otometrics Madsen Xeta User manual

MADSENXeta
Reference Manual
Doc. No.7-50-0870-EN/17
Part No.7-50-08700-EN

Copyright notice
© 2010,2019Natus MedicalDenmark ApS. All rights reserved. ® Otometrics, the OtometricsIcon, AURICAL, MADSEN, Otoscan,
ICS and HORTMANN are registered trademarks of Natus MedicalDenmark ApS in the U.S.A. and/or other countries.
Version release date
2019-06-09 (214081)
Technical support
Please contact your supplier.
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Table of Contents
1 Introduction to MADSEN Xeta 7
1.1 The OTOsuite Audiometry Module 7
1.2 Intended use 8
1.3 About this manual 8
1.4 Typographical conventions 9
1.4.1 Navigation 9
2 Getting started 10
2.1 Patient data 11
2.1.1 Clearing test data 12
2.1.2 Viewing results 12
2.2 Preparing the patient 12
2.3 Automatic Air Conduction testing 12
2.3.1 Automatic Threshold testing 12
2.3.2 Automatic Screening 13
2.4 User-defined tests 14
3 Overview of MADSEN Xeta 15
3.1 Display 15
3.2 Front panel controls 16
3.2.1 Front panel layout 17
3.2.2 STIMULUS 17
3.2.3 MASKING 18
3.2.4 TEST 18
3.2.5 Signal indicators 19
3.2.6 Extended Range 19
3.2.7 Clear 20
3.2.8 Patient handling buttons 20
3.2.9 Setup 20
3.2.10 Change Ear (L <--> R) 21
3.2.11 Store/toggle threshold status 22
3.2.12 Response indicator 22
3.2.13 Stimulus/masking intensity knobs 22
3.2.14 Present signal buttons 23
3.2.15 Frequency 23
3.2.16 Talk Over 23
3.2.17 Mic. (microphone) 24
3.2.18 Start/Pause 24
3.3 Socket connections - rear panel 24
4 Navigating in the OTOsuite Audiometry Module 27
4.1 Audiometry Module features 27
4.2 The Audiometry Module menu system and toolbar 28
4.2.1 File menu 28
4.2.2 Edit menu 28
4.2.3 View menu 29
4.2.4 Tools menu 30
4.3 The Patient Responder indicator 31
4.4 The Masking Assistant 31
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4.5 The Audiometry Module Control Panel 33
4.5.1 The Control Panel 34
4.6 The stimulus bar 35
4.6.1 The Tone stimulus bar 36
4.7 The Tone test screen 36
4.7.1 The work area in the Tone screen 37
4.7.2 The audiogram 37
4.7.3 Curves and symbols selection 39
4.7.3.1 Selecting a symbol or curve 39
4.7.3.2 Creating new symbols 40
4.7.4 Compare audiograms 41
4.7.5 The Legend box 41
4.7.6 Tone view options 41
4.8 Work-flow related features 43
4.8.1 Selecting orientation 43
4.8.2 Ear shift frequency and level setting 43
5 Preparing for testing 45
5.1 Preparing the test environment 45
5.2 Preparing the test equipment 45
5.2.1 Connecting the cables of the test equipment 46
5.2.2 Patient record lists 46
5.2.3 The patient responder 47
5.2.4 Preparing for air conduction testing 47
5.2.5 Preparing for bone conduction testing 48
5.2.6 Preparing for testing with masking 49
5.3 Listening check 49
5.4 Preparing the client 50
5.4.1 Hygienic precautions 50
5.4.2 Inspecting the client’s ear(s) 50
5.5 Preparing the Audiometry Module for testing 50
5.6 Proper transducer placement 50
5.7 The client/patient list 52
5.7.1 Create patients for the patient list 52
5.7.2 Transfer the patient list to the audiometer 52
5.8 Fetch test results from audiometer 52
5.9 Preparing the patient for testing 53
6 MADSENXeta Test Settings 55
6.1 Test-specific settings 55
6.1.1 Auto Threshold test settings 55
6.1.2 Auto Screening test settings 56
6.2 General settings 58
6.2.1 Return to default settings 58
6.3 Items in the Setup menu 59
7 Testing a patient with MADSENXeta 67
7.1 Automatic tone testing 67
7.2 Manual tone testing - getting started 67
7.3 Air Conduction threshold test (manual) 67
7.4 Bone Conduction threshold test (manual) 70
7.5 Testing with masking 72
7.5.1 Air conduction with masking - suggested procedure 72
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7.5.2 Bone conduction with masking - suggested procedure 73
7.6 SISI (Short Increment Sensitivity Index) 74
7.6.1 Masking during SISI 75
7.6.2 Using STORE in the SISI test 75
7.7 ABLB (Alternate Binaural Loudness Balance) 76
7.7.1 Using STORE in the ABLB (Fowler) test 77
7.8 The Stenger test 77
7.9 Storing data 78
7.9.1 Registering “no response” 78
7.9.2 Overwriting stored values 78
7.9.3 Erasing a stored threshold 78
7.9.4 Viewing stored values 78
7.10 Deleting patient records 78
8 Configuring the Audiometry Module 79
9 Communicating with the device 80
9.1 Reconnecting to the device 80
9.2 Updating device firmware 80
10 Maintenance and calibration 81
10.1 Service and repair 81
10.1.1 Fuses 81
10.2 Cleaning 81
10.3 Calibration 82
11 Unpacking and installing 83
11.1 Unpacking 83
11.2 Storing 83
11.3 Installation 83
11.3.1 Powering 84
11.3.2 Connecting to a pc 84
11.3.3 Air conduction 84
11.3.4 Bone conduction 85
12 Maximum non-destructive voltage 87
12.1 Input and output sockets 87
12.2 RS232 interface sockets 87
13 Abbreviations 89
14 Standards and safety 91
14.1 Symbols used 91
14.2 Warning notes 92
14.3 The OTOsuite Audiometry Module 93
14.4 Manufacturer 93
14.4.1 Responsibility of the manufacturer 93
15 Technical specifications 95
15.1 MADSEN Xeta 95
15.2 Accessories 98
15.3 Notes on EMC (Electromagnetic Compatibility) 98
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Index 103
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1 Introduction to MADSEN Xeta
MADSEN Xeta is an audiometer for testing a person's hearing.
MADSEN Xeta offers air and bone audiometry as well as masking. Besides manual testing,
MADSEN Xeta employs fast automatic screening and threshold audiometry algorithms.
MADSEN Xeta incorporates multi-patient data storage and patient testing according to a pre-
loaded patient list.
• MADSEN Xeta can be used in connection with the OTOsuite Audiometry Module software for online monitoring of
test results, data export and storage, printing, and NOAH compatibility.
Test intensities and frequencies as well as the current test settings and other information are shown on the PC mon-
itor.
A patient list can be edited in the software and downloaded to MADSEN Xeta.
Operation
The front panel buttons have indicator lights, which clearly show the device's current settings.
Sound level, frequency and other information are shown clearly on the device display.
You can download new firmware to MADSEN Xeta, and if this involves no change to the transducers, MADSEN Xeta does
not need to be recalibrated.
1.1 The OTOsuite Audiometry Module
The OTOsuite Audiometry Module software provides a comprehensive overview of the cur-
rent stimulus and masking choices both numerically and graphically in the displayed audi-
ogram(s) while testing with a connected Otometrics audiometer.
As the module is part of OTOsuite, audiograms can be used directly in other OTOsuite modules such as AURICAL Coun-
seling and Simulations for an optimized workflow independent of NOAH.
The OTOsuite Audiometry Module lets you work with NOAH or save and view results via XML files.
The current version supports
• basic tone audiometry and
• speech testing
• special tests, depending on the audiometer being used.
Masking AssistantTM
The special Masking AssistantTM feature will notify you of thresholds that you might consider checking again with masking
applied. You may use this feature not only during testing but also to pinpoint possible masking issues with previously recor-
ded audiograms. The applied masking rules match the general recommendations in the audiometry literature.
Over the rim testing
Testing with the audiometer connected to a PC allows you to use the audiometer primarily as a handy control panel while
you follow the actual stimulus settings and test progress on your standard PC display. The large stimulus and patient
response graphics at the top of the display gives you a clear overview while keeping your focus on the patient.
Patient test planning
The OTOsuite Audiometry Module supports planning of patients for safe offline testing in the field. You can create a list of
patients which can then be downloaded to the audiometer. Each planned patient can now be safely identified, selected
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and tested with the audiometer based on name and personal identification. The results can be bulk uploaded to the PC
later on.
For specific information regarding audiometric test procedures and settings, please see the documentation for the specific
audiometer.
1.2 Intended use
MADSEN Xeta and the Audiometry module
Users: audiologists, ENTs and other health care professionals in testing the hearing of their patients.
Use: screening and diagnostic audiometric testing.
1.3 About this manual
Installation
See Unpacking and installing ►83 and Overview of MADSEN Xeta ►15 for a full description of unpacking instructions,
controls and socket connections.
Safety
This manual contains information and warnings which must be followed to ensure the safe performance of MADSEN Xeta.
Warning •Local government rules and regulations, if applicable, should be followed at all times.
•Standards and safety ►91
gives you an overview of device labelling and standards.
•Warning notes ►92
contains relevant warning notes.
Training
It is recommended that you read this manual and the OTOsuiteUser Guide, and make yourself familiar with MADSEN Xeta
before you begin testing a patient.
Note •If you are using the OTOsuite Audiometry Module with NOAH, we recommend that you are familiar with the
screens and functions provided in NOAH.
Terminology
The correct term for the person being tested/evaluated/serviced may depend on the setting in which the system is being
used. For this manual the term “Patient” was chosen, but you may configure OTOsuite to use another term.
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1 Introduction to MADSEN Xeta

1.4 Typographical conventions
The use of Warning, Caution and Note
To draw your attention to information regarding safe and appropriate use of the device or software, the manual uses pre-
cautionary statements as follows:
Warning •Indicates that there is a risk of death or serious injury to the user or patient.
Caution •Indicates that there is a risk of injury to the user or patient or risk of damage to data or the device.
Note •Indicates that you should take special notice.
1.4.1 Navigation
Menus, icons and functions to select are shown in bold type, as for instance in:
• Click the Set Options icon on the toolbar or select Tools> Options...
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1 Introduction to MADSEN Xeta

2 Getting started
1. If you are using OTOsuite, install OTOsuite from the OTOsuite installation disk. See the OTOsuiteInstallation Manual.
2. Install MADSEN Xeta as described in Unpacking and installing ►83.
3. Connect the accessories, Installation ►83:
Socket connections - rear panel ►24 shows the location of the sockets for the various accessories required.
4. Customize your test setup and prepare the test equipment:
–User-defined tests ►14
–Preparing for testing ►45
5. Switch on MADSEN Xeta. MADSEN Xeta is ready for testing as soon as it is switched on.
6. Launch the OTOsuite Audiometry Module, if required.
7. MADSEN Xeta automatically starts in manual test mode. A new patient record is automatically available and is shown
briefly on the display.
Patients scheduled in the OTOsuite Audiometry Module and not yet tested are indicated by an empty set of par-
entheses: ().
See Patient data ►11 for patient handling.
8. You are ready to start testing.
–Manual air conduction testing
To perform manual air conduction testing, see Air Conduction threshold test (manual) ►67.
–Bone conduction testing
To perform bone conduction testing, see Bone Conduction threshold test (manual) ►70.
–Special tests
To select other tests such as
SISI, see SISI (Short Increment Sensitivity Index) ►74,
Stenger, see The Stenger test ►77,
Fowler (ABLB), see ABLB (Alternate Binaural Loudness Balance) ►76.
Press the function key below the test you wish to perform.
These tests are optional. To add any of these tests to your configuration, contact your local supplier.
9. To perform automatic testing, press:
–Auto Threshold for Automatic Threshold testing (Automatic Air Conduction testing ►12).
–Auto Screening for Automatic Screening (Automatic Screening ►13).
10. The tests settings are customised for the individual test types. To change these settings, see MADSENXeta Test Set-
tings ►55.
MADSEN Xeta controls
Front panel controls ►16
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2 Getting started

A. Stimulus
B. Masking
C. Tests
D. Signal indicators
E. Display
F. Patient handling
G. Settings
H. Store/toggle status of thresholds
I. Stimulus/masking intensity knobs
J. Present/interrupt signal buttons
K. Frequency selection knob
L. Start/Pause
2.1 Patient data
Patients are
• either scheduled and listed in OTOsuite (Scheduled patients) or
• stored in numbered patient records in MADSEN Xeta (Tested patients).
See also Patient record lists ►46.
A. Tested patient records
B. Scheduled patients
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2 Getting started

2.1.1 Clearing test data
If you want to clear the tests you just made without saving them, press the Clear button and choose Current. You will have
to confirm the data deletion.
2.1.2 Viewing results
You can view results for tested patients:
• Press Preview and scroll back and forth using the arrow buttons to select the patient record.
Already tested patients are indicated by a record number in parenthesis in the lower right corner of the display, e.g.
(16).
Example:
• Use the Left level knob to scroll through test results.
2.2 Preparing the patient
1. Instruct the patient in using the Patient Response Switch. See The patient responder ►47.
2.3 Automatic Air Conduction testing
2.3.1 Automatic Threshold testing
The Automatic Threshold test presents tones to the patient at rising and falling levels in relation to the actual patient
response.
The test logic adheres to the modified (ascending) Hughson & Westlake method. See Air Conduction threshold test
(manual) ►67 for a description of the method.
1. Select Auto Threshold testing: Press Auto Threshold. The button lights to indicate that you have selec-
ted the test.
A. Auto Threshold test
B. Current frequency
C. Starting Hearing Level
D. Starting ear selected
For symbols used, see Symbols used ►91.
2. Press Start or Setup.
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2 Getting started

–Start to start the test.
If the patient fails to respond to the presented signal, the level is automatically increased until the patient
responds to the signal.
The signal is by default presented for each tone in the following order:
1000Hz, 2000Hz, 4000Hz, and 8000Hz, followed by 1000Hz (if Cross Check is enabled), 500Hz and 250Hz.
If the patient responds before the signal is presented, the message Illegal resp.! flashes on the display and the
test is paused.
Note •You can use Talk Over at any time during the test. This will pause the test. The test is resumed when you
release the Talk Over button.
3. MADSEN Xeta beeps twice and the display shows that the test is completed. The results are stored automatically.
4. If the Masking Assistant flashes M, alternately ?, to indicate that masking may be recommended for specific fre-
quencies, scroll through the frequencies. The audiogram symbol will flash at the specific frequencies where masking
may be recommended.
5. To retest any frequencies, see Air Conduction threshold test (manual) ►67 and, if required, Testing with masking ►
72.
6. If required, select the next patient record (press Previous/Next) or press New Patient.
2.3.2 Automatic Screening
Screening audiometry is a quick and simple way to identify patients in need of thorough audiological evaluation.
The test involves presenting tones at a predefined Hearing Level, the screening level. The patient is either able or unable
to hear the presented tone. The results show whether the Hearing Thresholds are better or worse than the defined
screening level.
Screening audiometry can be combined with Threshold determination of the frequencies where the screening level is not
audible.
1. Press Auto Screening. The button lights to indicate that you have selected the test.
A. Auto Screening
B. Current frequency
C. Starting Hearing Level
D. Starting ear selected
For symbols used, see Symbols used ►91.
2. Press Start or Setup.
–Start to start the test.
–Setup to change the specific Auto Screening test settings (see Auto Screening test settings ►56).
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2 Getting started

If the patient does not respond to the presented signal, the level is automatically increased until the patient
responds to the signal.
The signal is as default presented for each tone in the following order:
1000Hz, 2000Hz, 4000Hz, and 8000Hz, followed by 500Hz and 250Hz.
If AS Do AT when AS fails ►57 is set to to Yes, the Auto Threshold test is activated immediately when a fre-
quency fails. The test returns to Auto Screening when a threshold has been determined for the specific fre-
quency. See also Automatic Air Conduction testing ►12.
Note •You can use Talk Over at any time during the test. This will pause the test. The test is resumed when you
release the Talk Over button.
3. Xeta beeps twice and the display shows that the test is completed. The results are stored automatically.
4. To retest any frequencies, see Automatic Air Conduction testing ►12 and Air Conduction threshold test (manual) ►
67.
5. If required, select the next patient record (press Previous/Next) or press New Patient.
2.4 User-defined tests
With MADSEN Xeta you can quickly and easily customize your tests for maximum efficiency.
Make the changes you want in the setup of MADSEN Xeta and save these changes as a specific User Test. See Setup ►20.
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2 Getting started

3 Overview of MADSEN Xeta
A. Rear panel connections
The rear panel contains the ON/OFF switch, the sockets for connecting
various accessories and the socket for power connection. See Socket
connections - rear panel ►24.
B. Display
Settings and the test as it progresses are shown on the display. See Dis-
play ►15.
C. Front panel controls
MADSEN Xeta is operated from the front panel. See Front panel con-
trols ►16.
3.1 Display
A. Test signal indicator
B. Audiogram symbols
C. Stored threshold
D. Function key markers
E. Ear indicator
During start-up the display briefly shows information regarding the device type and version, followed by the test screen last
used.
The abbreviations used on the display are explained in Abbreviations ►89.
Top line
During testing the top line in the display shows the intensity numerically in dBHL for the left and right ear.
Ear selection
The ear being tested is indicated with Lor Rin the display. The display side for Land Rcan be changed in the settings. See
Display ►61.
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Frequency
The selected test frequency for tone testing is shown at the center.
Masking
If masking for the contralateral ear is enabled, this is shown on the opposite side.
Symbols used
Left ear
Response
Left ear
No response
Right ear
Response
Right ear
No response
Air, unmasked
Air, masked
Bone, mastoid, unmasked
Bone, mastoid, masked
Other symbols
Stored
aAutomatically tested (preceded by the relevant response symbol)
fs Failed screening level (Auto Screening only)
sScreening level (preceded by the relevant response symbol)
3.2 Front panel controls
You can access all basic functions directly by using the buttons and knobs on the front panel.
The button light indicators
Each button has its own function. Some buttons have a light to indicate whether the function is currently active or not.
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3 Overview of MADSEN Xeta

• Press the button to activate.
• Press the button again to deactivate.
3.2.1 Front panel layout
The MADSEN Xeta buttons and controls are grouped according to their function and how frequently they are used.
The buttons and knobs most frequently used are placed directly below the display.
A. STIMULUS ►17
B. MASKING ►18
C. TEST ►18
D. Signal indicators ►19
E. Display ►15
F. Extended Range ►19
G. Clear ►20
H. Patient handling buttons ►20
I. Setup ►20
J. Change Ear (L <--> R) ►21
K. Store/toggle threshold status ►
22
L. Response indicator ►22
M. Stimulus/masking intensity knobs ►
22
N. Present signal buttons ►23
O. Frequency ►23
P. Talk Over ►23
Q. Mic. (microphone) ►24
R. Start/Pause ►24
Beep
If you try to use a button which is not enabled, you will hear two short beeps.
MADSEN Xeta also beeps when an automatic test is completed and when settings are stored.
3.2.2 STIMULUS
Air
Selects air conduction (via headset or inserts).
The transducer selected under Setup is displayed as long as the button is pressed. See AC Transducer ►62.
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3 Overview of MADSEN Xeta

Bone
Selects bone conduction (via bone conductor on mastoid).
Reverse
Reverses the function of the Present stimulus button:
•Active (indicator lit)
The test signal is presented continuously and the stimulus is interrupted when you press the Present stim-
ulus button.
•Inactive (indicator not lit)
The test signal is presented when you press the Present stimulus button.
Note •The presentation only applies to the stimulus signal. The masking signal is normally always ON. To change the
masking interrupter's function see Mask. present. ►60.
Warble
Frequency modulates the stimulus signal ±5% at a rate of 5Hz around the selected frequency.
Pulsed
The stimulus signal is presented with a Pulse/Pause ratio of 50%.
Timed
The stimulus signal is presented with a preset duration. Does not apply in Reverse mode.
3.2.3 MASKING
• By default, you always adjust the stimulus signal level on the LeftLevel knob, regardless of whether you are testing
the right or left ear.
• To adjust the masking intensity use the RightLevel knob.
To change the default setting, see Level knob ►62.
Contra Air
Contralateral masking via stereo Air Conductor (headset or insert phones).
Mono Insert
Contralateral masking via mono insert phone (for bone conduction test only).
Level Lock
Makes the masking level follow the stimulus signal level. You can adjust the difference between the stimulus
signal and the masking signal by using the Right level knob.
3.2.4 TEST
Manual Tone testing is active by default.
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3 Overview of MADSEN Xeta

Auto Threshold
Selects the Automatic Threshold test. For a description, see Automatic Air Conduction testing ►12.
When activated, the button flashes to indicate that you have selected the test, or that the test has been
paused by the user, by faulty responses or by talk-over.
Auto Screening
Selects the Automatic Screening test. For a description, see Automatic Screening ►13.
When activated, the button flashes to indicate that you have selected the test, or that the test has been
paused by the user, by faulty responses or by talk-over.
More (tests)
Press to see the optional test types. Press the desired function key to select.
For a description of the additional tests, see
•SISI (Short Increment Sensitivity Index) ►74
•The Stenger test ►77
•ABLB (Alternate Binaural Loudness Balance) ►76
These tests are optional. To add any of these tests to your configuration, contact your local supplier.
3.2.5 Signal indicators
The indicators are located on either side of the display. They light up when the selected test signal is presented
in the corresponding ear.
•Discreet mode
In the Auto Threshold and Auto Screening tests you can change the setting of the signal indicators to Dis-
creet mode, which means that they do not light up when the test signal is presented. If MADSEN Xeta is in
view of the patient, this will prevent the patient from knowing when a signal is presented.
This mode also prevents the patient from simulating hearing, because the stimulus level is hidden during
the automatic test.
3.2.6 Extended Range
Enables presentation of stimuli above the safety limit (approx. 100dB). The safety limit is set to 20dB
below the maximum dBHL for a given transducer and frequency.
Note •Automatic testing is always limited to 100dBHL.
Extended Range has 2 modes (to select, see Extended Range ►61):
•Auto
All levels at all frequencies are always accessible, but the Extended Range button will start flashing when a level above
100dB HL is reached.
•Manual
The first time extended range above 100dBHL is reached after patient change or ear change, press the Extended
Range button once to allow for access to any level at any frequency with any selected manual test and signal type
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3 Overview of MADSEN Xeta

(totally unrestricted after manually confirmed once). If active, the button is lit at lower levels to indicate that it is act-
ive, and starts flashing as a warning when entering the extended range.
You can manually deactivate the Extended Range button at any time, meaning that you must press it again, if the
extended range is reached again.
3.2.7 Clear
Deletes patient records:
• Press to clear current or all records.
You will be prompted to select current or all records. Select and confirm your selection.
3.2.8 Patient handling buttons
New Patient
Selects a new empty patient record. These records are numbered automatically.
See also Patient record lists ►46.
Preview
Press to view patient records and test data.
Displays the patient name and ID. If the name is too long, the display will show the first part briefly, then switch
to the second part.
If required, press Change Ear to view data for the other ear.
See also Viewing results ►12 for examples.
Scroll Patient List
When MADSEN Xeta is switched on, a new patient record is automatically available.
Scroll through the patient records list. The list may include patients scheduled from the PC.
Previous scrolls through patients already tested.
Next scrolls through scheduled patients.
When you have reached the start or the end of the list, the “New” record will be displayed once
more.
See also Patient data ►11.
3.2.9 Setup
Changing the setup
•Test-specific settings ►55.
•General settings ►58.
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3 Overview of MADSEN Xeta