GSI TympStar Version 2 Reference Instruction Manual Rev 10.0 March 2008

Title:

GSI TympStar Version 2 Middle-Ear Analyzer Reference Instruction Manual

Date:

March, 2008

Copyright © 2005 Grason-Stadler. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the prior written permission of Grason-Stadler. The information in this publication is proprietary to Grason-Stadler. Part number:

2000-0120

Printing history:

January, 2001 October, 2001 June, 2002 October, 2002 February, 2003 Septermber, 2003 January, 2005 February, 2005 July, 2005 March, 2008

First printing Second printing Third printing Fourth printing Fifth printing Sixth printing Seventh printing Eighth printing Ninth printing Tenth printing

Rev 1.0 Rev 2.0 Rev 3.0 Rev 4.0 Rev 5.0 Rev 6.0 Rev 7.0 Rev 8.0 Rev 9.0 Rev 10.0

Contents Introduction ... 1-1 General ... 1-1 Equipment connections and options... 1-2 The probe ... 1-2 Instrument controls ... 1-3 Hardkeys and softkeys ... 1-3 Rotary pressure control ... 1-3 Test modes and menu navigation ... 1-3 Changing parameter settings ... 1-5 Menu diagrams ... 1-5 GSI default parameter settings ... 1-5

Installation ... 2-1 Unpacking and inspecting the GSI TympStar Version 2... 2-1 TympStar Accessories Supplied ... 2-2 Equipment connections ... 2-4 Rear panel ... 2-4 Probe ... 2-5 Power ... 2-5 Preparing the probe assembly ... 2-6 Powering the instrument ... 2-7 Prior to applying power ... 2-7 Applying power ... 2-7 Preparing the printer ... 2-8 Paper supply... 2-8 Adjusting the display contrast ... 2-9 Front panel controls ... 2-10 Hardkeys ... 2-10 Softkeys ... 2-12 Menu diagrams ... 2-12 GSI default parameter settings ... 2-12

Pre-Operation ... 3-1 Cleaning probe tubes ... 3-1 Caring for eartips ... 3-2 Preparing test materials ... 3-3 Calibration checks... 3-3

GSI TympStar Version 2 Reference Instruction Manual

Contents - 1

Contents

Test cavity calibration ... 3-3 Altitude/Barometric pressure calibration ... 3-4 Equivalent compliance values ... 3-4 Tracing/Meter Calibration check for Tympanometry ... 3-5 Pressure range check for tympanometry ... 3-11 Manual pressure check for tympanometry ... 3-11 Screening reflex check - tymp screening ... 3-12 Reflex threshold mode check ... 3-13 Intensity limits check for reflex threshold ... 3-16 Instructing the patient... 3-17 General ... 3-17 Positioning the probe box ... 3-17 Suggested probe insertion technique ... 3-17

Operation ... 4-1 Overview of functions ... 4-1 Test and other functions ... 4-1 Default parameters ... 4-2 Program modes ... 4-3 Probe tone frequencies ... 4-3 LCD graphic traces ... 4-3 Probe lights ... 4-3 LCD screen ... 4-3 Erasing and clearing test data ... 4-4 External reflex test stimuli ... 4-5 Paging test data and the cursor ... 4-5 Printing tests ... 4-6 Error codes and problem reporting ... 4-6 Test procedures ... 4-7 Tympanometry (Tymp Mode) ... 4-7 Two component tympanometry ... 4-7 Gradient ... 4-9 Tymp width method ... 4-9 Ratio method ... 4-10 Selecting the gradient method ... 4-10 Tymp diagnostic softkey menu structure ... 4-11 Automatic tympanometry test procedure ... 4-11 Sweep direction ... 4-12 Tymp test: Y at 226Hz ... 4-13 Baseline ON ... 4-13 Baseline OFF ... 4-13 Stopping the test ... 4-13 Automatic scaling ... 4-13 Cursor ... 4-14 Tymp tests other than Y at 226Hz ... 4-14 Cursor and TYMP SET PEAK function ... 4-14 Contents - 2

Grason-Stadler

Contents

Manual tympanometry test procedure ... 4-15 Tympanometry printout samples ... 4-18 Tympanometry normative values Ytm, 226 Hz ... 4-18 Static Admittance Norms (mmho) ... 4-19 Tymp screening with Reflex (Tymp mode) ... 4-20 Tymp screening softkey menu structure ... 4-20 AUTO START ON ... 4-21 AUTO START OFF... 4-21 BASELINE ON ... 4-22 BASELINE OFF ... 4-22 REFLEX OFF ... 4-22 REFLEX ON ... 4-22 Screening reflex test scoring ... 4-23 Tymp screening sample printout... 4-24 Program mode for tympanometry ... 4-25 Program mode softkey menu structure ... 4-25 Screen and diagnostic softkeys ... 4-25 User softkeys ... 4-25 Program Mode ... 4-25 Programming default parameters for SCREEN and DIAGNOSTIC modes ... 4-26 Programming default parameters for user tests ... 4-27 Acoustic Reflex testing ... 4-28 Non-acoustic Reflex testing ... 4-29 Reflex Threshold softkey menu structure ... 4-29 Reflex Threshold automatic test procedure ... 4-30 Stimulus Timing ... 4-30 Auto timing of stimuli ... 4-31 Minimum and maximum timing allowable for reflex threshold ... 4-31 Manual timing of stimuli... 4-31 Mark Threshold ... 4-34 Threshold Seek ... 4-34 Reflex threshold sample printouts ... 4-38 Reflex Threshold MANUAL test procedure... 4-39 Reflex threshold summary ... 4-40 Program mode for Reflex Threshold ... 4-41 Softkey menu structure ... 4-41 Program mode ... 4-41 Reflex Decay testing ... 4-43 Softkey menu structure ... 4-43 Minimum and maximum timing levels allowable in Reflex Decay ... 4-44 Reflex Decay sample printout... 4-46 Program mode for Reflex Decay ... 4-47 Eustachian Tube Function Testing for Intact Eardrums ... 4-49 Pressure-swallow test ... 4-49 Softkey menu structure ... 4-50 ETF-Intact automatic test procedure ... 4-51

GSI TympStar Version 2 Reference Instruction Manual

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Contents

ETF-Intact sample printout ... 4-53 ETF-Intact normative data ... 4-53 Eustachian Tube function testing for perforated eardrums ... 4-54 Softkey menu structure ... 4-54 ETF-Perforated TM automatic test procedure ... 4-55 Minimum and maximum levels allowable ... 4-56 ETF-Perforated TM sample printout ... 4-57 ETF-Perforated TM manual test procedure ... 4-58 ETF-Perforated TM normative data ... 4-58 Program mode for ETF ... 4-59 Softkey menu structure ... 4-59 Program mode ... 4-59 ARLT-Special test mode ... 4-61 Softkey menu structure ... 4-61 ARLT test procedure ... 4-61 Minimum and maximum timing levels allowable in ARLT ... 4-62 ARLT sample printout ... 4-64 Normative test data ... 4-64 ARLT program mode ... 4-65 Acoustic Reflex Sensitization-Special Test Mode ... 4-67 Softkey menu structure ... 4-67 A. R. Sensitization test procedure ... 4-67 Minimum and maximum timing levels allowable in A.R. Sensitization ... 4-68 A. R. Sensitization sample printout ... 4-71 A. R. Sensitization -manual test procedure ... 4-72 A. R. Sensitization program mode ... 4-73 Multiple Hz-special test mode ... 4-75 Softkey menu structure ... 4-76 Multiple Hz test procedure ... 4-77 Multiple Hz sample printouts ... 4-81 Multiple Hz Program Mode ... 4-83 Altitude Calibration Mode ... 4-85 Calibration procedure ... 4-85 Auto Sequence testing ... 4-87 Auto Sequence test procedure ... 4-87 Auto Sequence program mode... 4-89 Instrument options ... 4-91 Softkey menu structure... 4-91 Print format ... 4-91 Data Transfer Settings ... 4-93 Language... 4-93 Test Sequence ... 4-93 Remote Settings ... 4-94 Date and Time ... 4-94 Facility Name ... 4-95

Contents - 4

Grason-Stadler

Contents

Index Appendix A ... Specifications Appendix B ... Bibliography Appendix C ... Basic Problem Solving Appendix D ... Remote Specifications

GSI TympStar Version 2 Reference Instruction Manual

Contents - 5

Contents

Contents - 6

Grason-Stadler

Preface This manual contains the information necessary to install and operate the GSI TympStar Version 2 Middle-Ear Analyzer. This information is essential for the efficient use of the analyzer, and must be read and understood to avoid test errors. Here is what you will find in this manual: Chapter 1: Introduction • Introduction to the GSI TympStar Version 2 Middle-Ear Analyzer Chapter 2: Installation • Unpacking and inspection • Connections • Probe assembly • Printer preparation • Front panel controls • Powering the instrument Chapter 3: Pre-Operation activities • Cleaning probe tubes • Care of eartips • Preparing test materials • Calibration checks • Instructing the patient • Suggested probe-insertion technique Chapter 4: Operation • General format • Test proceedures • Tympanometry mode (Diagnostic and Screening Tymp with Reflex) • Program mode - Tympanometry • Reflex Diagnostic mode • Program mode - Reflex Diagnostic • Reflex Decay - Special Test mode • Program mode - Reflex Decay • ETF mode (Eustachian Tube Function) • Eustachian Tube Function testing • Program mode - ETF

GSI TympStar Version 2 Reference Instruction Manual

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Preface

• Acoustic Reflex Latency Test (ARLT) - Special Test mode • Program mode - ARLT • Acoustic Reflex Sensitization (A. R. SENSI) - Special Test mode • Program mode - A. R. SENSI • Multiple Hz • Program mode - Multiple Hz • Operator Altitude Cal. mode - Special Test mode • Auto Sequence Testing • Instrument Options - Special Test mode Appendix A:Specifications Appendix B: Bibliography Appendix C:Problem solving Appendix D:Remote Specifications

Conventions used in this manual Icons

This manual uses the following icon conventions to draw special attention to information: NOTES Note icons indicate important related information, reminders, recommendations, and suggestions. Notes are shown in bold type. CAUTIONS Caution icons indicate information regarding a situation or condition that could result in equipment malfunction or damage, or in lost data. Cautions are shown in bold type. WARNINGS Warning icons indicate information regarding a situation or condition that could result in personal injury or death. You should not proceed until you thoroughly read and understand the warning information. Warnings are shown in bold type.

Operating controls

ii

References to user controls on the instrument’s front panel or LCD panel are shown as UPPER CASE in operating procedures and other instructions.

Grason-Stadler

Preface

Safety Considerations General safety precautions must be followed when operating electical equipment. Failure to observe these precautions could result in damage to the equipment and injury to the operator or patient. The employer should instruct each employee in the recognition and avoidance of unsafe conditions and the regulations applicable to his or her work environment to control or eliminate any hazards or other exposure to illness or injury. It is understood that safety rules within individual organizations vary. If a conflict exists between the material contained in this manual and the rules of the organization using this instrument, the more stringent rules should take precedence. WARNING The GSI TympStar Middle-Ear Analyzer is designed to be used with a hospital grade outlet. Injury to personnel or damage to equipment can result when a three-prong or two-prong adapter is connected between the GSI TympStar power plug and an AC outlet or extension cord. WARNING The use of ACCESSORY equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system. Consideration relating to the choice shall include: • Use of the ACCESSORY in the PATIENT VICINITY • Evidence that the safety certification of the ACCESSORY has been performed in accordance with the appropriate IEC 601-1 and/or IEC 601-1-1 harmonized national standard. ANY EQUIPMENT CONNECTED TO THE GSI TYMPSTAR AND USED IN THE PATIENT VICINITY MUST BE POWERED BY AN ISOLATED POWER SOURCE TO MAINTAIN THE ELECTRICAL SAFETY OF THE OVERALL SYSTEM. The isolated power source can be purchased directly from GSI, or elsewhere when approved for use by GSI.

GSI TympStar Version 2 Reference Instruction Manual

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Preface

WARNING - ELECTRIC SHOCK HAZARDS Do not open the case of the TympStar. Refer servicing to qualified personnel. Do not remove any TympStar covers. Refer servicing to qualified personnel. WARNINGS - ELECTRICAL GROUNDING This device uses a three wire power cord with a hospital grade plug (for international applications, IEC 601-1 approved plug). The chassis is earth grounded. For grounding reliability, connect the device to a hospital grade or hospital only receptacle (for international applications, IEC 601-1 approved receptacle). Inspect the power cord often for fraying or other damage. Do not operate the apparatus with a damaged power cord or plug. Improper grounding is a safety hazard. Do not use extension cords for the TympStar. Extension cords can cause ground integrity and impedance problems. Periodically check the system ground integrity. WARNING - EXPLOSION This system is not explosion proof. Do not use in the presence of flammable anesthetics or other gasses.

WARNINGS - CONNECTIONS Do not switch on any system power until all cables have been properly connected and verified. See this manual for setup instructions, which accompanies all deliveries of the system. Switch off the system power before connecting or disconnecting any system component(s) or accessories. Otherwise you may damage the device(s). WARNINGS - GENERAL Proper use of this device depends on careful reading of all instructions and labels. Follow all safety standards set by your place of employment. Prolonged use of auditory stimuli can cause damage to patient hearing.

iv

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Preface

CAUTIONS - ELECTRICAL POWER Electrical Shock Hazard. Do not remove covers. Refer servicing to qualified personnel only. Make sure your power cord plug is proper for the power outlet into which it will be plugged. I.e., plug in a 120V rated power cord into a 120V outlet only. TympStar test results data is not stored when the power is turned off. To maintain test results data in the presence of power brown-outs or temporary power interruptions, an Uninterruptable Power Supply (UPS) must be used. CAUTION - CONNECTIONS If you disconnect cables, please be careful to reconnect them in their proper locations.

CAUTIONS - PREVENTIVE MAINTENANCE Preventative maintenance does not require access to the interior of the instrument and may be performed by the user. For this device, preventative maintenance consists of periodically cleaning and inspecting the exterior of the instrument. Periodic electrical safety testing is recommended. It is recommended a schedule be established for these purposes, with at least an annual cleaning, calibration and safety testing. Cleaning consists of removing all dust from the exterior surface of the system with a soft brush or cloth. Use a brush to dislodge any dirt on or around the connectors and panel edges. Remove any dirt with a soft cloth. CAUTIONS - GENERAL If the system is not functioning properly, do not operate it until all necessary repairs are made and the unit is tested and calibrated for proper functioning in accordance with Grason-Stadler published specifications. It is recommended that all repairs be performed by a qualified service representative only. Prolonged use of auditory stimuli can cause damage to patient hearing.

GSI TympStar Version 2 Reference Instruction Manual

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Preface

Product Warranty We warrant that this product is free from defects in material and workmanship and, when properly used, will perform in accordance with applicable specifications. If within one year after original shipment it is found not to meet this standard, it will be repaired, or at our option, replaced at no charge when returned to a Grason-Stadler service facility. Changes in the product not approved by Grason-Stadler shall void this warranty. Grason-Stadler shall not be liable for any indirect, special or consequential damages, even if notice has been given of the possibility of such damages. THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

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Introduction General

1

The GSI TympStar Version 2 Middle-Ear Analyzer is a technically advanced, computer-based admittance instrument designed to be used in a clinical or research setting. The TympStar builds on the sophistication, functionality and flexibility of the GSI 33, offering unparalleled testing capabilities. It contains total capabilities for complete, manual or automatic diagnostic testing for analysis of middle ear function. Admittance (Y), and its components Susceptance (B) and Conductance (G), may be measured with probe tone frequencies of 226, 678, and 1000 Hz. The extensive battery of test mode choices include: • Diagnostic Tympanometry • Acoustic Reflex Threshold and Decay Measurements • Eustachian-Tube Function Testing (Both intact and perforated eardrums) • Screening Tympanometry/Reflex (Automatic Only) • Acoustic Reflex Latency Testing • Acoustic Reflex Sensitization • Multiple Frequency Tympanometry (250 Hz to 2000 Hz) Operators have a choice of using GSI preprogrammed test parameters, or programming their own test criteria. A large liquid crystal display (LCD) clearly displays test parameter choices and the possible alternatives. Admittance and pressure indications are shown on the LCD along with a continuous digital readout. Test status and invalid choices are also shown on the LCD. The tympanometric measurement results are automatically scaled and presented in equivalent ml of compliance at “Y”, 226 Hz. All “B” and “G” measurements and measurements performed at probe tone frequencies of 678 Hz and 1000 Hz are expressed in mmhos. Sensitivity scales for the display of reflex measurement results can be selected manually. Reflex test stimuli can be input from an external source and presented via external control. A cursor is available in all test modes for calling out numeric positions on the X and Y axes.

GSI TympStar Version 2 Reference Instruction Manual

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Chapter 1

Test results are displayed in real time. The user can view the results as they are being measured and then has the choice of printing the display or retesting the patient. The high-speed printer generates reports in concise graphical formats that are easy to read. Equipment connections and options

TympStar options that can be connected to the rear panel include an external

stimulus source, an external Present control, RS232 serial communication, a keyboard for entering patient information, an HP DeskJet® or LaserJet® printer and a VGA monitor for displaying test results. Other options offered for the TympStar for managing and archiving data, include: • Internal memory for storing up to 26 test results • Data export to an external PC via RS232 serial interface • Remote control of the TympStar via RS232 commands from an external PC. The probe

The innovative lightweight probe is designed for patient comfort, ease-of-seal, and accurate test results. A wide variety of both standard and special sized eartips are supplied with the GSI TympStar to hermetically seal the ear canal. In addition, a set of screening eartips is provided for screening tymp and reflex tests. The operator has a choice of three mountings to support the probe box; the standard lightweight shoulder mounting, standard clothes clip, or an optional operator wrist attachment. The probe box has 2 LED’s to indicate test status. Within the probe box there are two small loudspeakers, a microphone and a pressure transducer. One loudspeaker delivers the probe tone to the ear canal, while the microphone monitors the intensity of the probe tone within the ear canal. The second loudspeaker delivers the ipsilateral (ipsi) stimuli to the ear canal. The contralateral (contra) insert phone contains its own loudspeaker. The pressure within the ear canal can be varied up to a range of +400 daPa to -600 daPa. At no time is it possible to exceed specified maximum limits. Pressure can be varied automatically or manually and from negative to positive or from positive to negative values. Pressure within the ear canal is monitored continuously in order to maintain pressure accuracy throughout each test sequence.

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Grason-Stadler

Introduction

Instrument controls

A combination of hardkeys and softkeys are used to select the test modes and parameters and to conduct tests.

Hardkeys and softkeys

Hardkeys are located on the front panel and the sides of the LCD panel and provide fixed functions that do not change. Softkeys are located directly under the LCD and change to support the requirements of a test session.

LCD panel

Softkey

Hardkeys Front panel

Pressure control

Rotary pressure control

A rotary pressure control is also provided to change or fine-tune pressure within the ear canal.

Test modes and menu navigation

Selecting a test mode by pressing a hardkey causes the required test screen to be displayed on the LCD with the appropriate menu of test parameters shown across the bottom. The softkeys are then used in conjunction with a few hardkeys to navigate through the menus and set parameter values for the selected tests. For example, pressing the TYMP hardkey causes the Tymp Diagnostic screen to be displayed.

Tymp hardkey

Tymp Diagnostic screen

Tymp parameter menu

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Chapter 1

Pressing the softkeys displayed across the bottom of the LCD allows the user to navigate through the Tymp Diagnostic parameter menus diagrammed below. GSI default softkey selections are circled on menu diagrams. The first level of parameter menu selections includes AUTO SEQUENCE, PROBE Hz, ADMITTANCE, P-RANGE, EAR and MORE. First level

AUTO SEQUENCE

PROBE Hz

226

Second level

50

200

600/200

Y ml

1000

P-RATE daPa/s

12.5

Default selection

678

P-RANGE daPa

ADMITTANCE

B G B/G mmho mmho mmho

NORMAL

START daPa

BASELINE

-600 -400 -200 +200 +400 MORE

ON OFF

-500

-300

0

EAR

WIDE

RIGHT

MORE

LEFT

GRADIENT

TYMP WIDTH RATIO daPa ml

CURSOR

OFF

OFF

MORE

TYMP 1 TYMP 2 TYMP 3 SET PEAK SET PEAK SET PEAK

+300 MORE

First level

A second level of menus can be displayed by pressing the MORE softkey and includes P-RATE, START, BASELINE, GRADIENT, CURSOR and MORE.

Second level

The MORE softkey is used to toggle between the top and lower levels of menus while the test screen portion above the softkeys remains unchanged. 1-4

Grason-Stadler

Introduction

Pressing a parameter menu softkey causes a sub-menu of parameter settings to be displayed. Often submenus will also contain MORE softkey selections that provide access to additional setting alternatives.

START daPa

Sub-menu of START daPa

-600 -400 -200 +200 +400 MORE

-500

-300

0

+300 MORE

Sub-menu of START daPa

Changing parameter settings

Settings can be changed for a selected parameter by pressing the desired softkey as shown in this example of changing the Probe Hz from 226 to 1000.

Making the new selection returns the display to the previous menu level with the new setting shown above the selected parameter. If no change is desired, the display can be returned to the previous level by pressing the RETURN hardkey. In the manner described above, menus can be navigated and settings can be changed for any of the test modes. Menu diagrams

Menu structure diagrams like the diagrams shown on these pages will be used throughout the remainder of this manual as a convenience to the user.

GSI default parameter settings

GSI default parameters are circled on menu structure diagrams shown throughout the remainder of this manual.

START daPa -600 -400 -200 +200 +400 MORE

GSI default value

GSI TympStar Version 2 Reference Instruction Manual

-500

-300

0

+300 MORE

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Chapter 1

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Grason-Stadler