Interacoustics Titan User manual

Titan –DPOAE
Operating Manual
80655281 ver. 06/2011

Table of contents
1Introduction ............................................................................................................................... 5
1.1 Introduction......................................................................................................................... 5
2Getting Started .......................................................................................................................... 7
2.1 Preparing for the Test......................................................................................................... 7
2.1.1 DPOAE patient Instruction ............................................................................................. 7
2.1.2 Visual inspection of the ear canal................................................................................... 7
2.2 Starting from OtoAccess™................................................................................................. 7
2.3 Starting from Noah3 ........................................................................................................... 8
2.4 PC Controlled Operation via Bluetooth .............................................................................. 9
2.5.1 Main Tab Menu Structure............................................................................................. 10
2.5.2 Uploading Client Information to the Hardware (OtoAccess™ & Noah3)...................... 11
2.5.3 Downloading data from the Titan to OtoAccess™ & Noah3 ........................................ 12
3Distortion Product OAE PC Controlled................................................................................. 15
3.1 General Operation in DPOAE .......................................................................................... 15
3.2 General Operation in between and during DPOAE Testing............................................. 17
3.2.1 Probe Check................................................................................................................. 17
3.2.2 DP-Gram bar view........................................................................................................ 19
3.2.3 DP-Gram graph view.................................................................................................... 20
3.2.4 DP-I/O (DP-Input/Output)............................................................................................. 22
3.2.5 Response & Zoom graph ............................................................................................. 23
3.2.6 Probe Status & Stimuli Tolerance ................................................................................ 24
3.4 User Guide ....................................................................................................................... 25
3.5 Temporary Setup.............................................................................................................. 26
3.6 Norm Data setup .............................................................................................................. 27
4Handheld Use of the Titan...................................................................................................... 29
4.1 Titan - Operation Panel Dictionary................................................................................... 29
4.2 Getting Started ................................................................................................................. 29
4.3 Probe Status Indication .................................................................................................... 30
4.4 Operating Titan................................................................................................................. 30
4.4.1 Test............................................................................................................................... 31
4.4.2 Done............................................................................................................................. 32
4.4.3 Select Client & Save..................................................................................................... 33
4.4.4 Edit New ....................................................................................................................... 33
4.4.5 View Clients.................................................................................................................. 34
4.4.6 View Details.................................................................................................................. 34
4.4.7 Edit Details ................................................................................................................... 34
4.4.8 View Sessions .............................................................................................................. 35
4.4.9 View Session................................................................................................................ 35
4.4.10 Select Protocol ......................................................................................................... 36
4.4.11 Setup ........................................................................................................................ 36
4.4.11.1 Language… ...................................................................................................... 36
4.4.11.2 Date & Time… .................................................................................................. 36
4.4.11.3 Titan… .............................................................................................................. 37
4.4.11.4 Printer…............................................................................................................ 37
4.4.11.5 Clinic Info… ...................................................................................................... 37
4.4.11.6 License….......................................................................................................... 37
4.4.11.7 About…............................................................................................................. 38

5Protocol Setup......................................................................................................................... 41
5.1 DPOAE Protocol Setup .................................................................................................... 41
5.1.1 DP-Gram Test Settings ................................................................................................ 42
5.1.2 Common Test Settings for a DP-Gram Test ................................................................ 44
5.1.2.1 Stop criteria .......................................................................................................... 44
5.1.3 DP-I/O Settings............................................................................................................. 47
5.1.4 Common Test Settings for a DP-I/O Test..................................................................... 48
5.1.4.1 Stop criteria .......................................................................................................... 48
5.2 Renaming a Protocol........................................................................................................ 51
5.3 Deleting a Protocol........................................................................................................... 52
5.4 Exporting a Protocol......................................................................................................... 53
5.5 Importing a Protocol ......................................................................................................... 54
5.6 Transferring Protocols to Titan......................................................................................... 55
5.7 Show/hide Protocols in Titan Suite................................................................................... 57
5.8 Changing and using password protection........................................................................ 58
6Printing and making reports.................................................................................................. 59
6.1 Using the Thermal Printer ................................................................................................ 59
6.2 The Print Wizard............................................................................................................... 59
6.2.1 Designing a Customized Print Template...................................................................... 61
6.2.2 Design Elements .......................................................................................................... 62
6.3 Creating Reports .............................................................................................................. 69
6.3.1 Operation of the Report Editor ..................................................................................... 69
7FAQ/Troubleshooting ............................................................................................................. 73
8Part List.................................................................................................................................... 75

Titan DPOAE Operating Manual Page 5
1Introduction
1.1 Introduction
The Titan with DPOAE440 is intended for use in the diagnostic audiologic evaluation and
documentation of ear disorders using Distortion Product Otoacoustic Emissions. The target
population for Titan with DPOAE440 includes all ages.
The Titan with DPOAE440 is designed to be used only by skilled personnel such as audiologists,
ENT surgeons, doctors, hearing healthcare professionals or personnel with a similar level of
education. The device should not be used without the necessary knowledge and training to
understand its use and how results should be interpreted.
The following sections of the Operation Manual will guide you through PC controlled and Handheld
Use of the Titan with DPOAE440.
Please refer to the Titan Setup and Installation Manual for information relating to hardware setup,
installation of software, safety information and technical information.

Titan DPOAE Operating Manual Page 6

Titan DPOAE Operating Manual Page 7
2Getting Started
2.1 Preparing for the Test
2.1.1 DPOAE patient Instruction
Place the patient on a comfortable chair or on an examination table if necessary. Small 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 screen the hearing organ for its functionality.
The tip of the probe will be inserted into the ear canal and has to make a good seal.
Multiple tones will be heard during the test.
No 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 excessive wax to prevent the
probe opening from clogging which will inhibit testing. Excessive hairs may have to be cut.
2.2 Starting from OtoAccess™
To start the Titan Suite from OtoAccess™:
1. Open OtoAccess™
2. Select the patient you want to work with by highlighting it blue
3. If the patient is not yet listed:
-press the New client button
-fill in at least the mandatory fields, marked with a red asterisk.
-save the patient details by pressing the Save patient information button.
4. Double click on the Titan Suite in the Select Instrument box.
Now the Titan Suite will open and automatically search for the hardware. If it does not detect the
hardware a dialog box pops up and asks if you want to run the Titan Suite in Simulation mode. To
continue with the use of hardware,
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5. Switch the Titan on by pressing the or button.
6. Check if the Titan is correctly connected to the PC through correct placement in the cradle
or direct connection using a USB cable.
For further instructions about working with the database, please see the operation manual for
OtoAccess™.
2.3 Starting from Noah3
The functionality of the Titan Suite differs when running from Noah3 in comparison to running from
OtoAccess™. When running from Noah3 you are only able to upload the selected client details to
the Titan (one patient at a time). In addition, when you are downloading sessions to the database
you can only download sessions to the patient which has been selected in Noah3.
To start the Titan Suite from Noah3:
1. Open Noah3
2. Search for and select the patient you want to work with. The screen will change to show
the saved sessions of the selected patient.
3. If the patient is not yet listed:
-press the New client button
-fill in the required fields and click on Work with Client
4. Open the Module selection dialog box, enter the Measurement tab and double click on
the Titan Suite icon.
Now the Titan Suite will open and automatically search for the hardware. If it does not detect the
hardware a dialog box pops up and asks if you want to run the Titan Suite in Simulation mode. To
continue with the use of the hardware:
5. Switch the Titan on by pressing the or button.
6. Check if the Titan is correctly connected to the PC through correct placement in the cradle
or direct connection using a USB cable.
For further instructions about working with the database, please see the operation manual for
Noah3.
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2.4 PC Controlled Operation via Bluetooth
Instead of using a USB connection with the Titan you are able to make PC operated
measurements while connecting via Bluetooth. In order to do so, first make sure that your PC
allows the use of Bluetooth and that it is switched on.
Secondly, check that your Titan is setup to use its Bluetooth for connecting to a PC (and not to a
printer). This is done by switching on the hand held unit and pressing Protocol | My Titan | Titan…
Item Bluetooth connection should be set to “PC”.
Now start up the Titan Suite without having the Titan connected via a USB cable. The message
below will pop up and the software will automatically start searching for Bluetooth devices. As soon
as a Titan is found it will show a button with its serial number (which can be viewed from the
Protocol | My Titan | Setup | License… screen). Press the button to initialize the Bluetooth
connection.
With a proper Bluetooth connection the message disappears and the Titan will show “PC
Controlled” on its screen.
If the button grays out after pressing it, check the following:
-Is your Titan within a reasonable range of your PC?
-Is your Titan still switched on?
-Does your Titan match the serial number?
-Is the Titan setup to use its Bluetooth for a PC connection (instead of a printer)?
For further instructions on setting up a Bluetooth connection, please refer to the User Guide at the
end of the Titan Setup and Installation Manual.

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2.5 Operations from the Main Tab
When the Titan Suite is started it opens in the Main tab. From here you have the option to access
Client Upload or Session Download screens. On startup, the Main tab always opens with the
Start screen.
2.5.1 Main Tab Menu Structure
When selecting Menu from the Main tab you will find the following options:
Menu | Setup | Hardware protocols takes you to a window from where you can maintain
the protocols which are available on the Titan hand held unit.
Menu | Setup | Language allows selection of one of the available languages. The
language selection change will come into effect after the Titan Suite is reopened.
Menu | Help | About suite… displays an information window showing the following:
oTitan Suite Version
oHardware Version
oFirmware Version
oCopyright Interacoustics 2009
Further, you can reach the Interacoustics website from this window by clicking on the link
to www.interacoustics.com
By pressing the License button you are able to change the license keys of the Titan Suite.
The license keys for the Titan are specific for each serial number and define which
modules, tests, protocol settings and other functionalities are available. Never change the
license key without help of an authorized technician.
The Check for software updates button allows you to check for software updates when
connected to the internet.
Menu | Help | Operation manual… launches a digital version of the Titan Operation
manual (Adobe Acrobat required).

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2.5.2 Uploading Client Information to the Hardware (OtoAccess™ & Noah3)
Before using the Titan in hand held mode, you can store names and other details of patients who
are expected for an assessment on the hardware. Patient data can be uploaded from either the
OtoAccess™ database or Noah3.
Noah3 behaves differently from the OtoAccess™ database and only allows you to add one client at
a time to the hardware. With the OtoAccess™ database, you can add multiple clients at a time.
To upload patient information from OtoAccess™:
1. Launch the OtoAccess™ database, select any client and start up the Titan Suite with the
Titan connected and switched on. Click on Client upload on the Main tab.
2. A list of available patients in OtoAccess™ is shown from which you can select the patients
you want to add to the hardware.
3. If your patient cannot easily be found, you can search in the OtoAccess™ database by
typing a query in the Search field and selecting the Field you wish to search in.
4. After selecting one or more patients, press Add to add the names to the Clients on
hardware.
5. If you want to change the order in which the patients appear on the hardware, select a
patient in the Client on hardware list and use the up and down arrows to move them in the
list.
6. Press Save to Hardware to store the patient data on the hardware.
7. To remove a patient from the hardware, highlight it in the Clients on hardware list and click
on Remove.

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To upload patient information from Noah3:
1. Open Noah3. Make sure the Titan is connected and switched on.
2. Search for and select the patient from the Client Register screen whose details you want
to upload to the Titan hardware. The screen will change to show the saved sessions of the
selected patient.
3. Open the Module Selection dialog box, go to the Measurement tab and double click on
the Titan Suite icon.
4. After the Titan Suite has opened in the Main tab, click on the icon for Client upload.
5. The single selected patient details from Noah3 will appear in the Client search list.
6. Press the Add button to add the patient‟s details to the Titan hardware.
7. If you want to change the order in which the patients appear on the hardware, select a
patient in the Client on hardware list and use the up and down arrows to move them in
the list.
8. Press Save to Hardware to store the patient data on the hardware.
9. Repeat steps 2 to 8 for all other patients you wish to upload to the hardware.
10. To remove a patient from the hardware, highlight it in the Clients on hardware list and
click on Remove.
2.5.3 Downloading data from the Titan to OtoAccess™ & Noah3
After using the Titan in the hand held mode, saved data can be transferred and stored in the
OtoAccess™ or Noah3 database. Follow these steps in order to download saved sessions from the
hardware:
To download patient information to OtoAccess™:
1. Launch the OtoAccess™ database and select any patient in the list.
2. Start up the Titan Suite with the Titan connected and switched on. Press the Session
Download icon on the Main tab.
3. A list of stored sessions will automatically be shown. Underneath the Copy to PC header,
select which sessions you would like to copy to the OtoAccess™ database.
4. Press Download.
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5. Patient sessions which were already linked to a patient from OtoAccess™ are
automatically downloaded without prompting.
In the instance where you have patients (e.g, No Name 1) stored on the handheld unit that are not
linked to patients in the OtoAccess™database, the Client not known in database window will pop
up (see figure below). Here you are prompted to link sessions to patients in OtoAccess™. Continue
the downloading process in the Client not known in database window as described below. For
each Unknown client the generic name (A) and the sessions (B) stored for that patient are listed
on the screen.
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1. From the Select client target in database list you can select the patient to which you want
to store these sessions.
2. If your patient is not in the list you can search in the OtoAccess™ database by selecting
the Field you wish to search in and typing a query in the Search field.
3. Once the correct patient is selected, press Save to store the session in OtoAccess™.
4. If the patient details are not yet stored in OtoAccess™, press the Enter new patient button
to create a new patient in OtoAccess™. When the New client data window pops up, enter
the relevant patient details and press OK to save the session to this new patient or press
Cancel to abort.
5. The process will now continue for the remaining sessions you have selected to copy to
OtoAccess™. After the last session is stored, the window will close.
6. Pressing the Skip this Client button skips the patient and sessions shown on screen and
progresses to the next patient selected from the Copy to PC list. Sessions for the skipped
patient are not saved to OtoAccess™, but will remain on the handheld unit.
After the download process is finished, a confirmation pop up will appear to indicate that the
procedure was successful. Press OK to close the confirmation window. The Status of download
column will now be updated to show which sessions were downloaded. In the Copy to PC column,
the checkboxes for the downloaded sessions will now be grayed out to avoid downloading them
twice to the database. When the Titan is disconnected from your PC the download screen will be
reset.
To download patient information to Noah3:
When working through Noah, only one patient at a time can be selected in the database. As a
result you can only download a single patient session from the hand held unit at a time.
1. Open Noah3. Make sure the Titan is connected and switched on.
2. Search for and select the patient from the Client Register screen who you want to
download the saved session to from the handheld unit. The screen will change to show the
saved sessions of the selected patient.
3. Open the Module Selection dialog box, go to the Measurement tab and double click on
the Titan Suite icon.
4. Press the Session Download icon on the Main tab.
5. A list of stored sessions will automatically be shown. Underneath the Copy to PC header,
select which sessions you would like to copy to the Noah client you are working with.
6. Press Download.
7. Repeat the above process for all sessions to be transferred from the handheld unit to the
Noah database.
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3Distortion Product OAE PC Controlled
3.1 General Operation in DPOAE
The following operations are available on the DPOAE tab of the Titan Suite:
1. Menu to go to Setup, Print, Edit or Help. The menu
has the following structure:
Menu | Setup | Protocol setup…to enter the
Titan Setup where the settings of DPOAE
protocols can be viewed and changed. If data
is measured before you enter the protocol
setup, you are prompted to save or discard the
data.
Menu | Setup | Temporary setup…to enter
the protocol settings and make changes which
are only valid during the current session. If
temporary changes are made to a protocol, its
name appears ending with an asterisk. If data
is measured before you enter temporary setup
you are prompted to save or discard the data.
In temporary setup the same options are
available as in the normal protocol settings.
Menu | Setup | Show/hide protocols… to
enter the setup where you can chose to show
or hide protocols from the protocol dropdown
list for PC controlled measurements.
Menu | Setup | General setup…. to enter the
DPOAE general setup where you can set norm
data preferences, icons to be shown on the
graphs, the default start ear and view session
options.
Menu | Setup | User guide setup… to edit
the pictures and instructions displayed in the
user guide.
Menu | Setup | Norm data setup… to enter
the setup where norm data can be entered.
The norm data range can be displayed on the
DP-Gram as an indication at which levels
OAEs are normally expected.
Menu | Setup | Password protection... to
change and/or activate password protection for
the complete Titan Suite. When activated
users cannot enter the Protocol setup or
User guide setup.
Menu | Setup | Unlock protection…to
temporarily disable password protection.
Menu | Setup | Language to change the
language used in the software.
Menu | Print | Print… to print the current
measurement using the print template that is
linked to the current protocol. You will enter the
print window from where you can select your
printer and change settings before printing.
Note that you are prompted to select a
template if the protocol did not include a template.
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Menu | Print | Print preview…to see a print preview of the current measurement
using the print template that is linked to the current protocol. Note that you are
prompted to select a template if the protocol did not include a template.
Menu | Print | Print wizard…to open the print wizard window from where you can
select a template to print the current measurement.
Menu | Edit | Export… to export the current measurement to an XML file.
Menu | Help | About… brings you to an information window which displays the
following:
oTitan Suite version
oHardware version
oFirmware version
oCopyright Interacoustics 2009
Further, you can reach the Interacoustics website by pressing the link to
www.interacoustics.com
By pressing the License button you are able to change the license keys of the
Titan Suite. The license keys for the Titan are specific for each serial number and
define which modules, tests, protocol settings and other functionalities are
available. Never change the license key without help of an authorized technician.
The Check for software updates button allows you to check for software updates
when connected to the internet.
Menu | Help | Operation manual… to open the digital version of this manual.
2. The Guidance button opens the user guide which shows instructions for testing within the
DPOAE module. The guidance can be personalized in the User guide setup window.
3. Print button to print current viewed results directly to your default printer. Note that you
are prompted to select a print template if the protocol is not linked to a template yet.
4. Save & New Session icon to save the current measurements to your database (or to a
commonly used XML file when running in standalone mode) and start a new session,
ready for testing.
5. Save & Exit button to save current measurements to your database (or to a commonly
used XML file when running in standalone mode) and to close the Titan Suite.
6. Toggle Ear button to change from right to left ear and vice versa.
7. Toggle probe check/response view button allows you to toggle between viewing the
probe check information or the response graph. The probe check graph is only updated
before and in between testing. The response view shows the raw data of the DPOAE
measurements.
8. Protocol drop down menu to select one of the available protocols.
9. Temporary setup to enter the protocol settings and make changes which are only valid
during the current session. If temporary changes are made to a protocol, its name appears
ending with an asterisk. If data is measured before you enter temporary setup you are
prompted to save or discard the data. In temporary setup the same options are available
as in the normal protocol settings.
10. Historic session drop down menu where earlier stored measurements can be chosen for
review.
11. Go to current session button becomes active while you are viewing a historic session and
returns you to the current session when clicked.
12. Probe status is shown by a colored bar with description next to it. It shows the color of the
selected ear as long as the status is Out of ear (blue for left and red for right). When the
probe is detected to be In Ear the color is green. When Blocked the colored bar appears
amber. When No probe is detected the indication is grey.
13. The Monaural/Binaural view button toggles between showing the results of a single ear
or both ears.
14. The Report editor button opens a separate window for adding notes to the current
session. Remember that when saving the session this report is also saved to OtoAccess™
or Noah. After saving no changes to this report can be made.
15. Checking the Acceptable noise level Off box will disable the rejection of any recordings
even when there is too much noise in the recording.

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16. The Acceptable noise level slider allows setting the acceptable noise level limit between
-30 and +30 dB SPL above which recordings are considered to be too noisy. The VU meter
indicates the current noise level and becomes amber in color when exceeding the set level.
17. The Titan picture indicates that the software has detected the Titan hardware on startup
and is correctly connected. The Titan can be used in so called PC-controlled mode. If the
following picture is shown it means that you are running without the equipment connected,
called simulation mode:
18. Before testing, the Timer symbol indicates after how much time the DPOAE test will
automatically stop. During testing the timer counts down to zero. You can disable the
countdown by clicking on the timer during testing. As a result the timer will begin counting
up and indicate how much test time has passed. Then the test will continue until you
manually press stop.
19. The protocol listing shows all tests that are part of the selected protocol. The test that is
displayed in the test screen area is highlighted blue or red, depending on the chosen ear.
20. A checkmark in the box indicates that the test will run when START is pressed. During
testing the tests which have been completed will automatically become unchecked.
Uncheck the boxes of tests you do not wish to run under the selected protocol before
pressing START.
21. A white checkmark indicates that (at least some) data for this test is stored in the
memory.
22. START (and STOP) button are used for starting and stopping the session.
3.2 General Operation in between and during DPOAE
Testing
3.2.1 Probe Check
Interpreting probe check information from a graph is not always easy. Therefore the quality control
that is required to perform a proper DPOAE measurement is fully automated. In other words with
the Titan, it is not necessary to monitor probe check information yourself, but you are of course
welcome to do so. The following paragraphs give a few ideas about the information that can be
gained from the probe check graph.
To view the Probe check graph in the main display press the Toggle probe check/response
view button .
The stimulus that is used for the probe check is a broad band click. It is calibrated to give a
reasonably flat response between 200Hz and 8000Hz when measured by calibration equipment.
When presented in the ear and recorded by the probe microphone it typically results in a graphic
like the one shown below.

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It is generally said that when the best probe placement is achieved, the probe check will show a flat
response over a wide frequency area. However, because the probe microphone is used for this
monitoring, the intensities at the eardrum will be slightly different from those displayed on the
graph. Therefore a dip, like in this example, around 5 kHz is normal and represents the situation
measured at the end of the probe whereas at the eardrum the intensities are approximately the
same as for the other frequencies.
When monitoring the probe check graph you will normally also see noise that is being picked up by
the system. A probe that is slowly moving out of the ear can be recognized by the typical frequency
dip moving to a lower frequency range.
Below an example is shown for the adult ear where the probe has almost fallen out.
Looking at the low frequency area of the graph will also give you information about whether or not
the probe is in the ear.

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3.2.2 DP-Gram bar view
The DP-Gram can be shown in bar view or graph view. Your preference for these views is defined
in the protocol setup and can also temporarily be changed in the temporary settings.
The following information can be found in the DP-Gram bar view:

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1. The result can be labeled with Pass or Refer and is indicated above the measurement as
soon as the result is available. A user defined Pass/Refer criteria can be enabled within the
protocol setup. When Enable Pass/refer is used, if the measurement is stopped before
completion of the test, Incomplete will appear in the label.
2. The Bar representation shows the progress over time for each frequency measured in a
bar graph format. When a bar becomes completely filled and changes to green, it has
reached the stop criterion set in the protocol. Those bars that do not meet the stop
criterion will remain in the color of the selected ear (red or blue).
3. In addition, check marks above the green bars indicate that those frequencies have
reached their stop criterion. When a user defined Pass/refer protocol has been created,
although several bars might turn green it does not necessarily mean that it will result in a
pass. For example, within the protocol setup it can specified that particular frequencies are
mandatory for reaching an overall pass.
3.2.3 DP-Gram graph view
The DP-Gram can be shown in bar view or graph view. Your preference for these views is defined
in the protocol setup and can also temporarily be changed in the temporary settings.
The following information can be found in the DP-Gram graph view:
1. The result can be labeled with Pass or Refer and is indicated above the measurement as
soon as the result is available. A user defined Pass/Refer criteria can be enabled within the
protocol setup. When Enable Pass/refer is used, if the measurement is stopped before
completion of the test, Incomplete will appear in the label.
2. Each Measurement point shows the absolute DPOAE level in dB SPL as a function of
frequency. Selecting a measurement point by a left mouse click will show its details in the
Response & Zoom graph. Hovering the mouse over a measurement point allows you to
see the following details for that point:
- Measured indicates how many measurement samples were taken to get to the
current result.
- Rejected indicates how many samples were rejected due to too much noise.
- DP freq. refers to the frequency (in Hz) where the main DPOAE can be expected.
That is the 2f2-f1.
- DP S/N ratio indicates the difference between the absolute value of the DPOAE
and the noise floor around the DP freq. This difference is the signal to noise ratio.