AA222 Impedance Audiometer: Additional Information

Additional Information
AA222
Impedance Audiometer
D-0115567-B – 2017/05
Table of contents
1 About the AA222 ........................................................................................................................1
2 General operation of the tympanometry module ...................................................................3

2.1 Preparing for the tympanometry test ..............................................................................3
2.1.1 Tympanometry patient instruction ......................................................................3
2.1.2 Visual inspection of the ear canal ......................................................................3
2.1.3 Placement of the contralateral phone ................................................................4
2.1.4 Selecting the correct ear tip ...............................................................................4
2.2 Tympanometry ................................................................................................................5
2.3 Reflex ..............................................................................................................................7
2.4 Reflex decay ...................................................................................................................9
2.5 Reflex latency .............................................................................................................. 10
2.6 Eustachian tube function – non-perforated eardrum ................................................... 11
2.7 Eustachian tube function – perforated eardrum .......................................................... 12
2.8 Eustachian tube function – patulous eustachian tube ................................................. 13
3 General operation of the Audiometry module ..................................................................... 15

3.1 Pure tone audiometry................................................................................................... 15
3.1.1 Masking ........................................................................................................... 15
3.2 Weber........................................................................................................................... 15
3.3 Stenger ........................................................................................................................ 15
3.4 Auto – Hughson-Westlake ........................................................................................... 15
3.5 Alternate binaural loudness balancing (ABLB) – Fowler Test ..................................... 15
3.6 Speech audiometry ...................................................................................................... 15
3.7 QuickSIN – Quick signal in noise testing ..................................................................... 15
3.8 Short increment sensitivity index (SISI) ....................................................................... 15
4 Setup menu ............................................................................................................................. 17

4.1 Instrument settings ....................................................................................................... 17
4.2 Tympanometry setup menu ......................................................................................... 20
4.2.1 Common settings – IMP .................................................................................. 20
4.2.2 Protocol settings .............................................................................................. 21
4.2.3 Manage protocol settings ................................................................................ 32
4.3 Audiometry setup menu ............................................................................................... 33
4.3.1 Common settings - AUD ................................................................................. 33
4.3.2 Working with user-defined setups (test protocols) .......................................... 35
4.3.3 Tone settings ................................................................................................... 35
4.3.4 Speech settings ............................................................................................... 39
4.3.5 Auto settings ................................................................................................... 41
5 Diagnostic suite ...................................................................................................................... 43

5.1 Transferring a custom symbol scheme from the suite to the device ........................... 43
6 Operating through a database .............................................................................................. 45

6.1 OtoAccessTM ................................................................................................................ 45
6.1.1 Upload clients to the device and save the measurements to the clients ........ 45
6.1.2 Download the client information to one patient ............................................... 45
6.2 NOAH ........................................................................................................................... 45
6.2.1 Download the client information to a patient using NOAH .............................. 45
7 Print .......................................................................................................................................... 47
7.1 Printer direct ................................................................................................................. 47
7.1.1 Installing the direct printer ............................................................................... 47
7.1.2 Modify the custom logo printout ...................................................................... 47
7.1.3 Printing from a direct printer ............................................................................ 47
7.2 MPTIII (thermal printer) ................................................................................................ 48
7.2.1 Installing the Sanibel MPT-III thermal printer .................................................. 48
7.2.2 Modify the custom logo printout ...................................................................... 48
7.2.3 Printing from the MPT-III thermal printer......................................................... 49
7.3 Print Wizard (Diagnostic suite only) ............................................................................. 50
7.3.1 Opening the Print Wizard ................................................................................ 50
7.3.2 Print Wizard elements ..................................................................................... 51
7.3.3 Designing a customised print template ........................................................... 52
7.3.4 Taskbar ........................................................................................................... 53
7.3.5 Design elements ............................................................................................. 54
7.3.6 Saving your print template .............................................................................. 66
7.3.7 Editing a print template prior to printing .......................................................... 67
AA222 Additional Information Page 1
1 About the AA222
The AA222 is a device combining audiometry and tympanometry. The target population for the AA222
covers all ages. The AA222 is designed to be used only by skilled personnel such as audiologists, ENT
surgeons, doctors, hearing healthcare professionals or personnel with a similar type and level of education.
The device should not be used without the necessary knowledge and training to understand its usage and
how results should be interpreted.
Availability of the tests listed below, or specific settings within these tests on the hardware or in the software,
depends on the license purchased.
The Audiometry module contains the following tests:

 Pure tone audiometry
 Weber
 Stenger
 Auto: Hughson-Westlake
 Alternate binaural loudness balancing (ABLB)
 Tone in noise (Langenbeck)
 Speech
 QuickSIN
 Short increment sensitivity index (SISI)
The Tympanometry module contains the following tests:

 Tympanometry 226, 678, 800 and 1000 Hz
 Ipsilateral reflexes
 Contralateral reflexes
 Reflex decay
 Reflex latency
 Eustachian tube function – non-perforated
 Eustachian tube function – perforated
 Eustachian tube function – patulous
2 General operation of the tympanometry

module
2.1 Preparing for the tympanometry test
2.1.1 Tympanometry patient instruction

Place the patient on a comfortable chair or, if necessary, on an examination table. Younger children may feel
more comfortable sitting on a parent's or nurse's lap. Show the probe to the patient and then explain the
following:
• The aim of the test is to assess the mobility of the eardrum
• The tip of the probe will be inserted into the ear canal and has to make a perfect seal
• A small amount of air will flow through the probe to move the eardrum; it produces a sensation
similar to pressing a finger slightly into the ear canal
• One or more tones will be heard during the test
• No active participation is expected from the patient
• Coughing, talking and swallowing will disturb test results
2.1.2 Visual inspection of the ear canal

Check the external ear canal for wax with an otoscope and remove any excessive wax to prevent the probe
opening from clogging, as this would inhibit testing. Excessive hairs may have to be cut.
2.1.3 Placement of the contralateral phone

If the contra headphone is used, place the headband over the patient's head. The audiometric headphone is
placed over the non-test ear (or contralateral reflex ear).
If the insert phone is used, mount the proper foam tip on the end of the tubing before inserting into the non-
test ear.
2.1.4 Selecting the correct ear tip
The table below can be used as a guide to help you select an appropriate ear tip size.
Ear tips inserted against

Age (years) Ear tips inserted into the ear canal
ear canal opening
Ear tip 3-5 mm, flanged
Ear tip 7.5

mm, umbrella
Ear tip 9 mm,

0.5 umbrella
Ear tip 10 mm,
Ear tip 7 mm, mushroom
umbrella
Ear tip 11 mm,

umbrella
Ear tip 13 mm,

4 Ear tip 9 mm, mushroom
umbrella
10 Ear tip 15 mm,

umbrella
adults Ear tip 19 mm,

umbrella
Exceptional Ear tip 22 mm,

sizes umbrella

2.2 Tympanometry
The default display of tympanometry tests shows graphs for both left and right ear. The following information
is found in the display:
A The label above the graph indicates which probe tone frequency was used while measuring the
recording that is plotted.
B The normative box which shows where the peak of the audiogram is expected in normal middle ear
functioning. The size of the normative box can be customized in the protocol setup. Be aware that
the placement of the normative box is dependent on the ear canal volume. This means that when
the curves are shown in non-compensated view, the box will only be placed correctly after the ear
canal volume has been determined.
C The tympanometry curve(s). The numerical values of the curve should be read from the left Y-axis.
For tympanometry performed at 226 Hz the scaling is in ml. For all other probe frequencies, the unit
at the Y-axis is mmho.
D The equivalent ear canal volume. In automated tympanometry, the acoustic admittance (Y) at the
start pressure is taken as the reference value. In manually performed tympanometry, it takes the
acoustic admittance at the highest recorded pressure as a reference. Be aware that at probe
frequencies other than 226 Hz, the equivalent ear canal volume is read from right Y.
E The table with measurement values. Here you will find:

• Volume, the equivalent ear canal volume
• Compliance, the peak compensated static acoustic admittance. When the tympanogram is
shown compensated for the ear canal volume, it is the compliance value at the peak.
• Pressure, the tympanic peak pressure which is at the point of the curve where the highest
compliance value is detected
• Gradient, If it is chosen to show gradient as pressure, it gives the tympanogram width at
half the height of the peak compensated static acoustic admittance. If it is chosen to show
gradient as compliance, it gives the average of the two compensated admittance values
which are 50 daPa away from the peak pressure.
If the automated measurement for some reason does not reach the end pressure as set in the
protocol setup, the table will only show the equivalent ear canal volume.
Manual tympanometry testing
F The dot represents the measurement of the (non-compensated) acoustic admittance. It is only
shown when not recording. During recording, the display will always be non-compensated.
G The empty triangle indicates actual pressure.
H The full triangle is the pressure cursor showing the current target pressure. It is moved by turning the
wheel.
2.3 Reflex
Note that in cases where your protocol has no reflex test included, you can temporarily include a reflex test in
your protocol by pressing the I Reflex C button.
The default displays of reflex tests show a matrix of reflexes, which are measured in the order of appearance
on the screen. The following information is found in the display:
A The reflex matrix shows graphs of equal stimulus types in the rows and equal stimulus levels in the
columns. Note that scroll bars appear when more stimuli are available than can fit on the screen.
B Within the graph, the x-axis is the time scale on which the black bar indicates when the stimulus
was given.
C A green square indicates that the reflex threshold is set (either automatically or manually) at the
chosen stimulus level.
D The Deflection value is shown when this option is activated through the protocol settings.
E A grey square indicates a stimulus level that is not available for that particular stimulus type.
F The square outlined in black indicates which section of the matrix has been selected or is currently
being measured.
Note that the reflexes are indicated by the probe ear. This is shown as an example below.
In the first setup, the probe is placed on the right ear and the contra headphone is placed on the left ear.
In the second setup, the probe is placed in the left ear with the contra headphone placed on the right ear.
2.4 Reflex decay

Note that in cases where your protocol has no reflex decay test included, you can temporarily include a reflex
decay test in your protocol by holding the Shift button while pressing the I Reflex C button. Pressing this
combination also allows including and excluding a reflex decay test from running automatically.
The decay test will be automatically performed with an activator intensity of 10 dB above the reflex threshold.
The test will show a pop-up and ask for the intensity of the activator in case:
• the reflex threshold cannot be found within the same protocol
• the required intensity is at or above the warning level as determined in the protocol settings
• the required intensity is above the maximum level that the transducer will permit for this particular
activator
The default display of the reflex decay tests shows the graphs of the decay measurements from the selected
ear. The following information is found in the display:
A The tympanometric curve.
B Within the graph, the x-axis is the time scale on which the black bar indicates when the stimulus was
given.
C The table with measurement values which are only calculated if the measurement can be completed.
• Level, stimulus level.
• Pressure, the pressure at which the decay reflex is measured. Usually the decay test will be
set up to use the peak pressure of a preceding tympanogram.
• Stimulus, stimulus frequency.
• Decay value, the percentage difference of the two reflex deflection values taken half a
second after the stimulus started and half a second before the stimulus stopped. If decay is
present, the percentage shows as a negative number. When the calculation results in
numbers larger than 125 % or smaller than -115 % the outcome is invalid and will not be
shown.
2.5 Reflex latency

The reflex latency test will be automatically performed with an activator intensity of 10 dB above the reflex
threshold. The test will show a pop-up and ask for the intensity of the activator in case:
• the reflex threshold cannot be found within the same protocol
• the required intensity is at or above the warning level as determined in the protocol settings
• the required intensity is above the maximum intensity that the transducer will permit for this particular
activator
The default display of the reflex latency test shows the graphs of the latency measurements from the
selected ear. The following information is found in the display:
A The first 300 ms of the tympanometric curve.
B The table with measurement values which are only calculated if the measurement can be
completed.
• Level, stimulus level
• Pressure, the pressure at which the decay reflex is measured. Usually the decay test will
be set up to use the peak pressure of a preceding tympanogram.
• Stimulus, stimulus frequency
• Latency value, the time interval between onset of the stimulus and the point where 10 % of
the reflex deflection value is reached. The reflex deflection value is measured as the
average of the deflection between 250 and 300 ms after stimulus onset.
2.6 Eustachian tube function – non-perforated eardrum

The display of the Eustachian tube function test for the non-perforated eardrum shows graphs for the
selected ear in which the three tympanograms of the adapted Williams procedure are plotted. The Williams
procedure keeps the pressure between the first and second tympanogram at the stop pressure, and between
the second and third tympanogram at the start pressure. In between all tympanograms, the original Williams
procedure involves asking the patient to swallow. In order to achieve a larger displacement in the
tympanograms, we advise asking the patient to perform a Valsalva maneuver after the first tympanogram,
then swallowing after the second tympanogram.
The following information is available during testing:
A The non-compensated tympanometric curves.
B The equivalent ear canal volume where the acoustic admittance (Y) at the starting pressure of the
first tympanogram is taken as the reference value.
C The table shows the pressure values at which the three peaks are detected (or the highest
equivalent volume if there is no peak).
An instruction is displayed between the three tympanograms to tell you how to direct the patient. To
continue, press either Continue or Enter.
2.7 Eustachian tube function – perforated eardrum

The default display of the Eustachian tube function test for a perforated eardrum shows a graph for the
selected ear. The following information is available during testing:
A The pressure curve showing that the pressure drops each time the patient swallows. Notice that an
exponential release of pressure means that the probe sealing might not be sufficient.
Before the measurement starts, an instruction is displayed to tell you how to direct the patient. To
continue, press either Continue or Enter.
2.8 Eustachian tube function – patulous eustachian tube

The patulous Eustachian tube test is an impedance baseline test. It monitors changes in impedance over
time without applying pressure changes or acoustic stimuli. When a patulous Eustachian tube is present you
would typically expect to identify the breathing of the patient in the tympanometric curve. If the Eustachian
tube is closed and the tympanic membrane is intact, you would expect to measure small tympanometric
changes which can be caused by acoustic disturbances from around the patient, accidental displacements of
the probe, or by spontaneous movements of the eardrum. Additionally, it is possible to measure movements
due to the heartbeat as, for example, with a glomus tumor. Or the test can be used to measure reflexes
where the stimulus is presented through an external device such as a cochlear implant.
The default display of the Eustachian tube function test for the patulous Eustachian tube shows the graph for
the selected ear. Below is a real example of a measurement in which the breathing rhythm of the patient can
be recognized due to the presence of a patulous Eustachian tube.
3 General operation of the Audiometry module

3.1 Pure tone audiometry
Please refer to the quick guide ‘Tone Audiometry’ (D-0113813)
3.1.1 Masking
Please refer to the quick guide ‘Audiometric masking’ (D-0113988)
3.2 Weber
Please refer to the quick guide ‘Weber’ (D-0113814)
3.3 Stenger
Please refer to the quick guide ‘Stenger’ (D-0113811)
3.4 Auto – Hughson-Westlake

Please refer to the quick guide ‘Hughson-Westlake’ (D-0113805)
3.5 Alternate binaural loudness balancing (ABLB) – Fowler Test

Please refer to the quick guide ‘Alternate Binaural Loudness Balancing (ABLB)’ (D-0113803)
3.6 Speech audiometry

Please refer to the quick guide ‘ Speech Audiometry’ (D-0113990)
3.7 QuickSIN – Quick signal in noise testing

Please refer to the quick guide ‘QuickSIN’ (D-0113808)
3.8 Short increment sensitivity index (SISI)

Please refer to the quick guide ‘Short Increment Sensitivity Index‘ (D-0113810)
4 Setup menu
4.1 Instrument settings
Instrument settings is shared by the audiometry and impedance modules and contains all the general
settings including license, light, date and time, and printer settings.
Hold the Setup button (4) and select Instrument settings by rotating the wheel (34/38).
Impedance module Audiometry module
By rotating the wheel, the following settings can be selected and changed:
License
A AUD key. When pressing the button a pop-up window opens in which you can enter
a new license key for the audiometry module. The new license key is activated by pressing the
button. The previous license key will not be changed if the new key is not a valid
key.
B IMP key. When pressing the button a pop-up window opens in which you can enter
a new license key for the impedance module. The new license key is activated by pressing the
button. The previous license key will not be changed if the new key is not a valid
key.
Light
C You can alter the Display light by holding the button and rotating the wheel. You
will see the brightness of your screen change accordingly.
D You can alter the LED light by holding the button and rotating the wheel. You will
see the brightness of the LEDs around the Enter button change accordingly. Note that the LED
in the probe system cannot be adjusted.
Session settings
E Keep Session on Save will keep the session on the device when pressing save session.
System
F When pressing the button while Date and time is selected you can manually alter
the date and time.
The following window will pop up
Use the wheel to select day, month, year, hour and minutes. Use the and
buttons to adjust the number. Press the button to keep the changes and
set the date and time, or press the button to reject any changes made.
When the AA222 is connected to the Diagnostic suite, your PC automatically updates the date
and time.
Printer
G Under Printer type you can select which printer is connected to the USB port of your AA222.
By default, the Sanibel MPT-III thermal printer is selected. The list below shows the currently
supported printers:
H Under Printer color mode you can select your printer to print in black and white or 3 color
(CMY) or 4 color (CMYK) mode.
Startup screen
I Selects the startup screen for either the Aud or Imp module.
In addition, the following buttons are available:

Pressing Install allows you to install new firmware on the AA222. By pressing Install
the instrument will look for a USB dongle. If there is one or more installation file
available, the installation process will then commence.
Holding the Language button and rotating the wheel (34/38) allows selection of one
of the available languages. Note that you must restart the system before the new
language setting can be used.
Press Exit to leave Instrument settings
4.2 Tympanometry setup menu

When holding the Setup button a menu pops up where you can select one of the options by rotating the
wheel and then releasing the Setup button. By default, Protocol settings is selected in which you can
temporarily or permanently change the settings used during testing. You can also create new protocols here.
In Common settings - IMP you can modify common functionalities for all impedance tests.
The Instrument protocol settings hold the default settings when tests are added to a protocol. This is also
where you, for example, define which reflex stimuli are used by default, when adding contra reflexes to a
protocol.
From Protocol Settings it is possible to create user-defined protocols. It is possible to modify each protocol
individually in the same way as for the instrument protocol settings. Protocol settings applied in this setup
only affect the given protocol.
In Manage protocols you can show/hide and delete protocols, and set the required region for factory
protocols.
4.2.1 Common settings – IMP
For common settings - imp you can toggle between Auto start (default) and Manual start. Enabling Manual
start forces the system to start each protocol on pause. When Manual start is enabled the light indicator on
the device flashes to indicate that the measurement has been paused. You can then start the measurement
by pressing Enter or by pressing the button on the probe/shoulder box.
4.2.2 Protocol settings

Press the Setup button to enter protocol settings.
Note that you can only change the protocol settings of a test if there is no data stored for that test. In
instances where data is present, it will state at the top of the screen ‘Data is present, press New session to
allow changing settings.
The following buttons are available while in protocol settings.
Note that all changes to the settings are stored immediately. Pressing Exit will
therefore result in the settings being temporarily in use. After saving or clearing a
session by the New session button, the original protocol settings are restored.
Press Save or SaveAs to permanently save protocol settings. Factory protocols can
be temporarily saved (by pressing Exit) or saved with a new protocol name by
pressing SaveAs. To save customized protocols under a new name, hold the Shift
button and then press SaveAs.
Moves one test up in the current protocol.

Pressing shift simultaneously will move the selected test upwards in the protocol.
Moves one test down in the current protocol.

Pressing shift simultaneously will move the selected test downwards in the protocol.
Use the wheel while holding the Add button to select which test is added at the
bottom of the current protocol.
Note that each added test comes with the default settings as defined in the
Instrument protocol settings.
Pressing Remove deletes the currently selected test from the protocol, without
warning.
Use the wheel to browse through the different settings in the menu. Press Toggle to
change the check boxes, or hold Change and rotate the wheel to change settings with
more than two options. Touching the Enter button will also toggle between check
boxes or browse through setting options.
4.2.2.1 Tymp settings

Select a tymp test in your Protocol settings. By rotating the wheel, the following settings can be selected and
changed.
A Auto run. When enabled, the test will run automatically as part of the protocol.
B Probe tone frequency. The frequencies which can be selected are 226 Hz (recommended for
normal testing), 678 Hz, 800 Hz, 1000 Hz (usually recommended for testing babies up to 6 months
of age.
C Start pressure. To select the start pressure for automated tympanometry. The start pressure can
vary between +400 and -600 daPa. For calculating the equivalent ear canal volume, the
measurement points at starting value are taken.
D Stop pressure. To select the stop pressure for automated tympanometry. The stop pressure can
vary between +400 and -600 daPa.
E Add reversed sweep. When enabled, the automated tympanometry will run a tympanometry from
start pressure to stop pressure and back to start pressure again.
F Pump speed. To select the pump speed for automated tympanometry. The stated pump speeds
are dependent on the size of the ear canal or the cavity being used during the measurement. The
numbers below are therefore rough estimates.
• Automatic, is the high pump speed which automatically slows down to low pump speed
around the peak of the tympanogram. We recommend using this setting for screening and
normal tympanometry tests.
• Fast, results in a constant speed of about 300 daPa/s.
• Medium, results in a constant speed of about 200 daPa/s.
• Slow, results in a constant speed of about 100 daPa/s.
• Very slow, results in a constant speed of about 50 daPa/s.
G Manual mode minimum pressure allows you to set the lower limit of the pressure range during
manual tympanometry.
H Manual mode maximum pressure allows you to set the upper limit of the pressure range during
manual tympanometry.
I Gradient. Gradient as either a measure of compliance (in ml) or as a measure of pressure (in
daPa). Select to display the gradient.
J Show normative box. Select to show a rectangle in which the compliance peak is that expected
under normal conditions of the middle ear.
K- Normative box. Minimum and maximum pressure and compliance values are defined here.
N
4.2.2.2 Reflex settings

Select the reflex test in your Protocol settings. By rotating the wheel, you can select and change the following
settings. Note that this example shows all currently available reflex stimuli.
B Level increase. This defines the incremental level of each step during the threshold measurement
You can choose incremental levels from 1 dB to 20 dB.
C Choose either Fixed number of reflexes or Auto stop. When selecting Fixed number of reflexes,
the reflex test will complete the sequence from Start level up to Stop level, also if the threshold
criterion is attained before reaching Stop level. When Auto stop is chosen, the AA222 will detect the
reflex threshold depending on the threshold criterion, and confirm the reflex at the same intensity.
The sequence then stops. The stimulus level will never exceed the intensity level which is set at Stop
level.
D Threshold criteria let you set the sensitivity of the pass criteria. Three options are available:
• Very sensitive (0.02 ml) where a 'pass’ is given for a change in compliance larger than 0.02 ml
(at all probe tone frequencies)
• Sensitive (0.03 ml) a ’pass’ is given for a change in compliance larger than 0.03 ml (at all probe
tone frequencies)
• Normal (0.05 ml) where a ’pass’ is given for a change in compliance larger than 0.05 ml (at all
probe tone frequencies)
• Robust (0.08 ml) where a ’pass’ is given for a change in compliance larger than 0.08 ml (at all
probe tone frequencies)
E Probe tone frequency. The frequencies which can be selected are 226 Hz (recommended for
normal testing), 678 Hz, 800 Hz and 1000 Hz.
F Peak pressure offset defines how far from the peak pressure the reflex is measured. When multiple
peaks are found, the measurement is taken from the highest peak. Note that the automated reflex
can only use the peak pressure when a tympanogram measured at the same frequency precedes the
reflex test.
G Smoothing index allows you to choose the level of detail with which the reflex measurement is
measured and displayed. A smoothing index of 0 means that smoothing is not applied. A smoothing
index of 4 will smooth the curve significantly.
H Checking the Compensate for general drifting option ensures that the base of a reflex sequence
remains at zero even when the probe seal is not completely tight. The compensation takes place just
after a reflex measurement is completed. The reflex graph is then refreshed.
I Measure reflexes at ambient pressure allows you to measure reflexes while the tympanic peak
pressure is being disregarded. When checked, measurements are performed at 0 daPa.
J Pump active between reflexes, when checked, ensures that the pressure is restored to peak
pressure prior to each presentation of the stimulus. When not activated, the pump is used once for
each stimulus type at the start of each reflex sequence.
K Display reflexes as either Positive or Negative makes the reflex curve flip over the x-axis. When
Positive is chosen, you can normally expect the deflection to go in a positive direction. At probe tone
frequencies other than 226 Hz, the compliance is less stiffness-controlled and when measuring an
acoustic reflex it is then not uncommon to measure a negative deflection in adults. Therefore, the
display of reflexes at these probe tone frequencies shows both a positive and negative scale of the y-
axis. Changing this option to Negative will still mirror the graph over its x-axis.
L At Scale you choose the maximum values of the y-axis of the reflex graph. Note that for probe tone
frequencies other than 226 Hz, the scaling is in mmho instead of ml.
M When the AGC on stimulus (automatic gain control) checkbox is ticked, the size of the ear canal is
taken into account when adjusting the stimulus level. Without compensation, the intensity level will
increase as the size of the ear canal decreases. Note that current tympanometry standards do not yet
describe how AGC should be applied. We recommend that AGC is used when testing infant ears as,
theoretically, with ear canal volumes smaller than 0.2 ml, the stimulus level can be increased by 20
dB or more. The AGC is applied for both the ipsilateral and contralateral insert.
N The table shows which reflexes will be tested. Selecting the bottom row enables the addition a new
reflex sequence. Hold the button while rotating the wheel to select the stimulus you wish
to add. Note that rotating down gives ipsilateral stimuli, and rotating up gives contralateral stimuli. The
table below shows which stimuli are available depending on the probe tone frequency and which side
you are measuring. NB stands for narrow band noise. LP stands for low pass filtered noise which has
a spectrum from 400 Hz up to 1600 Hz. HP stands for high pass filtered noise which has a spectrum
from 1600 Hz up to 12 kHz. WBN stands for wideband noise which has a spectrum from 400 Hz up to
12 kHz.
O To select a reflex sequence from the table, hold the button and change the stimulus type
by rotating the wheel. Press the button in order to remove the reflex sequence from the
table.
P To select a reflex sequence start level from the table, hold the button while rotating the
wheel to select the desired start level.
Q To select a reflex sequence stop level from the table, hold the button while rotating the
wheel to select the desired stop level. For ipsilateral measurements at some frequencies, the
maximum output is limited compared to contralateral measurements.
Probe frequency 226 Hz 678 Hz 800 Hz 1000 Hz

Ear side Ipsi Contra Contra Contra Contra
250 250 250 250
500 500 500 500 500
1000 1000 1000 1000 1000
2000 2000 2000 2000 2000
3000 3000 3000 3000 3000
4000 4000 4000 4000 4000
6000 6000 6000 6000
8000 8000 8000 8000
250 NB 250 NB 250 NB 250 NB
Stimulus type
500 NB 500 NB 500 NB 500 NB
(in Hz)
1000 NB 1000 NB 1000 NB 1000 NB 1000 NB
2000 NB 2000 NB 2000 NB 2000 NB 2000 NB
3000 NB 3000 NB 3000 NB 3000 NB 3000 NB
4000 NB 4000 NB 4000 NB 4000 NB 4000 NB
6000 NB 6000 NB 6000 NB 6000 NB
8000 NB 8000 NB 8000 NB 8000 NB
LP LP LP LP LP
HP HP HP HP HP
WB WB WB WB WB
4.2.2.3 Reflex decay

Select a reflex decay test in your Protocol settings. By rotating the wheel, you can select and change the
following settings.
B Test duration sets the length of the probe tone to 10, 15, 20, 25 or 30 seconds.
C Show warning gives you the opportunity to set a level at which the AA222 will give a warning.
D Measure decay at ambient pressure allows you to measure reflex decay while the tympanic peak
pressure is being disregarded. When checked, measurements are performed at 0 daPa.
E Set stimulus level allows you to set the stimulus level to either Manual or Automatic. Manual
means that prior to the test, a pop-up window will ask you to set the stimulus level. When choosing
Manual it is recommended to have Show warning off. Otherwise, you may be asked twice to set the
stimulus level when it exceeds the warning level. Automatic means that the AA222 sets the stimulus
level 10 dB above reflex threshold level. If that stimulus level exceeds the warning level or cannot be
obtained, you will still be asked to set the stimulus level manually.
F Display reflexes as either Positive or Negative makes the reflex curve flip over the x-axis. When
Positive is chosen, you can normally expect the deflection to go in a positive direction.
G At Scale you choose the maximum values of the y-axis on the reflex graph.
H When the AGC (automatic gain control) checkbox is marked, the size of the ear canal is taken into
account for adjusting the stimulus level. Without compensation, the intensity level will increase as the
size of the ear canal decreases. Note that current tympanometry standards do not yet describe how
AGC should be applied. We recommend that AGC is used when testing infant ears, as, theoretically,
with ear canal volumes smaller than 0.2 ml, the stimulus level can be increased by 20 dB or more.
The AGC is applied for both the ipsilateral and contralateral insert.
I The table shows which reflex decay will be tested. Selecting the bottom row enables the addition of a
new decay stimulus. Hold the button while rotating the wheel to select the stimulus you
wish to add. Note that rotating down gives ipsilateral stimuli and rotating up gives contralateral stimuli.
NB stands for narrow band noise. LP stands for low pass filtered noise which has a spectrum from
400 Hz up to 1600 Hz. HP stands for high pass filtered noise which has a spectrum from 1600 Hz up
to 12 kHz. WBN stands for wideband noise which has a spectrum from 400 Hz up to 12 kHz.
J To select a reflex sequence from the table, hold the button while rotating the wheel, to
change the stimulus type. Press the button in order to remove the reflex sequence from
the table.
4.2.2.4 Reflex latency

Select a reflex latency test in your Protocol settings. By rotating the wheel, you can change the following
settings.
B Show warning gives you the opportunity to set a level at which the AA222 gives a warning.
C Measure latency at ambient pressure allows you to measure reflex latencies while the tympanic
peak pressure is being disregarded. When checked, measurements are performed at 0daPa.
D Set stimulus level allows you to set the stimulus level to either Manual or Automatic. Manual
means that prior to the test, a pop-up window asks you to set the stimulus level. When choosing
Manual it is recommended to have Show warning off. Otherwise, you may be asked twice to set the
stimulus level when it exceeds the warning level. Automatic means that the AA222 sets the stimulus
level 10 dB above reflex threshold level. If that stimulus level exceeds the warning level or cannot be
obtained, you will still be asked to set the stimulus level manually.
E Display reflexes as either Positive or Negative makes the reflex curve flip over the x-axis. When
Positive is chosen, you can normally expect the deflection to go in a positive direction.
F At Scale you choose the maximum values of the y-axis on the reflex graph.
G When the AGC (automatic gain control) checkbox is marked, the size of the ear canal is taken into
account for adjusting the stimulus level. Without compensation, the intensity level will increase as the
size of the ear canal decreases. Note that current tympanometry standards do not yet describe how
AGC should be applied. We recommend that AGC is used when testing infant ears, as, theoretically,
with ear canal volumes smaller than 0.2 ml, the stimulus level can be increased by 20 dB or more.
The AGC is applied for both the ipsilateral and contralateral insert.
H The table shows which reflex latency will be tested. Selecting the bottom row enables the addition of
a new latency stimulus. Hold the button while rotating the wheel to select the stimulus you
wish to add. Note that rotating down gives ipsilateral stimuli and rotating up gives contralateral stimuli.
NB stands for narrow band noise. LP stands for low pass filtered noise which has a spectrum from
400 Hz up to 1600 Hz. HP stands for high pass filtered noise which has a spectrum from 1600 Hz up
to 12 kHz. WBN stands for wideband noise which has a spectrum from 400 Hz up to 12 kHz.
I When a reflex latency is selected from the table, hold the button while rotating the wheel,
to change the stimulus type. Press the button in order to remove the reflex sequence from
the table.
4.2.2.5 Eustachian tube function – non-perforated eardrum

Make sure that you select the test labeled as Non-perforated from the list of tests on the left of the screen.
The Eustachian tube function test for the non-perforated eardrum, or ETF 1, or Williams procedure, is set up
to measure three tympanograms. It keeps the pressure between the first and second tympanograms at the
Start pressure, and between the second and third tympanograms at the Stop pressure. After testing, the
pressure is brought back to 0daPa. In between all tympanograms, a message informs you as to which
instruction you should give to the patient. The original Williams procedure asks the patient to swallow in
between the different tympanograms. Our advice is to ask the patient to perform the Valsalva maneuver after
the first tympanogram and to swallow after the second tympanogram, because the expected deviations of
the peak pressure will then be larger.
By rotating the wheel you can select and change the following settings.
While selecting this instruction, press the button to open a pop-up in which you can
B alter the instruction that is shown in between the first and second tympanograms. Connect a pc
keyboard to the USB port of the AA222 for easy typing options, including the use of special
characters.
C alter the instruction that is shown in between the second and third tympanograms. Connect a pc
keyboard to the USB port of the AA222 for easy typing options, including the use of special
characters.
D Start pressure. You can set the start pressure for the three automated tympanograms here. The
start pressure can vary between +400 and -600 daPa.
E Stop pressure. You can set the stop pressure for the three automated tympanograms here. The
stop pressure can vary between +300 and -600 daPa.
F Pump speed. You can select the pump speed for automated tympanometry here. The stated
pump speeds are dependent on the size of the ear canal or cavity that is being used during the
measurement. The numbers below are therefore rough estimates.
• Automatic, is the high pump speed which automatically slows down to low pump speed
around the peak of the tympanogram. We recommend using this setting for screening and
normal tympanometry tests.
• Fast, results in a constant speed of about 300 daPa/s
• Medium, results in a constant speed of about 200 daPa/s
• Slow, results in a constant speed of about 100 daPa/s

• Very slow, results in a constant speed of about 50 daPa/s
G Show normative box displays a rectangle within which to expect the compliance peak under
normal conditions of the middle ear.
H-K Normative box. Minimum and maximum pressure and compliance values are defined here.
4.2.2.6 Eustachian tube function – perforated eardrum
Make sure that you select the test labeled as Perforated from the list of tests on the left of the screen.
The Eustachian tube function test for the perforated eardrum, or Toynbee test, or ETF 2 puts the middle ear
under a certain Start pressure. The pump is then stopped, and over time it is measured if the patient can
release the pressure by opening the Eustachian tube. The patient is usually asked to swallow several times
during the test.
By rotating the wheel, you can select and change the following settings.
B change the instruction that is shown at the start of the measurement. Connect a pc keyboard to the
USB port of the AA222 for easy typing options, including the use of special characters.
C Start pressure. You can set the start pressure here. This can vary between +400 and -600 daPa.
D Test Duration. You can set the test duration here. This can vary from 30 up to 150 seconds.
4.2.2.7 Eustachian tube function – patulous Eustachian tube
Make sure that you select the test labeled as Patulous from the list of tests on the left of the screen.
The Eustachian tube function test for a patulous Eustachian tube, or ETF 3, monitors the compliance of the
eardrum over a certain period of time. If the Eustachian tube is spontaneously open, you expect to measure
compliance changes due to movements of the eardrum. Typically, you expect to recognize the rhythm of
breathing. Measuring the ETF 3 in a healthy subject only shows spontaneous disturbances in the compliance
due to probe movement, acoustical disturbances in the patient’s surroundings or spontaneous movements of
the eardrum. With the precision of the AA222, it is not uncommon to measure a patient’s heartbeat.
B change the instruction that is shown at the start of the measurement. Connect a pc keyboard to the
USB port of the AA222 for easy typing options including the use of special characters.
C Test Duration. You can set the test duration here. This can vary from 30 to 150 seconds.
4.2.2.8 Pause
Within a protocol it is possible to implement a Pause. This can be used as a break in between tests or to
give an instruction to the clinician before continuing with or ending a protocol.
A Auto run. When enabled, the pause will automatically be part of the protocol. And the test will be
paused with the pause is reached in the protocol.
B While selecting this instruction, press the button to open a pop-up in which you can
change the instruction that is shown at the start of the measurement. Connect a pc keyboard to the
USB port of the AA222 for easy typing options, including the use of special characters.
4.2.3 Manage protocol settings

Hold the Setup button and rotate the wheel until you can select Manage protocols. A window pops up
showing the currently available protocols on your instrument. By default, all custom made protocols are
displayed at the top of the list and all factory default protocols are displayed at the bottom of the list.
The following buttons are available when the Manage Protocols window is open.
Press Delete to remove the protocol permanently from the instrument. You will be
asked to confirm this action. The delete function is not available for factory default
protocols.
The Hide/ Unhide buttons allow you to organize which protocols are visible when
pressing the Tests button.
By holding the Region button and rotating the wheel, you can choose which default
factory protocols are to be selected.
Press Back to close the Manage Protocols window.

4.3 Audiometry setup menu

When holding the Setup button a menu pops up in which you can select one of the options by rotating the
wheel and then releasing the Setup button. By default, the settings of the current test, Tone settings or
Auto settings are selected. You can change these settings either temporarily or permanently. In Common
settings – AUD you will find settings that apply to all audiometric tests.
When saving settings permanently they are assigned to an individual user by selecting Save user settings
as… The Tone, Auto and Common settings are saved to the user that is specified.
4.3.1 Common settings - AUD

Hold the Setup button and rotate the wheel in order to select Common settings - AUD. By rotating the
wheel you can select and change the following settings.
Intensity (Tone, Speech, SISI)

A Intensity steps is the default intensity step (1 dB, 2dB or 5 dB steps).
B Default level when changing output is the level that the channel will default to when changing
output (changing transducer, changing test, changing ear).
C CH2 start intensity (From Off -> On) is the initial masking level when activating masking.
D CH2 intensity when changing freq. is the initial intensity on channel 2 when changing frequency.
Representation
E Show maximum intensities provides a display of the maximum intensity that can be presented for
the given transducer at each frequency. The Extended Range +20 dB button can be pressed to go
higher. The maximal loudness is determined by the transducer calibration.
F Show masking cursor enables and disables the display of the masking cursor in the audiogram.
G Default Symbols allows you to change between the symbol schemes: Australian standard,
German, International, Japan, UKBSA, US symbols
Weber
H Shown on tone audiogram will display the Weber results on the pure tone audiogram.
I Select Show on print to have your Weber results printed on the audiogram.
Pulse
J Use the slider on Multi to adjust the pulse length (duty cycle 50%).
K Use the slider on Single to adjust the length of the single pulse.
Start-up
L Enable Ask for setting at startup to see the list of users when starting the device.
Standard
M Tone standard displays the standard used for RETSPL. To change this, simultaneously press shift,
rotate to the field and select the required standard (ANSI, IEC, Norway or Sweden)
N Speech standard displays the standard used for RETSPL. To change this, simultaneously press
shift, rotate to the field and select the required standard (ANSI, IEC, Norway or Sweden).
O Filter mode makes it possible to change the filter settings to either Linear (default), FF eqiv., or non-
linear.
Data handling settings

P Enable the setting ‘Save IP measurement as AC’ to save the insert phone thresholds as AC.
Patient response
Q Enable patient response sound presents a sound in the monitor speaker, to the headset or speaker
when the patient response is pressed. Adjust the level of the patient response sound with the
Response volume slider.
In addition, the following buttons are available from Common Settings – Aud.
This is a multifunctional key that allows you to make changes to an individual
setting that has been selected.
Press to alternate between enabling and disabling a selected setting.
Brings you back to the test screen. If a change is made and Back is pressed
without pressing Save as, this change will be temporary.
Saves the user settings to a user. Press New to create a new user or Delete
to delete an existing user. Multiple users can be created, if clinicians have
different preferences to the setup.
Pressing the setup button from the audiometry module allows easy selection
of the user-defined protocol.
4.3.2 Working with user-defined setups (test protocols)

There are many different requirements regarding both the functionality and appearance of an audiometer,
depending on the specific situation as well as factors such as national standards. When the device asks for
settings at startup, the device will load the preferred protocol setup of a given clinician or clinic.
This provides the user with the flexibility to tailor the system according to their specific preferences. When
creating a protocol, save the protocol to a given name. The user settings are then loaded either when
selecting the defined protocol from the Setup, or when selecting the protocol list starting the device, if Ask
for setting at startup is activated in common settings – Aud.
4.3.3 Tone settings

Hold the Setup button and rotate the wheel in order to select Tone settings. From tone settings you can
change the following settings.
Measurement type
A In order to use dedicated symbols for aided and binaural measurements make sure you select the
correct measurement type here.
B Masking type is the default type of masking used for tone audiometry; NB or WN.
C The default Measurement type to start with can be set here. The options are Hearing Level (HL),
Most Comfortable Level (MCL), Uncomfortable Level (UCL) and Tinnitus.
Representation
D Select Show right and left in a single audiogram to view the audiometric results for the right and
left ear in a single audiogram.
E Show masking information on screen. The masking table will be shown below the audiogram.
F Show banana overlay displays the speech banana in the audiogram. You can adjust the frequency
and intensity of the banana by pressing the button in the setup.
G Enabling Magnify the head up display defaults to displaying the numerical information of the
transducer as large.
H Set the default presentation of channel 1 to Continuous, Single pulse, Multi Pulse.
I Set the default presentation to manual or reverse.
Hearing loss on audiogram

J You can enable or disable the Show European CPT-AMA index. When enabled, the European
CPT-AMA is then calculated and displayed on the tone test screen. CPT-AMA ensures that the
different frequencies are weighted in order to display a correct quantification of impairment due to the
hearing loss. The weighting and intensity of each frequency are shown below. CPT-AMA is used as
an average, indicating the severity of the hearing loss.
Please refer to Sibylle Bertoli, Katharina Staehelin, Elisabeth Zemp, Christian Schindler,Daniel
Bodmer & Rudolf Probst (2009) Survey on hearing aid use and satisfaction inSwitzerland and their
determinants, International Journal of Audiology, 48:4, 183-195
K When Show PTA (Flexher) index is enabled, a pure tone average is shown in the top of the
audiogram. You can then select the frequencies intended as part of the PTA calculation.
The default setting is 500, 1000, 2000, and 4000 Hz. In this calculation method all frequencies are
weighted equally and averaged to give the figure.
Note: The PTA is calculated for insert phones and head phones. However, if values for both are
stored, the threshold obtained at the best intensity is used.
Control
L Select Jump to 1 kHz by output change if you want to default to 1000 Hz when changing ear side.
M At Jump Strategy you define how the system automatically changes frequency when storing
thresholds.
Bottom makes the cursor start at 1 kHz and move upwards in frequency as the thresholds are
stored. After testing the high frequencies, the cursor will move back to re-test 1kHz and then move
downwards. When jumping back to 1 kHz, the Butterfly strategy can be set to start the re-test at
either the default start intensity or the intensity of the first threshold.
Butterfly makes the cursor start at 1 kHz and move upwards. When the high frequencies have been
tested, the cursor will jump to the lowest test frequency and move upwards towards 1kHz.
None will cause no change when pressing store. The change is carried out manually using the
hardkeys frequency up/down.
N Butterfly center freq. HL sets the intensity that is used when jumping to the butterfly center
frequency after storing a point at highest or lowest frequency.
O Intensity decrease when changing freq. sets the number of decibels by which the intensity must
decrease when jumping to the next frequency after storing a threshold.
P Warble frequency adjusts the frequency modulation of the warble tone from 0-25 Hz.
Q Warble intensity adjusts the intensity modulation of the warble tone from 0-25%.
Frequencies
R Enable or disable the frequencies required for the pure tone audiometry assessment.
In addition, the following buttons are available in the tone settings:

Shows settings for the speech banana.
Use Change +/- to change the frequency and intensity of the speech banana
display.
When the ‘Show PTA (Flecher) index is enabled, it is possible to set the
intended frequencies used for the calculation of the PTA.
This a multifunctional key. Press Toggle to toggle between enable or disable

for a selected setting. Press Change to change the setting selected.
Press back to return to the test screen.
Saves the user settings to a user. Press New to create a new user or Delete
to delete an existing user. Multiple users can be created, if clinicians have
4.3.4 Speech settings
Measurement type
A In order to use dedicated symbols for aided and binaural measurements, make sure you select the
appropriate measurement type here.
Representation
B Masking type allows you to toggle between SN (speech noise) or WN (white noise) as the default
masking signal.
C Toggles between a display of the speech in Table mode or Graph mode.
D Toggles between the Measurement types: SRT, MCL, UCL, WR1, WR2, WR3
E Magnify the head up display magnifies the head up display on the test screen once enabled.
F Select SRT for numbers speech material enables SRT when material containing numbers is
selected.
G Speech input selection allows you to toggle between CD input and Wave file input. Accordingly,
the material used when pressing Speech (26) will come from either the CD or Wave file.
Link stimulus type to curves

H Link the stimulus type to the WR1, WR2 WR3 or SRT pressing the change button.
Controls
I Number of words indicates the number of words in the wordlist before the test stops. The counter
applies to CD and microphone only.
J Reset speech score on intensity change. By enabling this function when an intensity change is
made, the speech score will reset and start from the beginning.
K When enabled, Reset score on HL to UCL change ensures that if you toggle the test from HL to
UCL, the scoring will restart so that the UCL test result does not then add on to the HL scoring.
Wave file
L Toggles between the different types of speech material available on the device in the Table
selection.
M Set the preferred type of running mode: continue, manual, time out. When ‘time out’ is selected, the
settings correct and incorrect will store the word as ‘correct’ or ‘incorrect’ respectively once timed
out. Enter the number of seconds before timeout takes place in the box if no scoring is entered
within []s.
To set the time between words after scoring, enter the time in seconds in the box within After
scoring wait another []s before playing the next word.
In addition the following buttons are available from the speech setup:
Phoneme norm curves can be set for phonemes using headphones and for
free field. Press Ph Norms to change the phoneme norms for the single and
multisyllabic curve displayed in the speech graph.
Press FF norms to change the phoneme norms for the single and
multisyllabic curve displayed for free field (FF).
Use the wheel for channel 1 to change the output of the frequency or intensity.
Use wheel 2 to move through the boxes.

for a selected setting.
Press Change to change the setting selected.
Press Set to set the setting for the one highlighted.
Go back
Save the user settings to a user. Press New to create a new user or Delete to
delete an existing user. Multiple users can be created, if clinicians have
4.3.5 Auto settings

Hold the Setup button and rotate the wheel in order to select Auto settings. By rotating the wheel, the
following settings can be selected and changed.
Hughson-Westlake
A Threshold method uses 2 out of 3 or 3 out of 5 as the criteria for a threshold.
B On time changes the ‘on time’ from 0-2 s.
C Random off time changes the ‘off time’ from 0-1.6 s. Off time = random off time + 2 s from 2-3.6 s.
Frequencies
D Enable or disable the frequencies that should be part of the Békésy test.
In addition the following buttons are available from the Auto settings:
for a selected setting.
Press Change to change the setting selected.
Go back
Save the user settings to a user. Press New to create a new user or Delete to
delete an existing user. Multiple users can be created, if clinicians have
5 Diagnostic suite
5.1 Transferring a custom symbol scheme from the suite to the device
1. It is possible to transfer a customized symbol scheme from Diagnostic suite to the device.
2. Go to AUD – Menu – Setup – General Setup
3. Edit the symbol scheme to your preference in the symbol editor.
4. From General Setup – Instrument Settings press Upload Custom Symbols.
5. The symbols will now be transferred to the device.
6. Disconnect the device from the PC.
7. Go to Setup – Common settings AUD – Default Symbols and select your custom symbols.
6 Operating through a database

6.1 OtoAccessTM
It is possible to operate the AA222 through Diagnostic suite to a database. This makes it possible to save the
obtained data directly to either one client in OtoaccessTM or multiple clients in OtoaccessTM.
6.1.1 Upload clients to the device and save the measurements to the clients
This way of transferring data is designed to transfer multiple clients simultaneously prior to starting testing. Once
all the measurements are completed, this data can then also be transferred simultaneously.
1) Open Diagnostic suite through OtoaccessTM with a client selected, that is not used for storing any
information to.
2) Go to the Sync tab and press Client upload. Select all the clients you wish to transfer to the device by
highlighting them and pressing Add. The clients will now appear in the list on the right and will be added to
the device.
3) Disconnect the device from Diagnostic suite and start the session’s measurements.
4) Once the session is completed, press Save session and select the client you would like to save the
information to. Then press Save on the device.
5) At the end of the day connect the device to Diagnostic suite through OtoaccessTM and go to the SYNC tab.
When the device is connected to the suite in the SYNC tab, it will state ‘Online and PC controlled mode’ on
the AA222 screen. In the SYNC tab the clients will appear in a list (if not press Refresh).The data obtained
on the device will automatically be transferred to the client in the OtoaccessTM database, and state
‘Already in database’ (see example below).
6) Press Save or Save & Exit in the suite to save the data.
7) The data can then be used for further interpretation or review in Diagnostic suite through OtoaccessTM.
6.1.2 Download the client information to one patient

1) Open Diagnostic suite through OtoaccessTM with your client selected.
2) Obtain the measurement on the device with the device connected to the Diagnostic suite including
audiometry and impedance.
3) Once completed press Save session on the device. The measurement will be transferred to Diagnostic
suite and appear in the Audiometry and Impedance tab.
4) From here it is also possible to print to PDF or a printer, so that the results can be shared externally.
Please refer to the section regarding the Print Wizard for further information.
5) Press Save or Save & Exit in the suite to save the data to the selected client in OtoaccessTM.
6.2 NOAH
It is possible to operate the AA222 through Diagnostic suite to a database. This makes it possible to save the
obtained data directly to a client created in NOAH.
6.2.1 Download the client information to a patient using NOAH

1) Open Diagnostic suite through NOAH with your client selected.
2) Obtain the measurement on the device with the device connected to the Diagnostic suite including
audiometry and impedance.
3) Once completed press Save session on the device. The measurement will be transferred to Diagnostic
suite and appear in the Audiometry and Impedance tab.
4) Press Save or Save & Exit in the suite to save the data in NOAH.
5) The data can then be used for further interpretation and fitting of hearing aids through NOAH.
7 Print
7.1 Printer direct
7.1.1 Installing the direct printer

• Ensure that the printer is powered and connected to the AA222 via the USB
• A list of supported direct printers will appear from the Instrument setting – Default printers
• Select the required printer from the list

• The printer is now setup for printing. Press Print on the AA222 to obtain a printout of the audiometry and
impedance data
7.1.2 Modify the custom logo printout

• It is possible to change the print logo through Diagnostic suite. Connect the device to the PC and enter
Diagnostic suite.
• Ensure that the device is switched on and properly connected
• Go to AUD – Menu – Setup – General Setup
• From the instrument settings press Upload Print Logo
• Find the picture that you would like to add and press Open. The logo will now be transferred and ready
for use on your print.
7.1.3 Printing from a direct printer

It is possible to print the results of the different audiometry and impedance measurements on the direct printer.
Below are some examples of the audiometry and impedance elements. If the name of the client has been
entered on the device the patient information will appear on printout.
7.2 MPTIII (thermal printer)
7.2.1 Installing the Sanibel MPT-III thermal printer

1. Ensure that the printer is powered by either battery or the power charger and that the paper is correctly
placed in the printer. For a detailed description of how to operate the MPT-III thermal printer, please
refer to the MPT-III Sanibel Mobile thermal mini printer user manual.
2. To set up the printer for MPT-III, press Setup – Instrument settings – Printer type – MPT-III.
3. Connect the MPT-III printer to the AA222 via the USB.
4. Turn on the printer.
5. The printer is now setup for printing. Press Print on the AA222 to obtain a printout of the audiometry
and impedance data.
7.2.2 Modify the custom logo printout

1. It is possible to change the print logo through Diagnostic suite. Connect the device to the PC and enter
Diagnostic suite.
2. Ensure that the device is switched on and properly connected.
3. Go to AUD – Menu – Setup – General Setup.
4. From the instrument settings press Upload Print Logo.
5. Find the picture that you would like to add and press Open. The logo will now be transferred, and ready
for use on your print.
7.2.3 Printing from the MPT-III thermal printer

It is possible to print the results of the different audiometry and impedance measurements on the MPT-III
printer. Below are some examples of the audiometry and impedance elements. If the name of the client has
been entered on the device the patient information will appear on printout.
7.3 Print Wizard (Diagnostic suite only)
The Print Wizard is designed to make it easy to customise the print template, so that the data shared with others
contains the information relevant to each individual clinic. The Print Wizard works with the Affinity suite, Callisto
suite, Equinox suite, Diagnostic suite, Titan suite and VIOT suite. This enables you to combine data from
various tests into one convenient printout.
7.3.1 Opening the Print Wizard

1. Open the Suite from your patient management system: Noah, OtoAccess™, or standalone.
2. You can access the setup for protocols from any of the tabs; VIOT, AUD, IMP, DPOAE, TEOAE, ABRIS,
REM or HIT.
3. Press Menu – Setup – AC440 Setup, or Menu – Setup – Protocol Setup in the Titan suite. This will open
a new window.
4. In the new window, you will find either Print Setup or Print Wizard (Titan suite). Please press this to open
the Print Wizard.
Affinity, Callisto, Equinox, VIOT and Diagnostic suite Titan suite

The print template created in this way is then linked to the individual protocol for quick printing.
7.3.2 Print Wizard elements

Now the Print Wizard window opens and shows the following information and functionalities:
1. Underneath Categories you can select:

• Templates to show all available templates
• Factory defaults to show only standard templates
• User defined to show only custom templates
• Hidden to show hidden templates
• My favorites to show only templates marked as favorite
2. The Templates viewing area displays the templates available in the selected category.
3. Factory default templates are indicated by the lock icon. These ensure that you always have a standard
template and do not need to create a customized one. However, in order to edit these default templates,
they must be saved under a new name. User defined/created templates can be set to Read-only
(showing the lock icon), by right clicking on the template and selecting Read-only from the drop down
list. Read-only status can also be removed from User defined templates by following the same steps.
4. Templates added to My favorites are marked with a star. Adding templates to My favorites allows
quick viewing of your most commonly used templates.
5. The template attached to the selected protocol will have a checkmark.
6. Press the New Template button to open a new empty template.
7. Select one of the existing templates and press the Edit Template button to modify the selected layout.
8. Select one of the existing templates and press the Delete Template button to delete the selected
template. You will be prompted to confirm that you want to delete the template.
9. Select one of the existing templates and press the Hide Template button to hide the selected template.
The template will now be visible only when Hidden is selected under Categories. To unhide the
template, select Hidden under Categories, right click on the desired template and select View/Show.
10. Select one of the existing templates and press the My Favorites button to mark the template as a
favorite. You will now be able to quickly find the template when My Favorites is selected under
Categories. To remove a template marked with a star from My Favorites, Right-click on the template
and press the My Favorites button.
11. Select one of the templates and press the Preview button to display the print preview of the template on
the screen.
12. Press Select to dedicate the selected template to the protocol from which you accessed the Print
Wizard
13. To leave the Print Wizard without selecting or changing a template press Cancel.
Right-clicking on a specific template provides a drop down menu offering an alternative method for performing
the options as described above:
7.3.3 Designing a customised print template

After clicking on the New Template (or Edit Template) button, the design window below is displayed. On the
left of the screen, you will see the elements which you can add to the layout. These are ordered by their
corresponding test module. For example, everything for input into the print template associated with the AUD
module, can be found under AUD.
1. On opening, a short description about how to create a template will show on the screen. Press Close to
close the message box. Uncheck the Show hints checkbox, if you do not want this message to appear
again.
2. This list shows the elements which can be dragged onto the blank template. Selecting General provides
a list of the general elements. Template elements for each module are listed when selecting the
relevant module name, for example AUD, IMP, REM, HIT. If other suites are installed, such as the
Titan suite, the relevant suites will also be displayed.
The handling and options for the different elements are discussed in a separate section below.
3. The taskbar includes numerous icons for customizing the elements that are dragged onto the blank
template page. These are described in the following section.
4. Press Save to save the print template and go back to the Print Wizard window. If you have created a
new template you will be prompted to give it a name. Press Save As… if you have modified an existing
template and want to save under a different name.
5. Pressing the Page Setup button opens the Page Setup window where you can choose the paper size,
source, margins and paper orientation.
6. If the template has more than one page, use the up and down arrows, , to scroll through the
different pages. You can also type in the page number that you would like to view and/or edit.
7. The Zoom drop down menu allows you to change the viewing size of the template on the screen.
8.
7.3.4 Taskbar
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1. Add page to make a template of more than one page.
2. Remove page. You will be prompted for confirmation that you want to delete the page and all its
contents.
3. Align left. If you select two or more elements (using the shift button on the keyboard) this button will
align these elements on their left sides.
4. Align right. If you select two or more elements (using the shift button on the keyboard) this button will
align these elements on their right sides.
5. Align top. If you select two or more elements (using the shift button on the keyboard) this button will
align these elements along the top edge..
6. Align bottom. If you select two or more elements (using the shift button on the keyboard) this button
will align thoee elements along the bottom edge..
7. Align horizontal. If you select two or more elements (using the shift button on the keyboard) this button
will align these elements on their horizontal central axis.
8. Align vertical. If you select two or more elements (using the shift button on the keyboard) this button
will align these elements on their vertical central axis.
9. Make equal size. If you select two or more elements (using the shift button on the keyboard) this button
will make all sizes equal to the element that was placed on the page first.
10. Same width. If you select two or more elements (using the shift button on the keyboard) this button will
make all widths equal to the width of the element that was placed on the page first.
11. Same height. If you select two or more elements (using the shift button on the keyboard) this button will
make all heights equal to the height of the element that was placed on the page first.
12. Send to back. This button sends the selected element(s) to the back.
13. Send to front. This button sends the selected element(s) to the front.
14. Lock element locks (or unlocks) the selected element(s). This means that the position and size of the
element is locked. When one of the taskbar functions is used on a locked element, it will automatically
unlock.
15. Display margins toggles between showing and not showing the print margins as a broken line.
7.3.5 Design elements

Add template elements to the template page by using the select, drag and drop function.
Click on the desired element and drag it onto the template page. The element will appear as a small box in the
upper left hand corner. Resize the element to the desired size and drag it to an appropriate location.
The section below describes the options available within each element once dragged onto the template. Right-
clicking on any element will list its options for customization.
7.3.5.1 General
1. Select
Select, let you select a window already on the print template and makes it possible to modify it.
2. Client information
a. By right clicking on an element you can see Select fields. In Select fields you can change the
order of the items by selecting one and pressing the up or down arrows. Pressing will
create a new empty field that can be named and shown in the template. Change a field’s name by
selecting it, waiting for 1 second, and then left-clicking on the name. Pressing will remove user
created fields. Press to restore the manufacturers’ default fields.
b. Format… opens the Format client window. Here you can change the font, font size and formatting,
and the appearance (borders) of the Client information area.
c. Selecting Rotate makes the element rotate 90 degrees clockwise.

3. Clinic information
a. Select fields displays the Select fields window where you can select which items are to be shown
in the clinic information element. You can change the order of the items by selecting one and
pressing the up or down arrows. Pressing will create a new empty field that can be named
and shown in the template. Change a field’s name by selecting it, waiting for 1 second, and then
left-clicking on the name. Pressing will remove user created fields.
b. Press to restore the manufacturers’ default fields.
c. Enter clinic info… opens the Clinic info editor window. Here you can type and save the clinic
information specifically for the selected print template. The Create date item cannot be changed as
it will always show the current date and time.
d. Format… Here you can change the font, font size and formatting, and the appearance (borders) of
the Clinic information area.
e. By selecting Show labels, the Clinic information fields can toggle between on and off.
f. Selecting Rotate makes the element rotate 90 degrees clockwise.
4. Logo
a. Select image opens a window where you can browse to find the image stored on your PC that
you want to include in the template.
b. Selecting Rotate makes the element rotate 90 degrees clockwise.
5. Text
Text allows you to add additional text, e.g. footnotes, on your template.
a. Enter text opens the Enter Text window where you can type in freetext and choose the font type,
size and formatting.
6. Date Time
Date and time allows you to put in a stamp on the template showing date and/or time of printing.
a. Enter setup…opens the Date Time setup window where you can choose the format in which the
date and/or time appears in the template.You can also choose the font type, size and formatting.
7. Session date
Session date allows you to put in a stamp on the template showing date and/or time that the
measurements were recorded.
a. Enter setup… opens the Date Time setup window, exactly as in 5a. Here you choose the
format in which the date and/or time appears in the template. You can also choose the font type,
size and formatting.
b. Selecting Modules gives the opportunity to define which modules’ session dates will be shown.
On the print out you can combine measurements from both the Callisto™ suite and Titan suite.
c. Toggle borders allows you to disable or enable the border around the Session date element.
d. Selecting Rotate makes the element rotate 90 degrees clockwise.
8. Protocol name
Protocol name allows you to display the protocol name/s on the template for the recorded
measurement/s.
a. Select modules gives the opportunity to define which modules’ protocol names will be shown.
On the print out you can combine measurements from Titan suite and other Interacoustics suites
(Callisto, Affinity, Equinox, Diagnostic).
b. Toggle border allows you to disable or enable the border around the Session date element.
c. Selecting Rotate makes the element rotate 90 degrees clockwise.
7.3.5.2 Using the different elements to create a template
1. Once drawn, you can move the element to your desired position on the template and also right click to
define the parameters of the information displayed. For instance, in the example displayed above, right
clicking on the object allows you to ‘select type’. Clicking on this opens a new window which will allow
you to define options such as the test ear and include sound examples etc. Every object you input
allows customization of the options the element can display. The options available for each can vary
depending on the module element selected.
2. When right-clicking on an element you have the option to rotate that element and also to toggle the
surrounding border.
3. Once you have clicked in all of your elements and have configured them to your preferences, you will
need to organise them. This can be done by moving them to the desired position and also sizing them
similarly. There are tools to assist you with this. If you left-click on an element you will notice the
highlighted tool bar below become active. The options available to you here are purely for ordering (e.g.
to send items backwards/forwards).
4. However, if you left-click on one element and then hold Control on your keyboard and left-click on
another, you will then be able to activate the rest of this tool bar. This presents the sizing and alignment
options. Hovering your cursor over each icon in this toolbar will reveal an explanation of its function.
These settings make it easier to match the sizes of the elements you have added to your print template.
The screenshots below demonstrate the ’make equal size’ option.
Notice how the first element clicked adopts the settings (size) from the second element.
5. Continue to click and further customize your print template. Once completed you can add information on
your clinic (via a blank Test box) and even a logo. You can do this via the General sub-tab on the left of
the screen.
Drawing a logo element allows you to create a section on your print template where you can import a
.jpg file. To do this, right-click on the element and click Select image… This opens the system dialogue
where you can navigate to the image that you wish to input. Please note that the Print Wizard only
accepts .jpg and .png format image files.
6. Finally, the screenshots below demonstrate the addition of a text box beneath the logo to show the site
address and contact details.
In this section, you can also alter the font and formatting of the text and how it will appear on your print
layout. This text box will then be common to this particular print template when it is printed in the future.
7.3.6 Saving your print template

Now that you have completed your print template and have designed it in line with your preferences and
requirements, you can click on Save or Save As… in the top left of the screen.
As this is a new print layout, Save will perform the same action as Save As… and a small window will appear
requesting you to name your print layout.
Once you have titled this layout and clicked Ok, it will appear in your Print Wizard as a new layout.
7.3.7 Editing a print template prior to printing

If you want to use a template different from the template linked to the protocol, go to Menu – File – Print
Wizard in any of the suites.
1. Select the template that you wish to use.

2. You have the option to press Preview to check that it is as required. To edit the template, right-click
and select edit.
3. Press Print to use the selected template for printing.

AA222 Impedance Audiometer: Additional Information

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AA222 Impedance Audiometer: Additional Information

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2 General operation of the tympanometry module ...................................................................3

3 General operation of the Audiometry module ..................................................................... 15

4 Setup menu ............................................................................................................................. 17

5 Diagnostic suite ...................................................................................................................... 43

6 Operating through a database .............................................................................................. 45

1 About the AA222

The Audiometry module contains the following tests:

The Tympanometry module contains the following tests:

2 General operation of the tympanometry

2.1.1 Tympanometry patient instruction

2.1.2 Visual inspection of the ear canal

2.1.3 Placement of the contralateral phone

2.1.4 Selecting the correct ear tip

Ear tips inserted against

Ear tip 3-5 mm, flanged

Ear tip 7.5

Ear tip 9 mm,

Ear tip 11 mm,

Ear tip 13 mm,

Ear tip 10 mm, mushroom

10 Ear tip 15 mm,

Ear tip 12 mm, mushroom

adults Ear tip 19 mm,

Ear tip 14 mm, mushroom

Exceptional Ear tip 22 mm,

Ear tip 19 mm, mushroom

E The table with measurement values. Here you will find:

Manual tympanometry testing

G The empty triangle indicates actual pressure.

2.4 Reflex decay

A The tympanometric curve.

2.5 Reflex latency

A The first 300 ms of the tympanometric curve.

2.6 Eustachian tube function – non-perforated eardrum

The following information is available during testing:

A The non-compensated tympanometric curves.

2.7 Eustachian tube function – perforated eardrum

2.8 Eustachian tube function – patulous eustachian tube

3 General operation of the Audiometry module

3.4 Auto – Hughson-Westlake

3.5 Alternate binaural loudness balancing (ABLB) – Fowler Test

3.6 Speech audiometry

3.7 QuickSIN – Quick signal in noise testing

3.8 Short increment sensitivity index (SISI)

Impedance module Audiometry module

In addition, the following buttons are available:

4.2 Tympanometry setup menu

4.2.1 Common settings – IMP

4.2.2 Protocol settings

The following buttons are available while in protocol settings.

Moves one test up in the current protocol.

Moves one test down in the current protocol.

4.2.2.1 Tymp settings

4.2.2.2 Reflex settings

Probe frequency 226 Hz 678 Hz 800 Hz 1000 Hz

4.2.2.3 Reflex decay

4.2.2.4 Reflex latency

4.2.2.5 Eustachian tube function – non-perforated eardrum