MedRx Avant Installation guide

www.medrx-int.com
MANUAL
AVANT
AUDIOMETERS
Air, Bone, Speech and
Masking Audiometry
TRAINING

Contents
Introduction………………….…………………………………………………
3
AVANT™ Audiometer Software Overview……..………………….…………….
4
AVANT™ Audiometer Software Options...……………….………..……………
4
Preparing for Testing……………………………………………………………
8
Pure Tone Audiometry………………………….………………………………
11
Speech Audiometry…………………………..……………….………….……
14
Speech MCL & Speech UCL…………………..……………….………….……
16
Word Recognition (WR)…………………….………………….……….…….…
18
QuickSIN

(Optional)………………………………………….……….………
19
Tinnometer(Optional)……………………….…………………….…………
21
Hearing Loss Simulator……………….………………………………….…….
32
Master Hearing Aid……………………………………………………..……….
33
Printing……………………………………………………………………….…
35
Limited Warranty……………………………………………………………...
37
www.medrx-int.com
Manufacturer:
MedRx, Inc.
1200 Starkey Rd., #105, Largo FL 33771, U.S.A.
Toll Free: [phone] • [phone]
Fax: [phone]
E-mail: [e-mail]
www.medrx-usa.com
MedRx's Authorized
Representative in Europe:
#0123
DGS Diagnostic A/S
Audiometer Alle 1
5500 Middelfart
Denmark
TÜV SUD Certificate Body
Ridlerstraße 65
80339 Munich
Germany
Distributor:
MAICO Diagnostics GmbH
MedRx International Sales
Sickingenstr. 70-71, 10553 Berlin, Germany
Tel.: [phone], Fax: -99
E-mail: [e-mail]
Web: www.medrx-int.com

D-0123003-B 05/2019
3
Introduction
The AVANT Audiometer series represents a new era of ultra-compact diagnostic
audiometry for your office. Compact yet rugged, this PC-Based system is USB powered and
supports current ANSI and IEC audiometric tests. This manual assumes that the
system hardware, software and drivers are installed and working properly.
Please refer to the MedRx AVANT Audiometer Installation Manual for assistance. The
Installation Manual is included in the original AVANT Audiometer packaging in both
printed and PDF formats.
The scope of this manual is to get you “up and running” with your AVANT Audiometer
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”.

D-0123003-B 05/2019
4
The AVANT Audiometer Software Overview
The AVANT Audiometer software can run stand-alone or from NOAHSystem or the
TIMSNOAH-Compatible Office System.
Launching the AVANT Audiometer Software
Stand Alone
NOAH
•Launch NOAH.
•Launch Avant Audiometer module
following NOAH procedures.
•
Double Click the AVANT
Audiometer shortcut on your
Windows Desktop.
Basic Software Options
Several options are available which allow the user to customize the AVANT Audiometer
Software to meet their needs.
Access these options from the File Menu on
the AVANT Audiometer Main Screen as
shown below.
The Options may also be accessed
from the Audio screen by clicking on
the Options text menu as shown
below.

D-0123003-B 05/2019
5
The View tab allows you to set the default
appearance of the test environment.
The Audiometry tab sets the look and
behavior of the audiometer.
The MHA/HLS tab sets the default look and
behavior of the Master Hearing Aid and
Hearing Loss Simulator.
If your system has a Tympanometer
connected, this tab will assist in configuring
the look of the display.
NOTE:Remember, more information is always available in the Interactive Help System by
clicking the Help Icon or pressing the F1 key.

D-0123003-B 05/2019
6
Assign Transducers
Option 1: On the Audiometry Options
screen click Transducers to assign specific
transducers to the audiometer outputs.
Option 2: You can change transducers by
Right-Clicking on any transducer icon on
the Audiometry screen.
The Transducers dialog box will then appear. Select the appropriate transducer for each
output.
To add or remove outputs, Click Outputs to enable or disable transducer buttons on the
Audiometry screen

D-0123003-B 05/2019
7
Advanced Options
The Advanced Options screen allows you to
configure your system to meet your individual
clinical needs. It also provides MedRx
Technical Support with tools for helping you
troubleshoot technical issues. Access this
screen from the File Menu on the Avant Main
Screen as shown to the right.
The key features of each tab are described below. For more in-depth information, consult the
interacti
ve Help system within the software by pressing the F1 key or clicking the Help icon.
The General Tab configures the overall
AVANT Audiometer behavior with respect to
other Windows programs, specifically NOAH.
Use the Audio Tab to select the proper audio
device for your Audiometer. This tab also
provides access to the Windows Audio
controls.
If your system has a Video Otoscope, the
Video tab allows you to select the
appropriate device driver.
If your system has a Tympanometer
connected, use this tab to identify it and
ensure the driver and software that control it
are correctly installed.

D-0123003-B 05/2019
8
Preparing for Testing
Use the accessories provided with your Avant Audiometer. Typical acceptable transducers
are shown on the “Transducer & Accessories” page in the Installation manual. Operator
headsets for use with the Avant Audiometer should have 32 ohms impedance and the
speaker power should be at least 50 watts. Air conduction transducers for use with this
device should have an impedance of 10 ohms. The speaker voltage should match the local
mains voltage where the device is used.
The Operator Headset with microphone is used by the device operator to communicate
with the patient. The patient talks to the operator using the Talk-Back microphone.
Placing the Earphones on the Patient
Insert Earphones
IMPORTANT: The foam tips used for the insert earphones are for SINGLE PATIENT USE ONLY.
Do not attempt to wash and re-use them.
1. Place a new set of foam tips on the earphone tubes as shown.
These tips are designed for single patient use and should not
be washed and reused.
•NOTE: When removing foam tips after use, be sure the clear
plastic tubing nipple remains attached to the long
earphone tube.
2.
Carefully compress the tip between
your fingers to allow it to fit into the
patient’s ear canal as shown. Do not
roll the tip between your fingers.
3. Pull up and back on the patient’s
pinna to straighten the ear canal.
4. Place the compressed foam tip deep
within the ear canal.
5. When properly placed, the outer
surface of the insert tip will be flush
with the opening of the ear canal as
shown.

D-0123003-B 05/2019
9
Supra-Aural Headphones
1. Place the headphones on the
patient’s head so the center of the
headphone is directly over the
opening of the ear canal.
2. Adjust the headband so the
headphones remain in place, but
be careful not to make it so tight as
to cause patient discomfort.
High Frequency Earphones (HDA 200) *Stealth Only*
NOTE: The HDA 200
Earphones are part of an
upgrade option for the
AVANT Stealth Audiometer.
If you need to test
frequencies beyond 8000
Hz, you must notify MedRx.
This option carries a price
differential which will be
detailed at the time of order.
1. Place the earphones on the
patient’s head so the center of the
earphone
is directly over the opening of the
ear canal.
Adjust the headband so the earphones
remain in place, but be careful not to
make it so tight as to cause patient
discomfort.
Placing the Bone Conductor
1. Locate the mastoid process behind the pinna. This is
the bony shelf just behind where the ear meets the
head.
2. Carefully place the bone conductor on the mastoid
process and hold it in place.
3. Place the headband over the head to the opposite
temple.
4. Carefully and slowly loosen your grip to check if the
bone vibrator and headband will stay in place.
If either moves, reposition until both the headband and
bone vibrator are secure.

D-0123003-B 05/2019
10
Sound Field Testing
The Sound Field speakers (Free Field) should be connected using optional or user supplied
amplifier and speakers. They should be calibrated annually as per ISO 8253-2, located at
least 1 meter from the patient ear and at the same height.
Device Maintenance
Annual re-calibration of the transducers used with the Avant Audiometer is
recommended. There are no user repairable components of this device. Refer to the
Installation Manual for care and cleaning instructions.
Performing Audiometric Testing
The screen shot below shows the controls which are available from the Audiometer main window.
The sections of the manual that follow explain how to use these tools to perform hearing
evaluations using your Audiometer.
1. Test selection tool bar
2. Ear selection
3. Output selector
4. Test Type Selector
5. Tone Type Selectors
6. Output Level Potentiometers
7. Masking interrupter and routing selector
8. No Response button
9. Test Interrupter
10. Back
11. Help
12. Discard
13. Talk Over
14. Legend

D-0123003-B 05/2019
11
Pure Tone Audiometry
Pure Tone Audiometry measures the patient’s peripheral hearing sensitivity, or the softest
levels they can hear pure tones at a variety of frequencies. These thresholds are plotted
on a standard graph called an audiogram. The AVANT Audiometer software controls the
hardware, stores the data (if running within NOAH or TIMS) and prints a standard
audiogram report. Pure tone Audiometry can be performed via earphones or a Bone
Conductor (Bone Conduction).
Prerequisites:
•Before performing audiometry, careful inspection of the ear canal should be
performed. This is best done with Video Otoscopy. After ensuring the ear canal is
clear, place the appropriate transducer on the patient as shown on page 8 & 9.
Pure Tone Audiometry via Earphones
(IP30 Insert Earphones, Eartone 3A Inserts or Supra-Aural Headphones)
1. From the main Audiometer Window, Click the button on the right side menu
bar.
2. By default, the button will be selected once you enter the main Audiometry
Screen. Other default settings (based on typical clinical practice and procedures)
are:
a. Right Ear
b. AC (Air Conduction)
c. Tone Stimulus
d. Continuous Tone
3. Instruct the patient that they will hear several very quiet (soft) tones (beeps) and that
they should signal (raise their hand, press the patient response button, etc.) as
soon as they hear it. It is helpful to also say “even if it seems very far away”.
4. Begin at 1000 Hz in the Right ear (unless the patient reports better hearing in the left
ear).
5. Present a tone at 60 dB by pressing the space bar or clicking the button.
6. If the patient does not hear the tone (does not signal), raise the level 5 dB using the
up arrow on your keyboard and present again.
7. Repeat step 6 until the patient signals that they hear the tone.
8. When the patient signals they hear the tone, decrease the level by 10 dB and present
the tone again.
9. Repeat steps 6 through 8 until the patient responds to a tone at the same level 2
times with the level ascending.
10. Using the right arrow key, change the test frequency to 2000 Hz and repeat steps 5
through 8 to establish the threshold at 2000 Hz.

D-0123003-B 05/2019
12
NOTE: If the threshold at 2000 Hz is more than 20 dB different (less than or
greater than) the threshold at 1000 Hz, repeat steps 5 through 8 at 1500
Hz
(the “half octave” between 1000 Hz and 2000 Hz).
11. Repeat steps 5 through 8 for 4000 Hz, 8000 Hz, 500 Hz and 250 Hz.
12. Repeat steps 5 through 11 in the opposite ear.
NOTE:The software automatically calculates the 3-frequency Pure Tone
Average (PTA) which is displayed above and inside the legend as
follows:
Pure Tone Audiometry via the Bone Conductor
1. Following the instructions on page 9, place the Bone Conductor on the mastoid
process behind the ear with better air conduction thresholds as measured above.
If the thresholds are equal, place the Bone Conductor on the mastoid process
behind the right ear.
2. Establish bone conduction thresholds as described above (see page 11, steps 5-8)
for 1000 Hz, 2000 Hz, 4000 Hz, 500 Hz and 250 Hz.
3. If the Bone Conduction (BC) threshold at a given frequency is less (better) than the
Air Conduction (AC) threshold by 15 dB or more, you must confirm the threshold
by performing masking.

D-0123003-B 05/2019
13
Masking for Pure Tone Audiometry
There are several accepted methods for masking. This manual will not promote one over
another, however, to use the masking function on the AVANT Audiometer, follow the
steps below:
1. Click the Masking button. The red light will
appear indicating that the masking is on.
2. Use your mouse to adjust the Masking Level
slider shown on the left to the appropriate
level based on your preferred method of
masking.
3. If you wish to maintain the balance of signal
and masking (for example, masking always
30 dB above the signal), Click the Lock
button after setting the masking and signal
levels.
4. The default for pure tone audiometry is to
deliver narrow band masking to the ear
opposite the test ear. If you wish to use a
different stimulus, or route the masking to
the same or both ears, Click on the arrow to
the right of the Masking On button.
5. Use your mouse to select the new masking
type and routing for your specific
application.
6. When you are finished making changes to
the Masking, Click Close.

D-0123003-B 05/2019
14
Optional High Frequency Audiometry
The AVANT Stealth Audiometer is available with the option to perform extended
range high frequency pure tone audiometry. This is used clinically to evaluate noise
induced hearing loss, ototoxicity and tinnitus. High frequency testing uses the same
procedure as described on page 13 for pure tone audiometry.
To start High Frequency audiometry, select a transducer
that supports high frequencies, such as the HDA 300.
The High Frequency control will appear on the right panel
and will allow choosing frequency ranges to be shown on
the plot. The power supply must be connected to activate
the high frequency control or when using the free field
amplifier.
NOTE:Extended High Frequency Audiometry is an upgrade option for the AVANT Stealth
Audiometer Only. If the high frequency control selectors do not appear on the right panel
and if you need to test frequencies beyond 8000 Hz, you must notify MedRx. This option
carries a price differential which will be detailed at the time of order.
Speech Audiometry
Speech audiometry evaluates how well the patient can hear and understand speech. The
typical test battery includes tests of speech threshold and tests of speech discrimination.
The sections below detail how to perform these tests on the AVANT Audiometer.
Speech Reception Threshold (SRT)
The Speech Reception Threshold (SRT) is defined as the lowest level at which the patient
can repeat Spondee words with 50% accuracy. Spondee words are two syllable words
with equal vocal emphasis on each syllable such as “baseball” or “hotdog.”
Instruct the patient that they will hear a series of two-syllable words that will get quieter as
the test progresses. They are to repeat the words as best they can, even if they sound very
far away. If they are not sure of a word, they should take a guess.
SRT is typically started 10-20 dB more or less than the patient’s Pure Tone Average, which
is displayed on the lower left of the screen. Set the level of the test signal to 10 dB above
the PTA and follow the steps below.
1. From the Avant Audiometer main
screen, Click the Audiometry
button.
2. Click the SRT button located on the
toolbar on the top of the screen.
3. Click the Word List button.

D-0123003-B 05/2019
15
4. Select Spondee Word Lists A&B
from the list.
5. Click Start Test.
6. Click the Play button or press the F9
key to present a word. The word will
play through the chosen transducer
as well as display on the screen.
7. If the patient correctly repeats the
word, click the Correct icon or
press F7.
8. If the patient incorrectly repeats the
word, click the Incorrect icon or
press F8.
Note that the score is calculated and displayed automatically.
If the patient exceeds a 50% score at a given presentation level, stop the test and decrease
the level by 10 dB and repeat the steps above.
If the patient fails to achieve a 50% score after 6 words at a given level, stop the test, raise the
level 5 dB and repeat the steps above.
When the patient scores 50% at a given level, the test is complete. The software
automatically plots the score on the SRT graph.

D-0123003-B 05/2019
16
Speech MCL & Speech UCL
The patient’s most Comfortable Level and Uncomfortable Level for speech can be
obtained while you are in Work Recognition (WR).
1. From the Avant main screen,
Click the Audiometry button.
2. Click the WR button located on
the toolbar on the top of the screen.
3. Click
UCL
or
MCL.
4. Choose an input option.
5. If you selected File or CD, select the
track you would like to play for the
test in the media player at the
bottom of the screen.
When you have selected your track in the
media player, click play on media player or
hit the spacebar to start.
Adjust levels up or down with keyboard
arrows or by clicking below the dB level at
the bottom of the graph.
6. To Input & Calibrate the Rainbow Passage
in WR for MCL:
a. Press small Green file folder in bottom
left of media player.
b. Select Rainbow Passage by double
clicking twice.

D-0123003-B 05/2019
17
c. Use the drop down in the media player
and select track 10 – Calibration
(1000Hz).
d. Click play or start signal.
e. On the VU meter at the top of the
screen, press the slider calibration icon
just below and to the left of the VU
meter.
f. Adjust with mouse or arrow keys so that
the blue bar stops over the black arrow
and there is no red.
g. Click on the channel icon just below
and to the right of the VU to switch
channels.
h. Repeat steps d - f for the remaining
channel.
Note: This calibration also needs to be
done with any custom word list.
7. When using the Mic or live voice option
make sure you press the Start Signal or
space bar to begin.
8. When using the Mic option adjust your
input using the slider so that it is peaking at
the black triangle under the VU meter.
The VU meter is at the top of the MedRx
Software and will become active once you
press Start Signal.

D-0123003-B 05/2019
18
Word Recognition (WR)
Word Recognition (WR) is a discrimination, or recognition type test using speech as the
stimulus. WR testing measures the percentage of mono-syllable words repeated correctly
from a phonetically balanced list. Unlike the SRT test, the WR test is performed at a fixed
intensity (dB) level. Typical patients will score their best on WR testing at a level between
35 and 40 dB above their SRT.
Before beginning the test, instruct the patient that they will hear a series of one-syllable
words. They are to repeat the words the best they can. If they are not sure of a word, they
should take a guess.
6. From the Avant main screen, Click
the Audiometry button.
7. Click the WR button located on the
toolbar on the top of the screen.
8. Click the Word List button.
9. Select the desired Word List from
the list. The W-22 or NU-6 lists are
good choices for typical adult
patients. When testing children, the
PBK lists should be used.
10. Click Start Test.
11. Click the Play button or press the F9
key to present a word. The word will
play through the chosen transducer
as well as display on the screen.
12. If the patient correctly repeats the
word, click the Correct icon or
press F7.
13. If the patient incorrectly repeats the
word, click the Incorrect icon or
press F8.
NOTE: that the score is calculated and displayed automatically. The test is complete when all
words in the list have been presented. The software automatically plots the score on the WR
graph.
14. Click the Advance button >> or
press the F10 key to present the
next word. Score accordingly as
described above.

D-0123003-B 05/2019
19
QuickSIN (Optional)
The primary complaint of hearing-impaired persons is difficulty hearing in background
noise. The measurement of SNR loss (signal-to-noise ratio loss) is important because
speech understanding in noise cannot be reliably predicted from the pure tone
audiogram (Killion & Niquette, 2000).
The QuickSIN test was developed to:
1. Provide a one-minute estimate of SNR loss.
2. Provide a quick way for clinicians to quantify a patient’s ability to hear in noise.
3. Determine if extended high frequency emphasis improves or degrades
understanding of speech in noise.
4. Assist professionals in choosing appropriate amplification and other assistive
technologies.
5. Demonstrate that hearing aids with directional microphones improve speech
intelligibility in noise.
6. Provide a large number of equivalent test lists for use in clinical and research work.
7. Provide information useful in counseling patients regarding realistic expectations.
The screenshot below shows the key features of the QuickSIN
test.
1. Calibration Button
2. Ear Selector
3. Output Selector
4. List Selector
5. Track Display
6. Track Control
7. Test Type Selector

D-0123003-B 05/2019
20
Performing the QuickSIN Test
•
From the Avant main
screen, click the
Audiometry icon.
•
Click the QuickSIN
button on the top of
the Audiometry
screen.
Present the test with earphones or in a sound field. The attenuator dial is set to 70 dB HL. For subjects with
PTA hearing losses greater than 45 dB HL, the attenuator dial is set to a level that is “loud but OK.”, this is
done by the program using the MCL value. A warning legend at the bottom of the window is shown if PTA
is not available. Instruct the patient to repeat the sentences spoken by the target (female) talker. When
testing in a sound field, have the patient hold the talkback microphone close enough so that responses are
clearly audible to the tester.
1. Select a list from the List
Selection Window one of
the following two ways:
•Click the list, then click Select.
•Or Double-Click the list number.
2. Play the first sentence in the
list by clicking the Play
button.
Ask the patient to repeat
the sentence.
3. Score the patient’s response
one of the following ways:
•Click the check-box of each
correct key word with your
mouse. This will record the
total number of correct key
words in the score pull-down.
•Record the total number of
correct key words using the
score pull-down or by pushing
1-5 key on the keyboard.
4. Click the next sentence and then
click Play or click >>. This will
advance & play.