Authored by: Whenever faced with purchasing new equipment, the makes and models on the market can be confusing. It helps to know some basics, what comparable products are on the market, and what each of the models currently has to offer. Since pediatric/newborn testing can be especially challenging, we have chosen to review a number of Auditory Evoked Potential (AEP) Systems available on the market. VivoSonic Integrity Gen 2: Greg Ollick, Sr., M.A. e3 Med-Acoustics Atlanta, Georgia The VivoSonic Integrity was originally developed as a unique AEP system designed especially for the application of non-sedated pediatric ABR measurements. It employs several special technologies to make this kind of testing viable. Besides making it possible to obtain these measurements on difficult-totest patients, this technology makes it possible to test in hostile environments in which excessive electrical interference is present. These environments include nurseries, operating rooms, and intensive care units as well as many modern medical offices where there is equipment that produces interference. Among these technologies are the following: The Patented Amplitrode - This is a shielded high-gain high-input impedance physiological pre-amplifier which is built around the ground electrode and applied directly to the patient. The new VivoAmp has proven to provide the same outstanding performance. This produces significantly cleaner test results in much less time. Less time is required because the averaged response is not corrupted by noise. SOAP Adaptive Processing (SNR-Optimized Adaptive Processing) is the result of extensive research and development at VivoSonic. It is an evolution of advanced digital signal processing algorithms that use Kalman Weighted Averaging techniques. This innovative technology applies sophisticated noise filtering algorithms which dramatically reduce artifacts from muscular and ocular electrophysiological activity, as well as electromagnetic interference, in evoked potential responses. (VivoSonic website) The new Gen 2 dual-channel software also has many other features, such as a split screen and the ability to analyze and collect responses at the same time, which enhance convenience and ease of use. The ability to collect two waveforms simultaneously during every run saves a considerable amount of time. It virtually Page 1 of 5
eliminates the need to acquire two or more traces in order to insure that the waveforms are repeatable and that a true response is present. The top 12 features of the new Integrity Gen 2 system are: Extremely effective noise immunity Ability to test non-sedated pediatric patients Ability to test in electrically hostile environments Superior signal processing (ultra-high sampling rate without processing errors) Covenant wireless operation (Bluetooth) Dual-channel operation Split-screen available during acquisition and analysis Ability to acquire averaged waveforms and analyze (mark) them simultaneously Acquisition of 2 waveforms (A & B) simultaneously Ability to display latency norms graphically on the waveforms during acquisition and analysis (marking) Very effective protocols for both ECochG and VEMP testing Transducer (inserts & bone) calibration built right into the connectors *All of these features work to together to enhance performance and provide more user utility. The bottom line is to obtain cleaner test results in significantly less time. We conducted a clinical trial and a performance comparison with the Integrity Gen 2 product earlier this year. We included ABR threshold, ECochG and VEMP testing in electrically hostile environments. An article summarizing our findings is published on the e3 Diagnostics website under Resources/Download Center and on the front page of the VivoSonic website. VivoSonic is continuously developing new software and will soon release an upgrade for the Integrity Gen 2 system which is designed outside of LabView. This version will have several enhancements including even easier operation and more flexible report generation. Grason-Stadler Audera Clinical AEP System: The Grason-Stadler Audera was designed to be a comprehensive diagnostic dualchannel AEP system with the option of ASSR and/or DPOAE. The Audera provides a very stable platform for these three functions. It is cost effective, durable and easy to use. We have had good success with this system in many practices. Page 2 of 5 The Audera offers the CE Chirp stimulus as a standard feature for threshold testing along with conventional clicks and tone bursts. The CE Chirp is a very efficient
Page 3 of 5 auditory stimulus. It reduces test time and produces a clear repeatable response at threshold levels. (For more information on the CE Chirp see the e3 Diagnostics website under Resource/Download Center.) The ECochG and cvemp test results are comparable with the other popular clinical AEP devices. The top 10 features of the GSI Audera AEP system are: Most cost effective 2-channel clinical AEP system on the market Offers the patented CE Chirp Stimulus One of the most durable AEP systems Ease of use one of the easiest to learn and use Outstanding ECochG and cvemp test results Comprehensive, effective and flexible clinical DPOAE option Electrode Impedance test is available for remote operation via the preamp All the absolute and inter-wave latencies are visible on the review screen Ability to easily edit existing test protocols and design/add new ones Multiple test charts can be used for each patient session Interacoustics ABRIS: The Interacoustics ABRIS is an AEP newborn infant hearing screening device developed as an option on the Titan middle ear analyzer and/or OAE system. We had the opportunity to do some clinical trials and performance comparisons with this system, and were granted unlimited access to all of the well-baby and the Neonatal Intensive Care Units (NICU) at a major Metro Atlanta hospital. With performance defined by test time, noise immunity and pass-rate, the ABRIS outperformed each of the other competing systems and had comparable performance with the Maico MB11. At the same time, it referred all of the babies that the other systems referred. With over 100 screenings completed, our average test time for normal hearing babies on both the Titan ABRIS and the MB11 (traditional version) was 24 seconds per ear. The performance of these two systems is outstanding and unmatched among today s AEP newborn infant hearing systems/devices. The unique application of a CE Chirp stimulus, noise reduction and ASSR response detection are among the technologies that make this extraordinary real-world performance possible. The top features of the Interacoustics ABRIS AEP infant hearing screener: True hybrid can operate as a stand-alone hand-held device or through the interface with Titan Suite software and the OtoAccess platform database High Performance speed, noise immunity and pass rate without missing a true refer Ease of use intuitive and automatic
Can be combined with 1000 Hz tympanometry and/or very efficient highperformance TEOAE screening Wireless (Bluetooth) printing BioLogic Navigator Pro AEP system: The BioLogic Navigator Pro is one in a long line of evoked potential products developed and manufactured by BioLogic. The NavPro quickly became the standard of the industry. This 2-channel clinical AEP system is found in almost every university audiology program as well as thousands of hospitals and clinics. The NavPro has gained a reputation as a dependable and accurate AEP measurement device. It provides excellent signal processing and very respectable noise immunity. The software is extremely flexible, offering the user many options for custom protocol setup. A built-in high-performance OAE (both TEOAE and DPOAE) option (Scout/Sport) is available with built-in utilities for protocol setup, patient reports and database (PT&I) management. The top 10 features of the BioLogic Navigator Pro 2 channel clinical AEP system: The Standard of the Industry many audiology users are very familiar with it Very flexible and comprehensive protocol setup utility AEP performance excellent signal processing Flexible report setup utility including test-conclusion macros High-performance OAE option (TEOAE and DPOAE) Small footprint very portable User can acquire waveforms and analyze them simultaneously Boys Town latency norms are built in (GraphMaster) Interaural latency difference automatically calculated Two cursors available for measuring inter-peak latencies during analysis If you have additional questions on any of the systems listed here, or would like a demo of one or more of the units, please contact your local e3 sales representative About e3 Diagnostics: Expertise, Excellence, Everyday: The e3 Difference e3 Diagnostics is comprised of thirty-six (36) full service offices nationwide - your network of local experienced experts, working in the field of Audiology instrumentation for decades. Our experience allows us to set the standard for the highest level of expertise in the hearing and balance field. The e3 Team makes a commitment to apply our knowledge Page 4 of 5
of the industry to assist our customers from assessment to purchase, installation and training, to calibration, maintenance and repair. We strongly believe you should have a choice, and we know how the small details make a difference to you! Our experts have a deep understanding of you and your needs. With e3 Diagnostics, you get more than just a partner; we are a family of people, dedicated to helping you provide only the very best to your patients. To find out more about e3, visit www.e3diagnostics.com. e3 Diagnostics 3333 N. Kennicott Ave Arlington Heights, IL 60004-1429 Toll-free: (800) 323-4371 Fax: (847) 459-7646 Page 5 of 5