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AA222

Operation Manual

Page 15

Interpretation of Test Results

Tympanometric Curves and Pathologies

- According to Feldmann -

Peak Pressure

Negative

Pressure:

1) Blocked

Eustachian
tube

2) Serous

otitis
media

Normal Pressure:

1) Ossicular bone

fixation

2) Adhesive fixation
3) Ossicular

discontinuity

4) Middle ear tumour
5) Eardrum abnormality

Positive

Pressure:

1) Early

acute otitis
media

Absence of

Pressure Peak:

1) Middle ear

effusion

2) Open tymp.

membrane

3) Artifact

Amplitude

Increased

Amplitude:

1) Eardrum

abnormality

2) Ossicular

discontinuity

Decreased Amplitude:

1) Ossicular fixation

bony or adhesive

2) Serous otitis media
3) Cholesteatoma,

polyps, granuloma

4) Glomus tumours

Unchanged Amplitude:

1) Blocked Eustachian

tube

2) Early acute otitis media

Shape

........................Slopes.......................

Smoothness:

Decreased / Flattened

slope:

1)  Serous otitis
2)  Ossicular fixation
3)  Tumours of middle

ear

Increased slope:

1) Eardrum

abnormality

2) Ossicular

discontinuity

Altered smoothness:

1) Eardrum abnormality
2) Ossicular

discontinuity

3) Vascular tumours
4) Patulous Eustachian

tube

Содержание AA222

Страница 1: ...Operation Manual Audio Traveler AA222 Valid from serial no 776588 software version 2 00200 80658225 vers 02 2011 ...

Страница 2: ......

Страница 3: ...Theory about Air and Bone Conduction 26 Air Conduction 26 Bone Conduction 28 General Considerations about Masking 29 Masking Procedure Step by Step Hoods Plateau 31 Basic Functions 34 Patient Communication 34 Pause 34 Preparing the Test 35 Main Menu 38 Test Procedures 39 Printing Test Results 40 Connection to PC 42 Installing Printer Paper 43 Reflex and Tympanometry 45 Modifying Reflex Test A and ...

Страница 4: ...arts 97 Connection Panel 98 Unpacking Inspection 99 Contents of Shipment 99 Reporting Imperfections 100 Care and Maintenance 101 Trouble Shooting 102 Frequently Asked Questions 104 Recommended Literature 107 Dictionary 109 Appendix A Setup 113 Tympanometry Setup Menu 114 Setup Menu for Reflex Test A and B 117 Reflex Methods 118 Audiometry Setup Menu 125 Manual Audiometry Setup Menu 127 Speech Audi...

Страница 5: ...ul handling of instrument whenever in contact with patient should be of high priority Calm and stable positioning while testing is preferred for optimal accuracy It is recommended that the instrument be operated within an ambient temperature range of 15 35 degree Celsius 59 95 degrees Fahrenheit Make sure that the instrument is operated in a silent environment and avoid unwanted sound radiation fr...

Страница 6: ...ed disinfectant 6 Be sure to use only stimulation intensities which will be acceptable for the patient 7 Do not insert or in any way try to conduct measurements without proper probe ear tip in place 8 When conducting audiometry using Ear tone insert phones do not insert or in any way try to conduct measurements without proper foam tip in place 1 Do not immerse the unit in any fluids 2 Use this dev...

Страница 7: ...unnecessary exposure to electromagnetic fields e g from mobile phones etc If the device is used adjacent to other equipment it must be observed that no mutual disturbance appears Electric and electronic waste may contain hazardous substances and therefore has to be collected separately Such products will be marked with the crossed out wheeled bin shown below The cooperation of the user is importan...

Страница 8: ...perly packed and postage prepaid Loss or damage in return shipment to Interacoustics shall be at purchaser s risk In no event shall Interacoustics be liable for any incidental indirect or consequential damages in connection with the purchase or use of any Interacoustics product This shall apply solely to the original purchaser This warranty shall not apply to any subsequent owner or holder of the ...

Страница 9: ...s not give or grant directly or indirectly the authority to any representative or other person to assume on behalf of Interacoustics any other liability in connection with the sale of Interacoustics products INTERACOUSTICS DISCLAIMS ALL OTHER WARRANTIES EXPRESSED OR IMPLIED INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FOR FUNCTION OF FITNESS FOR A PARTICULAR PURPOSE OR APPLICATION ...

Страница 10: ...ance will be obtained when the air pressure is equal on both sides of the tympanic membrane thus showing the highest compliance to the sound waves In this state the cavity responding to the introduced sound will be comprised of the outer ear canal as well as the middle ear This will reveal the total equivalent volume of the outer and middle ear The equivalent volume of the middle ear also called t...

Страница 11: ...e printout of the AA222 complies with the international standards in this respect and therefore may not produce tympanogram shapes directly comparable to other instruments if these do not meet the standard requirements The Peak The peak of the tympanogram will horizontally be placed at the air pressure of the middle ear as equal pressures on both sides of the tympanic membrane produces the highest...

Страница 12: ...the ossicles mass reactance At 226 Hz the stiffness component is by far the most dominant factor and is therefore the subject of measurement The Shape The shape of the tymp curve will change when the stiffness of the system is changed e g by ossicular chain disruption otitis media etc and this is a primary reason for the diagnostic value of this measurement However normal ears show a great variety...

Страница 13: ...obe tone e g 800 Hz is used Type AS characteristics The type As tympanogram is essentially a type A tympanogram in which the curve is much shallower than usual Peak is within the pressure range of type A of 50 daPa For children the middle ear pressure may be acceptable down to 150 daPa negative pressure The pathology could be immobile stapes due to otosclerosis no reflexes some form of otitis medi...

Страница 14: ...ot necessarily indicate a pathological ear Healed perforation of tympanic membrane fixation of parts of the bones after ossicular discontinuity flaccid eardrum with ear wax or maybe a ventilation tube blocked with ear wax and healed middle ear can cause peaking and notching resulting in many shapes at the top of the maximum compliance curve The curve could also be a narrow type E W shaped tympanog...

Страница 15: ...ar effusion 2 Open tymp membrane 3 Artifact Amplitude Increased Amplitude 1 Eardrum abnormality 2 Ossicular discontinuity Decreased Amplitude 1 Ossicular fixation bony or adhesive 2 Serous otitis media 3 Cholesteatoma polyps granuloma 4 Glomus tumours Unchanged Amplitude 1 Blocked Eustachian tube 2 Early acute otitis media Shape Slopes Smoothness Decreased Flattened slope 1 Serous otitis 2 Ossicul...

Страница 16: ...flex As the reflex measurements are based on observing the change in sound intensity of a 226 Hz tone as explained in Popular Introduction to Impedance it is possible that environmental noise of this frequency entering the ear will show up as part of the test result This is a problem inherent to the measuring method and therefore common to all normal impedance meters Heart beat talking and externa...

Страница 17: ...e contraction of the Stapedius muscle Some tumour ears have been reported to give only the negative onset but no further reaction Reflex Threshold For a given stimulus the lowest level that elicits a detectable reflex This is not an absolute measurement as no exhausting norm exits defining stimuli and related reflex characteristics Therefore differences in test setups and reflex evaluation will pr...

Страница 18: ... the headphone The average reflex threshold is 85 dB HL 70 dB 100 dB for normal ears of 20 year old patients when pure tones are used as stimulus Noise as stimulus produces a threshold approx 10 20 dB lower as noise is made out of many simultaneous tones together carrying more energy Increased stimulation level will produce a stronger reflex Cochlear and retrocochlear pathology may show less rapid...

Страница 19: ...e Tensor Tympany muscle of the middle ear can produce a reflex elicited by a non acoustic stimulus or by an acoustic stimulation loud enough to have a startling effect on the patient As the tensor reflex is a startle response it will decrease and disappear after a few equal stimulations Even though the tensor reflex is regarded late and unstable compared to the Stapedius reflex it may be useful in...

Страница 20: ...ding the number of seconds it takes before the Stapedius contraction falls to 50 of its initial maximum Note If a decay score is obtained you should assure that it is not due to an improper seal which might produce an artefact similar to a decaying curve See the chapter Preparing the Test for details of fitting the probe The fact that the light band of the probe goes off and the test starts is not...

Страница 21: ...ympanogram falling within the normal category The interpretations stated here are generalised examples taken from the currently available literature and they can of course vary with each individual case The diagnostic value of tympanograms showing a D or E shape is reduced today A probe tone higher than 226 Hz has been preferred for these particular tympanograms Pathology Normal ear Volume Normal ...

Страница 22: ... chain peripheral to stapes muscle attachment Volume Normal Pressure 100 daPa to 100 daPa Ventilation Present Reflex Absent Audiogram Conductive loss Pathology Disrupted ossicular chain medial to stapes muscle attachment Volume Normal Pressure 100 daPa to 100 daPa Ventilation Present Reflex Absent Present by contra lateral stimulation Audiogram Conductive loss Pathology Disruption of ossicular cha...

Страница 23: ...ve loss Pathology Ear wax in the external ear canal Obturating cerumen Volume Low Pressure Normal Ventilation Reflex Absent Audiogram Mild to moderate conductive loss Pathology Perforated tympanic membrane defect or ventilated tympanotomy Traumatic rupture Volume Normal High Pressure Not obtainable Ventilation Reflex Absent peaks Audiogram Mild to moderate conductive loss 20 dB Pathology Otosclero...

Страница 24: ... Normal Pressure Not obtainable Ventilation Reflex Absent Audiogram Moderate conductive loss Pathology Blockage of Eustachian tube fluid in the middle ear may be present Volume Normal Pressure Negative Ventilation Absent or poor Reflex Absent or elevated rare Audiogram Mild to moderate conductive loss Pathology Acute Serous Otitis Media Positive middle ear pressure is rarely observed in tympanomet...

Страница 25: ... may develop according to the tympanograms outlined below Status of middle ear drainage tubes Otoscopic or visual inspection of the drainage tube is difficult as it can easily be blocked from the inside All three situations below will result in a mild conductive loss ...

Страница 26: ...ometry is to establish the hearing sensitivity at various frequencies The test can specify the AC loss but it cannot distinguish between abnormality in the conductive mechanism or sensor neural mechanism Headset Placement Remove eyeglasses and earrings if possible and position the headband directly over the top of the head Place the rubber cushions so that the diaphragms are aimed directly at the ...

Страница 27: ...level If the responses are consistent the familiarisation is completed If not it should be repeated Threshold Determination using the Ascending Method 1 Present a tone which is 10 dB lower than the threshold obtained during the familiarisation procedure If response fails increase in 5 dB steps until the subject responds 2 Decrease the level by 10 dB and begin another ascending level series Continu...

Страница 28: ...l and should be repeated if possible Manual or automatic pulses may be used If manual pulses are used they should be at least one second in duration Bone Conduction The purpose of the BC test is to supply the test tone directly to the inner ear around the middle ear mechanism via the skull to establish the inner ear hearing threshold AC BC gap The difference between the AC threshold and BC thresho...

Страница 29: ...ke You may hear a noise in one of the earphones but you should only pay attention to the tones you hear The masking noise is calibrated as ipsilateral effective masking The masking intensity will just mask the tone if they were presented to the same ear When the masking and tone are connected to opposite ears the tone is damped by the cross damping of the head 40 50 dB by AC using normal headphone...

Страница 30: ... 0 to 5 dB 20 dB 65 to 70 dB Maximum masking Maximum masking is the highest level of masking intensity which does not change the true threshold of the test ear When ears with large AC BC gaps are tested the audiologist must be aware of the masking dilemma where minimum masking becomes over masking without finding the plateau where the masking is correct For AC tests Tone AC 50 dB For BC tests Tone...

Страница 31: ...ed Tell him that he will be hearing some noise but to disregard it as best as he can and respond only to the test signal as he did previously When air conduction is made both ears are covered by earphones The noise is presented through one earphone and the test signal through the other When bone conduction is made the noise is presented through one earphone placed on the non test ear The other ear...

Страница 32: ...e its level in 5 dB steps until it is heard Continue the procedure until a sequence occurs where the threshold remains the same over a series of masking noise increases This level is equivalent to the Plateau and the tone stimulus level can be considered to be the threshold for the frequency under test An option is to continue increasing the masking level until over masking occurs Over masking wil...

Страница 33: ... 33 I Record masked thresholds with appropriate symbols Do not record both the unmasked and masked results In addition indicate the type of noise utilised and the upper level of the noise when the masked threshold was determined ...

Страница 34: ... for 3 seconds A volume bar will appear on the screen Adjust the volume by turning the HL dB rotary dial 26 Press Store 27 to save as the default level Monitoring By activating Monitor 22 the presentation from e g tape can be heard through monitor headset or built in speaker connected to Monitor on the connection panel in the accessory compartment To adjust the volume in the monitor headset or spe...

Страница 35: ...nt and then explain the following That the aim of the test is to test the mobility of the eardrum That the tip of the probe will be inserted into the ear canal and that it has to make a perfect seal That a small amount of air will flow through the probe to move the eardrum this will produce a sensation equal to pressing a finger slightly into the ear canal That one or more tones will be heard duri...

Страница 36: ...ce the head band over the patient s head The audiometric headphone is placed over the non test ear or contralateral reflex ear B Slide the transducer house downwards in the head band holder Try to position the transducer holder slightly behind the ear to ensure free space for inserting the probe tip with the ear tip into the ear canal C Press Pause 10 to prevent the instrument from starting the te...

Страница 37: ...n of the probe as indicated in figure 5 Figure 5 Hair coming out of the ear canal may make an airtight fit difficult to obtain Therefore ideally excessive should be removed prior to testing Also a clinical ear tip covered with Vaseline may be helpful Make sure the ear tip does not have its opening closed by the wall of the ear canal or clogged by Vaseline or cerumen For decay test an absolutely ai...

Страница 38: ...or hold down shift 18 while pressing Back 7 this will bring you to the Main Menu from wherever you are in the instrument Figure 6 From the main menu it is possible to adjust the contrast of the display by means of F5 LCD and F6 LCD The instrument will always remember the last setting When holding down shift 18 the writing above F5 and F6 changes to LED and LED Now the brightness of the LEDs indica...

Страница 39: ...you to the Main Setup Menu The program version of AA222 is written in the middle of the screen Test Procedures Before every test is performed it is recommended to delete all stored patient data from the instrument Hold down shift 18 while pressing new subject 10 The following message will appear on the screen Figure 7 ...

Страница 40: ... to print out the present screen by holding down shift 18 while pressing print screen 8 Please see below some typical examples of printouts from the internal printer Printout 1 Printout 2 Printout 1 Printout 1 contains the following Tympanogram Reflexes sequence method with individual reflexes starting at 80 dB at 4 different frequencies ETF 1 test Eustachian Tube Function test ...

Страница 41: ... paper saving function This function is activated by holding down shift while pressing Print 8 In the top of the printout Clinic data and Subject data have been printed Printout 3 Printout 4 Printout 3 Printout 3 contains the following Tympanogram Reflexes sequence method with 5 individual reflexes starting at 80 dB at 4 different frequencies Audiogram with stored threshold for right and left ear ...

Страница 42: ...rinting minimum version 1 15 IA NOAH Imp Module interfacing to NOAH minimum version 1 12 IA NOAH Aud Module interfacing to NOAH minimum version 1 23 Diagnostic Suite minimum version newer than 1 00 In the software open the Instrument Setup Select the com port number see appendix B The Baud Rate in the PC software must be set to USB For OtoAccess set the Group to IAP Select the Instrument ID choose...

Страница 43: ...make the feeding of the paper easier see picture 4 Picture 4 Picture 5 3 Pull the blue lever picture 5 in the direction of the instrument in order to open the pathway of paper travel 4 Gently insert the paper between the lower part of the black rubber platen and the black plastic see picture 6 Picture 6 Picture 7 5 When the paper appears between the upper part of the rubber platen and the paper cu...

Страница 44: ...44 Make sure that the paper is aligned correctly see picture 6 and 7 6 Now guide the paper through the slot of the cover of the paper compartment 7 Close the plastic cover of the paper compartment again AA222 is now ready to print ...

Страница 45: ...g selected in the Common Setup Menu In order to choose between Tympanometry Test Reflex Test and Reflex and Tympanometry Test browse with the Tymp Reflex key 10 Figure 9 shows the Reflex and Tympanometry Test Screen Figure 9 In the Reflex and Tympanometry mode both indication lights of the Tymp Reflex key 10 will be active 1 Select test ear by means of Right 27 or Left 28 2 Select the wanted refle...

Страница 46: ...adset is used When using the clinical headset select Pause 8 in order to prevent the instrument from automatically starting the test as soon as an airtight fit has been obtained Now place the clinical headset over the patient s head or use the shoulder strap and insert the probe tip into the ear canal When an airtight fit has been obtained the tympanometric test is ready to be performed To start t...

Страница 47: ... the standard 3 ml tympanogram When the compliance peak exceeds the 3 ml scale like in figure 9 AA222 will give the operator the possibility to change between 1 5 ml 3 0 ml and 6 0 ml scale by pressing F5 Figure 10 When the tympanogram with the 6 ml scale is activated the 6 ml scale will be present for both right and left ear Figure 11 ...

Страница 48: ...test procedure the selected reflex Test A or B can be modified in order to meet the exact demands which are needed for the individual patients To modify reflex Test A or B press F6 Figure 12 Figure 13 shows the Modify Menu for Reflex Test A it is similar for Reflex Test B Figure 13 ...

Страница 49: ...the reflexes for Test A or B can be modified Finally press Back 7 to return to the test screen Ipsilateral and Contralateral Reflexes AA222 is capable of performing ipsilateral as well as contralateral reflexes In the Setup Menu for Reflex A or B it is possible to set up a reflex test procedure to perform either ipsilateral or contralateral reflexes only Alternatively AA222 can be set up to perfor...

Страница 50: ...r up setting selected in the Common Setup Menu In order to choose between 1 Tympanometry Test 2 Reflex Test and 3 Reflex and Tympanometry Test browse with the Tymp Reflex key 10 Figure 14 shows the Tympanometry Test Screen Figure 14 In the Tympanometry mode the left indication light only on the Tymp Reflex key 10 will be active 1 Select test ear by means of Right 19 or Left 20 2 Place the probe in...

Страница 51: ...en an airtight fit has been obtained the tympanometric test is ready to be performed To start the test select Pause 9 once again and the test will be carried out automatically Note From the Common Setup Menu it is possible to set up the Pause key 9 to be controlled from the Remote Switch of the probe On the screen the tymp test can be followed on line 3 Remove the probe from the first ear when the...

Страница 52: ...robe tone tympanometry please contact your Interacoustics dealer When the instrument is switched on it automatically powers up in 1 the Reflex and Tympanometry Test mode or in 2 the Tympanometry mode depending on the Power up setting selected in the Common Setup Menu In order to choose Tympanometry with High Probe Tone select High Probe Tone button F4 4 from the Tymp test Figure 15 shows the Tympa...

Страница 53: ...act same way as a normal Tympanometry test It is possible to perform normal Tympanometry and High Probe Tone Tympanometry in one test session and thus print out the test results for comparison When the first tympanometry curve has been drawn with normal or High Probe Tone press High Probe Tone 4 in order to enter or exit High Probe Tone mode Now the next curve will be drawn automatically Press Pri...

Страница 54: ... in 1 Reflex and Tympanometry mode 2 Tympanometry mode or 3 Audiometry mode Depending on the Power up setting selected in the Common Setup Menu To choose between 1 Tympanometry Test 2 Reflex Test and 3 Reflex and Tympanometry Test browse with the Tymp Reflex key 10 Figure 17 shows the Reflex Test Screen Figure 17 In the Reflex Test mode the right indication light only on the Tymp Reflex key 10 wil...

Страница 55: ...tip When a correct fit has been obtained the reflex test will begin 2a If clinical headset is used When using the clinical headset select Pause 9 to prevent the instrument from automatically starting the test as soon as an airtight fit has been obtained Place the clinical headset over the patient s head or use the shoulder strap and insert the probe tip into the ear canal When an airtight fit has ...

Страница 56: ...t the default intensity and frequency will be highlighted like in figure 17 With the Frequency Decr Incr buttons 27 and 28 and the HL dB rotary dial 26 it is possible to change the parameters for the manual reflex Figure 18 When ready press the Tone Switch 29 and the manual reflex will be performed and appear on the display The parameters for the manual reflex can be changed once again if the resu...

Страница 57: ...ndividual reflex not only in the small reflex boxes but also on the full screen After the automatic test procedure press Man Auto 17 and an empty reflex box will appear and below it the default intensity and frequency will be highlighted like in figure 19 Figure 19 Just above the F1 and F2 keys there are two small arrows pointing to the left and the right hand respectively By pressing the F1 and F...

Страница 58: ...two different ways to perform reflex decay tests with AA222 Reflex decay tests can be performed subsequently to an automatic test session or on their own After an automatic session where a number of reflexes have been recorded there might be a need for making one or more manual reflex decay tests This can be performed by pressing Man Auto 17 Now an empty and highlighted reflex box will appear and ...

Страница 59: ...ady press the Tone Switch 29 and the manual reflex decay will be performed and appear on the screen The parameters for the manual reflex can be changed by pressing the Frequency Decr Incr keys 27 and 28 and dialling the HL dB rotary dial 26 Figure 22 ...

Страница 60: ...res for performing another manual reflex or reflex decay test Eustachian Tube Function With AA222 it is possible to perform a Eustachian Tube Function test for non perforated ear drums the so called Williams Test With AA222 the test is semi automatic and will suggest the operator how to operate the instrument and how to instruct the patient To choose the Eustachian Tube Function test press the ETF...

Страница 61: ...rm the test the operator will have to press the blinking Pause key 9 to make a tympanometric curve After the first sweep an information window appears on the screen Figure 25 Follow this instruction To decrease the middle ear pressure create a negative middle ear pressure make the patient swallow while closing his hers nose with two fingers Now press the blinking Pause 9 key once again and the tes...

Страница 62: ... peak pressures of the three tympanometric curves are also expressed numerically in daPa If the three peak pressures are the same it has not been possible for the patient to operate his Eustachian tube to change the middle ear pressure This means that the Eustachian tube is temporarily or permanently out of function Note From the Common Setup Menu it is possible to set up the Pause key 9 to be con...

Страница 63: ...7 shows the Reflex and Tympanometry Test with the Child Function activated Figure 27 The train will continue moving until the selected reflex test session has finished When the test session has finished the train will automatically disappear ...

Страница 64: ...anual or automatic audiometry as default at power up The automatic audiometry threshold test is according to the Hughson Westlake HW test procedure which is defined as 2 out of 3 or 3 out of 5 correct responses at a certain level in a 5 dB increase and 10 dB decrease test procedure From the Test Audiometry Setup Menu it is possible to select between 2 out of 3 or 3 out of 5 correct responses for t...

Страница 65: ...In the horizontal bar above the right and the left audiogram it is possible to follow the test procedure see figure 25 To the left there is a small circle which is highlighted whenever a tone is audible to the patient Next to the circle there is a small rectangle which is highlighted whenever the patient presses the patient response button Finally the present dB value and frequency is expressed nu...

Страница 66: ...n the audiogram just below the horizontal bar the cursor will indicate the present masking intensity and frequency Note In the Audiometry Setup Menu it is possible to choose two different types of noise for output NB Narrow Band Noise or WN White Noise Insert Masking In cases where danger of over masking exists masking by insert phone is recommended This will improve the cross hearing of the maski...

Страница 67: ...eech Audiometry When the instrument is switched on it automatically powers up in 1 Reflex and Tympanometry mode 2 Tympanometry mode or 3 Audiometry mode depending on the Power up setting selected in the Common Setup Menu To select speech audiometry press either the Mic key 16 for live voice speech testing or press CD1 CD2 17 for presentation of pre recorded speech material CD or tape Figure 31 Fig...

Страница 68: ...n Mic 16 for approximately two seconds The message box shown below will now show up Figure 32 While presenting live speech into the built in microphone adjust the VU meter so that maximum deflection reaches 0 indication on its scale on the points of maximum intensity of the spoken words see arrow A The adjustment is carried out by dialing the HL dB rotary dial 26 To store the VU setting press Stor...

Страница 69: ...ess Store 27 Figure 33 In case two CD inputs are used e g one for recorded speech and one for recorded noise both inputs must be calibrated When being in the message box this is simply done by selecting CD1 or CD2 see arrow B by pressing CD1 CD2 8 and store the adjusted VU setting by pressing Store 27 In order to see the two stored VU settings hold down shift while pressing CD1 CD2 8 3 When calibr...

Страница 70: ... in percentage can be reset to 0 by pressing Reset F2 Note The word scoring method described here is the DEFAULT word scoring Method It is also possible to use the German Method in which only the correct button needs to be activated Please refer to the section on Speech Audiometry Setup Menu on page 129 for detailed information about how to change the scoring method Number of Words The number of w...

Страница 71: ...ech presentations simply by pressing Man Rev F3 Pulse You may choose pulsing speech for the speech presentation simply by pressing Pulsing F4 Masking and Speech Speech noise as masking may be selected and adjusted by dialling the HL dB rotary key 30 To switch off masking hold down shift 18 while dialling the HL dB rotary key 30 anticlockwise While using masking it is possible to synchronies the ma...

Страница 72: ...the Function Screen mode press F1 to select the ABLB test Instruct the patient that he will hear tones alternating in his left and right ear he is expected to press the response switch corresponding to the ear where the loudest tone is heard The patient must be informed that it is only the loudness of the tone loudness and not the character of the tone that should be considered A Set the intensity...

Страница 73: ...to 5 000 mS in steps of 50mS Stenger Test The Stenger test is a test for malingering based on the auditory phenomenon of referral to the ear in which the sound appears loudest the Stenger effect To select the Stenger test in the Audiometry mode press Function shift 18 with 25 In the Function Screen mode press F2 to select Stenger test In the Stenger Test mode the following test parameters can be a...

Страница 74: ... Rev C Present a continuous tone in channel 2 to the suspected ear at a level just below the level that the patient untruthfully has reported to be his hearing threshold for this ear D If the patient reports the tone in the normal ear to have disappeared thus claims he now hears nothing he is malingering SISI Test The Short Increment Sensitivity Index is designed to test the ability to recognise o...

Страница 75: ... 4000 Hz and an intensity 20 dB above hearing threshold are recommended for SISI testing As soon as being in the SISI Audiometry mode see figure 29 a continuous tone will be audible with 5 dB modulation increments automatically presented at random This is to familiarise the patient to discriminate the modulation and let him respond via the patient response button B When the patient understands the...

Страница 76: ...anged arbitrarily to prevent malingering For this purpose press F2 F4 or F5 to select 0 2 or 5 dB increments This can be done without affecting the test result as only increments at 1 dB are calculated After 20 increments at 1 dB the test stops automatically and the score is shown in percentage in the display If more frequencies have been tested during the SISI test procedure it is possible to see...

Страница 77: ...were designed specifically to obtain optimal measuring results and non original supplies may compromise results Cleaning of Probe Tip To secure correct impedance measurements it is important to make sure that the probe system is kept clean at all times Therefore follow the below illustrated instruction on how to remove e g ceru men from the small acoustic and air pressure channels of probe tip To ...

Страница 78: ...aling gasket Transducer House Probe Tip with the small acoustic and air pressure channels The cleaning of the acoustic and air pressure channels of the probe tip must be performed by means of the cleaning wire nylon wire which is part of the cleaning tool that can be found in the Ear tips Assortment provided with the AA222 When cleaning the acoustic and air pressure channels of the probe tip the c...

Страница 79: ...e acoustic and air pressure channels of the probe tip can be reassembled Place the sealing gasket onto the transducer house like shown in picture 12 and make sure that holes of the gasket are aligned with the holes in the holes of the transducer housing Picture 12 ...

Страница 80: ...AA222 Operation Manual Page 80 Place the probe tip onto the transducer housing a small flange will ensure correct positioning before the plastic nut is gently tightened Picture 13 ...

Страница 81: ...Reflex Selects 1 Tympanometry 2 Reflex and Tympanometry 3 Reflexometry 10 ETF Selects Eustachian Tube Function test 11 Pause Selects pause function when clinical headset is used 12 Ipsi To activate and deactivate the ipsilateral reflex stimulus which is presented through the probe 13 Contra To activate and deactivate the contralateral reflex stimulus which is presented through the audiometric head...

Страница 82: ...f a keyboard is installed new patient data can be typed 16 Mic Selects microphone for speech audiometry with live voice 17 CD1 CD2 Selects CD1 CD2 or CD1 and CD2 at the same time for speech audiometry with recorded speech and masking 18 Shift The shift key activates the sub functions of the other keys 9 27 written in italic 19 Right Selects right test ear 20 Left Selects left test ear 21 Bone Sele...

Страница 83: ...for browsing between the available intensities in the different tests 27 Frequency Decr Browses between the different frequency options in manual reflexometry and manual audiometry 28 Frequency Incr Browses between the different frequency options in manual reflexometry and manual audiometry 29 Tone Switch Stimulus presentation switch for manual audiometry and manual reflex mode 30 Intensity Incr R...

Страница 84: ...em Power Consumption 15VA Mains voltage fuses 100 240V 50 60Hz 0 5A max The AA222 is delivered with a power cord for the relevant national mains socket But AA222 can be powered by any national AC voltage Before use the correct attachment plug mains cable must be identified and installed Operation Environment Temperature 15 35 C 65 95 F Rel Humidity 30 90 Temperatures below 0 C 32 F and above 50 C ...

Страница 85: ...yed on the graphical display Range 600 to 300 daPa Pressure Limitations 800 daPa and 600 daPa Pressure Change Rate Minimum 50 daPa s medium maximum or automatic with minimum speed at compliance peak Selectable in the setup Compliance Range 0 1 to 6 0 ml Ear volume 0 1 to 8 0 ml No difference is measured in the recorded values between static and dynamic measuring mode Types Tympanometry Automatic w...

Страница 86: ...properties Probe tone Frequencies 226 Hz 1 678 Hz 1 800 1 Level 85 dB SPL 1 5 dB measured in an IEC 60318 5 acoustic coupler The level is constant for all volumes in the measurement range Distortion Max 3 THD Calibrated transducers Audiometry headset Telephonics TDH39 with a static force of 4 5N 0 5N Bone conductor Radioear B71 with a static force of 5 4N 0 5N Definition of units 1 ml at 226 Hz 1 ...

Страница 87: ...r Mic Connection for external microphone for live speech Talk Back Connection for talk back microphone Patient Response Patient response switch connection Output Audiometry Earphones Audiometric headphone left and right Bone Conduction B71 bone conductor Free Field 1 and 2 Electrical output for external 2 channel power amplifier AP12 and AP70 Monitor Monitor earphone disconnects the internal monit...

Страница 88: ... where the measured data will be sent to an external PC Keyboard Connection for external keyboard standard PC type Tolerance Probe tone frequency accuracy better than 2 Insert earphones frequency accuracy better than 3 Super aural earphone frequency accuracy better than 3 THD Probe tone THD is less than 3 Insert earphones THD is less than 5 Super aural earphone THD is less than 2 5 Attenuator Rang...

Страница 89: ...als are made to follow IEC 60645 1 Contralateral Earphone Pure tone ISO 389 1 for audiometric headphone Wide Band noise WB Interacoustics standard spectral properties As Broad band noise specified in IEC 60645 5 but with 500 Hz as lower cut off frequency Low pass noise LP Interacoustics standard spectral properties Uniform from 500 Hz to 1600 Hz 5 dB re 1000 Hz level Hign pass noise HP Uniform fro...

Страница 90: ...eadphone EAR Tone 3A Insert CIR22 Min Max Min Max Min Max Min Max Hz dB HL dB HL dB HL dB HL dB HL dB HL dB HL DB HL 250 10 110 10 105 0 100 500 10 120 10 110 0 105 10 105 1000 10 120 10 120 0 110 10 110 2000 10 120 10 120 0 105 10 105 3000 10 120 10 120 0 100 10 100 4000 10 120 10 115 0 95 10 100 6000 10 120 10 100 8000 10 110 10 95 WB noise 10 120 10 120 0 100 10 105 LP noise 10 120 10 120 0 100...

Страница 91: ...ent volumes of the ear canal Freq Variation of ipsi stimulus levels for different volumes of the ear canal Relative to the calibration performed on an IEC 126 coupler 0 5 ml 1 ml Hz dB dB 500 9 7 5 3 1000 9 7 5 3 2000 11 7 3 9 3000 0 8 0 5 4000 1 6 0 8 WB 7 5 3 2 LP 8 0 3 6 HP 3 9 1 4 ...

Страница 92: ...one with MX41 AR or PN 51 cushion EAR Tone 3A Audiometric headphone with MX41 AR or PN 51 cushion using IEC 303 coupler Hz dB dB Hz dB 125 3 32 5 125 17 5 160 4 160 14 5 200 5 200 12 250 5 36 250 9 5 315 5 315 6 5 400 6 400 3 5 500 7 37 5 500 0 5 630 9 630 0 750 750 800 11 800 0 5 1000 15 36 5 1000 0 5 1250 18 1250 1 1500 1500 1600 21 1600 4 2000 26 33 2000 6 2500 28 2500 7 3000 3000 3150 31 3150 ...

Страница 93: ... 26 22 0 22 0 250 25 5 25 5 4 67 67 14 11 0 11 0 500 11 5 11 5 4 58 58 5 5 4 0 3 5 750 7 5 8 5 48 5 48 5 2 2 0 1 0 1000 7 7 6 42 5 42 5 0 2 0 0 5 1500 6 5 6 5 6 36 5 36 5 2 0 5 1 0 2000 9 9 6 31 31 3 1 5 1 5 3000 10 10 6 30 30 3 5 6 0 4 0 4000 9 5 9 5 5 35 5 35 5 5 5 6 5 5 0 6000 15 5 15 5 5 40 2 2 5 0 5 8000 13 13 5 40 0 11 5 5 5 WB 8 5 5 LP 6 7 7 HP 10 8 8 ISO 389 3 ANSI S3 6 Valid for placement...

Страница 94: ...lectret bias Electret or 2000 dynamic microphone 100 V at max volume for 0 Vu reading 47 5 k 90 20kHz 6 2V through 4 75 k 1 3 mA Talk Back microphone Jack 6 3 mm stereo As for Microphone Outputs Phones Left Right Jack 6 3mm mono Voltage Min load impedance Up to 5 5V rms by 10 load 5 Bone conductor Jack 6 3mm mono As for Phones Left Right Free Field 1 2 Phono Voltage Min load impedance Freq respons...

Страница 95: ... green Ipsi Stim Gnd Ipsi Stim Signal Probe tone Gnd Gnd Vref 5V LED red Data I O USB USB type B USB port for communication See appendix A in service manual for detailed information Table 6 General properties for earphones Sound attenuation values for earphones Frequency Attenuation TDH39 with MX41 AR or PN 51 cushion EAR Tone 3A EAR Tone 5A Hz dB dB 125 3 33 5 160 4 200 5 250 5 34 5 315 5 400 6 5...

Страница 96: ...in Max Min Max Min Max Min Max Hz dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL 125 10 90 10 90 10 80 250 10 110 10 105 0 45 0 105 10 90 500 10 120 10 110 0 65 0 110 10 100 750 10 120 10 115 0 70 0 110 10 100 1000 10 120 10 120 0 70 0 110 10 100 1500 10 120 10 120 0 70 0 110 10 100 2000 10 120 10 120 0 75 0 110 10 100 3000 10 120 10 120 0 80 0 110 10 100 4000 10 120 10 115 0 80 0 105...

Страница 97: ...earphones B71 Bone conductor APS2 Patient Signal ATP AT235U Universal probe system with shoulder strap and wrist strap tubing 360mm Ø1 3xØ3 3 transparent silicone TPR26 3 rolls of recording paper Power cable Dust cover Operation Manual Multilingual CE instructions for use Additional Parts EARtone 5A Audiometric Insert Phones 50250 Peltor noise exclosures 21925 Amplivox noise exclosures ACC400 carr...

Страница 98: ...f at side of panel Connection to mains Connection for Probe System Power connection to optical USB Connection for FF amplifiers Connection for USB Contra Phone connection Connection for Patient response button Connection Piece for air supply to probe system Printer compartment for internal printer Test cavities 0 5 cc 2 cc tolerances are 0 2 cc Probe holder CD player connection Talk Back microphon...

Страница 99: ...ore carton for future shipment The AA222 comes in its own shipping carton which is specially designed for the AA222 Please store this carton It will be needed if the instrument has to be returned for service If service is required please contact your nearest sales and service office Contents of Shipment When AA222 is delivered as a standard unit the case contains the following Quantity Item Order ...

Страница 100: ...r scratches and missing parts Report immediately any faults Any missing part or malfunction should be reported immediately to the supplier of the instrument together with the invoice serial number and a detailed report of the problem In the back of this manual you will find a Return Report where you can describe the problem Please use Return Report Please realise that if the service engineer does ...

Страница 101: ...s Great care should be exercised when handling the transducers of AA222 as dropping them may alter the calibration Annual calibration The AA222 has been designed to provide many years of reliable service but annual calibration is recommended due to possible impact on transducers We do also recommend to calibrate the AA222 if something drastic happens to a part of it e g if headset or bone conducto...

Страница 102: ...ht on the probe Check if the transducer probe system is connected on the connection panel of AA222 The small rubber tube of the probe cable must be connected on the connection panel of AA222 Blocked is displayed in Tymp mode The probe is blocked at the ear tip either by wrong insertion into the ear canal or by cerumen Any accumulated cerumen at the probe tip opening should be removed very carefull...

Страница 103: ...n the Common Set Up under Printer Printer responds but nothing is printed on the paper The printer paper has been installed incorrectly meaning that the backside of the paper is facing the printer head Simply turn around paper roll Please refer to the chapter Installing Printer Paper Display is too bright or too dark From the Main Menu it is possible to adjust the brightness by means of LCD and LC...

Страница 104: ...h off the indication light in the Ipsi key and deactivate the ipsilateral reflexes Sometimes I would like to temporarily change the pre programmed reflex setup How can I do that It is always possible to modify the pre programmed reflex test A or B in the Reflex and Tympanometry test menu All previous data must be deleted by pressing new subject 9 while holding shift 18 In the lower right hand corn...

Страница 105: ...ressing the Pause key 9 When the Pause Function is selected either manually or as power up the indication light will be active on the Pause key 9 The Remote Switch on the probe does not allow me to change between right and left ear The function of the remote switch on the probe is defined under Remote Switch in the Common Setup Menu of AA222 It is possible to set up the remote switch to a L R in t...

Страница 106: ...flex test is highlight and the graphical data of the reflex test is shown in a large window above the reflex box What is Gradient Gradient is explained in the chapter Tympanometry Setup Menu of this manual My AA222 only displays 4 reflexes boxes I need 6 reflex boxes In the Common Setup Menu under Reflex Icon Boxes it is possible to select between either 4 or 6 reflex boxes Make sure that you sele...

Страница 107: ...l Aspects of Secretary Otitis Media Scand Aud Supp 26 1985 Brask T Extratympanic Manometry in Man Scandinavian Audiology supp 7 1978 Feldmann and Laura Ann Wilber Acoustic Impedance Admittance the measurement of middle ear function Williams Wilkins 1976 Fiellau Nikolajsen Mogens Tympanometry and Secretary Otitis Media Acta Oto L 1983 Harford Earl R Impedance Screening for Middle Ear Disease in Chi...

Страница 108: ...ediatric Audiology Göteborg 1982 Scandinavian Audiology supp 17 1983 Liden G et al Automatic Tympanometry in Clinical Practice Audiology 13 1974 Liden G et al Tympanometry for the Diagnosis of Ossicular Disruption Arch Otolaryngol vol 79 1974 Liden G Audiology Almqvist Wiksell 1985 Swedish language Popelka G R et al Hearing Assessment with the Acoustic Reflex Grune Stratton 1981 ...

Страница 109: ...the middle ear Contra lateral Reflex The middle ear muscle reflex that occurs in the ear contra lateral to the stimulus ear Dynamic Acoustic Compliance See Dynamic Acoustic Immittance Dynamic Acoustic Immittance The acoustic immittance as observed with a continuous change in air pressure tympanometry and or during the activation of the middle ear muscle s reflex measurements Ear Tip A cuff which i...

Страница 110: ...nes ossicles in the middle ear Pascal Pa A unit of pressure or stress equal to one Newton per m 2 Static Acoustic Compliance See Static Acoustic Immittance Peak Static Acoustic Immittance The static acoustic immittance obtained with a specific air pressure in the external auditory canal as adjusted to produce an extreme in the measured acoustic immittance Probe A coupling device that is inserted i...

Страница 111: ...coustic compliance to that of the middle ear Measured in millilitres or cm 2 Stimulus Ear The ear to which the reflex activating stimulus is presented in order to elicit a middle ear muscle reflex Note If a bone vibrator or a loudspeaker is used to deliver an acoustic reflex it may not be possible to define the stimulus ear Toynbee Test Test designed to determine the function of the Eustachian tub...

Страница 112: ...ear Syn Toynbee s manoeuvre Valsalva s Manoeuvre Blowing forcibly to open Eustachian tube by holding nose and closing mouth Named for its originator Antonio Valsalva Sometimes called Valsalva s experiment Williams Test Test designed to determine the function of the Eustachian tube in ears with non perforated eardrums ...

Страница 113: ...al setup menus navigation through the setup points and changing parameters in the individual setup points is very simple With the F keys F2 to F5 representing arrow keys it is possible to browse through the different setup points Parameters can be changed with Change F1 when it is highlighted To leave the individual setup menus press Back 7 This key will always take you back one level If one or mo...

Страница 114: ...u is reached from the Main Menu by pressing Setup F2 and Tymp F1 Figure 41 Start Pressure Indicates the starting point for the pressure sweep for the tympanometric curve It goes from 25 daPa to 300 daPa Stop Pressure Indicates the pressure where the sweep for the tympanometric curve will stop ...

Страница 115: ...matic setting speed and precision is combined in the tympanometric sweep At the start of the sweep the pump speed will be at maximum due to the fact that the information derived from the first part of the sweep only contains little information of diagnostic value The speed will gradually be reduced to minimum speed when coming closer to the peak Just before and just after the peak the pump speed w...

Страница 116: ...the compliance value If daPa is selected the gradient will be calculated the following way The program searches from each end of the tymp curve and stores the pressure at the point where the tymp curve is equal to compliance value divided by 2 Gradient is equal to the two stored pressures subtracted from one another High probe tone frequency Note that only when the AA222 was licensed to have the h...

Страница 117: ...ure 44 It is possible to choose between four different Reflex Methods Fixed Intensity Screening 10 dB Steps Auto 5 dB Steps Sequence Each Reflex Method can hold up to six individually pre programmed reflexes In the below figure 45 the starting conditions for each of the four Reflex Methods can be set up to personal needs Figure 45 The four arrow keys F2 to F5 browses between the parameters of the ...

Страница 118: ... 750 1000 1500 2000 3000 4000 6000 and 8000 Hz including also the noise stimuli WN LP and HP Level The intensity level for the reflexes goes from 60 dB to maximum Maximum depends on the selected frequency and the selected transducer In the final line of the table it is possible to switch on or off the reflexes according to the number of reflexes needed Note It might be relevant to set reflexes whi...

Страница 119: ... different algorithms to choose from each representing its individual level of Reflex Sensitivity These three Reflex Sensitivities are referred to as Sensitive Normal and Robust and they are expressed in ml When searching for the reflex by means of the following three Reflex Methods the algorithms in the software will continue to search for the reflex until the intensity has reached the maximum le...

Страница 120: ... 0 05 ml Figure 49 Robust 0 08 ml Figure 50 Robust 0 08 ml The first three reflexes are all examples of reflexes that have been accepted according to the different algorithms sensitive normal and robust They are accepted because they do not touch the pass box However figure 50 shows an example of a reflex that is not accepted according to the chosen algorithm The reflex is not accepted because it ...

Страница 121: ... the screen for setting up the Screening 10 dB steps Reflex Method Figure 51 The Screening Method is an automatic test for detecting reflexes The reflex parameters in the Screening Method can be set up to personal needs from the reflex table in the lower part of the screen The Screening Method starts with the selected Output Stimuli Level and Intensity Level from the parameter table in figure 37 a...

Страница 122: ...size is preferred see Reflex sensitivity above The Auto test then searches for suitable stimulus intensity before each reflex is tested Figure 52 The automatic procedure for determining which intensity to use for the reflex test follows these guidelines 1 A stimulus where the intensity quickly increases is presented to the ear Simultaneously the instrument monitors at which intensity a change of c...

Страница 123: ...y is displayed as the test result for the test Sequence Figure 53 shows the screen for the Sequence Reflex Method Figure 53 With the Sequence Method it is possible to have up to six single reflexes in one reflex window The reflex parameters in the Sequence Method can be set up to the personal needs from the reflex table in the lower part of the screen In the Sequence Method the intensity levels ar...

Страница 124: ... between each single reflex Choose between 5 6 8 9 or 10 Note A warning pops up when too high a Level Increase has been chosen together with too high a start intensity level This will violate the maximum output capabilities of AA222 Figure 55 Compensate for General Drifting When searching for reflexes with the Sequence Method the compliance may drift a little When the instrument is set to Normal t...

Страница 125: ...omatic Reflex Sensitivity appears in the line just below Test Stop Criteria when Automatic is selected Reflex Sensitivity functions in the same way as in the Screening and Auto Reflex Methods and can be set to Sensitive Normal or Robust Audiometry Setup Menu The Audiometry Setup Menu is reached from the Main Menu by pressing F2 Setup and F2 Aud see figure 58 Default Intensity Default Intensity is ...

Страница 126: ...t Heard Lines Enable or disables the lines between not heard symbols on the printout Not Heard Lines can be set to either On or Off Output Bone Masking Selects between these transducers for masking stimuli output Opposite CH1 The masking stimuli output will be presented via one of the audiometric headphones opposite the ear being tested with the bone conductor The transducer must be connected to t...

Страница 127: ...Selects between the built in swan neck microphone and an external microphone Output Ch2 Selects between Narrow Band and White Noise as masking for output in channel 2 Audiometer Mode Preselect Selects between Manual or Automatic Audiometry as default when pressing Audiometry 25 Manual Audiometry Setup Menu The Manual Audiometry Setup Menu is reached from the Main Menu by pressing F2 Setup Aud and ...

Страница 128: ... will cause the frequency to jump to 125 Hz ready to perform increasing frequency selection Butterfly Trying to increase the frequency selection beyond 8000 Hz causes the frequency to jump to 1000 Hz ready to perform decreasing frequency selection Trying to decrease the frequency below the lowest frequency causes the frequency to go to 1000 Hz ready to perform increasing frequency selection Pulse ...

Страница 129: ... the Speech Audiometry Setup Menu Figure 60 shows the Manual Audiometry Setup Menu Figure 60 Number of words Here you can assign the number of words in your word list This will make the basis of the result obtained via the automatic speech score counter Score Method It is possible to select between Default or German method Default mode will calculate the of correct answers when Incorrect or Correc...

Страница 130: ...f one syllable words and two syllable words Standard curves for headphone testing as well as Free Field testing are available The characteristics of these curves have been pre programmed in the AA222 However should you wish to alter the characteristics of these curves this is possible simply by browsing with the keys F2 to F4 The changing of the characteristics is carried out by the Change key F1 ...

Страница 131: ...r Manual Audiometry Communication The setting is USB It cannot be changed Remote Switch Selects the function of the Remote Switch of the probe Select between Off L R Pause and L R or Pause 1 When Off is selected the Remote Switch is out of function 2 When L R is selected it is possible to shift between left and right ear with the Remote Switch 3 When Pause is selected it is possible to control the...

Страница 132: ...22 is activated and can be used if an internal printer is installed Subject Data Printout when Printer is set to Internal Subject Data Printout can be set to either On or Off When set to On the labels of subject details will be printed To enter the Subject Screen a keyboard must be connected to the AT235 and the Keyboard Connected point in the Common Setup Menu must be set to Yes Clinic Data Print...

Страница 133: ... press F1 Edit and then F2 Print After Test Print After Test can be set to either On or Off When set to On the test result will be printed automatically when both right and left ear have been tested This automatic printing possibility is directly related to the Power up chosen Tymp or Reflex and Tymp When set to Off the print function must be activated manually Language It is possible to select be...

Страница 134: ... cable and turn on the instrument the following window should appear The Driver is available from Windows Update if the PC is connected to the internet or it can be found on the CD with the operation manual Click Next and the following window should appear Insert the CD if the PC is not connected to the internet click Next ...

Страница 135: ...er for Serial Converter B needs to be installed follow the directions above The Driver for the USB Serial Converter is now installed to find out which COM port to use when communicating with the instrument start the Device Manager Click Start My Computer properties Hardware Device Manager The Port is recognized as USB Serial Port use the one with the lowest number ...

Страница 136: ...s higher than it is possible to set in the PC application it is possible to change the number by selecting properties for the USB Serial Port then Click Hardware and Advanced the following window should appear Change the COM port number in the drop down box ...

Страница 137: ...d or by control replacement of the mains fuses Observe that no damage is present on the insulation of the mains cable or the connectors and that it is not exposed to any kind of mechanical load which could involve damage Consult the Operating Manual for the instrument in question to see how long time it takes from turning on the instrument until it is stabilised and ready to use For maximum electr...

Страница 138: ...inside of the instrument or the accessories After each examination of a patient it should be ensured that there is no contamination on the parts in connection with the patient general precautions must be observed in order to avoid disease from one patient being passed to others Ear tips should be changed after each patient and if ear cushions are contaminated it is strongly recommended to remove t...

Страница 139: ...AA222 Operation Manual Page 139 Return Report ...

Страница 140: ...AA222 Operation Manual Page 140 ...

Страница 141: ...AA222 Operation Manual Page 141 Drawing of Front Plate 1 2 3 4 5 6 7 8 9 10 11 16 19 12 24 17 20 14 15 25 18 29 23 22 13 21 26 27 28 30 ...

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