Operation

The Auditory Ranges:

In the edit and measuring modes gray areas may become visible to represent different values.

The light gray areas show tone audiometry values and the dark gray areas show the measuring limits of the AHA.

Measuring with hearing aids in the edit mode; no gray areas are displayed.

Measuring with hearing aids in the measuring mode; the dark gray measuring limits of the AHA are displayed.

Measuring without hearing aids in the edit mode; tone audiogram information such as the hearing levels and the uncomfortable loudness levels (UCLs) are displayed in light gray. This display permits for the measurement of the auditory range from a glance.

Measuring without hearing aids in the measuring mode; tone audiogram information such as the hearing levels and the uncomfortable loudness levels (UCLs) are displayed in light gray. The measuring limit is also displayed in dark gray (here 90 dB).

Operation in the Edit Mode:

In this mode curves can be entered manually. Left click in a diagram field and the selected value will be applied to the curve. A specified number of points is required to calculate and create a curve within the ACAM System; specify the number of points required in the setup menu.

A right click in the diagram field opens up a selection menu:

Figure 209: Selection menu

The selection menu options are (Figure 209):

Delete item – The selected point is deleted.
Delete curve – The curve in the corresponding auditory range (i.e. for the frequency) is deleted.
Delete diagram – Deletes all curves in all auditory ranges that are currently visible. All other curves are maintained.
Delete all diagrams – Deletes all curves within the AHA! saved curves section. All curves created with and without hearing aids are deleted.
Export to Paint – The graphics of all visible auditory ranges are saved in Paint as graphics.
Export to Word – The graphics of all visible auditory ranges are exported to Word. Microsoft Word must be installed in order to export documents to Word.
Export to Excel – "Data" are exported to Excel. Microsoft Excel must be installed in order to export documents to Excel.

Operation in the Measuring Mode:

The scaling measurement signals can be presented automatically or manually. In the manual selection mode, frequencies and levels can be manipulated.

To generate the measurement signal click in the auditory range of the measuring mode screen. The example the the left shows a 65 dB signal at 1000 Hz.

Manually scale the values using the free hand method; move your mouse to the desired coordinates on the graph. The manual method is considered much faster for selection of the intensity and frequency of the signal to be presented. The ACAM System provides suggestions and offers an orientation to determine the most appropriate measurement signals to use in for scaling procedures.

Supported mode:

Click on <Start testing sequence> or <Orientation> to present complete sequences of measuring values. The ACAM System will determine which series of values to present.

When using the <Orientation> option, the presentation values are not saved. Click on <Play recommended sound> to apply the proposed measurement parameters. In the example to the left the parameters that would be applied are 4000 Hz and 80 dB.

Click on <Review test series> to view the measured series generated by the ACAM System. Click on <Recalculate set> to have the ACAM System generate a new series of measurement parameters.

Manual Control:

	When you select a value within the manual control, a dialog box opens. When a signal is presented a green dot will appear in the right hand corner of the window, above the <ok> button. When the signal presentation is discontinued the green dot will disappear. Have the patient quantify the loudness level of the presentation signal by selecting one of the following options: - uncomfortably loud - very loud - loud - medium - soft - very soft - not heard Select the term used by the patient to quantify the loudness level of the signal.
	In order to close the dialog box, the <ok> button must be enabled. This is because the setup of the loudness scaling procedures is defaulted to have two stages. If the setup of the loudness scaling procedures was set to have one stage, the dialog box could be closed using the <ok> or <abort> buttons. Click on <measure> to present the signal a second time.
	Have the patient perform a "fine graduation" on the scale. This means have the patient select a number that they would associate to the loudness level of the presented signal. The number elicited by the patient can be selected in the signal presentation field. To close the dialog click on: <OK> – to save the value. The value is entered in the corresponding auditory range and the loudness function is calculated. <Abort> – to not save the value. The value is rejected; no value is entered in the corresponding auditory range and the loudness function is not calculated.
	Depending on the parameters within the setup menu, a message will appear if a measured loudness scale value is already available at the selected level and frequency. Select whether to save the old value, use the new value, or take the average of the saved and new values.

During a measurement you may refuse a measured value at every time via cancel for example when it was not heard.

Automatic Procedure:

Select <Orientation> or <start testing sequence> to perform the automatic loudness scaling procedure.

The dialog box within the automatic loudness scaling procedure is nearly identical to the dialog box within the manual loudness scaling procedure. One additional option is available in the automatic dialog box: <training/cancel test series>. Selecting this button will end the test series. Selecting <OK> or <Abort> will start the next value in the test series.

Detailed description of the automatic loudness scaling procedure.

When the test series starts the first value is automatically presented. A green dot will appear in the right hand corner of the window, above the <ok> button when the signal is being presented.
Following the signal presentation ask the patient to quantify the loudness level of the signal by selecting an option from the loudness scale list. (Please refer to the section "instruction" for more detail on loudness scaling patient instructions). Select the term used by the patient to quantify the loudness level of the signal.
In order to close the dialog box, the <ok> button must be enabled. This is because the setup of the loudness scaling procedures is defaulted to have two stages. If the setup of the loudness scaling procedures was set to have one stage, the dialog box could be closed using the <ok> or <abort> buttons.
Click on <measure> to present the signal a second time.
Have the patient perform a "fine graduation" on the scale. This means have the patient select a number that they would associate to the loudness level of the presented signal. The number elicited by the patient can be selected in the signal presentation field.
To close the dialog click on:

<OK> – to save the value. The value is entered in the corresponding auditory range and the loudness function is calculated.
<Abort> – to not save the value. The value is rejected; no value is entered in the corresponding auditory range and the loudness function is not calculated.

7. The next value of the test series will be presented. In the setup menu, it is possible to establish the procedures to include or exclude the special auditory ranges and extend or abbreviate test series.

8. During the measurement it is possible to discard the measured value at any time by clicking <abort orientation/measurement>. This feature may be useful if the signal is not audible to the patient.

9. It is also possible to cancel a complete measurement by clicking <Training/Cancel test series>. The measurement can be restarted any time.

Generating the Test Series:

When measured values are already available in the scaling database, the ACAM System generates measuring points into any gaps. Test series are generated so that pauses in presentation can occur between the previous presentation level and frequency and the next presentation level and frequency. This helps the patient avoid making comparisons between the current measurement value and the previous measurement value.

The minimum and maximum distances of the test series in relation to the test level and frequencies can be established in the setup menu. It is possible to show and hide the auditory ranges that will be measured. For more information on this top please refer to the section: "Scaling: Setup." In order to generate a personalized test series, a control file should be used, please refer to the section "Technical Information" for more details.

The Customer Dialog:

If the ACAM System has multiple monitors attached to it for operation, one of the monitors can be used as a touch screen where the patient can make selections during the loudness scaling procedures. A touch screen key pad must be available on the monitor in order for this function to work appropriately (Figure 210).

Figure 210: The ACAM System with three monitors attached; one of the monitors is aligned to be in the view of the patient.

In order to have the patient make selections with a touch screen, this option must be enabled in the setup menu.

As long as a measurement is running the patient can make selections and choices using the touch screen. The touch screen option also allows the patient to repeat the current test signal by selecting <Again!>.

The loudness scaling procedure can run automatically, without the assistance of the audiologist. Yet, it is recommended that the loudness scaling procedure be completed together with the patient. This is to account for patient questions and any necessary further instruction.

Operation in the Target Values Mode:

In the target values mode it is possible to view the conversion of the scaling results into target values.

The figure to the left shows the target values derived from the scaling results.

The target values can also be used within the Measure tab to adjust the hearing aids during test box or real ear measurements.

If <without hearing aids> has been selected, data can be seen immediately because these values are real ear gain values and can be applied automatically. With this selection, the scaling results can also be converted into a tone audiogram.
If <with hearing aids> has been selected, a second measurement is necessary in order to generate target values. The gain of the hearing aid is not known during this measurement and needs to be assessed before data can be shown.

Figure 211: Target values mode without hearing instrument

In the target values mode without a hearing aid, there are other options for selection on the bottom of the screen (Figure 211).

<vert pure tone audiogram into scaling>: This feature converts the pure tone threshold and the UCL into AHA values. If an AHA value is already saved in the memory of the ACAM system, it will be overwritten following a confirmation message.
<vert scaling into pure tone audiogram>: This feature generates a tone audiogram from the AHA scaling data.

Figure 212: Conversion values

Conversion values may be selected (Figure 212):

Select <Transfer HTL> to convert the hearing threshold level (HL).
Select <Transfer MCL> to convert the MCL.
Select <Transfer UCL> to convert the UCL.

If these values are already available in the tone audiogram a warning appears to notify you that the saved values will be overwritten (Figure 213).

The conversion feature is only available for the data which has been measured.

The above mentioned functions can help you avoid making repetitive measurements. They also allow you to select the conversion to be applied to the measurements, prior to the start of the scaling procedures.

Following the scaling procedure, the AHA values can be converted into tone audiometry values. This would allow you to obtain the patient's MCL and UCL values. This conversion would be helpful to perform a hearing aid presetting procedure using the percentile analysis function.

Figure 213: Warning message prior to conversion

Figure 214: Target values with hearing instrument

In the target values mode with a hearing instrument, a button appears which can determine the gain of the selected hearing instrument during the scaling procedures. This measurement must be performed in order to display the target values. The measurement is always performed consecutively for the right and left sides (Figure 214).

Figure 215: Measure hearing aid in test box window

A message will appear to determine if the hearing aid to be measured is already sitting in the test box (Figure 215). If the hearing aid is sitting in the test box and you would like to begin the measurement, select <yes>. If you do not want to start the measurement or you would prefer to continue to the next side, select <no>.

If you do not want to measure or measure again a side you select "no".

The measurement can take up to two minutes to complete. The measurement time will depend on the necessary adjustments for the measuring signal. Please refer to the section "Setup" for more information on this topic.

Following the measurement, the target values will be available in the target values mode in the AHA and in the test box.