Operation Manual: Clinical Audiometer AC40

Operation Manual
Clinical Audiometer AC40
Valid from serial no. 160252 - software version 1.70

80661204 – ver. 09/2008
Table of Contents
Introduction ......................................................................................... 3
Intended Use ..................................................................................... 3
Precautions........................................................................................ 3
Basic Functions .................................................................................. 5
Entering Patient Data ........................................................................ 5
Delete Function ................................................................................. 5
Printout .............................................................................................. 6
Patient Communication ..................................................................... 7
Monitoring .......................................................................................... 7
Swapping Channels .......................................................................... 8
Patient Response Switches .............................................................. 8
Remote Tone Switches ..................................................................... 8
External Keyboard ............................................................................. 8
The Different Headsets ..................................................................... 9
Recreating the default setup ............................................................. 9
Tone and Speech Presentation ....................................................... 11
Pure Tone Presentation .................................................................. 11
High Frequency Pure Tone Presentation ........................................ 12
Speech presentation ....................................................................... 15
Masking ............................................................................................. 18
Tests .................................................................................................. 20
SISI Test .......................................................................................... 20
Weber Test ...................................................................................... 21
DLI Test (Lüscher-Zwislocki) ........................................................... 22
DLF testing ...................................................................................... 23
ABLB Test (Fowler Test) ................................................................. 24
MLD Test ......................................................................................... 25
MLB test .......................................................................................... 27
TT-Decay ......................................................................................... 29
Békésy ............................................................................................. 30
Hughson Westlake .......................................................................... 34
DMU Test ........................................................................................ 37
Stenger ............................................................................................ 38
Loudness Scaling ............................................................................ 39
Quick Reference Guide AC40 .......................................................... 40
Function of buttons .......................................................................... 43
Technical Specifications .................................................................. 52
Accessories ..................................................................................... 55
AC 40 Operation Manual Page 1

External Printer Connection ............................................................ 56
Connection to OtoAccess ................................................................ 57
Unpacking and Inspection ............................................................... 58
Contents of Shipment ...................................................................... 58
Reporting Imperfections .................................................................. 59
Care and Maintenance .................................................................... 59
Trouble Shooting .............................................................................. 61
Appendix A: Setup ........................................................................... 65
Tone parameter Setup .................................................................... 65
Speech Parameter Setup ................................................................ 68
Common Setup ............................................................................... 69
Menu Setup ..................................................................................... 73
Entering Clinic name ....................................................................... 73
Test Setup ....................................................................................... 74
Communication setup...................................................................... 78
Appendix B: General Maintenance ................................................. 80
Return Report.................................................................................... 82
Instrument layout.............................................................................. 84
AC 40 Operation Manual Page 2

0 Introduction
14 Intended Use
The AC40 clinical audiometer is designed to be a device for
diagnosing hearing loss. Output and specificity of this type of device
are based on the test characteristics defined by the user, and may
vary depending on environmental and operating conditions. The
diagnosing of hearing loss using this kind of clinical audiometer
depends on the interaction with the patient. However, for patients not
responding well possibilities of various tests allow the tester of
having at least some evaluative result. Thus, a “normal hearing”
result should not allow for ignoring other contra indications in this
case. A full audiologic evaluation should be administered if concerns
about hearing sensitivity persist
The AC40 audiometer is intended to be used by an audiologist,

hearing healthcare professional, or trained technician in
an extremely quiet environment. Careful handling of instrument
whenever in contact with patient should be of high priority. Calm and
stable positioning while testing is preferred for optimal accuracy. It is
recommended that the instrument be operated within an ambient
temperature range of 15-35 degree Celsius (59-95 degrees
Fahrenheit)
15 Precautions
Notice - Be sure to use only stimulation intensities which will be
acceptable for the patient.
Notice - The transducers (headphones, bone conductor, etc.)

supplied with the instrument are calibrated to this instrument -
exchange of transducers require a recalibration.
Notice - It is recommended that parts which are in direct contact with

the patient (e.g. earphone cushions) are subjected to standard
disinfecting procedure between patients. This includes physically
cleaning and use of a recognised disinfectant. Individual
AC40 Operation manual Page 3

manufacturer's instruction should be followed for use of this
disinfecting agent to provide an appropriated level of cleanliness.
Notice - Never insert or in any way use the insert headset without a
new clean non defect test tip.
If this apparatus is connected to one or more other

devices with medical CE marking, to make up a
system or pack, the CE marking is only valid also for
the combination if the supplier has issued a
declaration stating that the requirements in the
Medical Device Directive article 12 are fulfilled for the combination.
Notice - Although the instrument fulfils the relevant EMC
requirements precautions should be taken to avoid unnecessary
exposure to electromagnetic fields, e.g. from mobile phones etc. If
the device is used adjacent to other equipment it must be observed
that no mutual disturbance appears.
Notice - Within the European Union it is illegal to

dispose electric and electronic waste as unsorted
municipal waste. Electric and electronic waste
may contain hazardous substances and
therefore has to be collected separately. Such
products will be marked with the crossed-out
wheeled bin shown below. The cooperation of
the user is important in order to ensure a high level of reuse and
recycling of electric and electronic waste. Failing to recycle such
waste products in an appropriate way may endanger the
environment and consequently the health of human beings.

1 Basic Functions
16 Entering Patient Data

Patient name, address, remarks etc. may be entered by the use of
an external keyboard (optional). Such data will appear on the
printouts from an external printer connected to the printer output of
the AC40.
1) While activating the shift function by holding down one of the

Tone Switches (47 or 50) select “subject” (“Delete” button (41)).
Now the Subject window appears.
2) Select “Reset” (F1) to delete previous patient’s name etc. Any
audiometric data will be deleted by this action so be careful! Now
use the external keyboard to enter desired patient data.
3) Leave by selecting “Menu”.
The “Common” setup in the AC40 must be set to “Print All” if patient
data are to appear automatically on printouts together with
audiometric data (press “Menu” (11)\Setup (F2)\Common (F3), Now
highlight the “Printer options”: “All” and turn it on with the “Change”
key (F1)).
External keyboard needed:

An ANK10 keyboard or an IBM AT keyboard must be
connected to the keyboard connection plug on the rear panel
(plug adapter available if needed), and the correct keyboard
must be selected in the AC40 setup (press: Menu (11)\Setup\
(F2)\Common (F3). Now highlight the “External Keyboard” and
select correct keyboard by use of the “Change” key (F1)).
No transfer to OtoAccess:
Patient data entered into the AC40 by use of keyboard will not
be transferred to the OtoAccess computer program.
17 Delete Function
The “Delete” button (41) carries 4 different functions:

1) One short push on the delete button and values corresponding
to the illuminated buttons on the front panel will be deleted.
2) A longer push on the delete button will delete all visible data for
the selected ear.
3) An even longer push on the delete button will delete all visible
data for the selected display.
4) Deleting all data stored in the AC40 is done by activating one of
the Tone Switches (47 or50), while pushing the Delete button
(41). Now the “Subject Editor” window appears. Select “Reset”
(F1) to clear all audiometric data in the memory of the AC40.
18 Printout
The data from the AC40 can be printed in different ways:
External printer:
Select “Print for external printer”. If an external printer (HP-
GL2 language compatible) is connected to the AC40, then
printouts of speech and tone audiograms will be controlled by
the “Print” button. (If the printer does not respond, check if
“External” printer is selected in the printer setup: Menu
(11)\Setup (F2)\Common (F3)\Printer).
Computer:
If the AC40 is connected to a PC with OtoAccess program
installed, speech and tone audiograms from the AC40 can be
printed on the PC.
NOTE! Name etc, entered into the AC40 is also transferred to

the computer but not by OtoAccess.
MS25 or MS40 audiometer printing:

If an MS25 or MS40 hearing aid fitting system is connected to
the AC40 speech and tone audiograms transferred to the
MS25 or MS40 can be printed on the internal printer of the
MS25 or MS40.
NOTE! The MS25 may need a software update to perform this

function, depending on its age.

19 Patient Communication
Talk forward:
The operator may talk to the patient through the patient’s
headset by activating the “T.Fwd.” button (12). The goose
neck microphone is normally used even though an external
microphone can be selected for speech testing. The volume in
the patient’s headset is adjusted on the volume control (H)
placed just above the “T.Fwd.” button (12).
Talk back:
If the patient is equipped with a microphone connected to the
talk back input the operator may listen to the patient by
pressing the “TB” button (13). The volume in the patient’s
headset is adjusted on the volume control (N) placed just
above the “TB.” button (13).
Instructions to assistant:
There is always a direct connection through the goose neck
microphone to the assistant wearing a headset connected to
the “Assistant Monitor” output.
20 Monitoring
Monitoring of channel 1, 2 or both channels together is available by
selecting the “Monitor” button (14) once, twice or three times.
Selecting it a fourth time will switch off the monitoring function again.
Selecting desired way of listening:

The monitor signal will be available through the monitor
headset if connected, in the internal monitor speaker, or
through the power monitor output driving an external speaker.
In “Common setup” you can turn speaker presentation on or
off (Menu (11)\Setup (F2)\Common (F3)\Monitor
Loudspeaker).

21 Swapping Channels
To eliminate fatigue in the hands of the operator due to the fixed
position of the body during testing, it is possible to swap between the
set of operation keys of the two channels. This enables the operator
to change his working conditions when needed.
In the pure tone speech testing screens the “Swap Ch.” function is
activated by pressing the F7 key. The Intensity Control (46) and
Tone Switch (47) on the left hand side of the audiometer are now
controlling channel 2, and the right hand Intensity Control (51) and
Tone Switch (50 are likewise operating channel 1. To return to
normal operation, select “Swap Ch” (F7) again. When “Swap Ch” is
selected it is active in all testing modes.
22 Patient Response Switches

The AC40 can indicate responses from two response switches, one
for Right and one for Left. The two red front plate indicators (B) (F)
light up accordingly. Either one of the response switches may be
used for indication in Békésy, Hughson Westlake and SISI testing.
23 Remote Tone Switches

The tone presentation switches (47) (50) on the front panel of the
AC40 may be activated with APS3 switches connected to remote
outlets on the rear plate of the AC40. (The APS3 switch is identical
to the patient response switch).
Such remote tone activation may be helpful in situations where the
patient otherwise would get undesired clues from operating
traditional tone switches.
24 External Keyboard
Short keys:

The external keyboard is used to enter clinical data for the
“Clinic Setup” and Patient data for the “Subject Editor”. Two
shortkey functions are available on the keyboard.
ESC = Main menu:

Pressing ESC will automatically leave the setup window and
return to the Main Menu window.
F10 = Print:
Press F10 to print out.
25 The Different Headsets

In addition to the standard TDH39 headset, three other air
conduction transducers may be used (they all connect to specific
outputs on the AC40):
High frequency headset:

Frequencies above 8 kHz are only presented through the high
frequency headset used for HF audiometry.
CIR22 for insert masking:

Insert phone CIR22 for insert masking has a limited sound
quality, making it only adequate for masking noise
presentation.
EAR-Tone 5A general purpose insert phone:

Insert headphone EAR-Tone 5A is a high quality transducer
that may be used instead of the TDH39. It improves cross
hearing from the normal approximate 40dB of the TDH39 to
approximately 70dB. Masking as well as avoiding over-
masking is thus easier with this type of headphone.
26 Recreating the default setup

All setup windows can be returned to standard factory settings by
holding down the “Shift” (47) and the “Delete” (41) buttons
simultaneously.

NOTE! “External printer” and “Internal FF Amplifier” will be selected.
This may not comply with your AC40. Please change manually if
needed.

2 Tone and Speech Presentation
27 Pure Tone Presentation

1) Press Menu (11) once or more to enter the “Main menu” window
2) Press Audio (F1)
Tone window will appear with default settings as shown below:
3) Select test ear as desired and transducer channel 1 (32, 33, 34,
35, or F8)
4) Select frequency with the frequency buttons (48, 49)
5) Select desired intensity with channel 1 attenuator (46)
6) Store chosen threshold by selecting “Store” (36)
Left + Right audiogram threshold comparison:

A direct comparison of L + R ear is possible by selecting
“Compare” (F5). The audiogram for the left ear will now be
displayed together with the audiogram for the right ear.
Warble tone selection:

Press “Warble” (21).

Multi-frequency:
Smaller steps between frequencies are available by selecting
the “Multi frequency” button (22).
Extended range:
An additional 20dB is available as extended range by
selecting the “Ext. Range” (24) button.
1 or 5dB attenuation steps:

Choose between 1dB or 5dB steps with the “dB” button (25).
Uncomfortable Level or UCL:

UCL may be tested by selecting “UCL” with F1. UCL values
may be stored and printed out.
“No response” sign may be stored:

To store “No Response” sign, hold down the channel two
“Tone Switch” while activating “Store” (50 + 36).
Reference tone with another frequency:

A reference tone with a different frequency to that of the test
tone may be presented to the ear not currently under test by
selecting “Reference” (F9).
Changing the reference frequency tone:

To change the frequency of the reference tone, enter the
“Tone Setup” by choosing Menu (11)/Setup (F2)/ Tone (F1)/
Low or High reference tone.
28 High Frequency Pure Tone Presentation

1) Press Menu (11) once or more to enter the “Main menu” window.
2) Press Audio (F1)
3) Select “Tone” (17)
4) Press “High” (F4)

The high tone window will appear with default settings:
The High Frequency (HF) headset must be used for HF testing.
5) Select the test ear by pressing Left and Right buttons (32 and
33).
6) Select the desired frequency with the frequency buttons (48 +
49).
7) Select Intensity with channel 1 Attenuator (46).
8) Present tone by touching channel 1 Tone switch (47).
9) Store threshold by selecting “Store” (36).
NOTE! If only the HF audiogram should be shown on screen, select

“Zoom in” (F2).
Left + Right audiogram threshold comparison:

A direct comparison of L + R ear is possible by selecting
“Compare” (F5). The audiogram for the left ear will now be
displayed together with the audiogram for the right ear.
Uncomfortable level or UCL:


“No response” sign may be stored:
To store “No Response” sign, hold down the channel two
“Tone Switch” while activating “Store” (50 + 36).
Warble tone selection:

Press “Warble” (21).
Multi-frequency:
Smaller steps between frequencies are available by selecting
the “Multi frequency” button (22).
Extended range:
An additional 20 dB is available as extended range by

Choose between 1 dB and 5 dB steps with the “dB” button
(25).
Reference tone with another frequency:

A reference tone with a different frequency than the test tone
may be presented to the other ear by selecting “Reference”
(F6).
To change the frequency of the reference tone, enter the

“Tone Setup” by choosing Menu (11)/Setup (F2)/ Tone (F1)/
Low or High reference tone.
18 kHz & 20 kHz high frequencies:

HF testing is possible by changing the setup of the AC40. In
the Common setup, choose “Display options” and change to
“Numerical”, then set the “High frequency Level” to SPL. Now
18 & 20 kHz HF audiometry is possible when “Zoom in” is
selected.
NOTE! Unfortunately 18 kHz and 20 kHz cannot be stored;

therefore these results are not printed or transferred to PC.

29 Speech presentation
1) Press Menu (11) once or twice to enter the “Main Menu” window
2) Press “Audio” (F1)
3) Select for channel 1 the “Mic” button (18) for live voice speech
testing, or select “CD/Tape” button (19) for presentation of pre-
recorded speech
The speech window will now appear on screen with default settings
as shown below:
4) Select desired test ear /Transducer (32, 33, 34, 35 or F8)

5) Prior to speech testing calibration of the intensity of the speech
signal must be done to match the requirements of the
audiometer. While presenting the speech signal from the
CD/Tape or through the microphone you must adjust the input
controls (J or K, located above the respective Mic and CD/Tape
selector) so the maximum deflection on the VU-meter (A) for
channel 1 reaches “0” indication on its scale on the points of
maximum intensity of the spoken words.
6) Select desired level with channel 1 attenuator (46)
7) Start the audiometric testing

Automatic speech score:
With automatic speech score, automatic calculations are
possible.
1) Present a word to the patient.

2) Choose “Correct/incorrect” depending on the result from
the patient.
3) Repeat 1 and 2 until the word list is completed.
4) Correct speech score is now displayed on screen.
NOTE! The number of words to be used in this test must be

entered in the Speech Setup: Menu (11)/Setup (F2)/ Speech
(F2). Now use the F1 key to assign the desired number of
words.
Multi speech curves (three speech curves):

In addition to the standard curves displayed as default, up to
three separate speech curves per ear may be entered in the
AC40. Each curve may be addressed by its function key (F2,
F3, and F4). The active curve is displayed as a thick line.
Extended range:
An additional 20 dB is available as extended range by

Choose between 1 dB and 5 dB steps with the “dB” button
(25).
Uncomfortable level or UCL:

Simultaneous speech presentation in channel 2:

Channel 2 may also be used to present the speech signal (27
or 28). The values stored will always be those of Channel 1.
Masking noise in channel 2:

Channel 2 is normally used for the masking signal, either by
selecting the internal noise generator by pressing the “N”

button (29), or by selecting the internal noise signal (28) from
the pre-recorded materiel, should it contain masking noise.
Internal gooseneck or external microphone:

For live testing you may use the internal gooseneck
microphone or you may connect an external microphone. The
desired microphone must be selected in the common setup
(Menu (11)/ Setup (F2)/Common (F3)/ Microphone 1).

3 Masking
Normal masking:
Select in channel 2 the ear to be masked (the opposite ear).
When channel 2 is activated it will automatically set itself to
masking. “Rev” (37) will be active, indicating continuous noise.
“NB”/N (29) will be active, indicating noise as masking
stimulus. The appropriate noise will automatically be selected;
Speech noise for speech testing and narrow band Noise for
tone testing. The attenuator of channel 2 controls the masking
level (51).
Insert masking:
In cases of suspected over-masking, masking by insert phone
may avoid this and is recommended. This improves the cross
hearing of the masking sound from approximately 40dB with
traditional headphone, to approximately 70dB of the CIR22
insert phone. The procedure is as follows:
5) Insert CIR22 insert phone into the ear to be masked

6) Select the “Insert masking” button (44)
7) Follow normal masking procedure
Synchronous masking:
For synchronous masking, lock attenuators together by
choosing “Synch” (button 23). Changing intensity in channel 1
(47) will now result in an equal change in the masking level of
channel 2.
To turn off channel 2, press channel 1 ”Tone Switch” (47) and

turn the channel 2 attenuator (51) counter clockwise.
Manual change of noise type:

The AC40 automatically selects the following masking noises:
Speech = “N” (29) Speech noise. Pure Tone = “NB” (29)
narrow band noise. If these types of masking noises are
inadequate, the following alternatives are available by manual
selection:
1) “NB” (in speech testing) – Narrow band noise with centre

frequency adjustable by the tone frequency buttons.

2) “N” (in pure tone setting), white Noise or Pink noise
depending on setup (Menu (11)/Setup (F2)/Common
(F3)/type of noise).

4 Tests
30 SISI Test
The Short Increment Sensitivity Index (SISI) is designed to test
the ability to recognize one decibel increases in insensitivity
during a series of bursts of pure tones presented 20dB above
threshold.
1) Press “Menu” once or more times to enter the “Main Menu”

2) Press “Tests” (F3)
3) Press “SISI” (F1)
Now the SISI test window appears as below:
The presentation of increments is automatic and can be monitored

on the screen. Frequencies between 500 and 4 kHz and intensities
20dB above hearing threshold are recommended.
5dB increments are pre-selected by the AC40. Use this to familiarize

the patient to discriminate the modulation and let him respond via the
patient response button. Other increment intensities may be selected
in this training period. Please avoid using 1.0 dB increments as this
will automatically start the scoring of test results.
Start the actual test by selecting the 1.0 dB increment (F6). After 20
increments at 1.0 dB have been presented the test stops
automatically and the score is shown on the display.

Malingering prevention:
Prevent malingering by inserting other intensities arbitrarily.
This can be done without affecting the test result, as only
increments at 1.0 dB are calculated.
Note: During SISI testing channel 2 is not active and no printout of

test results is possible.
31 Weber Test
The Weber test distinguishes between conductive and sensorineural
hearing loss originally by means of a tuning fork. Strike it softly and
place the fork in the middle of the patients head. If the patient hears
the tone better in the poorer ear the hearing loss is conductive, and
the tone is heard better in the better ear the hearing loss is
sensorineural at the given frequency. The tuning fork method,
however, typically only allows for testing at one frequency, unless the
clinician has many tuning forks. Using an audiometer together with a
bone conductor to do the Weber is more reliable and flexible than
the tuning fork method and has therefore become widespread.

32 DLI Test (Lüscher-Zwislocki)
A difference Limen Intensity test (DLI) is intended to establish
the smallest change in intensity which can be recognized.

3) Press “DLI” (F2)
Now the DLI-Test window appears as below:
Presentations of increments are automatic and can be monitored on

the screen along with the patient’s responses.
4) Select desired test ear (32, 33) and frequency (48, 49).
5) Use channel 1 attenuator (46) to set the intensity to 40dB
above the patient’s hearing threshold for the frequency being
tested.
6) Select increment intensity (F9) which is normally clearly
audible. Instruct the patient to respond via the patient
response button as long as they hear the beating character of
the tone. (Test of cooperation can be done by introducing the
0 dB increment (F1). This should make the patient cease to
respond).
Once the patient has learned to respond correctly, choose gradually

smaller increment intensities with the function keys until the smallest
increment detectable by the patent is found.
NOTE: Channel 2 cannot be selected in DLI test and printouts

cannot be made.

33 DLF testing
A Difference Limen Frequency test (DLF) is intended to
establish the smallest change in frequency modulation which
can be recognized.

3) Press “DLF” (F3)
Now the DLF test window appears as below:
4) Select the desired test ear, frequency and intensity.

5) Familiarization of the patient to discriminate the frequency
modulation is done using 5% (F9) which is normally clearly
audible. Let the patient respond using the Patient response
button.
Possible test procedures include a gradually rising of modulation

intensity from 0.0% (F1) until the patient starts hearing the
modulation, or a gradual lowering of modulation intensity from 5.0%
(F9) until the patient no longer hears the modulation.
NOTE: Channel 2 cannot be selected in DLI test and printouts

cannot be made.

34 ABLB Test (Fowler Test)
Alternate Binaural Loudness Balancing (ABLB) is a test to
dictate perceived loudness differences between the ears. This
is a possible test for recruitment when only one ear is expected
to suffer from recruitment.

3) Press “ABLB” (F4)
Now the ABLB-Test window will appear as shown below:
Instruct the Patient that he will hear tones alternating Left and Right
ears, that he is expected to press the response switch corresponding
to the ear where the loudest tone is heard and that only loudness
and not character of the tone should be considered.
4) Set the tone intensity to the poorer ear at a level 5dB above
threshold. Select “Start” (F2).
5) Adjust the level of tone for the other ear so that loudness
levels perceived are matched. Store the result by pressing
“Store”
6) Increase the level to the poorer ear 20dB and repeat test.
Repeat test at increasingly higher intensities until discomfort
or limit of output is reached.
Up to 4 different tests may be selected with the frequency knobs (48

+ 49). Alternative frequencies may be set up (Press Menu (11)/Setup
(F2)/ Tests(F6)/ABLB (F1)).

35 MLD Test
Masking Level Difference is a test aimed at the central auditory
function. Peripheral changes may also affect the MLD. MLD may
be defined as the difference in dB between the binaural (or
monaural) in. phase condition (SO NO) and a particular binaural
condition (e.g. Sπ NO or SO Nπ).
The assigned symbols are defined as follows:

SO NO: Signal binaurally in phase – Noise binaurally in phase
Sπ NO: Signal binaurally out of phase – Noise binaurally in
phase
SO Nπ: Signal binaurally in phase – Noise binaurally out of
phase
Menu function:
1) Press “Menu” once or more times to enter the “Main
Menu”
2) Press “Tests” (F3).
3) Press “MLD” (F5).
Now the MLD-Test window appears:
Test:
1) Instruct the patient to respond to tone only and that
when a pulsing tone is heard, the Patient Response
button should be activated.
2) Select the desired frequency with the frequency buttons
(48 + 49). 500Hz is usually preferred.
3) Now press “start” (F2).

4) Familiarize the patient. Direct attention to the pulsing
tone so they know exactly what to listen for.
5) Turn down the pulsing tone with channel 1 attenuator
(46).
6) Select the most comfortable noise level or intensity with
the channel 2 attenuator (51) for the patient, usually
between 50 – 80dB.
7) Now find the tone threshold. Start the test by using the
channel 1 attenuator (46) to perform a normal threshold
finding procedure for the pulsing tone. Press “Store” to
save the data.
8) Select Sπ NO (F2) (the signal will now be out of phase,
and noise will be in phase).
Find the Tone threshold:

Again use the channel 1 attenuator (46) to perform a normal
threshold finding procedure for the pulsing pure tone. A score
for the masking Level Difference is automatically calculated.
(Either SO-Sπ or SO-Nπ is used as a calculation procedure
according to the setup (Menu (11)/ Setup (F2)/ Tests (F6)/
MLD(F2)).

36 MLB test
Monaural Loudness Balancing is a test to detect perceived
loudness changes between different frequencies for the same
ear. This is a possible test for recruitment when both ears are
expected to suffer from recruitment or if one ear is deaf.

3) Press “MLB” (F6)
Now the MLB-Test window appears as show below:
Instruct the patient that he will hear two different tones alternating in
the same ear that the purpose of the test is to match the intensities
of the two tones, and that only loudness and not character of the
tone should be considered.
4) Set the tone intensity of the lower frequency at a level 5 dB

above threshold with the channel 1 attenuator (46).
5) Adjust the level of the higher frequency tone to a level so the
patient perceives the loudness levels as matched. Use
channel 2 attenuator (51).
6) Increase the level of the lower frequency 20 dB and repeat the
test for this intensity. Repeat the test at increasingly higher
intensities until discomfort or limit of output is reached.
Test new set of frequencies:

Select the next pair of frequencies by pressing the
“Frequency” buttons. Repeat the test as outlined above for this
new pair of frequencies.

Test up to 4 different pairs of frequencies:
The test may be carried on to encompass up to four different
pairs of frequencies.
NOTE! The pre-selected test frequencies may be changed

(“Menu” (11)/Setup (F”)/Test (F6)/MLB (F3)).
One useful alternative frequency setup could be:
Test box 1 Frequency 1: 250Hz

Frequency 2: 500Hz
Frequency 2: 1 kHz
Frequency 2: 2 kHz
Frequency 2: 4 kHz

37 TT-Decay
Threshold Tone Decay Test is used to determine if the subject
can continue to hear a pure tone presented for one minute at
his threshold of sensitivity. This test is performed according to
Carhart.

3) Press “TTD” (F7)
Now the TTD-Test window appears:
Instruct the patient that he will hear tones and should keep the
Patient response button activated whenever a tone is audible to him.
4) Select frequency range: Select “low” (F3) or “High” (F4)

according to what frequency is desired for testing
5) Select test frequency with the frequency buttons (48 + 49)
6) Select the test ear (32 or 33) in Channel 1
7) Find the correct level by touching the Tone Presentation
button (47) and adjust the channel 1 level (46) so the tone is
just audible for the patient.
8) Press “Start”
The test runs automatically. When the test is finished “Stop” above
F1 will be highlighted and the test score will be presented. Now the
other ear may be tested.
9) A printout is available by pressing “Print” (15)

38 Békésy
Békésy is a type of automatic audiometry. It is diagnostically
important from the classification of the results into one of five
types (after Jerger, et al) when responses to continuous and
pulsed tones are compared.

3) Select “Békésy” (F8)
Now the Békésy window appears:
Instruct the patient that tones with different frequencies will be heard,
and that the patient response button should be activated whenever a
tone is audible.
4) Test
−Fixed Frequency Békésy is selected automatically
−Frequencies in addition to the standard frequencies are
included in the test, if they are selected in the setup (Menu
(11)/Setup (F2)/Tone (F1)/ Frequency selection).
Sweep Frequency Békésy: I

If you select “Multi Freq” (22) the frequency will gradually
change in steps of 1/24th of an octave.
Continuous Tone or Pulsing Tone Békésy:

Pulsed Tone Békésy is possible by selecting pulsing (38).
This curve can be shown on screen in addition to the normal
curve for continuous pure tone.

BÉKÉSY PROCEDURE:
1) Select desired test ear in Channel 1 (32 + 33)
2) If only High frequency Békésy is needed, select “High”
(F5)
3) Select pulsing (38) tone if desired
4) Select “Famil” (F3) – a fixed frequency Békésy function
will now start for familiarization
5) Start test: When the patient has learned to respond
correctly via the patient response switch, select “Start”
(F2)
6) Automatic opposite ear test: When the test is completed
the other ear will be tested similarly and the test will stop
High Frequency Békésy:

If high frequency Békésy is needed, a different headset is
provided and must be used.
1) Select “High” (F6)

2) Select “start” (F2) and let the test run until it finishes
automatically.
Automatic testing of both ears:

Ipsi- and contralateral ears are tested automatically. However,
if there is an audiogram or part of an audiogram present in the
memory of the AC40 for the contralateral ear, the test will stop
after testing the ipsilateral ear, otherwise, the current
audiogram data will be deleted without warning. If a complete
automatic test of both ears is desired, make sure that no
audiometric data is stored for the contra lateral ear.
Trace / “Average” = Audiogram:

In order to calculate the audiogram from a fixed frequency
Békésy tracing simply press “Average” (F9) and the resulting
audiogram will be displayed. Return to the Békésy tracing by
pressing “Trace” (F9).
Pulsed or continuous tone audiogram according to setup:

Whether the average curve shall be calculated on the basis of
the pulsed tone tracing or the continuous tone tracing is
determined by the setup (“Menu” (11)/ “Setup” (F2)/ “Tests”
(F6)/ “Auto” (F4)/ “Curve to average”).

Printing the displayed data:
A printout of the tracing or the calculated audiogram can be
made according to whether “Tracing” or “Average” is selected
with F9.
Repeating a certain frequency or frequency range:

Any part of a tracing can be repeated and any desired
frequency or frequency range in an existing Békésy tracing.
Place cursor at desired point:

Simply place the frequency cursor at the desired frequency
(48 + 49) and select “Repeat” (F6). The test results now
obtained will replace the former test results for this frequency
or frequency range.
Testing only a limited frequency range:

You may start Békésy testing on any frequency you like.
Simply place the cursor on the desired frequency with the
frequency knobs (48 + 49). When you press “Start” (F2) the
test will be carried out from this frequency until you press
“Stop” (F1) or until 8 kHz is reached.
Testing for malingering:

If you expect a patient to be malingering, simply press ”-20 dB”
(F7). This will cause the intensity in the earphones to drop 20
dB below the value show on the screen. If the patient is
malingering the chances are, they will not be able to start
responding again at the same intensity as they have faked
before. The display trace will then show a drop in the curve
not corresponding to exactly 20 dB. Such a lack of identity
indicates malingering.
Deleting in a fixed frequency Békésy tracing:

Pressing “Delete” (41) will delete the test result of the
frequency indicated by the position of the cursor on the
screen.
For example: You want to delete a 2 kHz test result. Place the
cursor on 2 kHz by use of the frequency knobs (48 + 49).
Then press “Delete” (41).

Keeping “Delete” (41) activated for a few seconds will delete
the entire Békésy tracing – first for the selected ear and if kept
activated, finally for both ears.
Deleting in a sweep frequency Békésy tracing:

frequency band right above the frequency indicated by the
position of the cursor on the screen.
For example: You want to delete the frequency band from 2

kHz to 4 kHz. Place the cursor on 2 kHz by use of the
frequency knobs (48 + 49). Then press “delete” (41). This will
delete the frequency range from 2 kHz to 3 kHz. To delete the
remaining frequency band from 3 kHz to 4 kHz simply place
the cursor at 3 kHz and press “delete” (41). The frequency
band from 3 kHz is now deleted and the total frequency band
from 2 kHz to 4 kHz has now been deleted.

the entire Békésy tracing – first for the selected ear and if kept
Automatic control of test validity:

Unrealistic test results will terminate the test. If the results
exceed certain limits regarding number of reversals dictated
by the patient signal button as well as maximum deviation
among peaks and valleys the test will automatically be
terminated.
Thresholds set for test acceptance regarding number of

reversals and maximum deviation among peaks and valleys in
the Békésy tracing can be entered in setup (Menu (11)/ Setup
(F2)/ Tests (F6)/ Auto (F4)).

39 Hughson Westlake
Hughson Westlake is an automatic pure tone test procedure.
Threshold is defined as 2 out of 3 (or 3 out of 5) correct
responses at a certain level in a 5 dB increase and 10 dB
decrease test procedure.

2) Select “Tests” (F3)
3) Select “auto” (F8)
4) Select “H.W.” (F8)
Now the Hughson Westlake window appears:
Instruct the patient that he will hear tones with different frequencies
and that he is supposed to push the patient response button
whenever a tone is audible to him.
5) Select desired test ear in channel 1 (32 + 33). If only high

frequency testing is required select “High” (F5).
6) Select “Famil” (F3) if you want to familiarize the patient in the
procedure. When the familiarization is finished, the test
automatically starts. This is indicated by highlighting the “start”
above the F2 button.
If you want to omit the familiarization procedure simply activate

directly to “start” (F2) instead of selecting “Famil” (F3).
When all frequencies are tested the test automatically continues on

the other ear. However, if audiometric data are already present for

the other ear the test will not be continued as this would delete the
previously entered data without warning.
Trace / “Average”:
In order to calculate the audiogram from the HW tracing
simply press “Average” (F9) and the resulting audiogram will
be displayed. Return to the HW tracing by pressing “Trace”
(F9).
Printing:
A printout of the tracing or the calculated audiogram can be
made according to whether “Tracing” or “Average” is selected
with F9.
Repeating a certain frequency (or frequency range):

Any part of a tracing can be repeated at any desired frequency
or frequency range in an existing HW tracing.
Simply place the frequency cursor at the desired frequency

(48 + 49) and select “Repeat” (F6). The test results now
obtained will replace the former test results for this frequency
or frequency range.
Testing only a limited frequency range:

You may start HW testing at any frequency you like. Simply
place the cursor on the desired frequency with the frequency
knobs (48 + 49). When you press “Start” (F2) the test will be
carried out from this frequency until you press “Stop” (F1) or
until 8 kHz or 16 kHz is reached.
Deleting in a HW tracing:
frequency indicated by the position of the cursor on the
screen.
For example: You want to delete a 2 kHz test result. Place the
cursor on 2 kHz by use of the frequency knobs (48 + 49).
Then press “Delete” (41).

the entire HW tracing – first for the selected ear and if kept
Setting up the HW test procedure:

The test procedure of the HW test may be set up to be either 2
out of 3 or 3 out of 5 correct answers to identical presentations
(press “Menu” (11)/ “Setup” (F2)/ “Tests” (F6)/ “Auto” (F4)/
“Threshold Method”).

40 DMU Test
The DMU ( Difference Masked/Unmasked) test enables you to
make a masked as well as unmasked curve available in the
audiogram. A comparison between the two curves will reveal
the effect of applied masking.

3) Select “DMU” (F9)
Now the DMU window appears:
4) Make an unmasked audiogram using standard procedure.

(Select Air Conduction or Bone conduction as desired).
5) Repeat the test this time applying contra-lateral masking as
required.

41 Stenger
The Stenger test is a test for malingering based on the auditory
phenomenon of the referral ear in which the sound appears
loudest (the Stenger effect).

3) Select “Tone” (F2)
Now the Tone window appears:
Ask the patient to press the patient response button when he hears a
tone (do not mention which ear).
4) Activate Rev. (37) for continuous presentation. Present a tone

in channel 1 to the normal ear 5-10 dB above its threshold.
5) Present a continuous tone in channel 2 (39) to the suspect ear
at a level just below the level that the patent (untruthfully?) has
reported to be his threshold for this ear. If the patient reports
the tone in the normal ear to have disappeared, thus claims he
now hears nothing, he is malingering.

42 Loudness Scaling
The Loudness Scaling is used to map the patient’s perception
of loudness to levels of sound and is useful as a basis for
hearing instrument fitting of particularly non linear hearing aids
It is possible to perform Loudness Scaling on the Clinical Audiometer

AC40.
1) To enter the Loudness Scaling activate F4 in the main menu.
In the display is drawn a curve for normal hearing people. A curve

will be drawn for each frequency selected.
The test can be performed at six different frequencies: 250, 500,

1000, 2000, 4000 and 6000 Hz which is selected by means of the
buttons F1-F6.
2) Select first the output: Left, Right, FF1 or FF2 by the buttons
(32), (33) or (35). The intensity – dB SPL is adjusted by means
of the attenuator in the bottom left-hand corner (46).
3) The indication from the patient (if the tone is not heard, if the
tone is comfortable or if the tone is too high etc.) is adjusted in
the form by means of the Frequency Decr/Incr (48) or (49) and
plotted by activating the Store Button (36).

5 Quick Reference Guide AC40
Clearing memory
1) Clear screen by pressing “Delete” (41)
2) Clear all memory by pressing “Delete” (41) while activating
“Tone” (47)
Communicating with patient

1) Talk to patient in swan neck microphone while pushing
“T.fwd” (12). Control volume by “H”
2) Listen to Patient by pushing “TB”. Control vol. With “N”
Presenting pure tones

1) Enter Main Menu with “Menu” (11)
2) Enter manual audiometry with “Audio” (F1)
3) Select “Tone” (17) in channel 1
4) Select desired output (32), (33), (34), (35)
5) Select desired frequency (48), (49)
6) Select desired level (46)
7) Present tone (47)
8) When threshold is found store value by “Store” (36)
Features:
1) Change attenuator steps to 1dB with (25)
2) Enter extended range levels with “Ext. Range” (24)
3) Add Warble to tone (21)
4) Enable smaller frequency steps with “Mult Freq.” (22)
5) Reverse function of “Tone Switch” by Man Rev” (37)
6) Compare Left audiogram to Right (F5)
High frequency test:

1) Use HF Headset
2) Select “High” (F4)
3) Select “Zoom in” (F2) if large screen is desired. All
functions are similar to normal tone presentation
Masking
In manual audiometry masking can be applied with channel 2
1) Select the output to carry the masking sound (42), (43),
(44), and (45). (Relevant type of noise is automatically
pre-selected as indicated by (29))

2) Adjust masking level with (51)
Speech testing
1) Enter Main Menu with “Menu” (11)
2) Enter manual audiometry with “Audio” (F1)
3) Select “Mic” (18) or “CD/Tape” (19) in channel 1
4) Select desired output (32), (33), (34), (35)
5) Select desired HL level (46)
6) Present word
7) Monitor patient reply with “TB” (13) and “N”
8) Enter score of each word by “Incor” (30) or “Correct” (31)
Features:
1) Monitor pre-recorded speech material with “Monitor” (14)
and volume “0”
2) Change attenuators steps to 1dB by (25)
3) Enter extended range levels with “Ext.Range” (24)
4) Create additional speech curves with (F3), (F4)
5) Test UCL level by “HL-UCL” (F1)
6) Compare headphone results to FF with (F5)
Note: Calibration of (J) or (K) is correct when max. VU-meter

(A) deflections are reaching “0” during speech presentation.
Re-programmed test
1) Enter Main menu with “Menu” (11)
2) Enter pre-programmed tests with “tests” (F3)
3) Select desired test with (F1-8)
4) If relevant select output (32), (33), (34), (35)
5) If relevant select frequency (48, (49)
6) If relevant select intensity (46)
7) If relevant control test “Start” (F2) – “Stop” (F1)
Auto threshold test feature:

1) The pre-programmed “Auto” test carries HW and Békésy
test. Select with “Bek-HW” (F8)
2) Train patient in response procedure with “Famil” (F3)
3) Control actual test by “Start” (F2) and “Stop” (F1)
4) Convert curve from trace to audiogram with (F9)

Printing
Most test results may be printed out by selecting “Print” (15).
(laser printer)

6 Function of buttons
See the drawing at the back of this manual for reference:
1 – 10) F-Keys: The function of these keys is dependent on the

actual status of the AC40. For this reason no
general function description can be given.
However, the function of any F-key will always
be written in the display right above the key.
11) Menu key: This key will move you one step back in the
menu hierarchy until the “Main menu” is
reached.
12) Talk forward: Pushing this key will present your spoken
instructions in the patient’s headphones. When
this key is not pushed your instructions are
automatically presented in the assistant’s
headphones (Optional).
13) Talk back: Pushing this key presents the patient’s

comments to the operator.
14) Monitor: Pushing this key lets you listen to signals

presented by the audiometer.
- First push: You listen to Channel 1.
- Second push: You listen to channel 2.
- Third push: You listen to both channels.
- Fourth push: Monitor function turns off.
15) Printing: This key activates the printer (see “printout

chapter for details).
16) F.Feed: Not in use.
17) Tone: Selects pure tone testing in channel 1.
18) Microphone: This button selects speech testing and desired

microphone for channel 1.

- First push: Microphone 1 (goose neck or
external microphone according to setup).
- Second push: Microphone 2 (external).
19) CD/Tape: Selects speech testing and desired input

channel 1.
- First push: selects the channel of your
playback equipment which is connected to
the “Tape/CD1” input.
- Second push selects the channel of your
20) Narrow band noise/noise:

Selects between narrow band noise and white
noise as stimulus in channel 1.
- First push selects narrow band noise (centre
frequency indicated on display).
- Second push selects white noise.
21) Warble: Adds warble to pure tones.
22) Multi-frequency:
Selects smaller steps in between the main
audiometric frequencies. The size of the steps
is set up in the “Tone Setup”.
23) Synchronize: Locks the two actuators together. This function

may be used to perform synchronous masking.
24) Extended range:

Allows the attenuators to operate into the
extended range. 20 dB extra are available this
way. In the display this function is indicated by
a “+” preceding the numerical indication of the
dB level.
25) 1 or 5 dB steps:
Selects between attenuator steps of 1 dB or 5
dB.

26) Tone: Selects pure tone testing in channel 2.
27) Microphone: Selects a microphone for input to channel 2.

- First push: Microphone 1 (goose neck or
external microphone according to setup).
- Second Push: Microphone 2 (external).
28) CD/Tape: Selects CD or Tape desired as input for

channel 2.
- First push: Selects the channel of your
- Second push selects the channel of your
playback equipment, connected to the
“Tape/CD2” input.
29) Narrow band noise/noise:

Selects between narrow band noise and white
noise/pink noise as stimulus in channel 2.
- First push selects narrow band noise (centre
frequency indicated on display).
- Second push selects white noise or Pink
noise, depending on the setup (see chapter
“Common setup”.
30) Automatic speech score – incorrect:

For automatic speech score counting while
speech testing, you push this button after every
word not heard correctly by the patient.
31) Automatic speech score – correct:

For automatic speech score counting while
speech testing, you push this button after every
word heard correctly by the patient.
32) Right: Selects the right earphone as transducer for

channel 1.
33) Left: Selects the left earphone as transducer for

channel 1.

34) Bone conductor R/L:
Selects bone conductor as transducer for
channel 1.
- First push: Selects the right ear.
- Second push: Selects the Left ear.
35) Free field 1/2: Selects free field speakers as transducer for
channel 1.
- First push: Selects FF speaker 1.
- Second push: Selects FF speaker 2.
36) Store: Store the found threshold value. If there is no

response even at maximum intensity the store
button may be activated while touching the
“Tone Switch” of channel 2. This will cause the
signal to be presented continuously, only
disappearing when the “Tone Switch” of
channel 1 is touched.
37) 37: Manual/Reverse:

This button has two different settings for
channel 1.
- “Man” will present the signal to the patient
only when the Tone Switch of channel 1 is
touched.
- “Rev” will cause the signal to be presented
continuously, only disappearing when the
Tone Switch of channel 1 is touched.
38) Single Pulse/Multi Pulse:

Choose between single and continuous pulse
presentation.
- First push: Single pulse.
- Second push: Multi pulsing.
39) Manual/Reverse:
Continuous or manual presentation has two
different settings for channel 2.

- “Man” will cause the signal to be presented
to the patient only when the Tone Switch of
channel 2 is touched.
- “Rev” will cause the signal to be presented
continuously, disappearing when the “Tone
Switch” of channel 2 is touched.
40) Simultaneous/Alternate:
Presentation in both channels offers the
possibility of locking presentation channel 1 and
channel 2 together, or to have the presentation
in the two channels alternating to each other.
41) Delete: Pushing this button will delete the data on the
screen. The data will be deleted in sequence,
so recently entered data may be deleted
without deleting other data. Simply hold down
the key until the desired amount of data has
been deleted.
Activation of one of the “Tone Switches” (47 +

50) while you press the “Delete” button displays
the subject editor window for editing patient
data. Pressing “Reset” (F1) deletes all
audiometric data.
42) Right: Selects the right earphone as transducer for

channel 2.
43) Left: Selects the left earphone as transducer for

channel 2.
44) Insert masking:

Push for selection of the CIR22 insert phone as
transducer for channel 2.
45) Free field 1/ 2: Selects FF speakers as channel 2 output.

- First push: FF speaker 1.
- Second push: FF speaker 2.
46) Channel 1 attenuator:

Adjusts the attenuator of channel 1. Selected
intensity is indicated on the display. The
attenuator may be a rotary switch or two
separate push buttons, one for increasing and
one for decreasing intensity.
47) Tone switch Channel 1:

Manual tone presentation of channel 1. This
button also carries the shift function which while
selecting “Store” or “Delete” will have different
function (see 36 and 41 for details).
48+49) Frequency: Change frequency up and down.
50) Tone switch channel 2:

Manual tone presentation of Channel 2. This
button also carries the shift function which while
selecting “store” or “Delete” will have different
function (see 36 and 41 for details).
51) Channel 2 attenuator:

Adjusts the attenuator of channel 2. Selected
intensity is indicated on the display. The
attenuator may be a rotary switch or two
separate push buttons, one for increasing and
one for decreasing intensity.
A) VU. Meter channel 1:

Indicates the level of speech audiometry or talk
forward. Adjusted by “J” or “K” to reach “0”.
B) Patient response for right ear:

This indicator lights up when right ear patient
response is pressed.
C) Tone indication:
This indicator lights up when signal is
presented in channel 1.

D) Display: Here all information is shown, including
audiograms, status of instrument, and current
function of the F-keys.

E) Tone indication:
This indicator lights up when the left ear patient
response button is pressed.
F) Patient response for left ear:

This indicator lights up when left ear patient
response is pressed.
G) VU.Meter channel 2:
Indicates the level of speech audiometry. Is
adjusted by “L” or “M” to reach “0”.
H) Talk forward intensity control:

Selects an appropriate level in the patient’s
headphones to make talk forward instructions
audible.
I) Display brightness:
Adjusts the display brightness.
J) Microphone calibration:
Adjust this so the channel 1 VU-meter deflects
to “0” for live voice in speech testing.
K) Playback equipment calibration:

Adjust this so the channel 1 VU-meter deflects to
“0” for pre-recorded speech testing material.
L) Microphone calibration:
“0” for live voice in speech testing.
M) Playback equipment calibration:

“0” for pre-recorded speech testing material.
N) Volume of talk back signal:

Adjusts talk back in operators headphone to a
comfortable level.

O) Volume in monitor of channel 1 signals:
Adjusts the monitor Ch. 1 signal to a comfortable
level.
P) Volume in monitor of channel 2 signals:

Adjusts the monitor Ch. 2 signal to a comfortable
level.
Q) Gooseneck microphone:
May be used for live voice speech testing as well
as for talk forward and instructions to assistant.
NOTE! This internal microphone must be

selected in the “Common” setup to be active in
speech testing.

7 Technical Specifications
Standards:
Audiometer: EN 60645-1, EN 60645-2, EN 60645-4/ANSI S.
3.6. 1996, type 1 and A or A-E
Safety: EN 60601-1 and EN 60602-1-2
EMC: EN60601-1-2
Medical CE-mark:
The CE-mark indicates that Interacoustics A/S meets the
requirements of Annex II of the Medical Device Directive
93/42/EEC. TÜV Product Service, Identification No. 0123,
has approved the quality system.
Maximum Hearing Levels dBHL:
Extended Range Function

Allows air conduction intensities to be limited to 20 dB below
max output.
Channels:
Two independent channels.
Channel 1: Input: Tone, Microphone 1&2, Tape/CD 1&2, NB,
SN, WN, and PN. Output: Left, Right, Bone L+R, Free Field
1+2, Insert-phones, HF-phones.
Channel 2: Input: Tone, Microphone 1+2,Tape/CD, 1&2, NB,
SN, WN, and PN. Output: Left, Right, Free Field 1+2, Insert-
phones, HF-phones, Insert masking.

Presentations Ch 1: Manual or reverse. Continuous, single or
multiple pulses. Single and Multiple Pulse Speed:
Programmable from 50-5000 mS in 50 mS steps.
Presentations Ch 2: Manual or reverse. Continuous,
simultaneous or alternate to Ch 1.
Frequency Range:
125-20000 Hz divided in two ranges: 125-8000 Hz and 8000-
20000 Hz.
Synchronous Masking:
Locks Ch 2 attenuator to follow Ch 1 attenuator.
Attenuators:
Totally Click free, -10 to 120 dB HL in 1 or 5 dB Steps.
Talk forward:
0-110 dB SPL: Continuously adjustable on front panel, built-in
goose neck microphone.
Talk Back:
Microphone input. Level adjusted on operation panel.
Monitor:
Built in speaker or external loudspeaker. Monitor output level
for Ch 1 and Ch 2 adjusted separately on operation panel.
Assistant monitor:
Output to external earphone.
Printer:
Output to external Laser Printer (HP-GL/2 language) via 25
pin D connector.
Computer Communication:
Built-in RS232C two way computer interface which allows the
computer to both monitor and control the AC40.
Examples of Compatible Windows Software:

OtoAccess database program.
PrintView for on-line PC monitoring and printing.

NOAH hearing aid fitting software.
CONNEX hearing aid fitting software.
Tests:
Tone: Manual, continuous, single pulse, pulsing (variable).
Speech: Live voice through goose neck microphone or
external microphone, Tape or CD inputs. Score counter:
Calculates % of correct score for speech.
Auto Threshold: Patient controlled Hughson- Westlake Test
after ISO 8253-1. 3 out of 5 or 2 out of 3 as response criteria.
Reduced frequency range option for rapid testing.
Békésy Test: 125Hz to 16kHz. Fixed Frequency or Sweep
Frequency Békésy. Continuous or pulsed tone.
Difference Limen Intensity: 0.0dB - 5.0dB in 9 steps.
Difference Limen Frequency: 0.0% - 5.0% in 9 steps.
Loudness Balancing: 250Hz, 500Hz, 1kHz, 2kHz, 4kHz,
6kHz NB noise with direct comparison to standard curves.
Difference Masked Unmasked: Compares graphically the
threshold measurements with and without masking.
Weber: 250Hz to 8kHz with dedicated graphical presentation.
ABLB: Individually adjustable pulse speed and pulse length.
TT decay: Calculation according to Rosenberg (1958).
Masking Limen Difference: Noise out of phase and signal
out of phase. Automatic calculation.
Monaural Loudness Balancing: Programmable test setup.
SISI: 0, 0.2, 0.4, 0.6, 0.8, 1, 2, 3, 5 dB, 20 increments.
Automatic score counter which calculates in % the number of
responses to 1 dB increments.
Stenger: Pure tone or Speech can be used for Stenger test.
Lombard test.
Dofler Steward test.
Dimensions:
LxWxH: 50x47x20 cm/ 20x19x8 inches.
Weight: 13 kg/29 lbs.
Power Supply:
AC 50-60 Hz. 100-120 V, 220-240 V.
Consumption: Max. 180 VA.

43 Accessories

44 External Printer Connection
It is possible to connect a printer directly to the “printer” output on the
rear plate of the AC40.
All standard PC printers can be used if they handle HP GL/2

language. For example a HP4L laser printer.
Tone and speech audiograms and patient name:

Printouts normally carry the normal tone and speech
audiograms. However, if the Békésy of HW tracing is
displayed the tracing and not the audiogram will be printed.
Any patient information entered into the AC40 by the
connected keyboard will appear on the printout.
NOTE! “External Printer” must be selected in the “Common

setup”.

45 Connection to OtoAccess
The AC40 connects to the OtoAccess software program.
This software is capable of storing patient data as well as
audiometric results obtained by the AC40.
Data Transfer:
Transmitting data from the AC40 is done from the OtoAccess.
Please refer to the OtoAccess manual for Details.
NOTE! The computer must be connected to COM 1 on the

AC40. The baud rate of the AC40 must be the same as the
setup in the OtoAccess program (see “Communication setup).
Transmission must use verification (see “Communication
setup).
Connection cable must be an IFC59 for computers with 25 pin

DIN COM-port or IFC69 for computers with 9 pin COM-ports.
NOTE! The computer program called IA-Vbase is a DOS

program and does not work with the AC40. If you have the
OtoAccess and you want to operate the AC40 you must
convert to the Windows version called OtoAccess. All data
present in a previously used OtoAccess may be transferred to
the OtoAccess.

8 Unpacking and Inspection
Check box and contents for damage:
When the instrument is received please check the shipping
box for rough handling and damage. If the box is damaged it
should be kept until the contents of the shipment have been
checked mechanically and electrically. If the instrument is
faulty please contact the nearest service office. Keep the
shipping material for the carrier’s inspection and insurance
claim.
Keep carton for future shipment:

The AC40 comes in its own shipping carton, which is specially
designed for the AC40. Please keep this carton. It will be
needed if the instrument has to be returned for service.
If service is required please contact your nearest sales and

service office.
46 Contents of Shipment
As standard the AC40 is delivered with the following:
Quantity Item Order No.
1 Instrument AC40
1 Audiometric Headset TDH39
1 Bone Conductor B71
1 Bone Conductor Bag
1 Patient Response Button APS3
1 Operation Manual
1 CE Manual
Check numbers on AC40 and Manual:

The identification label on the connection panel holds the
serial number. This should be checked with the manual
number and written down for later service claims.

To maintain the validity of the CE-mark of the AC40 the power
supply must be CE-medical approved.
47 Reporting Imperfections
Inspect before connection:
Prior to connecting the AC40 to the mains it should once more
be inspected for damage. All of the cabinet and the
accessories should be checked visually for scratches and
missing parts.
Report immediately any faults:

Any missing part or malfunction should be reported
immediately to the supplier of the instrument together with the
invoice, serial number, and a detailed report of the problem. In
the back of this manual you will find a "Return Report" where
you can describe the problem.
Please use "Return Report":

Please realise that if the service engineer does not know what
problem to look for he may not find it, so using the Return
Record will be of great help to us and is your best guarantee
that the correction of the problem will be to your satisfaction.
48 Care and Maintenance

The performance and reliability of AC40 is prolonged if the following
recommendations for care and maintenance are adhered to:
Great care when handling the headset.

Great care should be exercised when handling the headset as
dropping it may alter the calibration.
Annual calibration:
The AC40 has been designed to provide many years of
reliable service but annual calibration is recommended due to
possible impact on transducers.

We also recommend to calibrate the AC40 if something drastic
happens to a part of it (e.g. if headset or bone conductor is
dropped on a hard surface).

9 Trouble Shooting
No tones in the TDH39 headphone:
Make sure Left (32) or Right (33) ear has been selected and
that the attenuator in Channel 1 (46) is turned up and the
“Tone” presentation signal is on.
If still no sound appears, check that the headphone is correctly

connected to the “Phones” output on the rear panel. Check
also that “Phones” is selected in the “Common” setup (Menu
(11)/ Setup (F2)/ Common (F3)/ Headset).
No signal in TDH39 when speech testing (Tones are OK):

Check that the presentation in channel 1 is on (C lighting up).
If not, activate by “Rev” (37).
Check that the intensities are calibrated for correct level by (J)
(K), making the VU meter (A) deflect up to “0”.
Make sure that the correct signal input is selected (18) (19)
and that the correct microphone is selected in the “Common”
setup (Menu (11)/ Setup (F2)/ Common (F3)/ Microphone 1).
Assure that the tape recorder inputs (channel 1 to “CD/TAPE

1” input and channel 2 to “CD/TAPE 2” input).
Goose neck microphone is not working in speech audiometry:

The internal goose neck microphone must be selected in the
“Common” setup to be active in speech testing (The goose
neck microphone is always active in Talk Forward and in Talk
Forward and the communication assistant) (Menu (11)/ Setup
(F2)/ Common (F3)/ Microphone 1. Select Mic 1).
Keyboard displays characters different to those being typed:

The wrong type of keyboard is selected in the “Common”
setup. (Menu (11)/ Setup (F2)/ Common (F3)/ External
Keyboard).

“Keyboard not active” displayed on the screen when trying to
enter Patient data:
No keyboard has been selected in the “Common” setup.
(Menu (11)/ Setup (F2)/ Common (F3)/ External keyboard).
“Shift” + “Subject” does not open the Subject Editor Window:

This function is not available when in Setup mode.
Monitor headphone is distorted:

Headphone is of low resistance type (8Ω or similar). Correct
by using a headset of 32 – 200 Ω.
The power monitor output may be used with a low resistance

headset if a slight background noise in the headset is tolerable
and the risk of extremely high output is acceptable.
Assistant’s headphone is distorted:

Headphone is a low resistance type (8Ω or similar). Correct by
using a headphone of 23 - 200Ω.
In Auto testing (Békésy or HW) the test stop after having tested
only one ear:
If there is any audiometric data in the memory for the other ear
the auto test is not automatically started on this ear as this
would delete the previously saved data without warning.
Please make sure no part of the audiogram is recorded for the
other ear before starting the auto test.
After having made a Békésy tracing and going to HW (or Vice

versa) the tracing still appears in the new window:
This is intended. The Békésy and HW tests are different
procedures of automatic tests. Only the procedure is selected
by the F8 key, not the automatic scoring.
No tone present in TDH39 headset when performing High

Frequency audiometry:
Use the special HF headphones. Connect these to the “High
frequency” headphone output.

Built-in monitor loudspeaker not active:
The built-in loudspeaker must be selected in the “Common”
setup (Menu(11)/ Setup (F2)/ Common (F3)/ Monitor
loudspeaker. Select: “On”).
Only parts of the tests made are printed on external printer:

Only patient data, tone audiograms and speech audiograms
are available on the external printer.
Multi-frequency Békésy trace does not convert into an

audiogram:
Only fixed frequency audiograms can be used for calculation
of an audiogram.
Stimulus is presented to the ear opposite to the indicated on the

front plate:
The “Swap Channel” function located on the F7 key in the
tone audiometry and speech audiometry windows is activated.
Remedy by entering either the gone audiometry screen of the
speech audiometry screen and activate F7 to cancel the
“Swap Channel” function.
In Békésy masking does not work:

Masking is not available in the AC40 Békésy test.
The “No response” button is not giving any signs on the

screen:
The “No response” sign (which is a shift function related to the
“Store” button) is only available when the “Extended Range”
button is activated and the attenuators are at max position. As
with any “Shift” function the “Tone Switch” must be activated
while selecting the “Store” button. The “No response” sign is
only available in manual pure tone audiometry.
18 kHz and 20 kHz are not available:

In the Common Setup “Display Options” must be set to
“Numerical”, and “High frequency Level” must be set to “SPL”.
“High frequency” mode must also be selected and “Zoom in”
selected.
18 kHz and 20 kHz are not printed or transferred to PC:

These two frequencies are not stored and therefore not
available for either printing or transfer to PC.
High Frequency testing gives strange results:

Calibration might have been changed from “HL” to “SPL” in
the “Common setup” (this is e.g. necessary to make an 18 kHz
and 20 kHz frequency available). A change from HL
calibration to SPL will affect reportedly threshold vales
markedly. Change back to HL if desired.
130dB not available:

130dB is available only at 1 kHz and only if the service
Technicians setup allows the 130dB to be available. Please
contact your Service Technician to activate the 130dB option.

10 Appendix A: Setup
49 Tone parameter Setup

2) Press “Setup” (F2)
3) Select “Tone” (F1) to enter the Tone Setup window:
Change of setup using Function Keys:

Use F2 through F5 to move the accessible (highlighted) area
on the screen. Then use the F1 key to change the assigned
values in the highlighted area.
Multi frequency in High audiometry:

When testing high frequency audiometry (8 kHz – 16 kHz) and
only the high frequency audiogram is displayed on the screen,
the multi frequency steps available will be determined in this
setup. The available multi frequency steps are: 1/1 1/2 1/3
1/6 1/12 1/24 octave.
Normal audiogram Multi frequency step in High part:

When testing high frequency audiometry (8 kHz – 16 kHz) and
the screen displays the high frequency audiogram as an
extended part of the normal low frequency audiogram, then
the multi frequency steps available will be determined in this
setup.
The available multi frequency steps are: 1/1 1/2 1/3 1/6 1/12
1/24 octave.

Multi frequency in low part:
When testing normal frequency audiometry (125Hz – 8 kHz),
the multi frequency steps available will be determined by this
setup. The available multi frequency steps are: 1/1 1/2 1/3
1/6 1/12 1/24 octave.
Frequency dB jump:
If you want to change intensity automatically when the
frequency is changed the number of dBs to increase or
decrease can be set up from here. Available jumps run from
+20dB to –80dB in steps of 5dB. -20dB is suggested.
Cursor frequency jump:

Two procedures are available: “Bottom” & “Butterfly”:
- “Bottom” sends you to 125Hz. Scrolling above 8 kHz sends
you automatically to 125Hz ready to perform increasing
frequency selection.
- “Butterfly” sends you to 1 kHz. Scrolling above 8 kHz sends
you to 1 kHz ready to perform decreasing frequency
selection.
Trying to increase the frequency selection beyond the 8 kHz

will cause the frequency to drop to 1 kHz ready to perform
decreasing frequency selection.
Trying to decrease the frequency selection below the lowest

frequency will cause the frequency to go to 1 kHz ready to
perform increasing frequency selection.
Low reference tone:

When you perform normal pure tone audiometry, a
simultaneous reference tone of a different frequency may be
presented to the other ear. The frequency of the reference
tone is set here.
Warble Modulation:
When warble (21) is selected in pure tone audiometry the
warble modulation (frequency changes) will be according to
this setup. Available modulations run from 0% to 25%. 5% is
advised.

Warble frequency:
When warble (21) is selected in pure tone audiometry the
warble frequency (number of changes per second) will be
according to this setup. Available frequencies run from 5Hz to
50Hz. 5Hz is advised.
Multi Pulse lengths:

When multi-pulse (38) is selected in pure tone audiometry the
length of the individual pulses is set according to the value
assigned in the Setup. The intermediate breaks will be similar
to the length of the tones. Available lengths run from 50mS to
5000mS. 500mS is advised.
Single Pulse Length:

When single pulse (38) is selected in pure tone audiometry the
length of the pulse will be according to the value assigned in
the Setup. Available length runs from 50mS to 5000mS.
Bone at 8 kHz:
Here you can decide if you want 8 kHz available for bone
conduction testing. The settings are “Yes” & “no”.
High frequency reference tone:

During high frequency pure tone audiometry a reference tone
of a different frequency may be presented to the opposite ear.
The frequency of the tone is assigned here.
Frequency selection:
You can remove certain frequencies from the automatic test
routine by not selecting them in this setup.
If you select “manual mode” only the reduced number of

frequencies selected are available in pure tone testing (in
addition to standard frequencies). If you do not select “Manual
mode” then all frequencies are available in manual pure tone
testing.

50 Speech Parameter Setup
3) Select “Speech” (F2) to enter the speech window:
Change of setup using function keys:

Use F2 through F5 to move the accessible (highlighted) area
on the screen. Then use the F1 key to change the assigned
values in the highlighted area.
Max Score:
Here you can enter the desired number of words in your word
lists. This will make the automatic speech score counter
calculate correctly, and when the full number of word scores
have been entered then the automatic speech score counter
will stop and display the final speech score. Available settings
run from 0 to 100 words on a list.
L/R standard curve:

The speech audiogram holds standard curves indicating
normal hearing of one-syllable words and two-syllable words.
Standard curves for headphone testing as well as FF testing
are available. The characteristics of these curves are
designed here - you must use the values for standard speech
curves used in your area.
1) Select an intensity for which you have a standard scoring

percentage
2) Enter the corresponding scoring percentage

3) Continue with 1) and 2) for all corresponding intensities
and scores
4) Any remaining set of figures are filled out with the intensity
of –10 and a score of 0
Avoiding standard curves:

If standard curves should not be used in a speech audiogram,
just fill out as bellow:
Intensity: -10 –10 –10 –10 –10
Score: 0 0 0 0 0
FF-curves according to your clinic:

NOTE! The FF1/FF2 curves must be designed according to
the actual free field setup of your clinic. If you do not want to
display standard FF curves, please enter the following figures
for FF1/FF2 standard curves:
Intensity: -10 –10 –10 –10 –10
Score: 0 0 0 0 0
51 Common Setup
3) Select “Common” (F3) to enter the Setup window:
Change setup keys:

Use F2 through F5 to move the accessible (Highlighted) area
around on the screen. Then use the F1 key to change the
assigned settings in the highlighted area.

FF amplifier:
The AC40 may be supplied with an internal FF-amplifier (can
be found by looking for the 10cm2 black heat sink on rear
panel). The AC40 must be set up for use of internal Amplifier
or external FF amplifier. Available settings are “Internal” and
“External”.
L/R settings:
Automatic ear selection makes it possible to change ear
selection in Channel 2 when you change test ear in channel 1.
To achieve this select “L/R CH1=>R/L CH2”.
To ensure that channel 2 always turns off when a new

transducer is selected in channel 1, select “L/R CH1 => CH2
Off”.
Bone symbols:
Two different types of bone conduction signs are available.
Select the type used in your area.
Available settings are: R = “<” – L=”>” and R=”>” – L=”<”
International settings are R = “<” – L=”>”.
Background:
On the left hand side of the display, the desired graphics may
be selected or inverted to give a different visual presentation.
Monitor loudspeaker:
The internal monitor loudspeaker may be turned on to monitor
the AC40 and to listen to patient talk back. Possible settings
are “On” and “Off”. On is recommended.
Printer:
To use an external printer connected to the AC40 is must be
selected in the setup by slecting “External”.
To print, simply press “Print” (15).
NOTE! On external printouts only pure tone audiograms and

speech audiograms are available.

Display options:
When performing manual Pure Tone Audiometry the display
may be set up to show the audiogram or show the attenuator
settings in large numerical readouts.
Move on Store
On/of
Microphone 1:
Select the desired microphone for speech testing; either
“internal” goose neck or “external” connected to “Mic 1” socket
on the rear plate.
NOTE! The goose neck microphone is always the active mic

for talk forward and assistant communication.
Type of Noise:
Selection of noise as stimulus can be done from the front
control board by selecting Noise (29) as stimulus for channel
2.
- When “NB” (29) is chosen in channel 2, narrow band noise
according to the frequency setting will be presented.
- When “N” (29) is chosen in channel 2 the noise will be
speech noise when channel 1 is set to Mic (18) or Tape/CD
(19). If however, channel 1 is set to Tone (17), noise in “N”
setting will be white or pink noise depending on the setup
here. Settings are “White noise” and “Pink noise”. White is
suggested.
NOTE! “N” (20) in channel 1 is always white noise.
Headset:
Selection of TDH39 headphone or EAR-Tone insert phones
shall be selected as default when you turn on the AC40.
Settings are “Phones” and “Insert”.

“Not heard” lines:
When pure tone audiometric thresholds are stored as “No
response” these points in the audiogram are connected by
lines to the audiogram of the heard thresholds to the stored
thresholds of the neighbour frequencies. To achieve this
select “On”. If “No response” points are not wished, select
“Off” as to avoid any connecting lines from “No response”
points.
Default intensity:
When pure tone audiometry is selected the attenuator will
automatically place itself on the value set up here. If “Off” is
selected the default intensity is set to 30 dB. Available settings
are: -10 dB to 6 0dB in 5 dB steps and “Off”.
External Keyboard:
If an external keyboard is connected to enter patient data the
type of keyboard must be selected in the Setup. The settings
are: “IBM AT”, ANK10 and “Off”.
High frequency level:

For high frequency audiometry in the 8-16 kHz region you may
choose between calibrated HL and a direct indication in SPL.
If SPL is selected, the high frequency audiogram will carry the
heading “Sound Pressure Level” to remind you of the un-
calibrated sound intensities.
Baud rate:
Baud rate is the communication speed with connected
computer equipment. The baud rate of the transmitting
instrument (AC40) must match the baud rate of the receiving
instrument or computer in order for communication to be
possible. If you use OtoAccess software in your computer you
must choose identical baud rates in the OtoAccess and in
AC40. Baud rate Settings are 9600, 19200 and 38400 and
USB Converter.
Printer Information:
Available settings are: “None”, “Clinic”, “Subject” or “Both”.

52 Menu Setup
3) Select “Menu” (F4) to enter the Menu setup window:
4) Change setup by F-keys: Use F2 and F3 buttons to choose

the Tone menu, the High menu or the speech Menu to be set
up
5) Press “Change” (F1). Now the chosen menu window will
appear.
6) Select desired setup: Select here, which buttons are active
whenever in this window
7) Press “Save”. (F10)
8) Repeat 4) to 7) for other setup menus
9) Edit power-up menu (F1) that is active as the first screen
displayed after the instrument is turned on. Highlight “Power-
up Menu” and select the desired screen with the “Change” key
(F1)
10) Leave this screen by pressing the “Menu” button (11)
53 Entering Clinic name

Data entered in this window is printed.

3) Select “Clinic” (F5) to enter the Clinic setup window:

4) Use an external keyboard to enter your clinic’s name. Leave
by pressing “Menu” (11)
NOTE! If a message appears on screen stating that the keyboard is

not connected or if the letters shown on screen do not correspond
with the letters on your keyboard the wrong type of keyboard is set in
the “Common” setup. Correct this by entering “Menu (11)/Setup
(F2)/Common (F3)/External Keyboard”.
54 Test Setup
1) Press “menu” once or more times to enter the “Main Menu”.
3) Select “Tests” (F6)
Proceed with the desired test set up as outlined below.
ABLB:
1) Press “ABLB” (F1) to enter the “ABLB Test Setup”
window:

2) Choose desired test: Use F2 and F3 to choose one of the
4 tests
3) Select the desired frequency by pressing “Change” (F1).
4) Repeat 2) and 3) to set up the remaining tests
5) Leave by pressing “Menu” (11)
MLD:
1) Press “MLD” (F2) to enter the “MLD Test Setup” window
2) Use F2 and F3 to choose one of the 4 tests

3) Select the desired frequency by pressing “Change” (F1)
4) Repeat 2) and 3) to setup the remaining tests
5) Use F2 or F3 to highlight “MLD difference”
6) Use F1 to select the method to be sued for calculating the
MLD score. Then leave by pressing “Menu” (11). Available
settings are: SO - Sπ and SO - Nπ. SO - Sπ is suggested.
MLB:
1) Press “MLB” (F3) to enter the “MLB Test Setup”

2) Use F2 and F3 to choose which frequency to set
3) Select the desired frequency by pressing “Change” (F1)
4) Repeat 2) and 3) to setup the remaining tests
NOTE! For recommendations on setup, please refer to the MLD test

chapter of this manual.
Auto Test:
1) Press “Auto” (F4) to enter the “Auto test setup”
2) Use F2 and F3 buttons to move the highlighted area on

the screen. Then use F1 button to change the assigned
vales in the highlighted areas.
Deviation among peaks and valleys:

When the patient is making a Békésy trace, the trace will be
made out of a lot of responses and no responses, resulting in
tracing constantly peaking and then falling again.
A normal concentrated cooperation of the patient will result in

a consistency between the peaks (or valleys) on the same
frequency giving e.g. 10 dB max deviation between peaks. If
something goes wrong in the test it will probably result in a
much larger deviation.
In this setup you may enter a threshold of deviation for a fixed

frequency Békésy that, if exceeded, will cause the test to
terminate. Suggested setting: 10dB.

Number of reversals:
During each fixed Békésy frequency test the patient, if
responding realistically, will obtain a certain number of normal
responses.
If a realistic number of responses are not given the test will

automatically terminate. The minimum acceptable number of
responses (Reversals) can be set up here. Suggested setting:
6.
Curve to average:
In fixed frequency Békésy the curve for continuous tone or the
curve for pulsed tone may be used for averaging. Select which
curve to use for averaging. Suggested setting: Continuous.
Threshold Method:
For speed and accuracy. Select if 2 out of 3 or 3 out of 5
correct responses to a given intensity shall determine the
threshold. Suggested setting: For speed: 2/3. For accuracy:
3/5.
Loudness Scaling
1) Press “LOUD” (F5) to enter the “Loudness Scaling Setup”
2) Use F2, F3, F4 and F5 buttons to choose the frequency

loudness to change
3) Use F1 to change the loudness setting
4) Repeat 2) and 3) to set up the remaining frequencies

55 Communication setup
3) Select “Comm.” (F4) to enter the “Communication setup”
4) Use F2 and F3 buttons to choose the baud rate, the

transmission, the transmit to or the transmit menu to be set up.
5) Select “Menu” (11) to leave the “Communication Setup”
window.
Baud rate:
Select baud rate by “Change”. *Press “Change” (F1) to
choose between baud rates of 9600, 19200 or 39400. Select
baud rate to match that of the connected computer.
Transmission:
Select Verification by “Change”. * “Verification” or “No
verification” may be selected. The OtoAccess program will
need “Verification” in order to operate, whereas other
programs may not need “No Verification” in order to operate
correctly.
Transmit to:
Select the instrument to transmit data to by “Change”. “PC” or
“MS40/MS25” may be selected.
Transmit:
Select the way in which to transmit data by “Change”.
“Normal” and “Special” may be selected.

11 Appendix B: General Maintenance
The performance and safety of the instrument will be kept if the
following recommendations for care and maintenance are observed:
- It is recommended to let the instrument go through at least

one annual overhaul, to ensure that the acoustical, electrical
and mechanical properties are correct. This should be made
by an authorised workshop in order to guaranty proper service
and repair.
- Before the connection to the mains network, be sure that the

local mains voltage corresponds to the voltage labelled on the
instrument. Always disconnect the power cord if the
instrument is opened or by control / replacement of the mains
fuses.
- Observe that no damage is present on the insulation of the

mains cable or the connectors and that it is not exposed to
any kind of mechanical load, which could involve damage.
- Consult the Operating Manual for the instrument in question to

see how long time it takes from turning on the instrument until
it is stabilised and ready to use.
- For maximum electrical safety, turn off the power from a mains
powered instrument when it is left unused.
- Do not site the instrument next to a heat source of any kind,

and allow sufficient space around the instrument to ensure
proper ventilation.
- To ensure that the reliability of the instrument is kept, it is

recommended that the operator at short intervals, for instance
once a day, perform a test on a person with known data. This
person could be the operator him/herself.
- A plastic cover can be provided to protect the instrument

against the accumulation of dust. The cover should only be
used when the instrument is left unused with the power turned
off.

- If the surface of the instrument or parts of it are contaminated,
it can be cleaned using a soft cloth moistened with a mild
solution of water and dish washing cleaner or similar. The use
of organic solvents and aromatic oils must be avoided. Always
disconnect the mains conductor during the cleaning process,
and be careful that no fluid is entering the inside of the
instrument or the accessories.
- After each examination of a patient, it should be ensured that

there is no contamination on the parts in connection with the
patient. General precautions must be observed in order to
avoid that disease from one patient is conducted to others. If
ear cushions or eartips are contaminated, it is strongly
recommended to remove them from the transducer before
they are cleaned. By frequent cleaning water should be used,
but by severe contamination it may be necessary to use a
disinfectant. The use of organic solvents and aromatic oils
must be avoided.
- Great care should be exercised by the handling of earphones

and other transducers, as mechanical shock may cause
change of calibration.

12 Return Report

13 Instrument layout

Operation Manual: Clinical Audiometer AC40

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Operation Manual

Clinical Audiometer AC40

Valid from serial no. 160252 - software version 1.70

AC 40 Operation Manual Page 1

AC 40 Operation Manual Page 2

The AC40 audiometer is intended to be used by an audiologist,

Notice - The transducers (headphones, bone conductor, etc.)

Notice - It is recommended that parts which are in direct contact with

AC40 Operation manual Page 3

If this apparatus is connected to one or more other

Notice - Within the European Union it is illegal to

AC40 Operation manual Page 4

16 Entering Patient Data

1) While activating the shift function by holding down one of the

External keyboard needed:

AC40 Operation manual Page 5

NOTE! Name etc, entered into the AC40 is also transferred to

MS25 or MS40 audiometer printing:

NOTE! The MS25 may need a software update to perform this

AC40 Operation manual Page 6

Selecting desired way of listening:

AC40 Operation manual Page 7

22 Patient Response Switches

23 Remote Tone Switches

AC40 Operation manual Page 8

ESC = Main menu:

25 The Different Headsets

High frequency headset:

CIR22 for insert masking:

EAR-Tone 5A general purpose insert phone:

26 Recreating the default setup

AC40 Operation manual Page 9

AC40 Operation manual Page 10

27 Pure Tone Presentation

Tone window will appear with default settings as shown below:

Left + Right audiogram threshold comparison:

Warble tone selection:

AC40 Operation manual Page 11

1 or 5dB attenuation steps:

Uncomfortable Level or UCL:

“No response” sign may be stored:

Reference tone with another frequency:

Changing the reference frequency tone:

28 High Frequency Pure Tone Presentation

AC40 Operation manual Page 12

The High Frequency (HF) headset must be used for HF testing.

NOTE! If only the HF audiogram should be shown on screen, select

Left + Right audiogram threshold comparison:

Uncomfortable level or UCL:

AC40 Operation manual Page 13

Warble tone selection:

1 or 5dB attenuation steps:

Reference tone with another frequency:

To change the frequency of the reference tone, enter the

18 kHz & 20 kHz high frequencies:

NOTE! Unfortunately 18 kHz and 20 kHz cannot be stored;

AC40 Operation manual Page 14

4) Select desired test ear /Transducer (32, 33, 34, 35 or F8)

AC40 Operation manual Page 15

1) Present a word to the patient.

NOTE! The number of words to be used in this test must be

Multi speech curves (three speech curves):

1 or 5dB attenuation steps: