Om Aa222new

Operation Manual
Audio Traveler AA222
Valid from serial no. 776588 software version 2.00200

80658206 – vers. 11/2011
Table of Contents
Introduction ......................................................................................... 5
Intended Use ..................................................................................... 5
Precautions ........................................................................................ 5
Explanation to Symbols ..................................................................... 7
Warranty ............................................................................................ 8
General Theory of Impedance Measurements ............................... 10
Understanding Tympanograms ....................................................... 11
Classification of Tympanograms ..................................................... 12
Interpretation of Test Results .......................................................... 15
Tympanometric Curves and Pathologies......................................... 15
Reflex Interpretation ........................................................................ 16
Pathways for the Stapedius Reflexes .............................................. 18
Reflex Decay Interpretation ............................................................. 20
Examples of Interpretation............................................................... 21
General Theory about Air and Bone Conduction .......................... 26
Air Conduction ................................................................................. 26
Bone Conduction ............................................................................. 28
General Considerations about Masking .......................................... 29
Masking Procedure - Step by Step (Hoods Plateau) ....................... 31
Basic Functions ................................................................................ 34
Patient Communication ................................................................... 34
Pause .............................................................................................. 34
Preparing the Test ........................................................................... 35
Main Menu ....................................................................................... 38
Test Procedures .............................................................................. 39
Printing Test Results ....................................................................... 40
Connection to PC ............................................................................ 42
Installing Printer Paper .................................................................... 43
Reflex and Tympanometry ............................................................... 45
Modifying Reflex Test A and B ........................................................ 48
Ipsilateral and Contralateral Reflexes .............................................. 49
Tympanometry - only ....................................................................... 50
Tympanometry with High Probe Tone ............................................. 52
Automatic Reflex Test - only............................................................ 54
Manual Reflexes .............................................................................. 56
Editing Automatic and Manual Reflexes .......................................... 57
Manual Reflex Decay....................................................................... 58
Eustachian Tube Function ............................................................... 60
AA222 Operation Manual Page 3

”Child” Function ............................................................................... 62
Automatic and Manual Audiometry................................................. 64
Masking ........................................................................................... 66
Speech Audiometry ......................................................................... 67
Automatic Speech Scoring Counter ................................................ 70
ABLB Test ....................................................................................... 72
Stenger Test .................................................................................... 73
SISI Test .......................................................................................... 74
Handling of Ear Tips ......................................................................... 77
Cleaning of Ear Tips ........................................................................ 77
Cleaning of Probe Tip ...................................................................... 77
Functions of Buttons........................................................................ 81
Technical Specifications .................................................................. 84
Impedance Measuring System ........................................................ 85
Reflex and Audiometer Functions ................................................... 87
Parts ................................................................................................ 97
Connection Panel ............................................................................ 98
Unpacking / Inspection .................................................................... 99
Contents of Shipment ...................................................................... 99
Reporting Imperfections ................................................................ 100
Care and Maintenance .................................................................. 101
Trouble Shooting ............................................................................ 102
Frequently Asked Questions ......................................................... 104
Recommended Literature .............................................................. 107
Dictionary ........................................................................................ 109
Appendix A: Setup .......................................................................... 113
Tympanometry Setup Menu .......................................................... 114
Setup Menu for Reflex Test A and B ............................................. 117
Reflex Methods.............................................................................. 118
Audiometry Setup Menu ................................................................ 125
Manual Audiometry Setup Menu ................................................... 127
Speech Audiometry Setup Menu ................................................... 129
Common Setup Menu.................................................................... 130
Appendix B: Installing the USB Driver on the PC....................... 134
Appendix C: General Maintenance Procedures.......................... 137
Return Report .................................................................................. 139
Drawing of Front Plate ................................................................... 141

Introduction
Intended Use
The AA222 is a combined automatic impedance audiometer and
audiometer suited for clinics performing screening, as well as
diagnostic work. The test battery includes tympanometry, acoustic
reflex testing, ipsilateral and contralateral reflex decay testing,
Eustachian tube function test and AC audiometry.
The AA222 tympanometer and audiometer is intended to be used by

an audiologist, hearing healthcare professional, or trained technician in
a quiet environment (tymp and reflexes) and extremely quiet
environment (Audiometry). 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). Make sure that the instrument is operated in a silent
environment and avoid unwanted sound radiation from pc’s, ventilators
and other equipments while you are testing. Make sure that the
instrument is operated in a silent environment and avoid unwanted
sound radiation from pc’s, ventilators and other equipments while you
are testing.
Precautions
WARNING indicates a hazardous situation which,
if not avoided, could result in death or serious
injury.
CAUTION, used with the safety alert symbol,

indicates a hazardous situation which, if not
avoided, could result in minor or moderate injury.
NOTICE is used to address practices not related

to personal injury

1. Never insert the probe tip into the ear canal without affixing an
ear tip as this may damage the patient’s ear canal.
2. Use only the disposable ear tips designed for use with this
instrument.
3. Be sure to insert the probe tip in a way, which will assure an

air tight fit without causing any harm to the patient. Using a
proper and clean ear tip is mandatory.
4. We recommend using a new ear tip for each patient.
5. Parts which are in direct contact with the patient (e.g.
earphone cushions) should be subjected to standard
disinfecting procedure between patients. This includes
physically cleaning and use of a recognized disinfectant.
6. Be sure to use only stimulation intensities, which will be
acceptable for the patient.
7. Do not insert or in any way try to conduct measurements

without proper probe ear tip in place.
8. When conducting audiometry using Ear tone insert phones –

do not insert or in any way try to conduct measurements
without proper foam tip in place.
1. Do not immerse the unit in any fluids.
2. Use this device only as described in this manual.
3. Use and store the instrument indoors only. Do not use this
instrument or its accessories in temperatures below 0°C/32°F
or above 50°C/122°F, or in relative humidity of more than
90%.
4. Do not drop or otherwise cause undue impact to this device. If

the instrument is dropped or otherwise damaged, return it to
the manufacturer for repair and/or calibration. Do not use the
instrument if any damage is suspected.

5. Keep the box of ear tips outside the range of the patient.
6. The transducers (headphones, bone conductor, etc.) supplied

with the instrument are calibrated to this instrument -
exchange of transducers require a re-calibration.
7. Do not attempt to open or service the instrument. Return the

instrument to the manufacturer for all service. Opening the
instrument case will void the warranty.
8. Regularly have the unit checked according to IEC 60601-1,

Class I, type B.
9. 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.
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
Explanation to Symbols
Explanation to symbols which may be found on the instrument:
Caution. Check the accompanying documents
Type B applied part
~ Alternating Current

Warranty
INTERACOUSTICS warrants that:
 The AA222 is free from defects in material and workman

ship under normal use and service for a period of 24
months from the date of delivery by Interacoustics to the
first purchaser.
 Accessories are free from defects in material and
workmanship under normal use and service for a period of
ninety (90) days from the date of delivery by Interacoustics
to the first purchaser.
If any product requires service during the applicable warranty

period, the purchaser should communicate directly with the local
Interacoustics service centre to determine the appropriate repair
facility. Repair or replacement will be carried out at Interacoustics’
expense, subject to the terms of this warranty. The product
requiring service should be returned promptly, properly packed, and
postage prepaid. Loss or damage in return shipment to
Interacoustics shall be at purchaser's risk.
In no event shall Interacoustics be liable for any incidental, indirect

or consequential damages in connection with the purchase or use
of any Interacoustics product.
This shall apply solely to the original purchaser. This warranty shall
not apply to any subsequent owner or holder of the product.
Furthermore, this warranty shall not apply to, and Interacoustics
shall not be responsible for, any loss arising in connection with the
purchase or use of any Interacoustics product that has been:
 repaired by anyone other than an authorized Interacoustics

service representative;
 altered in any way so as, in Interacoustics judgement, to
affect its stability or reliability;
 subject to misuse or negligence or accident, or which has
had the serial or lot number altered, effaced or removed; or

 improperly maintained or used in any manner other than in
accordance with the instructions furnished by
Interacoustics.
This warranty is in lieu of all other warranties, express or implied,

and of all other obligations or liabilities of Interacoustics, and
Interacoustics does not give or grant, directly or indirectly, the
authority to any representative or other person to assume on behalf
of Interacoustics any other liability in connection with the sale of
Interacoustics products.
INTERACOUSTICS DISCLAIMS ALL OTHER WARRANTIES,

EXPRESSED OR IMPLIED, INCLUDING ANY WARRANTY OF
MERCHANTABILITY OR FOR FUNCTION OF FITNESS FOR A
PARTICULAR PURPOSE OR APPLICATION.

General Theory of Impedance Measurements
To understand impedance measuring from a popular point of view it is
sufficient to know that a sound of 226 Hz. presented into a cavity like
the human ear will produce different SPLs depending on the volume of
the cavity. By measuring changes in the SPL, equivalent volume
changes can be established.
Presenting a high positive or negative air pressure to the outer ear

canal will stiffen the tympanic membrane, thus creating a cavity
acoustically consisting of only the outer ear canal. In this way the
equivalent volume of the outer ear canal can be established.
By gradually varying the air pressure from a positive pressure to a

negative the tympanic membrane and the attached ossicular chain will
gradually become more and more mobile, showing more compliance
to the sound pressure waves. The sound passage to the middle ear
will then be less and less reduced or impeded by the tympanic
membrane, and the impedance is said to be lower. The lowest
impedance will be obtained when the air pressure is equal on both
sides of the tympanic membrane, thus showing the highest
compliance to the sound waves. In this state, the cavity responding to
the introduced sound will be comprised of the outer ear canal as well
as the middle ear. This will reveal the total equivalent volume of the
outer- and middle ear.
The equivalent volume of the middle ear, also called the compliance,
is easily derived by subtracting the two volume measurements above.
This is done automatically on the AA222 and the result is presented as
"Compliance", measured in ml.
The impedance curve, drawn by a gradual sweep across a wide

pressure range, can reveal a great deal of information about the state
of the middle ear, the tympanic membrane, and the ossicular chain.
The above principle for measuring the stiffness of the tympanic

membrane can also be used to detect tympanic membrane stiffness,
caused by contraction of the middle ear muscles. This is usually
referred to as the "Stapedius Reflex". The normal ear will, when
subjected to loud signals, reflexively contract the Stapedius muscle
(and in some cases the tensor tympani muscle). This will immobilise
the tympanic membrane somewhat and this change of impedance is

detectable as explained above and a reflex recording of the
impedance change can be presented. Such a reflex is called a
Stapedius reflex, as the Stapedius muscle contraction is the dominant
factor in creating this impedance change. Reflex measurements are
normally carried out with air pressure in the outer ear canal set for
maximum compliance.
This Stapedius reflex can be elicited both ipsilateral and contralateral,

and has great diagnostic value. Together with the impedance curve
measurement the integrity of the complete middle ear system can be
evaluated.
Understanding Tympanograms
General Considerations:
A given curve drawn in a co-ordinate system will always have its
shape dictated by the vertical and horizontal graduations. The
printout of the AA222 complies with the international standards
in this respect, and therefore may not produce tympanogram
shapes directly comparable to other instruments if these do not
meet the standard requirements.
The Peak:
The peak of the tympanogram will horizontally be placed at the
air pressure of the middle ear, as equal pressures on both sides
of the tympanic membrane produces the highest compliance of
the system. A slight deviation of the peak in the direction of the
air pressure sweep may be experienced, due to an inherent
hysteresis of the middle ear and the test equipment. A slower
sweep speed may diminish the offset.
The Height:
The height of the tympanogram from its more or less horizontal
bottom line (measurements made from start pressure) to the top
shows the difference in compliance between stiffened tympanic
membrane and max. compliance. This difference is referred to
as "compliance" and is a measure for the equivalent volume of
the middle ear.

Equivalent Volume:
The term "Equivalent Volume", in which compliance is
measured, should be understood clearly in order to avoid
3
misinterpretation of test results. The unit of measurement is cm
(or ml.) but this does not mean that e.g. the middle ear has this
exact internal volume. It means that the middle ear, as seen
from the outer surface of the tympanic membrane, reacts the
same way as a hard walled cavity of this exact volume would
react.
Compared to a hard walled cavity a normal middle ear

incorporates at least three major differences. One is friction due
to the ligaments connected to the ossicles (resistance). The
second is stiffness caused by the elastic qualities of the
eardrum and the enclosed air and by a fluid pressure from the
inner ear exerted on the stapes (stiffness reactance). The third
is the mass of the eardrum and the ossicles (mass reactance).
At 226 Hz the stiffness component is by far the most dominant

factor and is therefore the subject of measurement.
The Shape:
The shape of the tymp curve will change when the stiffness of
the system is changed (e.g. by ossicular chain disruption, otitis
media, etc.), and this is a primary reason for the diagnostic
value of this measurement. However, normal ears show a great
variety of tymp shapes so this should never be taken as the only
basis for making a diagnosis. Furthermore, two different
abnormalities may have opposing effects, resulting in a normal
shape of the tymp curve.
Classification of Tympanograms
Tympanograms can be classified according to compliance (height,
3
measured in ml. or cm ), pressure at compliance maximum
(measured in daPa), rate of compliance change (gradient in %), and
shape. Please refer to the chapter "Examples of Interpretations" in this
manual for illustrations of the classic curve categories, and the names
given to them by Liden and Jerger. On the following pages a more
detailed description of each category is presented.

Type "A" characteristics:
The tymp curve shows a clear compliance peak within the
pressure range of  50 daPa for adults. For children the middle
ear pressure may be considered normal down to
-150 daPa negative pressure.
Normal ears often show type "A" tympanograms.
Type "AD" characteristics:

The type AD tympanogram is essentially a type A tympanogram
in which the curve is very high and may be outside the range of
the instrument / recording chart. Peak is within the pressure
range of type A of  50 daPa. The very mobile eardrum can
reproduce various curves.
It can represent ossicular discontinuity, flaccid eardrum or a

combination of both. Peaking and notching outside the test
range is possible. Note: The type AD curve may reveal itself as
being a type D curve, if a higher probe tone, e.g. 800 Hz, is
used.
Type "AS" characteristics:

The type As tympanogram is essentially a type A tympanogram
in which the curve is much shallower than usual. Peak is within
the pressure range of type A of  50 daPa. For children the
middle ear pressure may be acceptable down to -150 daPa
negative pressure. The pathology could be immobile stapes due
to otosclerosis (no reflexes), some form of otitis media, thick or
scarred eardrum, or just a normal variant. Infants’ ears may
show this small compliance.
Type "B" characteristics:

Low compliance without peak identification. Middle ear pressure
is unknown, probably negative. The type "B" is flat, going slightly
upwards by negative pressure. It may be associated with ears
having extremely stiffened middle ear systems. Indication of
fluid (serous or adhesive otitis media), retracted eardrum,
blockage of the external ear canal, or perforated eardrum e.g.
with drainage tube. Note: Ears with type B tympanograms
should be tested for peak identification down to -600 daPa.

Type "C" characteristics:
Normal compliance peak with peak identification in the negative
pressure range, e.g. below -50 daPa for adults (Bluestone) and
below -150 daPa for infants (Liden) .The type C curve shows all
the characteristics of normal type A, AD and AS curves.
The type C curve indicates poor Eustachian tube function with

possible developing or resolving middle ear effusion.
Type "D" characteristics:

Depicted by a deep curve with a small notch at the peak. Middle
ear pressure  100 daPa. This curve does not necessarily
indicate a pathological ear. Healed perforation of tympanic
membrane, fixation of parts of the bones after ossicular
discontinuity, flaccid eardrum with ear wax, or maybe a
ventilation tube blocked with ear wax and healed middle ear,
can cause peaking and notching, resulting in many shapes at
the top of the maximum compliance curve. The curve could also
be a narrow type E (W shaped) tympanogram. Note: May be
better detected with an 800 Hz probe tone.
Type "E" characteristics:

Depicted by a broad, deep, often multiple notching. "W" shaped.
This tympanogram is usually caused by ossicular discontinuity,
but may also indicate restored ossicular chain one year or more
after stapedectomy. Note: May be better detected with an 800
Hz probe.

Interpretation of Test Results
Tympanometric Curves and Pathologies

- According to Feldmann -
Peak Pressure
Negative Normal Pressure: Positive Absence of
Pressure: Pressure: Pressure Peak:
1) Blocked 1) Ossicular bone 1) Early 1) Middle ear

Eustachian fixation acute otitis effusion
tube 2) Adhesive fixation media 2) Open tymp.
2) Serous 3) Ossicular membrane
otitis discontinuity 3) Artifact
media 4) Middle ear tumour
5) Eardrum abnormality
Amplitude
Increased Decreased Amplitude: Unchanged Amplitude:
Amplitude:
1) Ossicular fixation 1) Blocked Eustachian
1) Eardrum bony or adhesive tube
abnormality 2) Serous otitis media 2) Early acute otitis media
2) Ossicular 3) Cholesteatoma,
discontinuity polyps, granuloma
4) Glomus tumours
Shape
........................Slopes....................... Smoothness:
Decreased / Flattened Increased slope: Altered smoothness:
slope:
1) Eardrum 1) Eardrum abnormality
1) Serous otitis abnormality 2) Ossicular
2) Ossicular fixation 2) Ossicular discontinuity
3) Tumours of middle discontinuity 3) Vascular tumours
ear 4) Patulous Eustachian
tube

Reflex Interpretation
Figure 1:
Onset and Offset:

As judged on the normal reflex these measurements have little
or no diagnostic value (See Decay Test). The attention should
be drawn to the fact that instrument variation exists in these
parameters. Roughly, it can be said that the more steep the
onset and offset slopes, the faster is the instrument. Especially
older instruments had rather flat slopes.
Noise:
Acoustical signals showing up in the reflex recording, yet
irrelevant to the Stapedius reflex. As the reflex measurements
are based on observing the change in sound intensity of a 226
Hz tone, as explained in "Popular Introduction to Impedance", it
is possible that environmental noise of this frequency entering
the ear will show up as part of the test result. This is a problem
inherent to the measuring method and therefore common to all
normal impedance meters. Heart beat, talking and external
noises are common causes of noise peaks seen on the reflex
curve.
A negative reflex may occur due to the following interference of

noise: Prior to recording the reflex activity an acoustic reference
level is measured in the ear canal without any Stapedius activity.
The difference between this reference level and the level

present when the Stapedius muscle is active is recorded as a
reflex. If, however, external noise was entering the ear only
during reference level measurement, and not during reflex
measurement, the level may actually be lower during the reflex,
thus resulting in a negative reflex. This is of course not a valid
measurement. The negative reflex is an extreme situation, but
noise will always distort the measurements to a certain degree
and should therefore be avoided.
Negative Onset:
It is quite common to see reflexes start out with a small negative
deflecting dip. In ears with stapedial otosclerosis this dip with an
additional dip at the end of the stimulation can be the only
reaction left from the contraction of the Stapedius muscle. Some
tumour ears have been reported to give only the negative onset,
but no further reaction.
Reflex Threshold:
For a given stimulus the lowest level that elicits a detectable
reflex. This is not an absolute measurement as no exhausting
norm exits defining stimuli and related reflex characteristics.
Therefore, differences in test setups and reflex evaluation will
produce somewhat different results. It is not uncommon to
report the reflex threshold as the intensity which produces a 1%
or 2% change in equivalent volume (Test "A" with 2%
sensitivity).
It should be noted that a visual examining of reflex test might

reveal some Stapedius muscle action, also at slightly lower
stimulus intensities. This procedure (see "Example of Popular
Fixed Intensity Reflex Test") is recommended for establishing
the absolute reflex threshold.
Generally, noise stimuli elicit reflexes at lower levels than pure

tones do.

Pathways for the Stapedius Reflexes
Figure 2:
The Nature of the Reflex:

The Stapedius muscle reflex is elicited binaurally via monaural
stimulation (Ipsilateral stimulation via the impedance probe -
contralateral stimulation via the headphone). The average reflex
threshold is 85 dB HL (70 dB - 100 dB) for normal ears of 20
year old patients when pure tones are used as stimulus.
Noise as stimulus produces a threshold approx. 10-20 dB lower

as noise is made out of many simultaneous tones together
carrying more energy. Increased stimulation level will produce a
stronger reflex. Cochlear and retrocochlear pathology may show
less rapid growth of reflex amplitude versus stimulation
amplitude.

Primarily, a reflex test shall answer these questions:
 Is the reflex absent or present?
 If present, is it present both contralateral and ipsilateral?
 What is the threshold of the reflex?
If the test shows normal reflex thresholds and a normal

tympanogram is present, the middle ear will usually be classified
as healthy. One exception, though, is the early stage of
otosclerosis.
Non Acoustic Stimulation:

The Tensor Tympany muscle of the middle ear can produce a
reflex elicited by a non acoustic stimulus or by an acoustic
stimulation loud enough to have a startling effect on the patient.
As the tensor reflex is a startle response, it will decrease and
disappear after a few equal stimulations. Even though the
tensor reflex is regarded late and unstable compared to the
Stapedius reflex, it may be useful in testing deaf or hard of
hearing patients. Below is shown the tactile sensitive area of the
face to be stimulated with e.g. a piece of wool. Stimulation may
also be a blow of air into the eye region of the patient.
Figure 3:
Air
Touch

Reflex Decay Interpretation
Figure 4:
Reflex Decay:
Reflex decay is calculated as the reduction of size of the
acoustic reflex during the first 10 seconds of muscular
contraction. Most normal ears will be able to maintain a
Stapedius contraction for 10 seconds or longer for frequencies
below 1000Hz, at a level 10dB above reflex threshold. A high
reflex decay score could indicate VIIIth nerve disorders.
Another way of stating the reflex decay is by finding the number
of seconds it takes before the Stapedius contraction falls to 50%
of its initial maximum.
Note: If a decay score is obtained, you should assure that it is

not due to an improper seal, which might produce an artefact
similar to a decaying curve. See the chapter “Preparing the
Test” for details of fitting the probe.
The fact that the light band of the probe goes off, and the test
starts is not an absolutely certain indication of a fit good enough
to produce valid decay test results. This is due to the prolonged
test time and the high sensitivity of the test.
Also great care should be taken to have the probe kept in a very
fixed position relative to the ear during testing.

Examples of Interpretation
In the following, some typical compliance curves, reflex curves and the
possibly associated pathology are shown. The curves are idealised
and only one expected pathology is described for each combination of
tympanogram and reflex.
A combination of variables always has to be taken into consideration.

E.g. the combination of a stiff middle ear system and a floppy eardrum
may result in a tympanogram falling within the normal category. The
interpretations stated here are generalised examples taken from the
currently available literature and they can, of course, vary with each
individual case.
The diagnostic value of tympanograms showing a "D" or "E" shape is

reduced today. A probe tone higher than 226 Hz has been preferred
for these particular tympanograms.
Pathology : Normal ear.
Volume : Normal.
Pressure : -100 daPa to +100 daPa.
Ventilation : Present.
Reflex : Present.
Audiogram : No hearing loss.
Pathology : Cochlea lesion.
Volume : Normal.
Reflex : Present or absent.
Audiogram : Sensory neural hearing loss.

Pathology : Retrocochlear lesion.
Volume : Normal.
Reflex : (Abnormal Decay.)
Audiogram : Sensory neural hearing loss
(May be unilateral).
Pathology : Supranormal eardrum

(floppy) or atrophic/scarred
eardrum.
Volume : Normal.
Reflex : Present.
Audiogram : Normal.
Pathology : Disrupted ossicular chain

peripheral to stapes muscle
attachment.
Volume : Normal.
Reflex : Absent.
Audiogram : Conductive loss.
Pathology : Disrupted ossicular chain

medial to stapes muscle
attachment.
Volume : Normal.
Reflex : Absent (Present by contra-
lateral stimulation).
Pathology : Disruption of ossicular

chain with bones fixated to
the tympanic membrane,
resonating. Supranormal
eardrum (floppy).
Volume : Normal.
Reflex : Absent / Present.

Pathology : Scarred and healed
(abnormal) eardrum.
Volume : Normal.
Reflex : Present.
Audiogram : Normal.
Pathology : Fluid in the middle ear, or

serous otitis media.
Volume : Normal.
Pressure : Peak not obtainable.
Ventilation : -
Reflex : Absent or elevated (rare).
Audiogram : Mild to moderate conductive
loss.
Pathology : Ear wax in the external ear

canal (Obturating
cerumen).
Volume : Low
Pressure : Normal.
Ventilation : -
Reflex : Absent.
loss.
Pathology : Perforated tympanic

membrane - defect or
ventilated tympanotomy.
Traumatic rupture.
Volume : Normal / High

Pressure : Not obtainable.
Ventilation : -
Reflex : Absent (peaks).
loss (20 dB).
Pathology : Otosclerosis or stapes

fixation.
Volume : Normal.
Audiogram : Moderate conductive loss.

Pathology : Adhesive otitis media.
Adhesive ossicular
fixation (glue ear).
Volume : Normal.
Pressure : Negative / moderate.
Ventilation : -
Reflex : Absent.
Pathology : Moderate fluid in the

middle ear.
Volume : Normal.
Pressure : Negative / negative.
Ventilation : -
Reflex : -
Audiogram : Mild conductive loss.
Pathology : Impact fluid in the middle

ear.
Volume : Normal.
Pressure : Not obtainable.
Ventilation : -
Reflex : Absent.
Pathology : Blockage of Eustachian

tube; fluid in the middle
ear may be present.
Volume : Normal.
Pressure : Negative.
Ventilation : Absent or poor
Audiogram : Mild to moderate
conductive loss.
Pathology: Acute Serous Otitis Media:

Positive middle ear pressure is rarely observed in
tympanometry. Usually it is a consequence of sneezing or
valsalvation. One pathological condition that may cause positive
pressure in the middle ear is acute serous otitis media in the
early stage.

A typical acute serous otitis media may develop according
to the tympanograms outlined below:
Status of middle ear drainage tubes:

Otoscopic or "visual" inspection of the drainage tube is
difficult, as it can easily be blocked from the inside.
All three situations below will result in a mild conductive loss.

General Theory about Air and Bone
Conduction
Hearing threshold levels can be determined by air conduction and
bone conduction audiometry. In air conduction audiometry the test
signal is presented to the test subject by earphones. In bone-
conduction audiometry the test signal is presented by a bone vibrator
placed on the mastoid or forehead of the patient. It is recommended to
start hearing threshold level determinations with air conduction
measurements followed by bone conduction measurements.
Hearing threshold levels can be determined using test tones with fixed
frequencies or a test signal with frequency varying with time according
to predetermined rate of change.
Air Conduction
The purpose of air conduction audiometry is to establish the hearing
sensitivity at various frequencies. The test can specify the AC loss, but
it cannot distinguish between abnormality in the conductive
mechanism or sensor-neural mechanism.
Headset Placement:
Remove eyeglasses and earrings if possible and position the
headband directly over the top of the head. Place the rubber
cushions so that the diaphragms are aimed directly at the
opening into the ear canal. Pull down the yokes of the phones
and adjust for tight fit. If the cushions are not tight to the ears,
the test result will be false at lower frequencies.
Background noise:
Background noise can also give false test results, especially at
lower frequencies. If necessary, the audiometric headphone can
be equipped with our Audiocup Exclosures type 21925. Please
contact the distributor.
Instruction of subject:
Prior to hearing threshold level measurements, the following
instruction of the subject about the test tones and the response

signal button shall be carried out: "You will now hear different
tones in the earphones with various intensities. Please push the
signal button when you hear the tone and release it when you do
not hear the tone".
Threshold Determination:
The test normally starts at 1000 Hz on the patient's best ear.
Familiarisation:
Present a tone of 40 dB to the test ear. Often this tone is
sufficient to evoke a clear response from the subject. Then
present a tone completely attenuated. If the subject does not
respond to a tone of 40 dB present tones that are successively
10 dB higher until a response occurs. Then reduce the tone
level by 20 dB.
In either case gradually increase the level until a response

occurs. Repeat the tone presentation at the same level. If the
responses are consistent, the familiarisation is completed. If not,
it should be repeated.
Threshold Determination using the Ascending Method:
1) Present a tone which is 10 dB lower than the threshold

obtained during the familiarisation procedure. If response
fails, increase in 5 dB steps until the subject responds.
2) Decrease the level by 10 dB and begin another ascending

level series. Continue until three responses out of a
maximum of five occur at the same level.
Almost the same results will be obtained, when two

responses out of three tone presentations occur at the same
level and frequency. If less than two responses out of three
(or less than three out of five) have been obtained at the
same level, present a tone 10 dB higher than the last
response and repeat the procedure.
3) Proceed to the next frequency. Decrease the level by 10 dB

and begin another ascending level series. Continue until
three responses out of a maximum of five occur at the same
level.

4) Repeat the familiarisation procedure. If the difference is 5 dB
or less go to the other ear. If the difference is 10 dB or
higher, repeat the test at further frequencies in the same
order until agreement to 5 dB or less has been obtained.
5) Proceed until both ears have been tested.
The hearing threshold at each frequency and ear shall be

calculated according to the following procedure:
 Find the lowest level where the subject responds in at

least 50% of the tone presentation series. This level is
defined as the hearing threshold level.
 If the lowest response levels span more than 10 dB

within the same frequency the test is doubtful and should
be repeated, if possible.
Manual or automatic pulses may be used. If manual pulses

are used, they should be at least one second in duration.
Bone Conduction
The purpose of the BC test is to supply the test tone directly to the
inner ear around the middle ear mechanism via the skull to establish
the inner ear hearing threshold.
AC-BC gap:
The difference between the AC threshold and BC threshold, the
so called AC-BC gap, will be the loss of the middle ear. The
middle ear loss is of great diagnostic interest as it may indicate
the need for medical attention.
The bone conductor is placed behind the test ear directly on the
skull where the tone is best heard. Activate "Bone R L" (11) and
the test is performed in the same way as for the air conduction
test.
The output switch is set to Bone and the test is performed in the
same way as for the air conduction test.

Cross Damping (BC):
For bone conduction the cross damping of the head is only 5-10
dB and both cochleae will therefore be stimulated with about the
same intensity. Masking should ALWAYS be used during BC
testing. (Unless both sets of air conduction thresholds are within
10 dB of the best bone thresholds at all test frequencies).
General Considerations about Masking

The purpose of masking is to apply a signal (noise) to the non-test ear
to keep it from responding for the ear being tested. For bone
conduction testing the masking is always supplied via the contra-
lateral earphone. The earphone must always be placed over the non-
test ear when BC testing is performed.
It may be advisable to give the subject a short instruction like ”You

may hear a noise in one of the earphones, but you should only pay
attention to the tones you hear".
The masking noise is calibrated as ipsilateral effective masking: The

masking intensity will just mask the tone if they were presented to the
same ear.
When the masking and tone are connected to opposite ears, the tone
is damped by the cross damping of the head (40-50 dB by AC using
normal headphones and 0-10 dB by BC). The actual damping of the
tone from the test ear to the masked ear will therefore depend on the
actual test: AC or BC ( as well as the frequency tested).
Cross damping:
The cross damping of the head for AC is 40-50 dB.
The cross damping of the head for BC is 0-10 dB.
Minimum masking level for masking out sound in non-test ear:

Without AC-BC loss in the masked ear: The AC tone level
minus 50 dB (AC dB -50 dB).
With AC-BC loss in the masked ear: The AC tone level minus
50 dB plus the AC-BC loss of the masked ear. (AC dB - 50 dB +
AB gap of masked ear.)

The minimum masking level required for BC will be: The BC
tone level minus 5 dB (Tone AC - 0 to 5 dB) presumed that the
masked ear has no middle ear loss. (The middle ear loss is the
difference between the AC and BC threshold).
If the ear has a middle ear loss, the masking intensity should be
increased by this loss as the masking to the masked ear is AC
sound, which of course will be damped by the AC-BC loss in the
masked ear.
If the BC tone is set to 50 dB, the minimum masking intensity

will be 50 dB to the masked ear without middle ear loss: 50 dB -
(0 to 5)dB = 45 to 50 dB.
If the masked ear has an Air Bone loss of 20 dB, the minimum
masking will be: 50 dB - (0 to 5) dB + 20 dB = 65 to 70 dB.
Maximum masking:
Maximum masking is the highest level of masking intensity
which does not change the true threshold of the test ear.
When ears with large AC-BC gaps are tested, the audiologist
must be aware of the masking dilemma where minimum
masking becomes over-masking without finding the plateau
where the masking is correct.
For AC tests: Tone AC + 50 dB

For BC tests. Tone BC + 50 dB.
Masking using insert earphones:

A more efficient masking can be obtained by using an insert
earphone (hearing aid earphone) for masking instead of the
audiometric headphone.
This insert earphone is equipped with a suitable ear tip and

inserted into the ear canal of the masked ear. Otherwise, the
masking procedure is the same. As the test ear is open during
the BC test with insert masking, it is important that the test is
performed in a sound cabin with no background noise.

When masking is supplied via normal audiometric headphones
during the BC test, the earphone over the test ear can be
moved a little forward, letting the ear open. This will prevent the
so-called occlusion effect at lower frequencies, especially 125-
750 Hz. In practise, this effect can be regarded as less
important.
Masking Procedure - Step by Step (Hoods

Plateau)
In air and bone conduction measurements the hearing threshold levels
of both ears are determined separately. Therefore, under specified
conditions, masking noise shall be applied to the ear not being tested
(contra lateral ear).
A) Find the unmasked thresholds for air conduction and then for
the better ear by bone conduction - see air and bone
conduction.
B) Notify the subject that masking will be used. Tell him that he will
be hearing some noise, but to disregard it as best as he can and
respond only to the test signal, as he did previously.
When air conduction is made, both ears are covered by earphones.

The noise is presented through one earphone and the test signal
through the other.
When bone conduction is made, the noise is presented through one

earphone placed on the non-test ear. The other earphone is placed in
front of the test ear and thereby not covering the ear. The bone-
conduction vibrator is placed on the mastoid process of the test ear.
C) Select Tone and output: Left or Right, Bone L R. Dial the “HL
dB” (30) to the right and the masking noise will automatically be
switched on.- Set the “HL dB” (26) dial to the test ear at the level
of the unmasked threshold by means of rotary switch.
D) Increase the masking in 10 dB steps with the rotary switch

channel 2 (allow approximately 2 seconds at each step), and
have the subject letting you know when he first starts to hear the
noise.

E) The noise will only be effective as a masker if it is heard, and
this procedure does not require that the tester knows to what
reference the masking noise is calibrated, what the minimum
masking is, etc.).
F) When the subject indicates that he hears the noise, the test
begins.
Begin the threshold shift procedure from this starting point (the
“HL dB” (26) dial set to the unmasked threshold level for the test
ear, and the masking at the point it is first heard by the subject).
G) Present the test tone. If the subject hears it, as indicated by

pressing the push button, increase the noise 10 dB and present
the test tone again. Continue the procedure as follows:
- Whenever the test tone is heard, increase the masking 10

dB.- Whenever the test tone is not heard, increase its level in
5 dB steps until it is heard.
- Continue the procedure until a sequence occurs where the

threshold remains the same over a series of masking noise
increases. This level is equivalent to the "Plateau" and the
tone stimulus level can be considered to be the threshold for
the frequency under test.
An option is to continue increasing the masking level until over-

masking occurs. Over-masking will be very noticeable because when
this level is reached, each 10 dB increase in noise will result in a 10 dB
increase in threshold. Caution must be exercised in air conduction
testing because over-masking may not occur. This will be true
especially when the unmasked results actually represented the true
thresholds. In this case, the threshold may not change even over a
very wide range of noise levels. Over-masking is much more likely to
occur in Bone Conduction testing.
H) As soon as the masked threshold has been determined, reduce

the noise to a level below the subject's threshold.

I) Record masked thresholds with appropriate symbols. Do not
record both the unmasked and masked results. In addition,
indicate the type of noise utilised and the upper level of the
noise when the masked threshold was determined.

Basic Functions
Patient Communication
Talk forward
The operator may talk to the patient through the patient’s headset by
activating the “T.Fwd.” button (9). 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 by
turning the “HL dB” rotary dial (26) while holding down the (T.Fwd”
button (9).
Talk back
If the patient is equipped with a microphone connected to the talk back
input, then the operator may listen to the patient by pressing the
“Monitor TB” button (22) twice. To adjust the volume in the patient’s
headset hold down “Shift” (18) and the “Monitor TB” button (22) for 3
seconds. A volume bar will appear on the screen. Adjust the volume
by turning the “HL dB” rotary dial (26). Press “Store” (27) to save as
the default level.
Monitoring
By activating “Monitor“ (22), the presentation from e.g. tape can be
heard through monitor headset or built-in speaker connected to
“Monitor” on the connection panel in the accessory compartment.
To adjust the volume in the monitor headset or speakers, hold down
“Shift” (18) and the “Monitor TB” button (22) for 3 seconds. A volume
bar will appear on the screen. Adjust the volume by turning the “HL
dB” rotary dial (26). Press “Store” (27) to save as the default level.
Pause
The pause function operated from “Pause” (10) has been built in to
AA222 to prevent the instrument from automatically starting the test as
soon as an air tight fit has been obtained. The pause function is mainly
used when using the clinical headset or shoulder strap on the patient.

Preparing the Test
AA222 must warm up:
After approximately 10 minutes the AA222 will reach operation
temperature. At this time it will automatically calibrate itself to
actual ambient barometric pressure. Tests carried out before
this automatic calibration has been performed by the AA222,
may show slightly wrong pressure results.
If the AA222 has been subject to very high or low temperatures

e.g. from being kept in a hot or cold car, the temperature of the
AA222 must be normalised to between 15 and 35 °C / 60 and 95
°
F before accurate result can be assured.
Patient Instruction:
Place the patient in a comfortable chair or on an examining
table if necessary. Small children may feel more comfortable
sitting on a parent's or nurse's lap. Show the probe to the patient
and then explain the following:
 That the aim of the test is to test the mobility of the eardrum.
 That the tip of the probe will be inserted into the ear canal,
and that it has to make a perfect seal.
 That a small amount of air will flow through the probe to
move the eardrum; this will produce a sensation equal to
pressing a finger slightly into the ear canal.
 That one or more tones will be heard during the test.
 That no participation is expected from the patient.
 That coughing, talking and swallowing will ruin test results.
Visual Inspection:
Check the external ear canal for wax with an otoscope and
remove excessive wax to prevent probe opening from clogging
which will inhibit testing. Excessive hairs may have to be cut.
Also check for a perforated eardrum as this may give a tymp

curve which may be mistaken for a fluid filled middle ear.
Ear Tip Selection:

The probe shall be fitted with an ear tip of suitable size before
testing. Be sure to insert the probe tip completely on the ear tip.

Transforming the Probe from Handheld to Clinical and Reverse:
The probe can be used as a handheld probe or it can be
transformed into a clinical probe. The probes are easily
exchanged by pressing the button and pulling the probe.
Picture 1:
Pull
Push
The squared hole

should face in the
same direction as
the push-button
The other probe is then pushed into the socket until a distinct
"click" is heard. Please note that the squared hole in the probe
connection must face in the same direction as the push-button.
Fitting the Clinical Headset – see picture 2

A) Place the head band over the patient's head. The
audiometric headphone is placed over the non test-ear (or
contralateral reflex ear).
B) Slide the transducer house downwards in the head band

holder. Try to position the transducer holder slightly behind
the ear to ensure free space for inserting the probe tip with
the ear tip into the ear canal.
C) Press "Pause" (10) to prevent the instrument from starting

the test as soon as an airtight fit is obtained.
D) Insert the probe tip into the ear canal until you have an
airtight fit. Pull the transducer house upwards again, until the
probe in the ear is hanging by the tubes from the transducer.

Picture 2: Picture 3:
Note: A shoulder strap is also available for performing clinical

tympanometry. See this shoulder strap in picture 3.
Making a Good Probe Seal:

Most ear canals are more or less curved. To get a good fit of the
ear tip, pull back the pinna to straighten out the ear canal during
insertion of the probe as indicated in figure 5.
Figure 5:
Hair coming out of the ear canal may make an airtight fit difficult
to obtain. Therefore, ideally, excessive should be removed prior
to testing. Also, a clinical ear tip covered with Vaseline may be
helpful. Make sure the ear tip does not have its opening closed
by the wall of the ear canal or clogged by Vaseline or cerumen.
For decay test an absolutely airtight fit is needed to avoid test
results indicating decay, where the test result is actually just an
artefact caused by a poor fit.

Main Menu
When the instrument is switched on it automatically powers-up in
1) Reflex and Tympanometry mode

2) Tympanometry mode
or
3) Audiometry mode
depending on the Power-up setting selected in the Common Setup

Menu.
To go to AA222’s Main Menu press “Back” (7) one or more times, or

hold down “shift” (18) while pressing “Back” (7) – this will bring you to
the Main Menu from wherever you are in the instrument.
Figure 6:
From the main menu it is possible to adjust the contrast of the display
by means of F5 “LCD-“ and F6 “LCD+”. The instrument will always
remember the last setting. When holding down “shift” (18) the writing
above F5 and F6 changes to “LED-“ and “(LED+)”. Now the brightness
of the LEDs (indication lights) of the instrument keys can be adjusted.
Also here the instrument will remember the last setting.

Pressing F1 “Test” will bring you back to the Test Screens. Pressing
F2 “Setup” will bring you to the Main Setup Menu. The program
version of AA222 is written in the middle of the screen.
Test Procedures
Before every test is performed it is recommended to delete all stored
patient data from the instrument. Hold down “shift” (18) while pressing
“new subject” (10). The following message will appear on the screen:
Figure 7:

Printing Test Results
To print test results obtained by the AA222 press "Print" (8) and the
internal thermal printer will start printing. It is possible to print out the
present screen by holding down “shift” (18) while pressing “print
screen” (8). Please see below some typical examples of printouts from
the internal printer:
Printout 1: Printout 2:
Printout 1:
Printout 1 contains the following:
 Tympanogram.
 Reflexes (sequence method with individual reflexes starting at 80
dB at 4 different frequencies).
 ETF 1 test (Eustachian Tube Function test).

Printout 2:
Printout 2 contains the following:
 Tympanogram.
 Reflexes (sequence method with 5 individual reflexes starting at
80 dB at 4 different frequencies). Unlike the reflexes from printout
1, the reflexes from printout 2 have been printed with the special
paper saving function. This function is activated by holding down
“shift” while pressing “Print” (8).
 In the top of the printout “Clinic” data and “Subject” data have
been printed.
Printout 3: Printout 4:
 Audiogram with stored

Printout 3: threshold for right and left
Printout 3 contains the ear.
following:
 Tympanogram. Printout 4:
 Reflexes (sequence Printout 4 contains the
method with 5 individual following:
reflexes starting at 80 dB  ETF 1 test (Eustachian
at 4 different frequencies). Tube Function test).

Connection to PC
The data from AA222 can be transferred to a PC by means of a USB

cable. The software needed for AA222 for transferring data to a PC is
one of the following Windows compatible software:
 OtoAccess™ Database Program + diagnostics modules minimum

version 1.25
 PrintView for PC monitoring and printing minimum version 1.15
 IA-NOAH-Imp Module interfacing to NOAH minimum version 1.12
 IA-NOAH-Aud Module interfacing to NOAH minimum version 1.23
 Diagnostic Suite minimum version newer than 1.00
In the software open the “Instrument Setup”:
 Select the com port number, see appendix B

 The Baud Rate in the PC software must be set to USB.
 For OtoAccess, set the Group to IAP
 Select the Instrument ID, choose “AA22X.100” if you want to
transfer Audiometer data
Select the Instrument ID, choose “AT235.100” if you want to transfer
Tympanometry data.

Installing Printer Paper
1. Open the plastic cover of the paper compartment of AA222.
2. Place the new paper roll in the paper compartment in such a way
that the paper ascends from the lower part of the paper roll. With a
pair of scissors cut two triangles of paper away. This will make the
feeding of the paper easier – see picture 4.
3. Pull the blue lever (picture 5) in the direction of the instrument in

order to open the pathway of paper travel.
4. Gently insert the paper between the lower part of the black rubber
platen and the black plastic – see picture 6.
5. When the paper appears between the upper part of the rubber
platen and the paper cutter, pull out an extra 10 to 15 centimetres
of paper and return the small blue lever to its original position.

Make sure that the paper is aligned correctly – see picture 6 and
7.
6. Now guide the paper through the slot of the cover of the paper
compartment.
7. Close the plastic cover of the paper compartment again. AA222 is

now ready to print.

Reflex and Tympanometry
1) Reflex and Tympanometry Test mode

or
3) Audiometry mode
(Depending on the Power-up setting selected in the Common Setup

Menu).
In order to choose between Tympanometry Test, Reflex Test and

Reflex and Tympanometry Test, browse with the “Tymp/Reflex” key
(10). Figure 9 shows the Reflex and Tympanometry Test Screen:
Figure 9:
In the Reflex and Tympanometry mode both indication lights of the

“Tymp/Reflex” key (10) will be active.
1. Select test ear by means of “Right” (27) or “Left“(28).
2. Select the wanted reflex test “Test A” or “Test B” with (F4).

Note: In the Setup Menu of AA222 it is possible to pre-program two
separate reflex tests “Test A” and “Test B”. When starting a test
procedure “Test A” is always default. Therefore if “Test B” is wanted
press F4 “Test A B”.
3. Place the probe in the test ear.
The probe will have an airtight fit when the indication light on the
probe is green. When the status “Leaking” or “Blocked” is displayed
in the upper right hand corner of the screen under the Status Bar, the
indication light on the probe will be yellow. This indicates a bad fitting
or a blocked ear tip.
When a correct fit has been obtained a tympanometric test is

automatically performed on the first ear. By means of the
tympanometric test, AA222 establishes the correct pressure in the
ear canal for the subsequent reflex test.
3a) If clinical headset is used:

When using the clinical headset, select "Pause" (8) in order
to prevent the instrument from automatically starting the
test as soon as an airtight fit has been obtained.
Now, place the clinical headset over the patient's head or

use the shoulder strap and insert the probe tip into the ear
canal. When an airtight fit has been obtained the
tympanometric test is ready to be performed. To start the
test, select "Pause" (8) once again and the test will be
carried out automatically.
Note: From the Common Setup Menu it is possible to set up “Pause”

key (9) to be controlled from the Remote Switch of the probe.
On the screen the tymp test can be followed on-line. When the tymp
curve has been drawn, the AA222 will automatically continue with the
selected reflex test “Test A” or “Test B”.
4. Remove the probe from the first ear when the test
sequence has finished. Select the other ear “Right” (27) or
“Left” (28) and move the probe to the second ear and
repeat the test sequence once again.
5. To print the test result, simply press “Print” (8).

Changing Scale:
When performing Tympanometry, situations might occur
where the compliance peak will exceed the standard 3 ml
tympanogram. When the compliance peak exceeds the 3 ml
scale like in figure 9 AA222 will give the operator the possibility
to change between 1.5 ml, 3.0 ml and 6.0 ml scale by pressing
F5.
Figure 10:
When the tympanogram with the 6 ml scale is activated the 6 ml

scale will be present for both right and left ear:
Figure 11:

Modifying Reflex Test A and B
Before starting the test procedure the selected reflex Test A or B can
be modified in order to meet the exact demands which are needed
for the individual patients:
To modify reflex “Test A or B” press (F6):
Figure 12:
Figure 13 shows the Modify Menu for Reflex Test A – it is similar for
Reflex Test B:
Figure 13:

In order to modify the individual reflex settings of Test A or B hold
down “shift” (18) while pressing F1 to F6 depending on which reflex
that needs to be modified.
When highlighted, it is possible to select between “Ipsi” (12) and

“Contra” (13). The frequency can be changed by means of the
“Frequency Decr / Incr” keys (27 and 28). The intensity can be
change by means of the “HL dB” rotary dial (26). Finally, it is possible
to switch on or off the highlighted reflex by pressing the F-key
underneath the highlighted reflex.
When the individual reflex for Test A or B has been modified to the
special personal needs, hold down “shift” (18) while pressing the F-
key underneath the highlighted reflex once again.
In the same way all the reflexes for Test A or B can be modified.
Finally, press “Back” (7) to return to the test screen.
Ipsilateral and Contralateral Reflexes

AA222 is capable of performing ipsilateral as well as contralateral
reflexes.
In the Setup Menu for Reflex A or B it is possible to set up a reflex

test procedure to perform either ipsilateral or contralateral reflexes
only. Alternatively AA222 can be set up to perform ipsilateral and
contralateral in the same test procedure.
By pressing “Ipsi” (12) or “Contra” (13) it is possible to switch on or

off the ipsilateral or contralateral reflexes. This means that it is
possible to manually overrule (meaning switch off) e.g. a contralateral
reflex that was selected as default for Reflex Test A or B simply by
pressing “Contra” (13).
The idea is that light indication in the “Ipsi” (12) and “Contra” (13)
keys indicates whether or not the ipsilateral and / or contralateral
reflexes will be performed in a preceding test session.

Tympanometry - only
1) Reflex and Tympanometry Test mode

or
3) Audiometry mode
(depending on the Power-up setting selected in the Common Setup

Menu).
In order to choose between 1) Tympanometry Test, 2) Reflex Test

and 3) Reflex and Tympanometry Test, browse with the
“Tymp/Reflex” key (10). Figure 14 shows the Tympanometry Test
Screen:
Figure 14:
In the Tympanometry mode the left indication light only on the

1. Select test ear by means of “Right” (19) or “Left” (20).


in the upper right hand side of the screen the indication light on the
probe will be yellow. This indicates a bad fitting or a blocked ear tip.
When a correct fit has been obtained a tympanometric test is

automatically performed on the first ear.

When using the clinical headset select "Pause" (9) in order
to prevent the instrument from automatically starting the
test as soon as an airtight fit has been obtained.
Now place the clinical headset over the patient's head or

use the shoulder strap and insert the probe tip into the ear
canal. When an airtight fit has been obtained the
tympanometric test is ready to be performed. To start the
test, select "Pause" (9) once again and the test will be
carried out automatically.
Note: From the Common Setup Menu it is possible to set up the

“Pause” key (9) to be controlled from the Remote Switch of the
probe.
On the screen the tymp test can be followed on-line.
3. Remove the probe from the first ear when the test
sequence has finished. Select the other ear “Right” (19) or
“Left” (20) and move the probe to the second ear and
repeat the test sequence once again.
Extend Function
In the Tympanometry mode it is possible to extend the
pressure range to go from +300 daPa to –600 daPa by
pressing F6. When the Extend Function is active “Extend” in
lower right hand corner of the screen is highlighted.
The pressure range is indicated by two small, bold, vertical

lines on the horizontal 0 ml line. To go back to the standard
pressure range press F6 once again.

The standard pressure range is set up in the Tympanometry
Setup Menu where Start Pressure and Stop Pressure are
defined.
Tympanometry with High Probe Tone

Note that high probe tone tympanometry and its settings are only
available and visible if the AA222 contains the proper license (for
AA222h). If this is not the case and you would like to use high probe
tone tympanometry, please contact your Interacoustics dealer.
When the instrument is switched on it automatically powers-up in 1)

the Reflex and Tympanometry Test mode or in 2) the Tympanometry
mode (depending on the Power-up setting selected in the Common
Setup Menu).
In order to choose Tympanometry with High Probe Tone select “High

Probe Tone” button F4 (4) from the Tymp test. Figure 15 shows the
Tympanometry Test Screen:
Figure 15:
The Tympanometry mode for High Probe Tone looks very similar to
the normal Tympanometry mode; however, the following differences
can be seen on the screen:

 The scaling is now measured in mmho.
 The pre-selected frequency (678, 800 or 1000 Hz) for the High
Probe Tone test is displayed in the upper left hand side of the
screen.
The Tympanometry test with High Probe Tones is performed in the
exact same way as a normal Tympanometry test.
It is possible to perform normal Tympanometry and High Probe Tone

Tympanometry in one test session and thus print out the test results
for comparison. When the first tympanometry curve has been drawn
(with normal or High Probe Tone) press “High Probe Tone” (4) in
order to enter or exit “High Probe Tone” mode. Now the next curve
will be drawn automatically. Press “Print” (1) and a printout
presenting both curves will appear:
Figure 16:

Note: It is not possible to perform reflexes on the basis of a High
Probe Tone Tympanogram.
Automatic Reflex Test - only


or
3) Audiometry mode

Menu).
To choose between 1) Tympanometry Test, 2) Reflex Test and 3)

Reflex and Tympanometry Test browse with the “Tymp/Reflex” key
(10). Figure 17 shows the Reflex Test Screen:
Figure 17:
In the Reflex Test mode the right indication light only on the

Note: It is recommended always to make a preceding tympanometry
test in order to establish the correct middle ear pressure which is the
optimal basis for precise reflex test.
If a reflex test is performed without first making a tympanometry

curve, the reflex will be performed at 0 daPa and not at the correct
middle ear pressure.

When a correct fit has been obtained the reflex test will begin.

When using the clinical headset select "Pause" (9) to
prevent the instrument from automatically starting the test
as soon as an airtight fit has been obtained.
Place the clinical headset over the patient's head or use the
shoulder strap and insert the probe tip into the ear canal.
When an airtight fit has been obtained the reflex test is
ready to be performed. To start the test, select "Pause" (9)
once again and the test will be carried out automatically.

probe.
On the screen the reflex test can be followed on-line.
3. Remove the probe from the first ear when the test sequence
has finished. Select the other ear “Right” (19) or “Left” (20),
move the probe to the second ear and repeat the test
sequence once again.

Manual Reflexes
With AA222 there are two different ways to perform manual reflexes.
Manual reflexes can be performed subsequently to an automatic test
session or on their own.
After an automatic session where a number of reflexes have been

recorded, there might be a need for making one or more manual
reflexes. This can be performed by pressing “Man/Auto” (17). An
empty reflex box will appear and below it the default intensity and
frequency will be highlighted like in figure 17. With the “Frequency
Decr / Incr” buttons (27 and 28) and the “HL dB” rotary dial (26) it is
possible to change the parameters for the manual reflex.
Figure 18:
When ready, press the “Tone Switch” (29) and the manual reflex will
be performed and appear on the display. The parameters for the
manual reflex can be changed once again if the result is not
satisfactory. When satisfied, press “Store” (24) to store the manual
reflex next to the automatic reflexes in the lower right hand corner of
the screen and AA222 will automatically prepare for performing
another manual reflex.

The number of manual reflexes available depends on the number of
automatic reflexes recorded. 18 reflex boxes per ear can be stored. If
for instance 6 automatic reflexes are store there are 12 manual
reflexes available and if for instance 12 automatic reflexes are stored
there are 6 manual reflexes available.
Editing Automatic and Manual Reflexes

After a session of automatically or manually recorded reflexes you
have the following possibilities to edit and work with the reflexes:
 Browsing between the reflexes.
 Repeating reflexes.
 Deleting reflexes
The idea of browsing between the automatically recorded reflexes is

to see the individual reflex not only in the small reflex boxes, but also
on the full screen. After the automatic test procedure press
“Man/Auto” (17) and an empty reflex box will appear and below it the
default intensity and frequency will be highlighted like in figure 19.
Figure 19:
Just above the F1 and F2 keys there are two small arrows pointing to
the left and the right hand respectively. By pressing the F1 and F2
keys it is possible to browse between the recorded reflexes.
Repeating and Deleting reflexes

When browsing between the recorded reflexes it is possible to
manually repeat the reflexes which have been recorded
previously. This is done simply by pressing the ”Tone Switch”
(29). Now the reflex is repeated at the same frequency and
intensity as the previously recorded reflex. This action can be
repeated several times. When satisfied press “Store” (24) to
store the reflex.

Figure 20:
When repeating a reflex, it is possible to change the frequency

by pressing “Frequency Decr / Incr” (27 and 28) and intensity
by pressing the “HL dB” rotary dial (26). This action can be
repeated several times. When satisfied press “Store” (24) to
store the reflex.
Note: If you do not press “Store” (24) the original automatically

recorded reflex will come back.
To delete a reflex use the F1 and F2 key to go to the reflex

which needs to be deleted. When the selected reflex is
highlighted, simply press F4 “Delete” to delete this reflex.
Manual Reflex Decay

There are two different ways to perform reflex decay tests with
AA222. Reflex decay tests can be performed subsequently to an
automatic test session or on their own.
After an automatic session where a number of reflexes have been

recorded, there might be a need for making one or more manual
reflex decay tests. This can be performed by pressing “Man/Auto”
(17).
Now an empty and highlighted reflex box will appear and below it the
default intensity and frequency will be highlighted like in figure 20.
Also “Decay” above the F5-key will be highlighted.
Note: To ensure the right basis for performing a reflex decay test it is
necessary to find the reflex threshold for the frequency to be tested.
When the reflex threshold has been found 10 dB must be added to
this threshold to get the correct starting point.

Figure 21:
When ready, press the “Tone Switch” (29) and the manual reflex
decay will be performed and appear on the screen. The parameters
for the manual reflex can be changed by pressing the “Frequency
Decr / Incr” keys (27 and 28) and dialling the “HL dB” rotary dial (26).
Figure 22:

Press “Store” (24) to store the manual reflex decay. AA222
automatically prepares for performing another manual reflex decay.
In Figure 21 an example of the decay test result can be seen. The

decay result is expressed graphically and numerically in percent (%).
When a reflex decay test has been accepted and stored it will be put
into one of the small reflex boxes. A small “D” (see figure 23) will
indicate that a Decay test has been performed.
Figure 23:
By storing the test result the instrument automatically prepares for

performing another manual reflex or reflex decay test.
Eustachian Tube Function

With AA222 it is possible to perform a Eustachian Tube Function test
for non-perforated ear drums, the so-called Williams Test. With
AA222 the test is semi automatic and will suggest the operator how
to operate the instrument and how to instruct the patient.
To choose the Eustachian Tube Function test press the “ETF” key
(11).
In the Eustachian Tube Function test mode the indication light on the
“ETF” key (11) will be active and at the same time the indication light
on the “Pause” key (9) will start blinking in order to tell the operator
that his/hers action is now needed.


The probe will have an airtight fit, when the indication light on the
Figure 24:
To perform the test the operator will have to press the blinking
“Pause” key (9) to make a tympanometric curve. After the first sweep
an information window appears on the screen:
Figure 25:
Follow this instruction. To decrease the middle ear pressure (create a

negative middle ear pressure) make the patient swallow while closing
his/hers nose with two fingers.
Now press the blinking “Pause” (9) key once again and the test will
make its second sweep. When the second sweep has been carried
out another information window will appear on the screen:

Figure 26:
Follow this instruction. To increase the middle ear pressure (create a

neutral middle ear pressure) make the patient blow softly with the
mouth closed while also closing his/hers nose with two fingers.
Press the blinking “Pause” (9) key once again as told in the
information window and the test will make its final and third sweep.
Now three tympanometric curves can be viewed in the screen where

a change in peak pressure graphically will indicate the function of the
Eustachian tube.
To the right of the tympanogram under Pressure 1, Pressure 2 and

Pressure 3 the peak pressures of the three tympanometric curves
are also expressed numerically in daPa.
If the three peak pressures are the same, it has not been possible for
the patient to operate his Eustachian tube to change the middle ear
pressure. This means that the Eustachian tube is temporarily or
permanently out of function.
probe.
”Child” Function
AA222 has been equipped with a special Child Function. The
intention of this function is to help the operator keeping the child
concentrated for the short while it takes to perform the test.
The Child Function is available from the 1) Tympanometry Test, 2)

Reflex Test and 3) Reflex and Tympanometry Test.
To activate the Child Function press F3.

Figure 27 shows the Reflex and Tympanometry Test with the Child
Function activated:
Figure 27:
The train will continue moving until the selected reflex test session
has finished. When the test session has finished the train will
automatically disappear.

Automatic and Manual Audiometry

or
3) Audiometry mode

Menu). To select manual tone audiometry, press the “Tone” key (25).
Note: From the Audiometry Setup Menu it is possible to select

between manual or automatic audiometry as default at power-up.
The automatic audiometry threshold test is according to the Hughson
Westlake (HW) test procedure, which 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. From the Test Audiometry Setup
Menu it is possible to select between “2 out of 3” or “3 out of 5”
correct responses for the HW test procedure.
In the Automatic Audiometry Test mode the right indication light of

the “Man/Auto” key (17) will be active and the indication light of the
“Pause” key (9) will be blinking.
Figure 28:

Test Procedure:
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.
1. Select desired test ear “Right” (19) or “Left“(2).
2. Select “Famili” (F2) to familiarise the patient with the HW

procedure. When the familiarisation procedure is
succeeded the HW test will start automatically. If the
familiarisation procedure is not needed simply press
“Pause” (9) to start the HW test.
When the audiogram for the first test ear has been completed
the test will automatically continue testing the other ear.
In the horizontal bar above the right and the left audiogram it is
possible to follow the test procedure see figure 25. To the left
there is a small circle, which is highlighted whenever a tone is
audible to the patient. Next to the circle there is a small
rectangle, which is highlighted whenever the patient presses
the patient response button. Finally, the present dB value and
frequency is expressed numerically.
Figure 28:
Manual Audiometry:
To perform manual audiometry first select “Audiometry” (11)
and then press “Man/Auto” (17). In the Manual Audiometry
Test mode the left indication light of the “Man/auto” key (17)
will be active. Now, manual audiometry can be performed.
Select frequency by pressing “Frequency Decr / Incr” (27 and
28) and intensity by dialling the “HL dB” rotary dial (26).
To store thresholds for the audiogram press “Store” (24).

Masking
Normal masking:
By turning the “HL dB” rotary dial (30), the AA222 will
automatically switch on the masking channel. The intensity of
the masking noise is adjusted with the “HL dB” rotary dial (30).
Figure 30:
In the horizontal bar right above the audiogram display of

AA222 it is possible to monitor 1) the masking intensity and 2)
the type of noise chosen NB or WN. See figure 26. In the
audiogram just below the horizontal bar the cursor will indicate
the present masking intensity and frequency.
Note: In the Audiometry Setup Menu it is possible to choose

two different types of noise for output; NB = Narrow Band
Noise or WN = White Noise.
Insert Masking:
In cases where danger of over masking exists, masking by
insert phone is recommended. This will improve the cross
hearing of the masking sound from the approximately 40 dB of
a traditional headphone to the approximately 70 dB of the
CIR33 insert phone.
A) Insert the CIR33 insert phone in the ear to be masked.

B) Follow normal masking procedure.

Synchronous Masking:
Lock the two attenuators together by pressing the "Synch"
button (F6). Changing the intensity for the tones with the “HL
dB” rotary dial (26) will now make an equal change in the
masking noise level. To turn off masking hold down “shift” (18)
and turn the “HL dB” rotary dial (30).
Speech Audiometry
1) Reflex and Tympanometry mode,

or
3) Audiometry mode
(depending on the Power-up setting selected in the Common Setup

Menu). To select speech audiometry, press either the “Mic” key (16)
for live voice speech testing, or press “CD1/CD2” (17) for
presentation of pre-recorded speech material (CD or tape).
Figure 31:
Figure 31 shows the Speech Audiometry Test Screen with two

recorded speech curves and permanent benchmark reference curve.

1. Select desired test ear and transducer (19, 20, 21, 22).
2. Prior to the actual speech testing the intensity of the speech

signal must be calibrated to match the requirements of the
audiometer. This goes for the microphone signal as well as
the signal from CD /tape.
A) To calibrate the microphone signal press “shift” (18) while

holding down “Mic” (16) for approximately two seconds. The
message box shown below will now show up.
Figure 32:
While presenting live speech into the built-in microphone adjust the
VU meter so that maximum deflection reaches “0” indication on its
scale on the points of maximum intensity of the spoken words (see
arrow A). The adjustment is carried out by dialing the “HL dB” rotary
dial (26). To store the VU setting press “Store” (27).
B) To calibrate the CD signal press “shift” (18) while holding down

“CD1/CD2” (8) for approximately two seconds.
The message box shown in Figure 33 will now show up.

For the CD (or tape) adjust the VU meter so that maximum deflection
reaches “0” indication on its scale on the points of maximum intensity
of the recorded speech or noise (see arrow A). The adjustment is
carried out by dialing the “HL dB” rotary dial (26). To store the VU
setting press “Store” (27).
Figure 33:
B
A
In case two CD inputs are used (e.g. one for recorded speech and
one for recorded noise) both inputs must be calibrated. When being
in the message box this is simply done by selecting CD1 or CD2 (see
arrow B) by pressing “CD1/CD2” (8) and store the adjusted VU
setting by pressing “Store” (27).
In order to see the two stored VU settings hold down “shift” while
pressing “CD1/CD2” (8).
3. When calibration is finished, select the desired test level for

the speech test by dialling “HL dB” (26) rotary key.

Automatic Speech Scoring Counter
With AA222 it is possible to perform automatic speech score
calculation. The procedure is as follows:
1. Present a word to the patient.
2. Select “Incorrect” (27) or “Correct” (28) according to the
response from the patient.
3. Repeat 1) and 2) until the word list is completed.
4. Correct speech score will be indicated on the screen in e.g.

80% correct responses. See below
Figure 34
5. The speech score in percentage can be reset to “0” by

pressing “Reset %” (F2).
Note: The word scoring method described here is the DEFAULT

word scoring Method. It is also possible to use the German Method,
in which only the correct button needs to be activated. Please refer to
the section on Speech Audiometry Setup Menu on page 129 for
detailed information about how to change the scoring method.
Number of Words
The number of words to be tested must be entered in the
Speech Setup.
Number of Curves
In addition to the permanent benchmark reference curve it is
possible to record up to 4 speech curves. In order to select and
browse between speech curves 1 to 4 simply press F5.

Deleting Speech Curves
In order to delete one or more recorded speech curves simply
assign the speech curve which must be deleted and delete
them individually by pressing “Delete” (F1).
Man/Rev
You may choose between manual or reverse speech
presentations simply by pressing “Man/Rev” (F3).
Pulse
You may choose pulsing speech for the speech presentation
simply by pressing “Pulsing” (F4).
Masking and Speech

Speech noise as masking may be selected and adjusted by
dialling the “HL dB” rotary key (30). To switch off masking hold
down “shift” (18) while dialling the “HL dB” rotary key (30)
anticlockwise.
While using masking it is possible to synchronies the masking

channel “HL dB” (30) to the speech presentation channel “HL
dB” (26).

ABLB Test
Alternate Binaural Loudness Balancing is a test to detect
perceived loudness differences between the ears. This is
suggested for diagnosing recruitment when only one ear is
expected to suffer from recruitment.
Figure 35:
To select ABLB test in the Audiometry mode press “Function” (shift

(18) with 25). In the Function Screen mode press F1 to select the
ABLB test.
Instruct the patient that
 he will hear tones alternating in his left and right ear
 he is expected to press the response switch corresponding to
the ear where the loudest tone is heard.
The patient must be informed that it is only the loudness of the tone
loudness and not the character of the tone that should be considered.
A) Set the intensity of the tone to the poorer ear at a level 5 dB

above threshold. Adjust the level of the tone for the other ear
so the loudness levels match.

B) Increase the level to the poorer ear 20 dB and repeat test.
Repeat test at increasingly higher intensities until discomfort or
limit of output is reached.
Note: In the Test Audiometry Setup Menu it is possible to adjust the

Pulse Length of the tones for the ABLB test. The Pulse Length can
be adjusted from 250 mS to 5.000 mS in steps of 50mS.
Stenger Test
The Stenger test is a test for malingering based on the auditory
phenomenon of referral to the ear in which the sound appears
loudest (the Stenger effect).
To select the Stenger test in the Audiometry mode press “Function”

(shift (18) with 25). In the Function Screen mode press F2 to select
Stenger test. In the Stenger Test mode the following test parameters
can be altered:
 Press F3 to select between manual or reverse (continuous)

tone presentation.
 Press F4 to select pulsing tones.
 Press F5 to select warble tones.

Figure 36:
A) Ask the patient to press the patient response button when

he hears a tone (Do not mention which ear).
B) Present a tone to the normal ear 5 or 10 dB above its

threshold. The tone presented to the patient must be a
continuous tone, therefore press F4 to highlight “Rev”.
C) Present a continuous tone in “channel 2” to the suspected

ear at a level just below the level that the patient
(untruthfully?) has reported to be his hearing threshold for
this ear.
D) If the patient reports the tone in the normal ear to have

disappeared, thus claims he now hears nothing, he is
malingering.
SISI Test
The Short Increment Sensitivity Index is designed to test the
ability to recognise one decibel increase in intensity during a
series of pure tones bursts presented 20 dB above threshold.

To select the SISI test in the Audiometry mode press “Function” (shift
(18) with 25). In the Function Screen mode press F3 to select the
SISI test.
Figure 37:
A) Select the desired test ear by choosing “right “ or “Left” ear

(19,20). The frequency is selected by pressing “Decr” or “Incr”
(27 and 28) and the intensity is selected by dialling the “HL dB”
rotary dial (26) (frequencies between 500 and 4000 Hz and an
intensity 20 dB above hearing threshold are recommended for
SISI testing).
As soon as being in the SISI Audiometry mode, see figure 29, a

continuous tone will be audible with 5 dB modulation increments
automatically presented at random. This is to familiarise the patient to
discriminate the modulation, and let him respond via the patient
response button.
B) When the patient understands the test procedure, start the

actual SISI test by pressing F3 “1 dB”. Now AA222 will present
1 dB modulation increments at random and the patient is
meant respond to these increments - if he can discriminate
them.

While the SISI test is running it is possible to follow how the patient is
responding to the 1 dB increment presentations. This can be
monitored from the two horizontal bars under “Presentations” and “
Responses” and from the two numerical values to the right of the two
horizontal bars, see figure 29.
During the test the increment intensity may be changed

arbitrarily to prevent malingering. For this purpose press F2, F4
or F5 to select 0, 2 or 5 dB increments. This can be done without
affecting the test result, as only increments at 1 dB are
calculated.
After 20 increments at 1 dB the test stops automatically, and the

score is shown in percentage in the display.
If more frequencies have been tested during the SISI test procedure
it is possible to see them all in the display at the same time by
pressing F6 “Table”.
Figure 38 shows tables of the SISI scores for right and left ear.
Figure 38:
C) To reset the SISI test press F1 “Reset”.

Handling of Ear Tips
Cleaning of Ear Tips
We recommend using a new ear tip for each patient. The ear tip is
not designed for reuse and an appropriate level of cleanliness cannot
be guaranteed even if recognized disinfecting procedures are used.
There is also a risk of material decomposition caused by the cleaning
agent. Only with new and original Interacoustics supplies is the
measuring accuracy guaranteed. Supplies were designed specifically
to obtain optimal measuring results and non-original supplies may
compromise results.
Cleaning of Probe Tip

To secure correct impedance measurements it is important to make
sure that the probe system is kept clean at all times. Therefore, follow
the below illustrated instruction on how to remove e.g. ceru-men from
the small acoustic and air pressure channels of probe tip.
To clean the small acoustic and air pressure channels of probe tip
unscrew the small ribbed plastic nut that holds the probe tip:
Picture 8:
To clean the small acoustic and air pressure channels of probe tip
unscrew the probe cap that holds the probe tip:

Picture 9:
After unscrewing the probe cap it is possible to detach the probe tip
with the small acoustic and air pressure channels from the
transducer house. Out of the probe tip you can take temporarily
remove the sealing gasket.
Picture 10:
Probe cap Sealing gasket Transducer House
Probe Tip with the small acoustic

and air pressure channels
The cleaning of the acoustic and air pressure channels of the probe
tip must be performed by means of the cleaning wire (nylon wire)
which is part of the cleaning tool that can be found in the Ear tips
Assortment provided with the AA222.
When cleaning the acoustic and air pressure channels of the probe
tip the cleaning wire must be inserted from the back of the probe tip
according to picture 11:

Picture 11
After cleaning all the acoustic and air pressure channels of the probe
tip can be reassembled. Place the sealing gasket onto the transducer
house like shown in picture 12 and make sure that holes of the
gasket are aligned with the holes in the holes of the transducer
housing.
Picture 12:

Place the probe tip onto the transducer housing – a small flange will
ensure correct positioning - before the plastic nut is gently tightened.
Picture 13:

Functions of Buttons
The numbers below refer to the drawing in the back of this manual.
1-6) F1 – F6 The six Function Keys hold functions

displayed in the screen right above the
individual F-key.
7) F7 - Back This key will always take you back one

level.
8) Print Prints out the obtained test data.
Shift + print screen Prints out the present screen.
9) Tymp/Reflex Selects:
1. Tympanometry.
2. Reflex and Tympanometry.
3. Reflexometry.
10) ETF Selects Eustachian Tube Function test.
11) Pause Selects pause function when clinical

headset is used.
12) Ipsi To activate and deactivate the ipsilateral
reflex stimulus, which is presented
through the probe.
13) Contra To activate and deactivate the
contralateral reflex stimulus, which is
presented through the audiometric
headphone.
14) Monitor TB First push: Monitor active (the

presentation to the patient from e.g. via
tape or CD can be heard through the
built-in monitor of AA222 or via a
monitor headset).

Second push: Talk Back active (the
patient’s comment or response can be
heard through the built-in monitor of
AA222 or via a monitor headset).
Third push: Monitor as well as Talk
Back is active.
Fourth push: will switch off the three
above functions. This can also be done
by holding down "shift" (10) while
pressing "Monitor TB" (22).
15) Talk Forward Activates the talk forward function.
Shift + new subject Deletes test

results and if a keyboard is installed new
patient data can be typed.
16) Mic Selects microphone for speech

audiometry with live voice.
17) CD1/CD2 Selects CD1, CD2 or CD1 and CD2 at

the same time for speech audiometry
with recorded speech and masking.
18) Shift The shift key activates the sub functions

of the other keys (9 – 27) written in italic.
19) Right Selects right test ear.
20) Left Selects left test ear.
21) Bone Selects bone conduction for left or right

ear.
22) FF 1-2 Pressing "FF 1 2" (30) will select free

field speaker as output for Channel 1.
First push: Free Field speaker 1.
Second push: Free Field speaker 2.
23) Man/Auto Selects between automatic and manual

testing.

24) Store Stores manually obtained data.
25) Tone Selects Audiometry.

Shift + 25) Function Pressing “Function” when being in the
Audiometry mode will take you to the
Select Function mode. From here it is
possible to select between ABLB,
Stenger and SISI Test
26) HL dB Rotary dial for browsing between the

available intensities in the different tests.
27) Frequency Decr Browses between the different

frequency options in manual
reflexometry and manual audiometry.
28) Frequency Incr Browses between the different

frequency options in manual
reflexometry and manual audiometry.
29) Tone Switch Stimulus presentation switch for manual

audiometry and manual reflex mode.
30) Intensity Incr Rotary dial for browsing between the

available intensities when performing
masking, ABLB or Stenger Test.

Technical Specifications
Standards:
Safety: IEC60601-1, Class 1, Type B
EMC: IEC60601-1-2
Impedance: IEC60645-5/ANSI S3.39, Type 2
Audiometer: IEC60645-1/ANSI S3.6, Tone Type
2, Speech Type B-E
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.
Power:
Consumption: 15VA
Mains voltage/fuses: 100-240V~, 50-60Hz, 0.5A max.
The AA222 is delivered with a power cord for the relevant

national mains socket. But AA222 can be powered by any
national AC voltage - Before use, the correct attachment
plug/mains cable must be identified and installed.
Operation Environment:
Temperature: 15 – 35 C / 65 – 95 F
Rel. Humidity: 30 – 90%
Temperatures below 0C / 32F and above 50C / 122F may

cause permanent damage to the instrument and accessories.
Warm up time: 10min at room temperature (20C /

68F)
Printer (Optional)
Type: Thermal printer with recording paper
in rolls.
Printing Time: Depending on the test printed.

Paper Rolls:
Width: 112 (+/- 0.5) mm
Diameter: 45 (+2.0) mm
Basis weight: 58.5 +/- 3g/m2
Thickness: 62 +/- 3 u
Tensile: Min. 3.2 kN/m
Impedance Measuring System

Probe tone:
Frequency : 226 Hz.
Level : 85 dB SPL with AGC, assuring
constant level at different volumes.
Air Pressure
Control: Automatic.
Indicator: Measured value is displayed on the
graphical display.
Range: -600 to +300 daPa.
Pressure Limitations: -800 daPa and +600 daPa.
Pressure Change Rate: Minimum (50 daPa/s), medium,
maximum or automatic with
minimum speed at compliance
peak. Selectable in the setup.
Compliance
Range: 0.1 to 6.0 ml (Ear volume: 0.1 to 8.0
ml). No difference is measured in the
recorded values between static and
dynamic measuring mode.
Types
Tympanometry: Automatic, where the start and stop
pressure can be user-programmed
from the setup menu.
Eustachian Tube
Function: Williams test (automatic
function).

Indicators
Graphical display : Compliance is indicated as ml and
pressure as daPa. Stimulus level is
indicated as dB Hearing Level.
Memory
Tympanometry: 1 curve per ear.
Eustachian Tube
Function: 3 curves per ear.
Impedance calibration properties

Probe tone
Frequencies: 226 Hz ± 1%, 678 Hz ± 1%, 800 ± 1%,
Level: 85 dB SPL ± 1.5 dB measured in an
IEC 60318-5 acoustic coupler. The
level is constant for all volumes in the
measurement range.
Distortion: Max 3% THD
Calibrated transducers
Audiometry headset: Telephonics TDH/DD45 with a static
force of 4.5N 0.5N
Bone conductor: Radioear B71 with a static force of
5.4N0.5N
Definition of units
1 ml at 226 Hz = 1 acoustic mmho,
-8 3
1 acoustics mho = 10 m /Pa·s
1 daPa = 10 Pascal

Reflex and Audiometer Functions
Signal Sources
Tone – Contra, Reflex: 250, 500, 1000, 2000, 3000, 4000,
6000 and 8000Hz.
Tone – Contra,
Audiometry: 125, 250, 500, 750, 1000, 1500,
2000, 3000, 4000, 6000 and 8000Hz
Tone – Ipsi, Reflex: 500, 1000, 2000, 3000 and 4000Hz.
Noise – Contra, Reflex: Wide Band, High Pass, Low Pass
Noise – Ipsi, Reflex: Wide Band, High Pass, Low Pass.
Noise – Audiometry: Narrow Band (IEC60645-1) White
Noise
Inputs
CD1/2: Connection for CD player or tape
recorder.
Mic: Connection for external microphone
for live speech.
Talk Back: Connection for talk back
microphone.
Patient Response : Patient response switch connection.
Output
Audiometry Earphones: Audiometric headphone, left and
right.
Bone Conduction : B71 bone conductor.
Free Field 1 and 2: Electrical output for external 2
channel power amplifier (AP12 and
AP70).
Monitor: Monitor earphone disconnects the
internal monitor loudspeaker when
inserted. Operator can monitor signal
when presented to the patient as well
as the talk back signal from the
patient’s microphone.
Contra Earphone: Audiometric headphones for reflex
and audiometry measurements.
Ipsi Earphone: Probe earphone incorporated in

probe system for reflex
measurements.
Reflex sensitivity: 0.001 ml is the lowest detectable
volume change.
Reflex detection: The risk of artefacts at higher

stimulus levels in reflex
measurements are minor and will not
activate the reflex detection system.
Air: Connection for air system to probe.
USB: Input/output for PC connection. An
external PC can be setup to both
monitor and control the instrument.
The control actions can be followed
on the display and the operation
panel. Online communication can be
selected, where the measured data
will be sent to an external PC.
Keyboard: Connection for external keyboard,
standard PC type.
Tolerance
Probe tone: frequency accuracy better than 2%
Insert earphones: frequency accuracy better than 3%
Super-aural earphone: frequency accuracy better than 3%
THD
Probe tone: THD is less than 3%
Insert earphones: THD is less than 5%
Super-aural earphone: THD is less than 2.5%
Attenuator
Range: 0 to 130 dB in 1 or 5 dB steps.
Typical range is –10 to 120 dB HL.
Range is individual for different
modes – see table 1.
Test Types
Manual Audiometry: Manual control of all functions.
Automatic Audiometry: Auto threshold according to ISO
8253-1 (Patient controlled Hughson
Westlake). Threshold is determined
by the activation of the patient
response.

Manual Reflex: Manual control of all functions.
Reflex Decay: Manually controlled with stimulus
duration of 10 seconds.
SISI: With automatic scoring calculation
(5 dB included for familiarisation.
Warble: 5 Hz sine, +/-5 % modulation.
Stenger: Binaural pure tone or speech
stimulation.
ABLB : Automatic loudness balance test
(Fowler).
Memory
6 ipsilateral and 6 contralateral graphs / curves, which each
can hold up to 6 pulses. There is an additional capacity for 6
manual tests.
Properties of stimuli
General
Specifications for stimulus and audiometer signals are made to
follow IEC 60645-1
Contralateral Earphone
Pure tone: ISO 389-1 for audiometric headphone
Wide Band noise (WB): Interacoustics standard
- spectral properties: As “Broad band noise” specified in IEC
60645-5, but with 500 Hz as lower cut-
off frequency.
Low pass noise (LP): Interacoustics standard
- spectral properties: Uniform from 500 Hz to 1600 Hz, ±5
dB re. 1000 Hz level
Hign pass noise (HP): Uniform from 1600 Hz to 10 kHz, ±5
Ipsilateral Earphone
Pure tone: Interacoustics standard
Wide Band noise (WB): Interacoustics standard
- spectral properties: As “Broad band noise” specified in IEC
60645-5, but with 500 Hz as lower cut-
off frequency.
Low pass noise (LP): Interacoustics standard
- spectral properties: Uniform from 500 Hz to 1600 Hz, ±10

Hign pass noise (HP): Uniform from 1600 Hz to 10 kHz, ±10
General about levels: The actual sound pressure level at the
eardrum will depend on the volume of
the ear. See table 2.
Electrical output properties

Initial Latency: 44.2 (+5/-0) mS
Rise Time: 44.2 (+5/-0) mS
Terminal latency: 44.2 (+5/-0) mS
Fall time: 44.2 (+5/-0) mS
Overshoot: 5 % (± 2%)
Undershoot: 5 % (± 2%)
Table 1: Frequencies and intensity ranges
Frequency Reflex
Contralateral Ipsilateral
Audiometric EAR-Tone 3A Insert/CIR33
headphone
Min Max* Min Max* Min Max* Min Max*
Hz dB HL dB HL dB HL dB HL dB HL dB HL dB HL DB HL
250 -10 110 -10 105 0 100 - -
500 -10 120 -10 110 0 105 10 105
1000 -10 120 -10 120 0 110 10 110
2000 -10 120 -10 120 0 105 10 105
3000 -10 120 -10 120 0 100 10 100
4000 -10 120 -10 115 0 95 10 100
6000 -10 120 -10 100 - - - -
8000 -10 110 -10 95 - - - -
WB noise -10 120 -10 120 0 100 10 105
LP noise -10 120 -10 120 0 100 10 105
HP noise -10 120 -10 120 0 100 10 105
Minimum level step size 5 dB
Maximum difference error between tow steps is less than ±3 dB
Residual noise is less than 25 dB (A)
Signal to noise ratio is larger than 80 dB (A)
ON-OFF ration is larger than 80 dB (A)
Rise-/fall time: 35 ms (±10 ms)

Table 2: Variation of ipsi stimulus levels for different volumes of
the ear canal
Freq. Variation of ipsi stimulus levels for different

volumes of the ear canal
Relative to the calibration performed on an IEC 126 coupler
0.5 ml 1 ml
[Hz] [dB] [dB]
500 9.7 5.3
1000 9.7 5.3
2000 11.7 3.9
3000 -0.8 -0.5
4000 -1.6 -0.8
WB 7.5 3.2
LP 8.0 3.6
HP 3.9 1.4

Table 3: General properties for earphones
Sound attenuation values for Difference between free field
earphones and coupler sensitivity
levels. Used by Free Field
equivalent earphone output
(Type A-E or B-E)
Freq. Attenuation Freq. Correction
values
Audiometric EAR- Audiometric
headphone Tone 3A headphone with
with MX41/AR MX41/AR or PN
or PN 51 51 cushion
cushion using IEC 303
coupler
[Hz] [dB] [dB] [Hz] [dB]
125 3 32.5 125 -17.5
160 4 - 160 -14.5
200 5 - 200 -12
250 5 36 250 -9.5
315 5 - 315 -6.5
400 6 - 400 -3.5
500 7 37.5 500 -0.5
630 9 - 630 0
750 - - 750 -
800 11 - 800 -0.5
1000 15 36.5 1000 -0.5
1250 18 - 1250 -1
1500 - - 1500 -
1600 21 - 1600 -4
2000 26 33 2000 -6
2500 28 - 2500 -7
3000 - - 3000 -
3150 31 - 3150 -10.5
4000 32 39.5 4000 -10.5
5000 29 - 5000 -11
6000 - - 6000 -
6300 26 - 6300 -10.5
8000 24 42.5 8000 1.5

Table 4: Reference values for stimulus and audiometer
calibration
Freq. Reference values for stimulus and audiometer
calibration
ISO ANSI ISO 389-4 ISO 389-3 ANSI ISO 389-2 ISO 389- ISO 389- Interacoustics Standard
389-1 S3.6 (ISO 8798) (ISO S3.6 7 7
(NB 7566) (Insert) Free Diffuse- TDH/DD Insert Ipsi
(TDH/ (TDH/DD masking) (BC) (BC) field field 45
DD45) 45) (FF) (FF)
[Hz] [dB [dB re. [dB re. [dB re. [dB re. [dB re. [dB re. [dB re. [dB re. [dB [dB re.
re. 20 20 µPa] 1µN] 1µN] 20 µPa] 20 20 20 re. 20
20 µPa] µPa] µPa] µPa] 20 µPa]
µPa] µPa]
125 45, 45 4 26 22,0 22,0
0
250 25, 25,5 4 67 67 14 11,0 11,0
5
500 11, 11,5 4 58 58 5,5 4,0 3,5
5
750 7,5 8 5 48,5 48,5 2 2,0 1,0
1000 7 7 6 42,5 42,5 0 2,0 0,5
1500 6,5 6,5 6 36,5 36,5 2 0,5 -1,0
2000 9 9 6 31 31 3 -1,5 -1,5
3000 10 10 6 30 30 3,5 -6,0 -4,0
4000 9,5 9,5 5 35,5 35,5 5,5 -6,5 -5,0
6000 15, 15,5 5 40 2 2,5 -0,5
5
8000 13 13 5 40 0 11,5 5,5
WB -8 -5 -5
LP -6 -7 -7
HP -10 -8 -8
ISO 389-3 / ANSI S3.6. Valid for placement on the human mastoid
Coupler types used by calibration

 TDH/DD45 is calibrated using a 6cc acoustic coupler made in
accordance to IEC 60318-3
 Insert phones are calibrated using a 2cc acoustic coupler made in
 Bone Conductor is calibrated using a mechanical coupler made in

Tabe 5. Specification of input/output connections
Inputs Connector Electrical properties

type
Mains connector IEC 60320-1 2.5A/250V AC
Type C6
Patient response Jack, 6.3mm Handheld switch: Signal is forced to +5V level when
stereo activated.
CD 1 and 2 Jack, 3.5mm Sensitivity: 9 mV at max volume and 0 Vu
stereo Impedance: 47.5 k
Freq. Response: 75-12000 Hz  3dB
Microphone Jack, 3.5 mm Type: Electret or 2000 dynamic
stereo Sensitivity: microphone.
Impedance: 100 V at max volume for 0 Vu
Freq.Response: reading
Electret bias: 47.5 k
90-20kHz
6.2V through 4.75 k (1.3 mA)
Talk Back Jack, 6,3 mm As for Microphone
microphone stereo
Outputs:
Phones, Left/ Jack, 6.3mm Voltage: Up to 5.5V rms. by 10 load
Right mono Min. load impedance: 5
Bone conductor Jack, 6.3mm As for Phones,
mono Left/Right
Free Field 1, 2 Phono Voltage: Up to 8.0V rms. by 100 load
Min. load impedance: 100
Freq. response: 75-12000 Hz +/-3dB
Output impedance: 500 ohm
Monitor Jack, 6.3mm Voltage: Up to 2.0V rms. by 8 load
mono Min. load impedance: 0
Phones, Jack, 6.3mm Voltage: Up to 5.5V rms. by 10 load
Contralateral mono Min. load impedance: 5
(Insert masking)

Transducer CANON, 15 Pin 1: Press. 1 signal
pole Pin 2: 12V
Pin 3: -12V
Pin 4: Remote key/detection
Pin 5: Probe tone
Pin 6: Mic. signal
Pin 7: LED blue
Pin 8: Press. 2 signal
Pin 9: LED green
Pin 10: Ipsi Stim. Gnd.
Pin 11: Ipsi Stim. Signal
Pin 12: Probe tone Gnd.
Pin 13: Gnd.
Pin 14: Vref., 5V
Pin 15: LED red
Data I/O:
USB USB type”B” USB port for See appendix A in service manual
communication for detailed information
Table 6: General properties for earphones.

Sound attenuation values for earphones
Frequency Attenuation
TDH/DD45 with MX41/ EAR-Tone 3A
AR or PN 51 cushion EAR-Tone 5A
[Hz] [dB] [dB]

125 3 33,5
160 4
200 5
250 5 34,5
315 5
400 6
500 7 34,5
630 9
750 -
800 11
1000 15 35,0
1250 18

1500 -
1600 21
2000 26 33,0
2500 28
3000 -
3150 31
4000 32 39,5
5000 29
6000 -
6300 26
8000 24 43,5
Table 7: Audiometry frequencies and intensity ranges

Frequency Audiometry
TDH/DD45 EAR-Tone Bone Insert Masking Free Field
conduction NB
3A
B71
Min Max Min Max* Min Max* Min Max* Min Max*
*
Hz dB dB dB dB dB dB HL dB dB HL dB dB HL
HL HL HL HL HL HL HL
125 -10 90 -10 90 - -- - - -10 80
250 -10 110 -10 105 0 45 0 105 -10 90
500 -10 120 -10 110 0 65 0 110 -10 100
750 -10 120 -10 115 0 70 0 110 -10 100
1000 -10 120 -10 120 0 70 0 110 -10 100
1500 -10 120 -10 120 0 70 0 110 -10 100
2000 -10 120 -10 120 0 75 0 110 -10 100
3000 -10 120 -10 120 0 80 0 110 -10 100
4000 -10 120 -10 115 0 80 0 105 -10 100
6000 -10 120 -10 100 0 55 0 95 -10 95
8000 -10 110 -10 95 0 50 0 90 -10 90

Speech Type -10 100 -10 90 -10 50 - - 0 100
B
Type -10 110 -10 90 -10 50 - - 0 100
B-E
Speech Type -10 100 -10 90 - - 0 90 0 90
Noise B
Type -10 110 -10 90 - - 0 90 0 90
B-E
Note: Max values are obtainable by selecting “Ext. Range” on the
instrument.
Parts
Included Parts:
Audiometric headphone Single contralateral headset
CIR33 Insert earphones
B71 Bone conductor
APS2 Patient Signal
ATP-AT235U Universal probe system with shoulder strap and
wrist strap (tubing 360mm Ø1.3xØ3.3 transparent silicone)
TPR26 3 rolls of recording paper
Power cable
Dust cover
Operation Manual.
Multilingual CE instructions for use
Additional Parts:
EARtone 5A Audiometric Insert Phones
50250 Peltor noise exclosures
21925 Amplivox noise exclosures
ACC400 carrying case
CAT50 calibration unit 0.2-0.5-2.0-5.0 ml
IES impedance ear simulator
GSE10 RS232 Galbanic isolation adapter
USB cable 2m black

Connection Panel
Power Connection Power connection toBack
Talk optical USB External microphone
On/Off at for Patient microphone connection
side of response connection
panel button
Connection for
Test cavities 0.5 cc & 2 cc, Connection Contra Phone
Probe tolerances are ± 0.2 cc for Monitor
holder
CD player
Connection for connection
bone conductor
Connection for
audiometric Contra Phone
Connection to headphone connection
mains Phones
Connection for
Connection for
FF amplifiers
Probe System
Connection Printer compartment Connection Piece for air

for USB for internal printer supply to probe system
Please note that the built-in test cavities are intended for a daily
check only and not for calibration purposes.

Unpacking / Inspection
Check box and contents for damage:
When the instrument has been 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.
Store carton for future shipment

The AA222 comes in its own shipping carton, which is specially
designed for the AA222. Please store 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.
Contents of Shipment
When AA222 is delivered as a standard unit the case contains the
following:
Quantity Item Order No.
1 Instrument AA222
1 Audiometric Headset Audiometric
headphone
1 Bone Conductor B71
1 Patient Signal APS2
1 Universal Probe System ATP-AT235U
3 Rolls of Recording Paper TPR26
1 Power Cable -
1 Box of 65 Assorted Eartips BET55
1 Operation manual
1 CE-manual

Check numbers on AA222 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.
Reporting Imperfections
Inspect before connection:
Prior to connecting AA222 to 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. Therefore using the
Return Report will be of great help to us and at the same time
it is your best guarantee that the correction of the problem will
be to your satisfaction.

Care and Maintenance
The performance and reliability of the AA222 will be prolonged if the
following recommendations for care and maintenance are adhered
to:
Great care when handling the transducers:

Great care should be exercised when handling the transducers of
AA222 as dropping them may alter the calibration.
Annual calibration:
The AA222 has been designed to provide many years of
reliable service, but annual calibration is recommended due to
possible impact on transducers.
We do also recommend to calibrate the AA222 if something

drastic happens to a part of it (e.g. if headset or bone
conductor is dropped on a hard surface).

Trouble Shooting
Data is not transmitted to the computer:
The correct COM port must be selected in the computer, and
this COM port must be chosen in the computer program.
The baud rate in the computer program must be set to USB.
The USB driver must be installed on the PC. Please refer to

“Appendix B” of this manual for instructions.
No Tymp curves are drawn:

The probe system has to make a perfect seal to the ear canal.
This has not been obtained if the display shows "Leaking" or
"Blocked" and the indication light on the probe is yellow. A
perfect seal is indicated with a green light on the probe.
Check if the transducer / probe system is connected on the

connection panel of AA222.
The small rubber tube of the probe cable must be connected

on the connection panel of AA222.
"Blocked" is displayed in Tymp mode:

The probe is blocked at the ear tip, either by wrong insertion
into the ear canal, or by cerumen. Any accumulated cerumen
at the probe tip opening should be removed very carefully.
Please refer to the chapter "Cleaning Probe and Ear tips" of

this manual for details.
Test starts despite a blocked ear tip:

The instrument must warm up for 10 minutes for calibration to
be accurate.
If the problem is still present a calibration of this feature by

means of a 0.2ml cavity calibrator is needed to match the
altitude related air pressure of the installation site. This is a job
for a technician.

Printer does not respond:
The printer might be out of paper!
Please refer to “Installing Printer Paper” in order to see how to

change the paper roll.
Maybe the printer is set to “Off” in the Common Set Up under

Printer.
Printer responds, but nothing is printed on the paper:

The printer paper has been installed incorrectly meaning that
the backside of the paper is facing the printer head.
Simply turn around paper roll. Please refer to the chapter
“Installing Printer Paper”.
Display is too bright or too dark:

From the Main Menu it is possible to adjust the brightness by
means of “LCD-“ and “LCD+” (F5 and F6).

Frequently Asked Questions
My Reflex Test (A or B) is pre-programmed to ipsilateral
reflexes. Is it possible also to have contralateral reflexes in the
same session or simply contralateral reflexes only?
Yes and yes!
In the Reflex and Tympanometry test menu the indication
lights of the “Ipsi” key (12) and the “Contra” key (13) will inform
you which reflex method is selected, Ipsilateral and / or
contralateral.
Normally, only the indication light of the “Ipsi” key (12) will be
active informing that only the ipsilateral reflex test will be
performed during the subsequent test procedure. Press the
“Contra” key (13) to activate also the contralateral reflex test
for the subsequent.
In case only contralateral reflexes are wanted, press the “Ipsi”

key (12) to switch off the indication light in the “Ipsi” key and
deactivate the ipsilateral reflexes.
Sometimes I would like to temporarily change the pre-

programmed reflex setup. How can I do that?
It is always possible to modify the pre-programmed reflex test
A or B in the Reflex and Tympanometry test menu. All previous
data must be deleted by pressing “new subject” (9) while
holding “shift” (18).
In the lower right hand corner of the display it is now possible

to activate the Modify Menu by pressing “Modify” (F6). In the
Modify Menu the selected Reflex Method (Fixed, Screening,
Auto or Sequence) can now be modified to personal need. It is
possible to select between ipsilateral or contralateral reflexes,
frequency and intensity can be changed and finally reflexes
can be switched on or off according to the number of reflexes
needed.
Note: The modifications carried out in the Modify Menu are

current only until all previous data have been deleted by
pressing “new subject” (9) while holding down “shift” (18).

Why is the light on the probe sometimes yellow?
When the light on the probe is yellow this indicates that the
probe tip is blocked e.g. against the wall of the ear canal or
that an airtight fit of the ear tip cannot be obtained.
Why does the test not start automatically?

Please check if the indication light on the “Pause” key (9) is
blinking!
AA222 is designed with a Pause Function, which is very

convenient especially in connection with the use of the clinical
probe.
The Pause Function can be chosen as power-up under

“Pause” in the Common Setup Menu or it can be selected from
the operation panel when needed when simply by pressing the
“Pause” key (9).
When the Pause Function is selected either manually or as

power-up the indication light will be active on the “Pause” key
(9).
The Remote Switch on the probe does not allow me to change

between right and left ear:
The function of the remote switch on the probe is defined
under Remote Switch in the Common Setup Menu of AA222. It
is possible to set up the remote switch to:
a. “L/R” – in this way you can select between left and right
ear.
b. “Pause” – in this way the Pause Function can be
controlled.
c. “L/R or Pause” – in this way you can select between left
and right ear, when the probe with the ear tip is out of the
ear. And the Pause Function can be controlled when the
probe with the ear tip is inside the ear.
d. The remote switch is set to “Off”.
The Remote Switch on the probe does not allow me to control

the Pause Function:
See previous paragraph!

The instrument only performs Tympanometry:
This is probably because of the fact “Tymp” has been selected
in Power-up under the Common Setup Menu instead of “Reflex
and Tymp”.
Can I review recorded reflexes?

Yes!
After a test session it is possible to review the recorded
reflexes. All recorded reflexes can be viewed in the small reflex
boxes in the lower part of the display. However, by pressing
“Man/Auto” (17) two small arrows “” and “” (F1 and F2)
makes it possible to browse between all recorded reflexes
from the small reflexes. When a specific reflex is viewed in the
small reflex box, the numerical data for the reflex test is
highlight and the graphical data of the reflex test is shown in a
large window above the reflex box.
What is Gradient?
Gradient is explained in the chapter “Tympanometry Setup
Menu” of this manual.
My AA222 only displays 4 reflexes boxes. I need 6 reflex boxes:

In the Common Setup Menu under Reflex Icon Boxes it is
possible to select between either 4 or 6 reflex boxes. Make
sure that you select the right number of reflex boxes according
to personal preferences.
I find the sensitivity of the reflex recording unsuitable! Can it be

modified?
Yes!
In the following Reflex Methods: Screening, Auto and
Sequence (Sequence only when Test Stop Criteria is set to
Automatic) it is possible to set the Reflex Sensitivity to
Sensitive, Normal or Robust.
In the chapter “Reflex Methods” in this manual, the three
settings are explained in detail.

Recommended Literature
Arlinger, Stig:
Manual of Practical Audiometry, Vol.1 (Taylor & Francis. 1989.)
Bess, Fred H. and Hall III, James W.:

Screening Children for Auditory Function. (Bill Wilkersen
Center Press 1992)
Biswas, Anirban:
Clinical Audiovestibulometry, (Bhalani Medical Book House,
th
Bombay, India 4 edition 2009)
Borg, Erik et al.:

Audiological Aspects of Secretary Otitis Media. (Scand. Aud.
Supp. 26. 1985)
Brask, T.:
Extratympanic Manometry in Man. (Scandinavian Audiology,
supp. 7. 1978)
Feldmann and Laura Ann Wilber:

Acoustic Impedance Admittance - the measurement of middle
ear function. (Williams & Wilkins 1976)
Fiellau-Nikolajsen, Mogens:
Tympanometry and Secretary Otitis Media. (Acta Oto-L. 1983)
Harford, Earl R.:

Impedance Screening for Middle Ear Disease in Children.
(Grune & Stratton. 1978)
Jerger, J.:
Clinical Experience with Impedance Audiometry. (1970)
Katz:
Handbook of Clinical Audiology, Fourth Edition 1994 (Williams
& Wilkins 1985)

Kunov, H.:
The "Eardrum Artifact" in Ipsilateral Reflex Measurements.
(Scand. Aud. 6. 1977)
Liden, G. et al.:
International Symposium on Impedance Audiometry and
Pediatric Audiology Göteborg 1982. (Scandinavian Audiology
supp. 17. 1983)
Liden, G. et. al.:

Automatic Tympanometry in Clinical Practice. (Audiology 13.
1974)
Liden, G. et. al.:

Tympanometry for the Diagnosis of Ossicular Disruption. (Arch
Otolaryngol vol.79 1974).
Liden, G.:
Audiology (Almqvist & Wiksell. 1985) (Swedish language)
Popelka, G. R. et al.:
Hearing Assessment with the Acoustic Reflex. (Grune &
Stratton 1981)

Dictionary
Acoustic Admittance:
The ease with which sound waves flow through a medium, as
the eardrum membrane. See Acoustic Immittance.
Acoustic Compliance:
Another term for Acoustic Admittance.
Acoustic Immittance:
Refers collectively to acoustic impedance and / or acoustic
admittance.
Compliance:
1) Ease with which air moves (e.g. influenced by the
eardrum and middle ear mechanism).
2) Often used to indicate the equivalent volume of air in
the middle ear.
Contra lateral Reflex:

The middle ear muscle reflex that occurs in the ear, contra
lateral to the stimulus ear.
Dynamic Acoustic Compliance:

See Dynamic Acoustic Immittance.
Dynamic Acoustic Immittance:

The acoustic immittance as observed with a continuous
change in air pressure (tympanometry) and/or during the
activation of the middle ear muscle(s) (reflex measurements)
Ear Tip: A cuff which is used to seal the probe into the external
auditory canal.
ETF: (Eustachian Tube Function). This function is tested by trying to

force air through the Eustachian tube and then by
tympanogram recordings checking if the expected change of
middle ear pressure has occurred.

Ipsilateral Reflex:
The middle ear muscle reflex which occurs in the stimulus ear.
Myringoplasty:
Surgical repair of the eardrum membrane.
Myringotomy:
(tympanotomy) A small incision made in the eardrum
membrane to remove fluid from the middle ear.
Non Acoustic Reflex:

A middle ear muscle reflex elicited by a non-acoustic stimulus.
Ossicular Chain Disruption:

(Ossicular chain interruption, discontinuity or disarticulation) A
break in the three connected bones (ossicles) in the middle
ear.
Pascal (Pa):
2
A unit of pressure or stress, equal to one Newton per m .
Static Acoustic Compliance:

See Static Acoustic Immittance.
Peak Static Acoustic Immittance:

The static acoustic immittance obtained with a specific air
pressure in the external auditory canal as adjusted to produce
an extreme in the measured acoustic immittance.
Probe:
A coupling device that is inserted into the external auditory
canal, to connect it to the acoustic immittance meter.
Probe Ear:
The ear into which the probe is inserted.
Probe Signal:
An acoustic signal that is emitted into the external auditory
canal by means of a probe. The signal is used to measure
acoustic immittance.

Probe Tip:
The upper part of the probe tip on which the ear tip, a cuff
which is used to seal the probe into the external auditory canal,
is placed.
Reflex Activated Acoustic Immittance:

The acoustic immittance measured with the middle ear muscle
reflex activated by a defined stimulus at a specified air
pressure and with a constant tonus of the middle ear muscle.
Static Acoustic Immittance:

1) The acoustic immittance as observed at a constant
specified air pressure and with a constant tonus of the
middle ear muscles.
2) The volume of air that is equivalent in acoustic
compliance to that of the middle ear. Measured in
2
millilitres or cm .
Stimulus Ear:
The ear to which the reflex activating stimulus is presented in
order to elicit a middle ear muscle reflex. Note: If a bone
vibrator or a loudspeaker is used to deliver an acoustic reflex it
may not be possible to define the stimulus ear.
Toynbee Test:
Test designed to determine the function of the Eustachian tube
in ears with perforated eardrums.
Toynbee's Manoeuvre:
See Valsalvation.
Tympanogram:
A chart of the results of tympanometry - compliance
measurements at the eardrum.
Tympanometry:
The measurement of the ability of the eardrum and ossicular
chain to transmit sound pressure waves. An intact eardrum is
subjected to air pressure changes to determine its stiffness
(impedance) and compliance (admittance).

Valsalvation:
Swallowing with the mouth and nose closed to draw air out of
the middle ear. Syn.: Toynbee's manoeuvre.
Valsalva's Manoeuvre:
Blowing forcibly to open Eustachian tube by holding nose and
closing mouth. Named for its originator, Antonio Valsalva.
Sometimes called Valsalva's experiment.
Williams Test:
Test designed to determine the function of the Eustachian tube
in ears with non-perforated eardrums.

Appendix A: Setup
The internal Main Setup Menu of AA222 is reached from the Main
Menu by pressing “Setup” (F2).
Figure 39:
From the Main Setup Menu it is possible to enter the following Setup
Menus by pressing F1 to F5:
 Tympanometry Setup
 Setup for Reflex Test A and B
 Common Setup
 Clinic Setup
In the individual setup menus navigation through the setup points and
changing parameters in the individual setup points is very simple.
With the F-keys (F2 to F5) representing arrow keys “, , , ” it is
possible to browse through the different setup points. Parameters
can be changed with “Change” (F1) when it is highlighted.
To leave the individual setup menus press “Back” (7). This key will
always take you back one level. If one or more parameters have
been changed the message in figure 36 will appear on the screen.
To confirm the changes press F1 for “Yes” or F6 for “No”.

Figure 40:
Tympanometry Setup Menu

The Tympanometry Setup Menu is reached from the Main Menu by
pressing “Setup” (F2) and “Tymp” (F1):
Figure 41:
Start Pressure:
Indicates the starting point for the pressure sweep for the
tympanometric curve. It goes from 25 daPa to 300 daPa.
Stop Pressure:
Indicates the pressure where the sweep for the tympanometric
curve will stop.

Pump Speed:
With AA222 there are four different pump speed settings:
 Minimum (17 daPa/sec).
 Medium (50 daPa/sec).
 Maximum (>150 daPa/sec).
 Automatic (see below).
A slow speed will be more time consuming, but may give more
detailed information. The horizontal displacement of the
tympanometric curve’s peak in the sweeping direction caused
by inherent hysteresis of the system and the middle ear itself
will be smaller with lower speed.
With the Automatic setting speed and precision is combined in

the tympanometric sweep. At the start of the sweep the pump
speed will be at maximum due to the fact that the information
derived from the first part of the sweep only contains little
information of diagnostic value.
The speed will gradually be reduced to minimum speed when

coming closer to the peak. Just before and just after the peak
the pump speed will be at minimum since this part of the
sweep diagnostically is the most important part. At the final
part of the sweep the speed will gradually increase again to
reach maximum at the end of the sweep.
Compensated Mode:
Figure 42: Compensated Figure 43: Non-Compensated

AA222 can be set to either Compensated Mode or Non
Compensated Mode. Compensated Mode is used when you
want the tympanometric curve to be displayed at the floor of
the co-ordinate system of the tympanogram. See figure 42.
Non Compensated Mode is used when you want the
tympanometric curve to be displayed including the ear canal
volume. See figure 43.
Gradient Unit:
The Gradient unit is an expression of the shape of the
tympanometric curve (narrow or wide).
 If ml is selected the program will go 50 daPa to each
side from compliance value and save the two ml
values. The gradient is the average of the two ml
values subtracted from the compliance value.
 If daPa is selected the gradient will be calculated the
following way: The program searches from each end
of the tymp curve and stores the pressure at the point
where the tymp curve is equal to compliance value
divided by 2. Gradient is equal to the two stored
pressures subtracted from one another.
High probe tone frequency:

Note that only when the AA222 was licensed to have the high
probe tones available, the option to select among three
different high probe tones; 678, 800 and 1000 Hz is presented.
From the Tympanometry Setup Menu you select which High

Probe Tone Frequency should be used when selecting the
“High Probe Tone” with button F4 (4) in the tympanometry test.
Tympanometry Scale:
For the tympanic tests is defined which is the default scaling. If
needed, you can set the scaling differently in the test screen by
pressing button F5 (5).

Setup Menu for Reflex Test A and B
The Setup Menu for Reflex Test A and B is reached from the Main
Menu by pressing “Setup” (F2), “Imp” (F1) and finally F2 “Reflex Test
A” or F3 “Reflex Test B”.
Figure 44:
It is possible to choose between four different Reflex Methods:

 Fixed Intensity
 Screening (10 dB Steps)
 Auto (5 dB Steps)
 Sequence
Each Reflex Method can hold up to six individually pre-programmed

reflexes. In the below figure 45 the starting conditions for each of the
four Reflex Methods can be set up to personal needs:
Figure 45:
The four arrow keys (F2 to F5) browses between the parameters of
the individual reflex.

Each reflex parameter can be changed by pressing “Change” (F1) or
by pressing the dedicated keys “frequency Decr / Incr” (27 and 28)
and by dialling the “HL dB” rotary dial (26).
Output:
It is possible to select between ipsilateral and contralateral
reflexes as output.
Stimuli Frequency:
For ipsilateral reflexes the stimuli frequency options are: 500,
1000, 2000, 3000 and 4000 Hz, including also the noise stimuli
WN, LP and HP.
For contralateral reflexes the stimuli frequency options are:

125, 250, 500, 750, 1000, 1500, 2000, 3000, 4000, 6000 and
8000 Hz, including also the noise stimuli WN, LP, and HP.
Level:
The intensity level for the reflexes goes from 60 dB to
maximum. Maximum depends on the selected frequency and
the selected transducer. In the final line of the table it is
possible to switch on or off the reflexes according to the
number of reflexes needed.
Note: It might be relevant to set reflexes which are only rarely

used to “off”. When used now and then these reflexes can be
turned “on” via the Modify Menu.
Reflex Methods
There are four different reflex methods for Reflex Test A and B:
Fixed Intensity Method:

With the Fixed Intensity Method the parameters of the
individual reflex (frequency and intensity) are fixed:

Figure 46:
Reflex Sensitivity:
To fully understand the reflex search procedure of the
following three Reflex Methods it is important to know about
the Reflex Sensitivity idea. Reflex Sensitivity appears under
the Reflex Method line when Screening, Auto or Sequence
Method are selected.
The software of AA222 uses an algorithm to determine if a
reflex is acceptable or not. There is a selection of three
different algorithms to choose from, each representing its
individual level of Reflex Sensitivity. These three Reflex
Sensitivities are referred to as Sensitive, Normal and Robust
and they are expressed in ml.
When searching for the reflex by means of the following three

Reflex Methods the algorithms in the software will continue to
search for the reflex until the intensity has reached the
maximum level for the selected transducer at the given
frequency. Therefore, a reflex can be accepted in two ways:
1. The reflex does not touch the pass box (the pass box is
normally invisibly - see figure 43 to 46).
2. Intensity is at maximum level.

To understand what is meant by pass box see the three
figures below. The pass box is the dotted rectangle in the
middle of the 4 figures.
Note: The pass box is not shown in the screen of AA222 but
serves as an example of what sensitivity is and how it is used.
Figure 47 to 50 show examples of how the Reflex Sensitivity

system functions:
Figure 47: Sensitive (0.03 ml) Figure 48: Normal (0.05 ml)
Figure 49: Robust (0.08 ml) Figure 50: Robust (0.08 ml)
The first three reflexes are all examples of reflexes that have
been accepted according to the different algorithms (sensitive,
normal and robust). They are accepted because they do not
touch the pass box. However, figure 50 shows an example of
a reflex that is not accepted according to the chosen algorithm.
The reflex is not accepted because it goes through the pass
box.
Sensitive makes the search algorithm accept small reflexes,

elicited by a relatively low stimulus intensity. Unfortunately, the
test is easily disturbed by noise and movements of the probe.

Robust needs more compliance change for the initial search
function to trigger - this will ensure a test which can be carried
out with a less than perfect test situation, but will also run
relatively high in intensity and provide similarly larger reflexes.
Normal is a compromise suitable for most applications - it is

relatively forgiving for the accuracy of the test procedure, and
still does not run excessively loud in intensities.
Screening (10 dB steps):

Figure 51 shows the screen for setting up the Screening (10
dB steps) Reflex Method:
Figure 51:
The Screening Method is an automatic test for detecting

reflexes. The reflex parameters in the Screening Method can
be set up to personal needs from the reflex table in the lower
part of the screen.
The Screening Method starts with the selected Output, Stimuli

Level and Intensity Level from the parameter table in figure 37
as starting point for the reflex test. It will automatically search
for the reflex in steps of 10 dB according to the selected
Reflex Sensitivity. If the reflex is above the above mentioned
pass box it will be accepted and drawn on the screen. The test
will then automatically proceed to the next reflex.

If the reflex goes through the pass box it is not accepted. The
intensity level automatically increases with 10 dB for another
reflex. This procedure continues until the reflex is above the
selected pass box or the maximum intensity level is reached.
Auto (5 dB steps):
Figure 52 shows the screen for the Auto (5 dB steps) Reflex
Method. The Auto test is used for testing where only one reflex
is needed per frequency, but a reflex of a certain size is
preferred (see “Reflex sensitivity” above). The Auto test then
searches for suitable stimulus intensity before each reflex is
tested.
Figure 52:
The automatic procedure for determining which intensity to use

for the reflex test follows these guidelines:
1) A stimulus where the intensity quickly increases is
presented to the ear. Simultaneously, the instrument
monitors at which intensity a change of compliance occurs
(typically caused by the reaction of the Stapedius muscle).
2) Now the actual reflex test will be performed, using the

intensity found in 1).
3) The recorded reflex will be checked automatically to

ensure that it meets the criteria (see “Reflex sensitivity”
above).

If it does, the test at this frequency is completed. If the
reflex does not pass the criteria, automatically 1) 2) and 3)
is repeated.
4) If the reflex found the second time does not meet the pass
criteria either, a new reflex is recorded at 5dB higher
intensity. Consecutively, higher intensities are used until a
reflex is accepted (if a pass cannot be obtained, the reflex
recorded at maximum intensity is displayed as the test
result for the test).
Sequence:
Figure 53 shows the screen for the Sequence Reflex Method:
Figure 53:
With the Sequence Method it is possible to have up to six

single reflexes in one reflex window. The reflex parameters in
the Sequence Method can be set up to the personal needs
from the reflex table in the lower part of the screen. In the
Sequence Method the intensity levels are marked with small
arrows pointing right indicating that a number of reflexes are
expected to come at a pre-selected increasing intensity.
Reflex pr. Sequence:

It is possible to choose between 2,3,4,5 or 6 reflexes per
sequence.

Please note that the higher number of reflexes selected per
sequence the less detailed the graphic in the small reflex
windows will be. Figure 54 shows an example of a sequence
with six reflexes starting from 70 dB with 5dB intensity
increases per reflex:
Figure 54:
Level Increase:
Selects how many dB the intensity will be increased between
each single reflex. Choose between 5, 6, 8, 9, or 10.
Note: A warning pops up when too high a Level Increase has

been chosen together with too high a start intensity level. This
will violate the maximum output capabilities of AA222:
Figure 55:
Compensate for General Drifting:

When searching for reflexes with the Sequence Method the
compliance may drift a little. When the instrument is set to
“Normal”, the drifting will mathematically be compensated for
(figure 57). Figure 56 illustrates what may when the setup
parameter Compensated for General Drifting is set to “Off”.

Figure 56: Off Figure 57: Normal
Test Stop Criteria:

When Test Stop Criteria is set to “Off” the Sequence test will
continue recording reflexes even after a reflex has been
identified and accepted. When the Test Stop Criteria is set to
“Automatic” the Sequence test will automatically stop as soon
as a reflex has been identified and accepted.
Reflex Sensitivity (when Test Stop Criteria is set to Automatic):

Reflex Sensitivity appears in the line just below Test Stop
Criteria when Automatic is selected. Reflex Sensitivity
functions in the same way as in the Screening and Auto Reflex
Methods and can be set to “Sensitive”, “Normal” or “Robust”.
Audiometry Setup Menu

The Audiometry Setup Menu is reached from the Main Menu by
pressing F2 “Setup and F2 “Aud” (see figure 58).
Default Intensity:
Default Intensity is used to select the step-down value of the
attenuator when the frequency is changed and can be set from
–10 dB to 50 dB in steps of 5 dB and Off. If the value is set to
“Off”, the intensity will not change when changing transducer.

Figure 58:
Masking Intensity:
It is possible to set the default masking intensity between 0 and
50 dB in steps of 5 dB. The masking intensity can also be set
to “Turn off”. In this situation when changing test ear the
masking will automatically turn off. The masking intensity can
also be set to “unchanged”. In this situation when changing test
ear the masking will automatically stay the same.
Not Heard Lines:

Enable or disables the lines between not heard symbols on the
printout. Not Heard Lines can be set to either “On” or “Off”.
Output Bone Masking:

Selects between these transducers for masking stimuli output:
 Opposite CH1: The masking stimuli output will be
presented via one of the audiometric headphones –
opposite the ear being tested with the bone conductor.
The transducer must be connected to the Left (30) and
Right (29) sockets.
 Contra: The masking stimuli can be presented either
via single audiometric headphone which is normally
used for contralateral reflex presentations, or via the
CIR33 Contralateral Insert Phone.

The selected transducer must be connected to the
Contra socket (34).
Bone at 8 kHz:
Selects whether or not it should possible have 8 kHz as output
when using the Bone Conductor.
Microphone Selection:
Selects between the built-in swan neck microphone and an
external microphone.
Output Ch2:
Selects between Narrow Band and White Noise as masking for
output in channel 2.
Audiometer Mode Preselect:

Selects between Manual or Automatic Audiometry as default
when pressing “Audiometry” (25).
Manual Audiometry Setup Menu

The Manual Audiometry Setup Menu is reached from the Main Menu
by pressing F2 “Setup”, “Aud” and finally F5 “Manual” .
Figure 59:

Intensity Stepdown:
Intensity stepdown is used to select the step-down value of the
attenuator when the frequency is changed. The step-down
value can be selected from 5 to 40 dB in steps of 5 dB, or
simply set to “Off”.
Audiometer Frequencies:
It is possible to disable/enable one or more of the following
frequencies: 125 Hz, 250 Hz, 750 Hz, 1500 Hz, 3000 Hz, 6000
Hz and 8000 Hz. To browse between the frequencies press
“Decr Incr Frequency” (27 and 28). The individual frequency is
set to “On” or “Off” by pressing F1 “Change”.
Frequency Jump Mode:

It is possible to select how the frequency jumps, when pressing
the frequency keys (27 and 28).
 Bottom: Trying to increase the frequency selection
beyond 8000 Hz, will cause the frequency to jump to
125 Hz, ready to perform increasing frequency
selection.
 Butterfly: Trying to increase the frequency selection
beyond 8000 Hz, causes the frequency to jump to
1000 Hz, ready to perform decreasing frequency
selection. Trying to decrease the frequency below the
lowest frequency causes the frequency to go to 1000
Hz ready to perform increasing frequency selection.
Pulse Key Function:

It is possible to define how the Pulse function in manual
audiometry. The Pulse function can be set to either single
singlepulse or multipulse.
Pulse Length:
It is possible to select the pulse length. The pulse length can
be changed from 250 mS to 5000 mS in steps of 50 mS. When
multipulse is selected in the above Pulse Key Function the
tone presentation and intermitted pause is equal.
Level Decr/Incr:
Selects 1 or 5 dB increments or decrements when dialling the
“HL dB” rotary key (26) between 1 dB and 5 dB.

Speech Audiometry Setup Menu
The Speech Audiometry Setup Menu is reached from the Main Menu
by pressing F2 “Setup”. When being in the Main Setup Menu press
F2 “Aud” to enter the Audiometry Setup and finally press F4 “Speech”
to enter the Speech Audiometry Setup Menu. Figure 60 shows the
Manual Audiometry Setup Menu:
Figure 60:
Number of words:
Here you can assign the number of words in your word list.
This will make the basis of the result obtained via the
automatic speech score counter.
Score Method:
It is possible to select between Default or German method.
Default mode will calculate the % of correct answers when

Incorrect or Correct button is activated.
Percent  Correct  100

Incorrect  Correct

German will start with 0 % and will increase with the result of the
equation below every time the "correct" button is activated:
Percent  100
Words selected in Item 21
L/R Standard Curves and FF1/FF2 Standard Curves:
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 Free Field
testing are available.
The characteristics of these curves have been pre-

programmed in the AA222. However, should you wish to alter
the characteristics of these curves this is possible simply by
browsing with the “, , , ” keys (F2 to F4). The changing
of the characteristics is carried out by the “Change” key (F1).
Common Setup Menu

The Common Setup Menu is reached from the Main Menu by
pressing “Setup” (F2) and “Common” (F4):
Figure 61:

Power-up:
Selects between “Audiometry”, “Tymp”, “Tymp and Reflex” or
“High Probe Tone” as Power-up.
Pause:
If “On” is selected the “Pause” key (9) is pre-selected as
default for 1) the Tympanometry Test, 2) the Reflex Test and
3) the Reflex and Tympanometry Test.
When “Off “ is selected the Pause Function must be switched

on manually. The Pause Function can be activated from for 1)
the Tympanometry Test, 2) the Reflex Test and 3) the Reflex
and Tympanometry Test.
Note: The pause function is always pre-selected for the

Automatic Audiometry Test and for the EFT Test. The pause
function cannot be selected for Manual Audiometry.
Communication:
The setting is USB. It cannot be changed.
Remote Switch:
Selects the function of the Remote Switch of the probe. Select
between “Off”, “L/R”, “Pause” and “L/R or Pause”.
1. When “Off” is selected the Remote Switch is out of function.
2. When “L/R” is selected it is possible to shift between left and

right ear with the Remote Switch.
3. When “Pause” is selected it is possible to control the “Pause”

key (9) from the Remote Switch.
4. When “L/R or Pause” is selected the “Pause” key (9) can be

controlled from the probe’s Remote Switch when the probe
tip is in the ear canal. The “Right” (19) and “Left” (20) keys
can be controlled when the probe tips is not in the ear canal.
Manual Reflex Attenuator:

Selects the intensity increase and decrease levels for manual
reflexes when dialling the “HL dB” rotary dial (26) (1, 2 or 5 dB.

Reflex Icon Boxes
With Reflex Icon Boxes it is possible to select between 4 or 6
reflex. See the appearance of the two possibilities below:
Figure 62: 4 Reflex Boxes Figure 63: 6 Reflex Boxes
Printer:
There are two different “Printer” settings; “Off” and “Internal”.
1. “Off” means that there will be no printing possibilities.
2. “Internal” means that the internal printer of AA222 is

activated and can be used, if an internal printer is installed.
Subject Data Printout (when “Printer” is set to “Internal”):

Subject Data Printout can be set to either “On” or “Off”. When
set to “On” the labels of subject details will be printed.
To enter the Subject Screen, a keyboard must be connected to

the AT235 and the “Keyboard Connected” point in the
Common Setup Menu must be set to “Yes”.
Clinic Data Printout:

If “On” is selected the Clinic data will be printed. Note that the
clinic details are only printed if they were entered and uploaded
through the Diagnostic Suite. See Clinic Screen in figure 64.

Figure 64:
To enter the above Clinic screen a keyboard must be

connected to the AA222 and the “Keyboard Connected” point
in the Common Setup Menu must be set to “Yes”. To enter
your own Clinic data press F1 “Edit” and then F2.
Print After Test:

Print After Test can be set to either “On” or “Off”.
When set to “On” the test result will be printed automatically

when both right and left ear have been tested. This automatic
printing possibility is directly related to the “Power-up” chosen –
“Tymp” or “Reflex and Tymp”.
When set to “Off” the print function must be activated
manually.
Language:
It is possible to select between “English” and “German”.

Appendix B:
Installing the USB Driver on the PC
Connect the Instrument to the PC with a USB cable and turn on the
instrument, the following window should appear. The Driver is
available from Windows Update if the PC is connected to the internet
or it can be found on the CD with the operation manual.
Click Next and the following window should appear.
Insert the CD, if the PC is not connected to the internet, click Next.

When the Driver is found the following window appears:
Click Finish, the Found New Hardware Wizard now starts over again
because a driver for Serial Converter B needs to be installed, follow
the directions above.
The Driver for the USB Serial Converter is now installed, to find out
which COM port to use when communicating with the instrument start
the Device Manager (Click Start, My Computer -> properties,
Hardware -> Device Manager). The Port is recognized as “USB
Serial Port” use the one with the lowest number.

If the COM port number is higher than it is possible to set in the PC
application, it is possible to change the number by selecting
properties for the USB Serial Port, then Click Hardware and
Advanced, the following window should appear:
Change the COM port number in the drop down box.

Appendix C:
General Maintenance Procedures
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
disease from one patient being passed to others. Ear tips should
be changed after each patient and if ear cushions are
contaminated, it is strongly recommended to remove them from
the transducer before they are cleaned. Water should be used for
frequent cleaning, but in the case of severe contamination it may
be necessary to use a disinfectant. The use of organic solvent 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.


Return Report

Drawing of Front Plate
1 2 3 4 5 6 7
8 9 10 11 12 13 14 15 16 17
18 19 20 21 22 23 24 25
27 28 29 30
26

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Operation Manual

Audio Traveler AA222

Valid from serial no. 776588 software version 2.00200

AA222 Operation Manual Page 3

AA222 Operation Manual Page 4

The AA222 tympanometer and audiometer is intended to be used by

CAUTION, used with the safety alert symbol,

NOTICE is used to address practices not related

AA222 Operation Manual Page 5

3. Be sure to insert the probe tip in a way, which will assure an

7. Do not insert or in any way try to conduct measurements

8. When conducting audiometry using Ear tone insert phones –

1. Do not immerse the unit in any fluids.

2. Use this device only as described in this manual.

4. Do not drop or otherwise cause undue impact to this device. If

AA222 Operation Manual Page 6

6. The transducers (headphones, bone conductor, etc.) supplied

7. Do not attempt to open or service the instrument. Return the

8. Regularly have the unit checked according to IEC 60601-1,

9. Although the instrument fulfils the relevant EMC requirements

Electric and electronic waste may contain hazardous

Explanation to symbols which may be found on the instrument:

Caution. Check the accompanying documents

Type B applied part

AA222 Operation Manual Page 7

 The AA222 is free from defects in material and workman

If any product requires service during the applicable warranty

In no event shall Interacoustics be liable for any incidental, indirect

 repaired by anyone other than an authorized Interacoustics

AA222 Operation Manual Page 8

This warranty is in lieu of all other warranties, express or implied,

INTERACOUSTICS DISCLAIMS ALL OTHER WARRANTIES,

AA222 Operation Manual Page 9

Presenting a high positive or negative air pressure to the outer ear

By gradually varying the air pressure from a positive pressure to a

The impedance curve, drawn by a gradual sweep across a wide

The above principle for measuring the stiffness of the tympanic

AA222 Operation Manual Page 10

This Stapedius reflex can be elicited both ipsilateral and contralateral,

AA222 Operation Manual Page 11

Compared to a hard walled cavity a normal middle ear

At 226 Hz the stiffness component is by far the most dominant

AA222 Operation Manual Page 12

Normal ears often show type "A" tympanograms.

Type "AD" characteristics:

It can represent ossicular discontinuity, flaccid eardrum or a

Type "AS" characteristics:

Type "B" characteristics:

AA222 Operation Manual Page 13

The type C curve indicates poor Eustachian tube function with

Type "D" characteristics:

Type "E" characteristics:

AA222 Operation Manual Page 14

Tympanometric Curves and Pathologies

1) Blocked 1) Ossicular bone 1) Early 1) Middle ear

AA222 Operation Manual Page 15

Onset and Offset:

A negative reflex may occur due to the following interference of

AA222 Operation Manual Page 16

It should be noted that a visual examining of reflex test might

Generally, noise stimuli elicit reflexes at lower levels than pure

AA222 Operation Manual Page 17

The Nature of the Reflex:

Noise as stimulus produces a threshold approx. 10-20 dB lower