MedRx Avant REM+ User manual

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D‐0125127‐C1
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D‐0125127‐C 2 
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0123
TÜVSÜDProductServicesGmbH
Ridlerstraße65◦80339Munich◦Germany
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www.medrx‐diagnostics.com
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1200StarkeyRd.,#105,Largo,FL33771U.S.A.
TollFree:(888)392‐1234•(727)584‐9600
Fax:(727)584‐9602•Email:medrx@medrx‐diagnostics.com
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MedRx'sAuthorizedRepresentativeinEurope
DGSDiagnosticsA/S
AudiometerAlle1•5500Middelfart•Denmark
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MedRx’sArchivedmanualsareavailableatwww.medrx‐diagnostics.com/support/manuals‐avant‐software/archive
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D‐0125127‐C3
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Contents
GettingtoKnowYourAVANTREM+.....................................................4
TransducersandAccessories.................................................................5
AlternateSpeakerOption......................................................................6
ProbeMicHangerInstallation...............................................................7
ConnectingtheSpeaker........................................................................8
TheMedRxStudioSoftwareOverview..................................................9
LiveSpeechMapping...........................................................................10
TopToolBar........................................................................................10
BottomToolBar..................................................................................11
GeneralLSMOptions...........................................................................12
PositioningtheSpeakers.....................................................................14
SpeakerCalibration.............................................................................14
ProbeTubeCalibration........................................................................15
Step‐by‐StepGuidetoLiveSpeechMapping......................................16
SpeechMappingwithRecordedInputs..............................................17
SpeechMappingwithLiveVoiceInputs..............................................18
RunningSpeechMapping“On‐Top”...................................................19
MedRxLiveSpeechMappingProtocol................................................19
RealEarMeasurements.......................................................................20
MedRxRealEarMeasuresProtocol....................................................21
AdditionalTests&Features.................................................................24
HowtoPerformtheRECDTask...........................................................25
MeasuringAcousticFeedback.............................................................26
HearingLossSimulator........................................................................27
MasterHearingAid..............................................................................27
Printing.................................................................................................29
RainbowPassage.................................................................................31
EMCPrecautions..................................................................................32
Safety...................................................................................................36
SymbolsThatMayBeUsed.................................................................37
RecommendedProceduresforCleaningandDisinfection..................38
TechnicalInformation..........................................................................39
LimitedWarranty.................................................................................40
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D‐0125127‐C4
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TheAVANTREM+isadevicethatisusedinmeasuringtherealearacoustical
characteristicsofhearinginstrumentsin‐situ.Thedeviceperforms
measurementsofrealearacousticalcharacteristicsofahearinginstrument
onagivenhumanear,anddoescomplywiththeInternationalStandardsANSI
S‐3.46andIEC61669.
Thismanualassumesthatthesystemhardware,softwareanddriversare
installedandworkingproperly.PleaserefertotheStudioSoftwareInstallation
Manualforassistance.TheInstallationManualisincludedintheoriginal
AVANTREMpackaginginbothprintedandPDFformats.
Thescopeofthismanualistogetyou“upandrunning”withyourAVANTREM
(RealEarMeasurement)System.PleaseconsulttheinteractiveHelpSystem
withinthesoftwareformoredetailedinformationoffeaturesand
functionality.Toaccessthistool,presstheF1keyatanytime,orclicktheHelp
iconortextmenuwithyourmouse.Accessthesebyclickingonthe“Help”tab
atthetopofthescreen,andselect“HelpTopics”.Selectanitemfromthelist
intheIndextabandclick“Display”.Measurementuncertaintyis+/‐1dB.
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GettingtoKnow
YourAVANTREM+
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IntendedUseStatement:
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Thehearingaidanalyzerisintendedtobeusedforthepurposesofcorrectly
configuringandprescribingtheaudiblesoundlevelsfromahearing
device/aid.Itisintendedtomeasuretheinternaleffectofsuchdeviceusing
smallandthinprobemicrophoneswhichcanbeplacedinthepatients’ear
canaltoallowthecliniciantoobjectivelyquantifythebenefitandeffectthe
devicehasonthepatientshearing.Thesemeasuresareusefulinthefitting
andprescriptionofacoustichearingaidsincorrespondencewiththe
informationacquiredduringthepatient’shearingassessment.
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TargetTreatedPopulation:
Thetargetpopulationforrealearmeasurementassessmentincludesallages.
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IndicationforUseStatement:
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Thehearingaidanalyzersaretobeusedbytrainedpersonnelonly,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.

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D‐0125127‐C5
TransducersandAccessories
UsetheaccessoriesprovidedwithyourREM+device.Useofunapprovedaccessoriesisnotrecommended.
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ProbeMicrophones
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ProbeMicHanger
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Headphones(Optional)
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DCPowerSupply
(Optional)
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BluetoothActiveSpeaker
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BluetoothSpeakerAudio
Cable
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USBCable
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DesktopActiveSpeakers
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BluetoothSpeakerPower
Supply
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D‐0125127‐C 6 
AlternateSpeakerOption
AVANTREMSpeech+
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Notice!TheRed&Blueadaptersareincludedandmustberemoved
toattach18gage(1.0mm)FreeFieldspeakerwiresandthenreinstalled.
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ToInstallFreeFieldSpeakerWires:
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UnplugboththeRed&Blueconnectors.
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Placeasmallflatheadscrewdriveronthesmallorangetabsandpush
downwhileinsertingaspeakerwireintotheopeningthenremovethe
screwdriver.Besurethewireissecure.
Repeatuntilallthespeakerwiresaresecuredthenplugbothconnectors
intothedeviceasindicatedabove.
A15V2ADCPowersupplyprovidedbyMedRxmustbeusedwhenusing
passiveFreeFieldspeakers.
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Screw
Driver
Screw
Driver

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D‐0125127‐C 7 
ProbeMicHangerInstallation
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1. YouwillneedthetwoProbeMics,theProbe
MicHangerandtheclip.
 
2. Installthehookonthebacksideoftheprobe
mic.Pullhookdowntoseatonthepost.
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3. OnceinstalledthelargeO‐ringsshouldbe
adjustableforfitting.
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4. Gentlypressclipintoplace.
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5. Turnclipover,placeprobemicwires
intoclip.
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6. Largerviewofclipwithwiresinserted.
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7. ProbeMicHangerinstallationassembly
complete.

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D‐0125127‐C8
ConnectingtheSpeaker
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Thefrontsideofthespeakerisplacedata
distanceofabout1meter(19”‐39”)fromthe
patient,fornormaluse.
Itispreferredtoplugthespeakerintothepower
supplybutitmaybepoweredbytheinternal
battery.TheBluetoothoptionisnotused.
Thespeaker’spowercableisaUSB“maleAto
micro‐Btype”.

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D‐0125127‐C9
TheMedRxStudioSoftware
Overview
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TheMedRxStudiosoftwarecanrunstand‐alone,fromNoahSystemor
theTIMSNoah‐CompatibleOfficeSystem.
LaunchingtheMedRxStudioSoftware
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StandAlone
DoubleclicktheMedRxStudioshortcutonyour
WindowsDesktop.
 
Noah
LaunchNoah.
Selectapatient.
LaunchMedRxStudiomodulefollowingNoah
procedures.
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BasicSoftwareOptions
Severaloptionsareavailablewhichallowtheusertocustomizethe
MedRxStudioSoftwaretomeettheirneeds.
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Accesstheseoptionsbyclickingthesettingswheelinthe
toprightmenubar.
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TheMedRxStudiosoftwaremainscreen.
Iconsareselectabledependingonyourequipment.

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D‐0125127‐C 10 
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The MainScreensettingsallowsyoutosetthedefaultmodules,
database,printtemplatesandmore.
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IfyouhavemorethanoneMedRxproductyoucanshow/hidemodules
intheMainScreensettings.
NOTE:Remember,moreinformationisalwaysavailableinthe
InteractiveHelpSystembyclickingthe“?”Iconinthetoprightcorner
ofthesoftwareorpressingtheF1key.
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LiveSpeechMapping


SelectLSMfromthemainmenu.
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TopToolBar 
TheToolBariconshavethefollowingfunctions:

1. On‐TopWindow
2. TubeCalibration
3. SpeakerCalibration
4. SaveSessionandExit
5. SaveSession
6. Print
7. ShowJournal
8. ShowSettings
9. ShowHelp
10. MoreOptions
TheMoreOptionsiconshavethefollowingfunctions:
1. Savethecurrentsessiontoafile
2. Opensessionfromafile
3. ClearDatafromCurrentTest
4. ProbeMonitor
5. MicrophoneCalibration

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D‐0125127‐C 11 
BottomToolBar 
TheBottomToolBariconshavethefollowingfunctions:___________________________________________________________________________
TheWrenchicon
displaysoptionsfor:
1.EarSelection
2.StimulusSelection
3.ViewingMode
4.OpenFitFunction
5.Start&StopButtons

TheTargetSelection
iconsetsup:
1.Targettype
2.Clientinformation
3.Hearingaidparameters

TheDisplayiconsets
upwhichtargetlines
todisplayonthe
measurementscreen.




NOTE:Rememberthatmore
informationisalwaysavailableinthe
InteractiveHelpSystembyclicking
theHelpIconorpressingtheF1key.

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D‐0125127‐C12
GeneralLSMOptions

Clickthesettingswheelinthetoprightmenubar.




TheLSMtabsetsyour
defaultviewanddefault
targetlevels.





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TheGeneraltabdefines
thedefaultappearanceof
theLiveSpeechMapping
testenvironment.
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TheFittingtabsetsthedefaultfittingrule,clientinformation,
outputandhearingaidparameters.
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TheFittingtabalsosetsdefaultNALorDSLdefaultsettings.


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D‐0125127‐C13
TheSignaltabsetsthesignalsdisplayedontheLiveSpeech
MappingScreen.


TheShownTeststabsetsthetestsdisplayedintheLive
SpeechMappingmodule.


TheREURtabsetsthedefaultappearanceandunitsdisplayed
ontheREURgraph.

TheREORtabsetsthedefaultappearanceandunitsdisplayed
ontheREORgraph.

ThePercentilestabsetsthedefaultappearanceand
percentilesdisplayedonthegraph..


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D‐0125127‐C 14 
Preparing for Testing
PositioningtheSpeakers



Properpositioningoftheloudspeakersrelativetothepatient’shearing
aidsiscriticalformakingaccurateandrepeatablemeasurements.Seat
thepatientsotheirearisbetween19and39inchesfromthe
loudspeaker.
Thespeakerisdesignedtositatdeskheight.WhenusingLiveSpeech
inputs,positionthepatientandloudspeakerasshownbelow.

SpeakerCalibration

OpentheSpeakerCalibrationscreen
byclickingtheSpeakericonfromthe
REM/LSMtopmenubar.



Thespeakershouldbepositionedinsuchawaythatnothingblocksthe
pathoftheemanatedsoundinfrontandonthesidesofthespeaker.
Forexample,positioningaspeakerbehindamonitorisincorrectand
canseverelyaffectitsresponseatthemeasurementlocation.The
speakerdiaphragmshouldbeataboutthesamelevelasthepatient's
earandthereferencemicrophone.
Placethereferencemicrophoneonthepatientabout1meterfromthe
speakers.
ClickonStarttobeginthecalibrationandwaituntilitends.Observe
theresponsecurvetoflattenitselfout.Thedarkercurveisshowingthe
responseusedbytheequalizationalgorithm,thelightercurveis
showingthecurrentmicrophoneinput.Useofthepoweredspeaker
suppliedwiththisdeviceisrecommended.



D‐0125127‐C 15 
ProbeTubeCalibration
  Forreasonsofinfectioncontroland
reliabilityofresults,MedRxrecommends
thatanewprobetubebeusedwitheach
patient.Toensureaccuratemeasurements,
itisnecessarytocalibratetheprobetube
eachtimeitisreplaced.
1. Placeanewprobetubeontheprobemicro‐
phoneportasshown.

2. Placetheprobetubebetweenthecalibration
nibsasshown.Besurethattheopeningofthe
probetubeiscenteredontheopeningofthe
referencemicrophone.


IntheMedRx
StudioLSM
software,
clickthe
ProbeTube
Calibration
icon.



Positionprobemicrophonebetween19and39inchesfromthe
loudspeakerandclickStartBothtorunsimultaneously.Thesignalmust
beatleast70dBtocompleteavalidcalibration.Ifthescreenprompt
indicatesthesignalistoolow,increasethevolumeontheloudspeaker
ormovethepatientcloserandrestartthecalibration.
Repeatfortheotherprobeifcalibratedoneatatime.Validcalibrations
havethesameapproximateshapeasthegraytargetcurve.Ifthe
measuredcalibrationcurvediffersgreatlyinshapeoramplitudefrom
thegraytargetcurve,checkorreplacetheprobetubeandre‐calibrate.
Ifthisdoesnotcorrecttheproblem,contactMedRxtechnicalsupportat
(888)392‐1234.

Thecalibrationvaluesareavailable
undertheCalibrationtopmenuicon.
ClicktheMoreOptionsicon(3dots)then
clicktheCalibrationicon.

ReturnProbeMicrophonestoMedRxforannualre‐calibration.Annualre‐calibration
oftheAvantREM+ProbeMicrophonesisrecommended.Therearenouserrepairable
componentsonthisdevice.




D‐0125127‐C 16 
Step-by-StepGuidetoLive
SpeechMapping
EnsurethattheAudiogramisentered
BeforemakingLiveSpeechMappingmeasurements,thepatient’spure
toneaudiogrammustbeavailabletothesoftware.Thiscanoccur
severalways:
1. TheaudiogramwasautomaticallyenteredbyMedRxStudio
softwarewhentesting.
2. TheaudiogramwasmanuallyenteredintotheNoahaudiogram
moduleorNoah4softwareandsaved.
3. Theaudiogramwasenteredusinganothermanufacturer’s
audiogrammodule.



Ifnoneofthesehaveoccurred,
youmaymanuallyenterthe
audiometricdataintotheREM
softwareasfollows:

1. UnderGeneral,thenShown
Tests,selectshowTone.




2. SelectAUDmodulelocatedatthetopleftofthe
software.
3. Usingyourmouse,selectthetestear.
4. SelectthetesttypeAC.
5. Enterthresholdsbyclickingtheintersectionpointswiththe
mouse.(Youmayalsoentertheaudiogrambyselectingthe
audiotabineithertheREMorHLS/MHAscreens).
6. RepeatforUCL(BoneandMCLoptional).
7. Repeatsteps3‐5fortheotherear.

Aftertheaudiogramisentered,clicktheLSMbuttonto
returntotheMedRxStudioLSMtestingscreen.

TheOperatorHeadphone(optional)isusedbytheoperatorto
monitorthesignalbeingreceivedbytheprobemicrophone.



D‐0125127‐C 17 
SpeechMappingwith
RecordedInputs

TheStudiosoftwareprovidesseveraldigitalaudiofilestouseasa
repeatablestimulusforSpeechMapping.Theseareaccessedby
clickingtheFilebuttonontherightandthenselectingthedesiredtrack
fromthepull‐downmenuintheaudioplayer.Peakmeasurementsare
recommended.
Oncethedesiredpuretoneorwhitenoisetrackisselected,clickthe
Startbuttontobeginmeasuring.Apuretoneorwhitenoisewillbe
presentedandonceitreachestheselectedinputlevelwiththeslide
bar,thechosentrackwillplay.Whenenoughdataiscollected,clickthe
Stopbuttontostoptherecordingandrecordthemeasurement.


ItisalsopossibletouseanaudioCD,suchasthepatient’sfavorite
musictoperformSpeechMapping.


SelectCDasanoptionunderGeneralandSignal.


SelecttheCDbuttonandthenselecta
track.Usethesoundlevelmeteron
screentochecktheproperlevel.Adjust
theoutputofthespeakertodesired
levelusingthesoundlevelmeter.
(Rememberconversationalspeechis
65dBat1meter).



D‐0125127‐C 18 
Thescreenshotbelowprovidesanoverviewofallthetoolsand
controlsontheLiveSpeechMappingscreen.Formoreinformationon
thesefeatures,pleaseconsulttheInteractiveHelpsystembypressing
theF1keyorclickingtheHelpicon.

1. SoundLevelMeter
2. EarSelection
3. TestStimulus
4. MeasurementType
Peaks
LTAS
5. OpenFitFunction
6. ResetButton
7. StartandStopButtons
8. ToolsTab,TargetSelectionTab,andDisplayTab
9. Legend
10. TargetArea–canbeanyofthefollowing:
MedRxModifiedSpeechSpectrum
DSLIO
NAL‐NL2
NAL‐NL1
SpeechMappingwithLive
VoiceInputs

Usingthemicrophoneallowsmeasurementofboththeprofessional’s
voiceandthatofathirdpartye.g.,thepatient’ssignificantotheror
familymembers.
Toimproverepeatabilityofmeasurements,itisrecommendedthatthe
speakerreadastandardpassagesuchasthe“RainbowPassage”which
isprovidedonpage31.
NOTE:ThescreenshotaboveshowstheMedRxModifiedSpeechSpectrum
(Canoe).ItisalsopossibletouseDSLIOorNAL‐NL2targetsonthisscreen.
ClicktheSettingwheelinthemenubaronthetoprightofthescreentoselect
andconfigurethesetargetstomeettheneedsofyourpractice.


D‐0125127‐C 19 
RunningSpeechMapping
“On-Top”
TheMedRxStudiosystemistightlyintegratedwithNoah,theindustry
standardforaudiometricandfittingdatastorageandretrieval.The
On‐TopmodeoftheLSMsoftwareallowsyoutoeffortlesslyalternate
betweenmeasurementandfittingadjustments.

FromtheMedRxStudioLSMmainscreen,clicktheOn‐Top
Window.
TheLSMwindowwillreduceinsizeand“float”ontopofyourfitting
software.
Usethetextmenusandgreen(start)andred(stop)buttonsinthe
floatingLSMwindowtopreformSpeechMappingmeasurements.

CompletingtheOn-TopModeProcess
ClosetheREMmodulebyclickingtheXbuttonorthebackarrowinthe
topleft.Savethesessionasnormally.


MedRxLiveSpeechMapping
Protocol
Unlikeotherproducts,theAVANTREM+systemplacesfullcontrolover
themeasurementenvironmentfirmlyinthehandsofthehearingcare
professional.Thesystemispowerful,yetextremelyflexible,allowing
eachprovidertouseLiveSpeechMappinginawaythatcomplements
theirpracticestyleratherthancompromisingit.
Inordertogetyou“upandrunning”withtheAVANTREM+system,
MedRxhasdevelopedthefollowingprotocol.Thissimpleprocedure
hasbeenfoundtobeeffectivewithbothaudiologistsandhearing
instrumentspecialists.Aftermasteringthebasicoperationofthe
systemutilizedinthisprotocol,youareencouragedtofurtherexpand
youruseofLiveSpeechMappinginyourpractice.Feature‐specifichelp
isavailablebysimplypressingtheF1keyorclickingontheHelpiconor
textmenu.

1. Completeacarefulotoscopicexaminationasinstructedbythe
manufacturerofyourotoscope.
a. ForMedRxVideoOtoscopes,refertotheHelpsystem
withinthesoftwarebypressingtheF1keyorclicking
theHelpiconortextmenu.



D‐0125127‐C 20 


2. BasicDiagnostics.
a. Usingyouraudiometer,
measureandrecordthe
followingvalues:
b. PureToneAirandBone
conductionthresholds.
c. NarrowBandNoiseorPure
ToneUCLat500,1000,
2000and4000Hz.
d. Othertestsifneededin
yourpracticeorjurisdiction.

3. Positionpatientasdescribed
earlierinthismanualonpage14.

4. CalibrateProbeTubeasdescribed
earlierinthismanualonpage15.

5. Measureandplacetheprobetube
intheearcanal.(Usecharttothe
left).

6. CompleteaLiveSpeechMapping
measurementUNAIDED(REUR).
a. ISTSorfileinput
b. PeakMeasures
c. 1/3Octaveresolution



7. Carefullyplacethehearinginstrumentintheearwithout
disturbingtheprobetube.
8. CompleteaLiveSpeechMappingmeasurementAIDED(LSM).
9. UsingtheOn‐Topmode,makeanyadjustmentsneededtothe
hearinginstrumentsothat:
a. TheLSMcurveforQuietSpeech(50dB)isatthebottom
ofthewhitemodifiedspeechspectrum(canoe).
b. TheLSMcurveforConversationalSpeech(65dB)
shouldbewithinthewhitemodifiedspeechspectrum.
c. TheLSMcurveforloudsounds(80dB)(veryloud
speech,clappinghands,etc.)isapproximately10dB
belowtheUCLcurve.

RealEarMeasurements





InadditiontoLiveSpeechMapping,theAvantREM+supportsall
conventionalRealEarMeasurements(REM).Allthesetestsare
accessedfromthemainREMscreen.
Tobegin,clicktheREMiconontheMedRxStudiomainscreen.