How to Use InSituGram www.siemens.com Wendy Davies Abstract: Siemens InSituGram allows pure tone audiometry to be performed using the hearing instrument. The insitu audiogram will usually be very similar to the results from traditional audiometry but takes into account the individual acoustics of the patient’s ear canal as well as any venting effects. This delivers an improved fitting, reducing the need for fine tuning. Connexx 7: InSitugram I. Introduction Siemens InSituGram allows pure tone audiometry to be performed using the hearing instrument, in order to supplement and verify traditional audiometry. InSituGram audiometry is performed in the same way as normal audiometry but instead of using headphone or insert earphones, the tones are presented through the hearing instrument The InSitu audiogram will usually be very similar to the results from traditional audiometry but takes into account the individual acoustics of the patient’s ear canal as well as any venting effects. This delivers an improved fitting, reducing the need for fine tuning. II: How to complete InSituGram Step 1: Connect and detect hearing instrument using the icon. Under Next Steps, select ‘New fitting’, click OK Step 2: Complete coupling to ear data in Acoustical Parameter tab This information is required to allow Connexx 7 to correctly calibrate the InSituGram to correctly allow for venting and tube effects. Once this data has been completed, select the InSituGram tab Step 3: Record the InSituGram The hearing instrument is muted once the InSituGram tab is selected. Place the hearing instrument in the patient’s ear, ensuring it is correctly fitted. Copyright © Siemens AG 2012. All rights reserved. 2 Connexx 7: InSitugram The traditional audiogram is displayed In grey and the InSituGram in red and blue. The display of the traditional audiogram can be deactivated via the curve display settings dialog. The shaded areas at the bottom of the audiogram chart are the maximum intensities available. This shaded area will alter depending on the venting and coupling types selected Adjusting frequency and intensity Frequency is changed using the left/right arrows at the bottom of the screen or by using the left/right arrows on the keyboard. Intensity is adjusted using the up/down arrows at the bottom of the screen or by using the up/down arrows on the keyboard Copyright © Siemens AG 2012. All rights reserved. The tone can be presented by moving the mouse pointer over the loud speaker icon or by pressing the space bar on the keyboard. Threshold is stored by either double-clicking the required value or by pressing the enter key on the keyboard 3 Connexx 7: InSitugram To record “not heard”, right mouse click on the InSituGram screen and select Not Heard from the drop-down menu Place the hearing instrument in the patient’s ear, ensuring that the ear mould/shell/LifeTube/Receiver is fitted correctly and that the hearing instrument is still connected to the Hi-Pro, NoahLink or ConnexxLink Instruct the patient to respond to the tones as per normal audiometry. Once the InSituGram is completed, select Use InSituGram for First Fit if desired. Step 4: Complete InSituGram The InSituGram is now complete and will be used in the First Fit calculation. If required, the Critical Gain Measurement can be performed by selecting the Critical Gain tab. Alternatively, select the Fitting Formula Tab where first fit can be applied. III. How to customize InSituGram On the Home page of Connexx 7, select Preferences followed by Edit User Preference Copyright © Siemens AG 2012. All rights reserved. 4 Connexx 7: InSitugram Click on the Audiogram icon Select the ‘InSituGram Specific Settings’ page Copyright © Siemens AG 2012. All rights reserved. 5 Connexx 7: InSitugram Activate Silent Mode if required. Silent Mode allows the tone to be presented by hovering the mouse pointer over the loud speaker icon on the InSituGram screen. Click OK. IV: FAQ 1. Q. Why is the InSituGram deleted when I change the acoustic parameters? A. The InSituGram is calibrated to allow for any venting or thin tube effects. Therefore InSituGram results are only valid for a particular set of acoustic parameters and if these are changed, the InSituGram will be deleted and must be re-measured. 2. Q. When I use an open dome, the InSituGram does not allow me to present tones at the same intensity as when I use an ear mould. Why is this? A. The InSituGram needs to account for venting effects. For open style fittings the leakage effect can be very big and tones can only be presented in a clean, undistorted way until a certain level. 3. Q. How close will the InSituGram compare to the headphone audiogram? A: The mean deviation between the InSituGram values and the hearing thresholds measured with conventional audiograms is normally less than 5dB. 4. Q. Do I need to perform InSituGram for all fittings? Copyright © Siemens AG 2012. All rights reserved. 6 Connexx 7: InSitugram A. No, InSituGram is optional but will provide a First Fit that includes the individual acoustics of the patient’s ear canal. 5. Q. Can I perform InSituGram with demo products? A. The InSituGram should be performed with the patient’s actual hearing instruments. The coupling used and the way the instruments fit in the ear will affect the InSituGram results. 6. Q. Can I do InSituGram with conductive hearing loss? A. It is not recommended to perform InSituGram with conductive losses as masking and bone conduction measurements cannot be made. Copyright © Siemens AG 2012. All rights reserved. 7