Audiology Clinic Generator Instructions Introduction The Audiology Clinic Generator, Version 2 (henceforth called AC Generator) is a utility program for use with The Audiology Clinic, Version 2. It is assumed that you are familiar with the operation of that program. If you have not used The Audiology Clinic and reviewed its text/manual, you should do that before proceeding. The Audiology Clinic has numerous new features that are described in Appendix I. Instructions for installing AC Generator are detailed in Appendix II. Even if you have used the previous version of AC Generator, we recommended that you read this manual because there are some significant changes. The user of The Audiology Clinic may consist of a diverse body including students, neophyte clinicians, and others desiring to learn audiometry and immittance. Throughout this discussion we will refer to those users with the term "students". AC Generator enables you to manipulate cases. A case is a set of data that constitutes the hearing profile of a factitious patient, including pure tone, speech, immittance, and case history information. The program offers you three (3) powerful functions: To generate files of one or more cases for students to "test" using The Audiology Clinic. To view and edit files of existing cases and optionally to add additional cases to them. To evaluate the results of cases students have tested using The Audiology Clinic. These three functions are accessed from the File menu seen here: Add Cases New File enables you to create a new file with one or more cases. Add Cases Existing File permits you to add one or more cases to a file that already exists (i.e., it contains at least one case). View/Edit Cases allows you to view and also to edit, if desired, existing files of cases. Analyze Cases lets you analyze and grade cases that students have tested and submitted their results to you. Close must be used in order to switch among the above functions. Print can be used with View/Edit to produce a hardcopy. Creating New Cases Although The Audiology Clinic contains 100 case studies, it is likely that you will want to create your own favorite audiograms, speech and immittance data, thereby generating new cases for students to test. This is done initially by clicking on File, followed by Add Cases New File. After you select New File from the File menu, you are presented with the standard Windows file dialog box as shown below.
If you accepted the default values when you installed AC Generator, you will be in the Documents sub-directory on your hard drive. Enter your preference for a filename. We recommend using eight characters or fewer. AC Generator will automatically add the extension.aud to your filename. Thus, all the data files that you create will end with.aud. You may want to use a naming scheme with a built-in cataloging feature, such as "CasesF02" or "Quiz3", etc. Click OK to proceed. You will then be prompted to select one of six options for the type of transducer and Inter-aural attenuation. These choices are seen here. There are two types of transducers available: standard earphones in circum-aural cushions and insert earphones. Inter-aural attenuation can either be fixed at 40 db for circum-aural earphones and 60 db for insert earphones, or it can be customized to whatever values you choose. As can be seen, the first three options result in fixed Inter-aural attenuation, allowing either type or both types of transducer to be available to the student. The last three choices also permit the selection of transducer but also require that you enter the values for Inter-aural attenuation. Realize that the above decisions are made on a case by case basis, so that each case can offer a different type of transducer and/or Inter-aural attenuation values.
If you selected one of the last three choices above, a window will appear so that you can enter the desired custom Inter-aural attenuation values. The values entered for Inter-aural attenuation must be between 40 and 95 db (and divisible by 5). In the example above the fourth option button was clicked from the previous picture (Both Circum-aural and Insert ) so that you must enter Inter-aural attenuation values for both the Circum-aural and the Insert transducers. Notice that only six (6) numbers are needed for each type of earphones; that is 125-250 Hz and the remaining octave and half-octave values must be the same. Had you chosen only Circum-aural or only Insert earphones, then only six values, rather than the 12 above, would be entered. After the type of transducer and optionally custom Inter-aural attenuation values have been entered, the data table will appear. The upper portion is shown below. Notice that it displays the kind of earphone(s) and the Inter-aural attenuation values at the top. In this example the user selected only insert earphones in combination with default (i.e., 60 db) Inter-aural attenauation. The letters for default Inter-aural attenuation are green. In contrast, the next example shows a case in which both types of transducers were picked along with custom values for Inter-aural attenuation. These letters are purple.
The next picture shows the entire data table. Be aware that you are currently preparing to add data for Case 1, and you are in Generator Mode (upper left). The remaining screen is divided into four (4) main parts. The upper panel provides space for entering pure-tone, speech, and immittance data for the right ear, while the lower panel provides space for entering these same data for the left ear. At the very bottom of the screen is the box for entering case history information. At the right of the screen is a set of nine (9) check boxes that regulate the privileges that the student will have when testing this case. Data Entry Requirements Every cell must have a value entered into it before you can save the case, and the
values must be entered sequentially. In other words you cannot click on the Left ear and enter those values first. Furthermore, each input will be validated. Entry of an illegal value will be rejected, and appropriate feedback will be issued. So a legal input must be entered in order to continue. The normal process is to enter a value, then press the Tab key to advance to the next cell, enter the next value, and press Tab, etc. For the Right and Left ears the range of acceptable values for each cell is presented in the table below. Air, Bone, and SRT -10.. 110 in 5 db increments, or nr Word recognition (WR) 0.. 100 in 5 db increments, or dnt Tymp. Class. Up to 20 characters Middle Ear Pressure -400.. 200 or np Ytm 0.1.. 4.0 or np Equivalent Canal Volume Ipsi & Contra Thresholds 0.3.. 7.1 60.. 110 nr, or dnt Ipsi & Contra Decay 0.. 100 or dnt nr stands for "no response"; this value should also be used to represent an absent value, such as an absent reflex threshold. dnt stands for "did not test"; it is used for "could not test" as well. np stands for "no peak". The reason that a value must be entered into every cell is that you are modeling the dynamics of a human ear. The ear has the properties of sensitivity, stiffness, etc. at each test condition whether or not you intend to test that condition in the clinical setting. It may seem particularly strange to have bone conduction thresholds at 125, 6000, and 8000 Hz, yet The Audiology Clinic needs that information to calculate air conduction crossover at those frequencies. Again, the ear has a sensory mechanism that responds to sounds at the frequencies of 125, 6000, and 8000 Hz and all other frequencies, even though those frequencies may not normally be tested clinically. In some cases dnt constitutes a legal value. It is strongly recommended, however, that you do not do use this value except in instances where it makes sense. For example, you cannot measure reflex decay if there was no response for the reflex thresholds. To repeat, threshold values or nr must be entered for all 11 frequencies in both ears for both air conduction and bone conduction. This is true even if, for example, you only want students to test at a small, selected range of frequencies. This is because The Audiology Clinic needs all these data to function correctly. The best strategy is to enter legitimate data into all cells. Four cells deserve special emphasis. Tymp(anometric) class(ification) can be any combination of up to 20 characters. Most of the examples in the text/manual for The Audiology Clinic use the Jerger nomenclature of letters. You may, however, prefer to use other descriptors, like "Normal", "Flat", etc. Whatever system you prefer, you must inform your students about, as their responses must match the values you enter exactly including upper/lowercase, else their responses will be graded as incorrect. Moreover, a datum must be entered for Middle Ear Pressure, Ytm, and Equivalent Canal Volume; this is not an option, and dnt will not be accepted. Once the data have been entered for the right and left ears, brief case history
information may be entered. The limit is a maximum of 200 characters including punctuation and spaces. Editing It is possible to edit a newly created case after all values have been entered but before clicking the Save Case button. So if you make a mistake, continue to enter values until all values are entered, then go back and change any one or more values. Finally, click the Save Case button. A replacement value, naturally, must fall within the legal range. With Version 2 of AC Generator the air-bone gap can be of any magnitude, even greater than the Inter-aural attenuation that has been chosen, so give careful consideration to the values that you select. On the other hand bone conduction cannot be more than 10 db poorer than air conduction. Any non-legitimate value will be flagged, and an appropriate error message displayed. Privileges The right-hand column, labeled Privileges, contains nine check boxes. These boxes represent privileges that the student has when using The Audiology Clinic. Incidentally, the 100 built-in cases offer most of these privileges for most cases. When creating a new case, the Privileges panel is initially disabled. However, after you enter all the pure tone and immittance data, you can access this panel and adjust the settings, if desired, as described next. The top panel of five check boxes relates to the students' capacity to view the results of a case, including the (case) History, the Audiogram, the Speech results, and the Immittance results. If a box is checked, then the student will have access to this information; but if a box is unchecked then the student will not have access to this information. A subcategory under audiogram is the Mask check box. By default this box is checked whenever the Audiogram check box is checked. But un-checking this box prevents The Audiology Clinic from calculating crossover when displaying the audiogram. Thus, you have the capacity to display illogical results to students to determine their ability to detect erroneous configurations. It is possible, of course, that the audiogram will show hearing thresholds students will be unable to obtain because of a masking dilemma. The next panel, labeled Threshold, Masking, and Crossover, permits or denies the students' access to automatic threshold testing and automatic masking curves and ability to view the Crossover diagram. Again, if checked, then the student may execute automatic testing and view the crossover phenomenon; and if unchecked, then the student is denied access. The bottom panel controls Variable thresholds, that is the variability with which the listener responds at and near threshold. This features permits the development of potentially very difficult-to-test listeners because of the inconsistent responses that will result if this box is checked. If left unchecked, then the listener always responds at the threshold value and never responds to levels 5 db less than threshold. There may be ample situations in which you want to restrict students' access to certain privileges both with the 100 built-in cases and with the customized cases that you create. When testing students, for example, you probably will not want them to be able to view the completed audiogram, immittance results, etc. In contrast, there may be instances when you want to them
to have access to partial results, such as being able to view only immittance results when performing pure-tone audiometry, or visa versa. Thus, by manipulating the privileges a student has when assessing a particular case, you can impose many different types of clinical protocols on the student such as implementing the immittance first vs. the pure-tone audiometry first vs. the SRT first approaches. There may be occasions when you want to check the privileges the students have for a particular case from The Audiology Clinic. This can easily be done by clicking Options, then Privileges. They will all be listed in the small window that subsequently appears. Saving Cases When all the data have been entered to your satisfaction and the privileges set, click the Save Case button, and the case is saved to disk. The screen then changes to a gray color, and the individual cells can no longer be accessed. The only possible action with the current file is to click the Add button at the top right in order to add another case (i.e., Case 2). If you want to edit the case just entered, then you must change to View/Edit mode. First, click File, followed by Close. Then click File, followed by View/Edit and select the same file again at which point the data table will appear giving you the opportunity to make changes (see Viewing and/or Editing Cases below) The students must have access to the data files you create. Two ways to do this are to copy these files to the subdirectory that houses The Audiology Clinic or supply the students with a floppy diskette containing the files. In either event the students will have to know the filename(s) that they are to access. Table and Chart View Data are entered in Table View (the default). Once a case is completed, it may be viewed in either Table View or in Chart View. The latter presents the data like a clinical report, that is an audiogram with spaces for the immittance and history information. Changing views is accomplished by clicking on View and then on Chart or Table, as desired. It should be realized that new cases can only be added when in Table View. Important: Chart View displays the thresholds that you entered; recall that these values represent the organic loss. It does not symbolize the typical audiogram in that there is no crossover. To repeat, these are organic thresholds, not measurable thresholds using pure-tone audiometry. In Chart View by default the audiogram just shows the octave frequencies from 250-8000 Hz. By clicking Options, Audiogram and All frequencies, the display can be modified to show all 44 thresholds, a complete albeit crowded display. When you have finished adding cases, terminate this mode by clicking File and Close to leave this mode or Exit to end the program. Viewing and/or Editing Existing Cases Any file of case data that you have previously created can be viewed and, if desired, edited. It is even possible to view and edit the master case data file that accompanies The Audiology Clinic.
All of these operations are done by clicking on File, and then on View/Edit cases. Select the disk and directory desired, if other than the default. All the.aud files will be listed; these are files that you have created. To open one of your files, click on its name once to select it, then click OK. Before altering any of the pure tone thresholds or immittance data, you must decide whether you want to change the type of transducer and/or inter-aural attenuation values. If you want to do so, click the Chg IA button at the top of the table to the right of the current transducer/interaural information. If you click this button, then you will go through the same sequence of choosing a transducer or transducers and optionally entering values for inter-aural attenuation that you did when you first created the case (see pp. 2 and 3). If you do not desire to change the transducer and/or inter-aural attenuation values, then you can proceed to modify any datum by clicking its cell and erasing it. Note: clicking anywhere in the table will cause the Chg IA button to become disabled. It you subsequently decide that you want to adjust the transducer and/or inter-aural attenuation, you must reinitialize this case. If there is more than one case in the file, click Next to go to the next case and then click Prev to return to the case you want to modify. If there is only one case in the file, then close the file and reopen it. Enter a new datum and press the Tab key to register the change. Following this instruction is essential, and it appears in red letters at the top of the data table to remind you, as the following picture indicates. As always, illegal values will be rejected. You can move conveniently among Note: After each change is entered press the Tab key cells by clicking the desired cell or tabbing from cell to cell. After the first modification has been made, the Save Case button will become enabled thus permitting you to resave the file. If the Save Case button is not pressed, the changes will not be made. If you make a change or changes and forget to click this button, you will be warned when you exit the program. Master Data File Opening the master data file requires an extra step. In order to access the master data file that accompanies The Audiology Clinic, click File and Close to exit the present file (if any). Then click File, followed by View/Edit Cases. Click the down arrow below "List files of type" at the lower left portion of the window. This will open a drop-down list box that has one entry: "Std. data file (*std)". Click on Std. data file. The associated filename, "Casedata.std", will appear in the text box above. Click on this name once to select it, and then click OK. Warning: modifying the "Casedata.std" file may cause inconsistencies between the text/manual and the case data. Use extreme caution, if you modify these data. You may wish to make a note of any changes that you make, so that the original values can be restored later, if desired.
Evaluating Students' Results The final function of AC Generator is to evaluate a student's work. This option enables you to have students record the results of their clinical tests on a diskette and submit it to you for evaluation. The cases which they test can be selected from the 100 cases built into The Audiology Clinic or customized cases that you create as described in "Creating New Cases" on page 2. To evaluate a student's work, click on File first and Analyze cases next. Files that students have saved will have the extension.ev1. Select the file that you want and click OK to open it. (Actually two files are opened: one contains the student's results and the other contains the original, correct data for the case.) When you open a student's file, you may view all the cases they tested (up to 5 in a single file) in sequential order; the first case is displayed first. Chart View Students' cases are initially shown in Chart View. As shown in the illustration below, the lower right panel of the screen reveals the filename currently being viewed (in this case "Student2") and the case number within that file (Case 1). The elapsed time required for the student to obtain all the results is also revealed. Analysis of Student2 Case No. 1 Elapsed time = 00:04:10 The audiogram panel (illustrated below) shows all correct thresholds in large symbols in the traditional red or blue colors (not evident here). If a threshold is incorrect, then the correct threshold is also presented using a smaller, dark symbol. Furthermore, all thresholds not tested are displayed using the smaller, dark symbols. Concentrate on the thresholds at 250 Hz. Right air is correct. Right bone is incorrect. The student reported the threshold at 0 db (large symbol), but the correct threshold is 20 db (small symbol). Further, left air and bone were not tested (they show up as the small, dark symbols with no corresponding large symbols to represent the student's findings). In addition, the student did not test at 125 Hz. There are no large red and blue symbols at 125 Hz; rather only the small, dark symbols are plotted. The situation for immittance is somewhat different as these results are recorded as numbers. The illustration beneath shows the immittance results for the probe in the left ear. All results were correct except for the ipsilateral reflex threshold as 1000 Hz. Incorrect thresholds have a line through them. The student did not measure the contra lateral thresholds or decay (dnt).
Critique View Visualizing the student's results in Chart View is a bit awkward, especially the audiogram. Accordingly, the results may be inspected in Critique View, which summarizes the errors. Click View, then click Critique. An example is disclosed below for the pure-tone results shown on the audiogram above. In this instance five of the thresholds recorded by the student were incorrect (because the right bone thresholds were not masked). The average error was 12 db. The table summarizes the individual thresholds by showing the submitted threshold minus the correct threshold. Accordingly, a "0" indicates a correct result. The magnitude of each error for right bone can be seen for each frequency. A "-" (hyphen) reveals a condition that the student did not test; hence no thresholds were obtained in the left ear. The "X"s represent the conditions that cannot be tested (bone at 125, 6000, and 8000 Hz). The bottom table summarizes the number of errors by the magnitude of the error. Similar tables indicate the errors for SRTs and immittance. Presentation View The final way of viewing students' results is by means of the Presentation trail (shown on the next page). For this option click View and Presentation trail. This display shows the history of the settings on the audiometer as a student proceeded. Thus, you can verify that the student used the modified Hughson-Westlake procedure (which is taught in The Audiology Clinic) or any other procedure you require them to use to obtain thresholds. As can be observed by inspecting
the drawing on the next page, this student measured the right air conduction threshold at 1000 Hz by using three ascending runs that resulted in a threshold of 15 db. Any of the three display modes, Chart, Critique, or Presentation trail, may be printed to produce a permanent record. Just click the Print button on the respective screen. Since a permanent record exists on the diskette, a student's results can be compared over a period of time or between different kinds of cases. Recording Students' Results Instructions for how students record test results are not presented in The Audiology Clinic text/manual. Rather they are presented here, and you can inform the students of the procedure. The process is quite simple. First, the student must know what cases to test. For instance, you might assign certain cases among the 100 built-in cases, or you might assign a set of customized cases you have created. In the latter instance, the student must know how to access the file (i.e., via diskette, hard drive, etc.), and they must know the filename. If the cases are among the 100 built-in cases then a student would start the program as usual, by clicking File and Open - Standard file. If the cases are custom-designed, then the student would click File, followed by Open - Extra data file. The standard Windows file dialog box appears, and the student can select the drive the file is on (diskette, hard drive, network drive, etc.), click on the filename to select it, and then click OK. This process will open the desired file. This latter option necessitates, of course, your having already generated a set of cases using AC Generator. Second, before selecting a case to test, the student must start the recorder. It is easy to forget this critical step. (If the student does forget and begins testing without first initializing the recorder and then returns to the Case menu to start the recorder, the case must be reselected, and the test must be started all over again.) As a reminder to the student the Title Bar of The Audiology Clinic changes to: The Audiology Clinic (Recording Case 1), when recording is initiated. To start the recorder, the student clicks Case, then click Record results. Every keystroke and/or mouse click the student makes is then recorded. A maximum of five (5) cases can be saved in a single file. Remember, the recorder cannot be invoked after case results have already been obtained and plotted as this action closes the case resulting in the loss of all results already obtained.
Third, when entering values like speech or immittance results into the text boxes on the screen, the message "After entering a value, press the Tab key" appears below the box. The students needs to get in the habit of doing this because in some instances the value typed in will not be recorded if he or she does not subsequently press the Tab key. Fourth, when finished testing, the student clicks Case and then Save case(s). The Save event enables the student to select the drive and directory to save the file in. Instruct them whether you want the file saved on a diskette, the hard drive, a network drive, etc. Also inform them of the name you want them to give the file. The student must be reminded to perform this essential step also. Computerized evaluation may be a new operation to some students and the process must be adhered to precisely, so it is strongly recommended that you offer some practice sessions before giving a test using this methodology. Providing a checklist of the steps to take may also be of benefit. Filenames What to name a file is frequently a problem. We recommend that you restrict filenames to eight (8) or fewer characters, as this offers the greatest compatibility with the older versions of Windows. Again, students must be informed how you want them to name their files. There are many convenient methods. One way would be to use the initials of their name followed by the date, for instance JFK92302, which would stand for September 23, 2002. Another method would be a course number, a letter you assign to each student in a section, followed by a descriptor of the assignment, for example 231AQ1, which stands for Course 231, Student "A", Quiz 1. Also remember to require students to affix their name to their diskette to avoid the stack of unlabelled diskettes that inevitably materializes each semester. Another possibility would be for students to E-mail their file to you. The file-naming issue remains the same, however, as you have to keep track of the files from the various students. Password Protection AC Generator affords password protection for any file, both standard and instructor-generated. This feature provides the utmost security if files have been created with which to evaluate students. Such files may well have certain (or all) privileges canceled, so that the student cannot see the results he or she is to obtain. It is conceivable, however, that a hacker could gain access to this program (AC Generator) and restore those privileges for the student. As a result you may wish to protect any (or all) data files with passwords. The password feature is accessed through the Options menu. A password can be added to any data file, but only when Case 1 is displayed. A password can consist of 1 to 8 symbols (letters and numbers). It must be re-entered for confirmation before it is accepted. The password is then in effect and must be entered whenever the file is opened for modification. It is important to understand that a password does not preclude the use of the file by The Audiology Clinic, rather just the viewing and/or modification of the file using AC Generator. When a file with password protection is successfully opened, the password can be removed by again going to the Options menu while Case 1 is selected. Just enter the password correctly, and the password is deleted
and is no longer required when opening the file. Caution: a password-protected file cannot be accessed without the password, so do not forget the password! Summary Hopefully, the above description has indicated clearly the capabilities of AC Generator and how to utilize all its features. There are a few keys points to remember. When creating new cases, enter data into every cell. Enter all these data sequentially. Press Tab to advance from one cell to the next. When editing, remember to click Save Case when you have finished making changes to a case. Be absolutely explicit when informing students of the terminology to use to designate types of tympanograms. Give thought to what privileges you want students to have for each case. When creating cases with which to test students, you will probably want to restrict most, if not all, of their privileges. Remind students they must start and stop the recording process when recording their results for evaluation. Consider whether files used for evaluative purposes should be password-protected. The Audiology Clinic, Version 2 has the following new features: Two types of earphones, circum-aural and insert, may be used with each case. The instructor can control the type of earphones and restrict a case to only one type, if desired. Inter-aural attenuation can have default values, 40 db for circum-aural earphones and 60 db for insert earphones, or it can be customized to any value between 40 and 95 db that the instructor wishes. New sound-generating capabilities should produce pure tones with any sound card. Enhanced screen layout permits all windows involved with clinical testing to be visible simultaneously on high resolution (1024x768 and greater) screens. Help file can be used to search or to view the text/manual in electronic form.