index (SISI)............................................................................ 15
4Setup menu .................................................................................................................................. 17
4.1 Instrument settings............................................................................................................ 17
4.2 Tympanometry setup menu.............................................................................................. 20
4.2.1 Common settings – IMP....................................................................................... 20
4.2.2 Protocol settings................................................................................................... 20
4.2.3 Manage protocol settings..................................................................................... 33
4.3 Audiometry setup menu.................................................................................................... 34
4.3.1 Common settings - AUD ...................................................................................... 34
4.3.2 Working with user-defined setups (test protocols)............................................... 36
4.3.3 Tone settings........................................................................................................ 36
4.3.4 Speech settings.................................................................................................... 39
4.3.5 Auto settings ........................................................................................................ 41
5Diagnostic suite........................................................................................................................... 43
5.1 Transferring a custom symbol scheme from the suite to the device ................................ 43
6Operating through a database ................................................................................................... 45
6.1 OtoAccessTM ..................................................................................................................... 45
6.1.1 Upload clients to the device and save the measurements to the clients............. 45
6.1.2 Download the client information to one patient.................................................... 45
6.2 NOAH................................................................................................................................ 45
6.2.1 Download the client information to a patient using NOAH................................... 45
7Print............................................................................................................................................... 47
7.1 Printer direct...................................................................................................................... 47
7.1.1 Installing the direct printer.................................................................................... 47
7.1.2 Modify the custom logo printout........................................................................... 47

7.1.3 Modify the custom logo printout witout PC connection........................................ 47
7.1.4 Printing from a direct printer................................................................................. 49
7.2 MPTIII (thermal printer)..................................................................................................... 49
7.2.1 Installing the Sanibel MPT-III thermal printer....................................................... 49
7.2.2 Modify the custom logo printout........................................................................... 49
7.2.3 Printing from the MPT-III thermal printer.............................................................. 50
7.3 Print Wizard (Diagnostic suite only).................................................................................. 51
7.3.1 Opening the Print Wizard..................................................................................... 51
7.3.2 Print Wizard elements.......................................................................................... 52
7.3.3 Designing a customised print template................................................................ 53
7.3.4 Taskbar................................................................................................................ 54
7.3.5 Design elements .................................................................................................. 55
7.3.6 Saving your print template ................................................................................... 69
7.3.7 Editing a print template prior to printing............................................................... 70

AA222 Additional Information Page 1
1About the AA222
The AA222 is a device combining audiometry and tympanometry. The target population for the AA222
covers all ages. The AA222 is designed to be used only by skilled personnel such as audiologists, ENT
surgeons, doctors, hearing healthcare professionals or personnel with a similar type and level of education.
The device should not be used without the necessary knowledge and training to understand its usage and
how results should be interpreted.
Availability of the tests listed below, or specific settings within these tests on the hardware or in the software,
depends on the license purchased.
The Audiometry module contains the following tests:
Pure tone audiometry
Weber
Stenger
Auto: Hughson-Westlake
Alternate binaural loudness balancing (ABLB)
Tone in noise (Langenbeck)
Speech
QuickSIN
Short increment sensitivity index (SISI)
The Tympanometry module contains the following tests:
Tympanometry 226, 678, 800 and 1000 Hz
Ipsilateral reflexes
Contralateral reflexes
Reflex decay
Reflex latency
Eustachian tube function – non-perforated
Eustachian tube function – perforated
Eustachian tube function – patulous

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2General operation of the tympanometry
module
2.1 Preparing for the tympanometry test
2.1.1 Tympanometry patient instruction
Place the patient on a comfortable chair or, if necessary, on an examination table. Younger children may feel
more comfortable sitting on a parent's or nurse's lap. Show the probe to the patient and then explain the
following:
•The aim of the test is to assess the mobility of the eardrum
•The tip of the probe will be inserted into the ear canal and has to make a perfect seal
•A small amount of air will flow through the probe to move the eardrum; it produces a sensation
similar to pressing a finger slightly into the ear canal
•One or more tones will be heard during the test
•No active participation is expected from the patient
•Coughing, talking and swallowing will disturb test results
2.1.2 Visual inspection of the ear canal
Check the external ear canal for wax with an otoscope and remove any excessive wax to prevent the probe
opening from clogging, as this would inhibit testing. Excessive hairs may have to be cut.

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2.1.3 Placement of the contralateral phone
If the contra headphone is used, place the headband over the patient's head. The audiometric headphone is
placed over the non-test ear (or contralateral reflex ear).
If the insert phone is used, mount the proper foam tip on the end of the tubing before inserting into the non-
test ear.
2.1.4 Selecting the correct ear tip
The table below can be used as a guide to help you select an appropriate ear tip size.

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2.2 Tympanometry
The default display of tympanometry tests shows graphs for both left and right ear. The following information
is found in the display:
A
The label above the graph indicates which probe tone frequency was used while measuring the
recording that is plotted.
B
The normative box which shows where the peak of the audiogram is expected in normal middle ear
functioning. The size of the normative box can be customized in the protocol setup. Be aware that
the placement of the normative box is dependent on the ear canal volume. This means that when
the curves are shown in non-compensated view, the box will only be placed correctly after the ear
canal volume has been determined.
C
The tympanometry curve(s). The numerical values of the curve should be read from the left Y-axis.
For tympanometry performed at 226 Hz the scaling is in ml. For all other probe frequencies, the unit
at the Y-axis is mmho.
D
The equivalent ear canal volume. In automated tympanometry, the acoustic admittance (Y) at the
start pressure is taken as the reference value. In manually performed tympanometry, it takes the
acoustic admittance at the highest recorded pressure as a reference. Be aware that at probe
frequencies other than 226 Hz, the equivalent ear canal volume is read from right Y.
E
The table with measurement values. Here you will find:
•Volume, the equivalent ear canal volume
•Compliance, the peak compensated static acoustic admittance. When the tympanogram is
shown compensated for the ear canal volume, it is the compliance value at the peak
•Pressure, the tympanic peak pressure which is at the point of the curve where the highest
compliance value is detected
•Gradient,If it is chosen to show gradient as pressure, it gives the tympanogram width at
half the height of the peak compensated static acoustic admittance. If it is chosen to show
gradient as compliance, it gives the average of the two compensated admittance values
which are 50 daPa away from the peak pressure
If the automated measurement for some reason does not reach the end pressure as set in the
protocol setup, the table will only show the equivalent ear canal volume.

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Manual tympanometry testing
F
The dot represents the measurement of the (non-compensated) acoustic admittance. It is only
shown when not recording. During recording, the display will always be non-compensated.
G
The empty triangle indicates actual pressure.
H
The full triangle is the pressure cursor showing the current target pressure. It is moved by turning the
wheel.

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2.3 Reflex
Note that in cases where your protocol has no reflex test included, you can temporarily include a reflex test in
your protocol by pressing the I Reflex C button.
The default displays of reflex tests show a matrix of reflexes, which are measured in the order of appearance
on the screen. The following information is found in the display:
A
The reflex matrix shows graphs of equal stimulus types in the rows and equal stimulus levels in the
columns. Note that scroll bars appear when more stimuli are available than can fit on the screen.
B
Within the graph, the x-axis is the time scale on which the black bar indicates when the stimulus
was given.
C
A green square indicates that the reflex threshold is set (either automatically or manually) at the
chosen stimulus level.
D
The Deflection value is shown when this option is activated through the protocol settings.
E
A grey square indicates a stimulus level that is not available for that particular stimulus type.
F
The square outlined in black indicates which section of the matrix has been selected or is currently
being measured.
Note that the reflexes are indicated by the probe ear. This is shown as an example below.
In the first setup, the probe is placed on the right ear and the contra headphone is placed on the left ear.

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In the second setup, the probe is placed in the left ear with the contra headphone placed on the right ear.

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2.4 Reflex decay
Note that in cases where your protocol has no reflex decay test included, you can temporarily include a reflex
decay test in your protocol by holding the Shift button while pressing the I Reflex C button. Pressing this
combination also allows including and excluding a reflex decay test from running automatically.
The decay test will be automatically performed with an activator intensity of 10 dB above the reflex threshold.
The test will show a pop-up and ask for the intensity of the activator in case:
•the reflex threshold cannot be found within the same protocol
•the required intensity is at or above the warning level as determined in the protocol settings
•the required intensity is above the maximum level that the transducer will permit for this particular
activator
The default display of the reflex decay tests shows the graphs of the decay measurements from the selected
ear. The following information is found in the display:
A
The tympanometric curve.
B
Within the graph, the x-axis is the time scale on which the black bar indicates when the stimulus was
given.
C
The table with measurement values which are only calculated if the measurement can be completed.
•Level, stimulus level.
•Pressure, the pressure at which the decay reflex is measured. Usually the decay test will be
set up to use the peak pressure of a preceding tympanogram.
•Stimulus, stimulus frequency.
•Decay value, the percentage difference of the two reflex deflection values taken half a
second after the stimulus started and half a second before the stimulus stopped. If decay is
present, the percentage shows as a negative number. When the calculation results in
numbers larger than 125 % or smaller than -115 % the outcome is invalid and will not be
shown.

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2.5 Reflex latency
The reflex latency test will be automatically performed with an activator intensity of 10 dB above the reflex
threshold. The test will show a pop-up and ask for the intensity of the activator in case:
•the reflex threshold cannot be found within the same protocol
•the required intensity is at or above the warning level as determined in the protocol settings
•the required intensity is above the maximum intensity that the transducer will permit for this particular
activator.
The default display of the reflex latency test shows the graphs of the latency measurements from the
selected ear. The following information is found in the display:
A
The first 300 ms of the tympanometric curve.
B
The table with measurement values which are only calculated if the measurement can be
completed.
•Level, stimulus level
•Pressure, the pressure at which the decay reflex is measured. Usually the decay test will
be set up to use the peak pressure of a preceding tympanogram
•Stimulus, stimulus frequency
•Latency value, the time interval between onset of the stimulus and the point where 10 % of
the reflex deflection value is reached. The reflex deflection value is measured as the
average of the deflection between 250 and 300 ms after stimulus onset

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2.6 Eustachian tube function – non-perforated eardrum
The display of the Eustachian tube function test for the non-perforated eardrum shows graphs for the
selected ear in which the three tympanograms of the adapted Williams procedure are plotted. The Williams
procedure keeps the pressure between the first and second tympanogram at the stop pressure, and between
the second and third tympanogram at the start pressure. In between all tympanograms, the original Williams
procedure involves asking the patient to swallow. In order to achieve a larger displacement in the
tympanograms, we advise asking the patient to perform a Valsalva maneuver after the first tympanogram,
then swallowing after the second tympanogram.
The following information is available during testing:
A
The non-compensated tympanometric curves.
B
The equivalent ear canal volume where the acoustic admittance (Y) at the starting pressure of the
first tympanogram is taken as the reference value.
C
The table shows the pressure values at which the three peaks are detected (or the highest
equivalent volume if there is no peak).
An instruction is displayed between the three tympanograms to tell you how to direct the patient. To
continue, press either Continue or Enter.

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2.8 Eustachian tube function – perforated eardrum
The default display of the Eustachian tube function test for a perforated eardrum shows a graph for the
selected ear. The following information is available during testing:
A
The pressure curve showing that the pressure drops each time the patient swallows. Notice that an
exponential release of pressure means that the probe sealing might not be sufficient.
Before the measurement starts, an instruction is displayed to tell you how to direct the patient. To
continue, press either Continue or Enter.

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2.9 Eustachian tube function – patulous eustachian tube
The patulous Eustachian tube test is an impedance baseline test. It monitors changes in impedance over
time without applying pressure changes or acoustic stimuli. When a patulous Eustachian tube is present you
would typically expect to identify the breathing of the patient in the tympanometric curve. If the Eustachian
tube is closed and the tympanic membrane is intact, you would expect to measure small tympanometric
changes which can be caused by acoustic disturbances from around the patient, accidental displacements of
the probe, or by spontaneous movements of the eardrum. Additionally, it is possible to measure movements
due to the heartbeat as, for example, with a glomus tumor. Or the test can be used to measure reflexes
where the stimulus is presented through an external device such as a cochlear implant.
The default display of the Eustachian tube function test for the patulous Eustachian tube shows the graph for
the selected ear. Below is a real example of a measurement in which the breathing rhythm of the patient can
be recognized due to the presence of a patulous Eustachian tube.

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3General operation of the Audiometry module
3.1 Pure tone audiometry
Please refer to the quick guide ‘Tone Audiometry’ (D-0113813)
3.1.1 Masking
Please refer to the quick guide ‘Audiometric masking’ (D-0113988)
3.2 Weber
Please refer to the quick guide ‘Weber’ (D-0113814)
3.3 Stenger
Please refer to the quick guide ‘Stenger’ (D-0113811)
3.4 Auto – Hughson-Westlake
Please refer to the quick guide ‘Hughson-Westlake’ (D-0113805)
3.5 Alternate binaural loudness balancing (ABLB) – Fowler Test
Please refer to the quick guide ‘Alternate Binaural Loudness Balancing (ABLB)’ (D-0113803)
3.6 Speech audiometry
Please refer to the quick guide ‘ Speech Audiometry’ (D-0113990)
3.7 QuickSIN – Quick signal in noise testing
Please refer to the quick guide ‘QuickSIN’ (D-0113808)
3.8 Short increment sensitivity index (SISI)
Please refer to the quick guide ‘Short Increment Sensitivity Index‘ (D-0113810)

AA222 Additional Information Page 16