Echo-Screen Reference Guide

Medical Background Information
and Application Hints for

Echo-Screen Plus
(T, D, A, TD, TA, DA, TDA)
REFERENCE GUIDE
P/N 051591E
January 2010
2010 Natus Medical Incorporated

All rights reserved.
Distribution of contents to persons other than customers of Natus is strictly prohibited.
Reproduction of any part of this document without the expressed written consent of Natus is strictly
prohibited.
AABR, Natus, and Echo-Screen are registered trademarks of Natus Medical Incorporated.
NuPrep is a trademark of D.O. Weaver & Co.
Windows is a registered trademark of Microsoft Corporation.
Manufactured by:
Natus Europe GmbH
Brmannstrasse 38
D-81245 Munich, Germany
Distributed and Supported by:

Natus Medical Incorporated
1 Bio-logic Plaza
Mundelein, IL 60060
USA
Phone: +1 (650) 802-0400
Fax: +1 (650) 802-0401
Email: Customer_Service @natus.com
www.natus.com
CONFIDENTIAL
PROPERTY OF NATUS MEDICAL INCORPORATED
ALL RIGHTS RESERVED
Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Explanation of Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Precautionary Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Documentation Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Example Data and Screen Shots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Buttons, Menus, and Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Overview of Screening Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

About Otoacoustic Emissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Types of OAEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Transient Evoked Otoacoustic Emissions (TEOAEs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Distortion Product Otoacoustic Emissions (DPOAEs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Working with OAEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Recording OAEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
OAE Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
About AABR Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Echo-Screen Device Technology Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Screening Device & Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Front View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Display & Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Keys, Terms, Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Data Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Top View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bottom View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Back View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Ear Probe Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Test cavity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Y Probe Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ABR Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Screening Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Echo Couplers & Snap Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Ear Tips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
P/N 051591E
Echo-Screen Users Guide
Setting Up the Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Initial Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Unpacking the Echo-Screen device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Storing the Echo-Screen Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Charging the Battery Pack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Removing the Battery Pack and Connecting the Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Monitoring the Battery Charge Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Battery Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Battery Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Increasing Service Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Battery Replacement & Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Language, Date/Time, Testing Alert & Background Light Settings . . . . . . . . . . . . . . . . . . . . . . . . 20
Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Date / Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Date / Time Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Background Lighting (display). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Default Test Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Data Input, User Access, & Patient Data Display Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Edit Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
User Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Setting User Login Names and IDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Patient List Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ABR Configuration Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ABR Notch Filter Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ABR Stimulus Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Storing Default Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Preparing for Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

TEOAE & DPOAE Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
AABR Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Connecting the ABR Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Connecting the Ear Probe Cable or Y Probe Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Checking the Test Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Screening Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Screening Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Step 1: Power on the Echo-Screen device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Step 2: Enter Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Step 3: Prepare Patient and Attach Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Skin Prepping Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Applying Echo Couplers (Y probe cable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Step 4: Start Screening/Monitor Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
TEOAE Screening Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
DPOAE Screening Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
ii
P/N 051591E
AABR Screening Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Using the ear probe cable (ear tips) for AABR tests: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Using the Y probe cable (Echo Couplers) for AABR tests: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Monitoring the AABR test progress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Status messages during AABR test: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Screening Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Viewing Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Understanding PASS & REFER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
TEOAE results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
DPOAE Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
AABR Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Printing Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Transfer & Deletion of Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Data Transfer Using Wireless (Infrared) or Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Installing EchoLinkII Software on the PC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Transferring Test Records from the Echo-Screen Device to a PC . . . . . . . . . . . . . . . . . . . . . . . . 53
Transferring Test Records from the PC to the Echo-Screen Device . . . . . . . . . . . . . . . . . . . . . . 55
Deleting Screening Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Quick Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Equipment Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Performing Self tests/Equipment Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Probe Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Discharge Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Codec Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
LCD Display Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Keypad Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Memory Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Software and Hardware Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Error Messages & Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Echo-Screen Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Cleaning the Echo-Screen Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Maintenance of the Probe Tip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Cleaning, Disinfection, & Sterilization of the Probe Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Probe Tip Cleaning Procedure:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Wet Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Changing the Acoustic Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Cleaning, Disinfection and Sterilization of Ear Tips and Cleaning Wire . . . . . . . . . . . . . . . . . . . . 70
P/N 051591E
iii
Cleaning of the Y Probe Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Maintenance of the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Echo-Screen Hearing Screener Limited Product Warranty . . . . . . . . . . . . . . . . . . . . . . . . 73
Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Operating Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Technical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
TEOAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
DPOAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
AABR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Probe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Y Probe Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Device Class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Applied Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Manufactured by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
List of Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
iv
P/N 051591E
Introduction
Intended Use
The Echo-Screen Hearing Screener is a fast, reliable, portable device
designed to screen for hearing loss in newborns, infants, children, and adults.
During screening, the patient should be asleep or in a quiet state.
IMPORTANT: Newborns must be at least 34 weeks gestational age to be
tested with the Echo-Screen device.
IMPORTANT: Before setting up the Echo-Screen device or screening
patients, read all sections of this manual carefully.
The Echo-Screen is designed as a completely modular system. According to
the current scientific standard, three important methods are suitable for the
screening of hearing loss. These methods are distinguished by features that
qualify them for specific situations, target groups, and screening protocols.
Depending on your situation, you might have a choice of a single method or a
combination of methods. The Echo-Screen system is available as a single or
multi-step hearing screener. An advantage of an Echo-Screen that incorporates
multiple methods is that different methods can be applied successively without
requiring follow-up procedures.
The Echo-Screen device incorporates the following three types of technologies
for the screening of hearing loss:
Transient Evoked Otoacoustic Emissions (TEOAE) technology
Distortion Product Otoacoustic Emissions (DPOAE) technology
AABR technology
With this combination of technologies, the Echo-Screen is flexible in both

handling and application, and is suitable for all stages of life.
Otoacoustic Emissions (OAE) technology measures the acoustic response of
the outer hair cells within the inner ear and indicates whether the cochlea is
functioning properly. TEOAE technology is optimized for use with newborn and
pediatric populations, while DPOAE technology is appropriate for patients of all
ages. The DPOAE technology has the advantage of providing a
frequency-specific test. Both technologies can be used as a first stage
screening test within a multi-stage screening program.
AABR technology measures the electrical response of the auditory nerves and
the brain to brief click stimuli. It is optimized for use with newborn patients. This
technology is appropriate as a second screening step for children at risk of
hearing loss.
After you start the Echo-Screen measurements, all the methods and the
interpretation of the measurements proceed automatically. By providing
automatic PASS and REFER results, the Echo-Screen device does not require
P/N 051591E

Safety Information
special technical skills or interpretation of results. Basic training with the

equipment is sufficient to learn how to screen correctly.
The Echo-Screen is designed for every measurement modality so that the tests
meet the needs of various groups and hearing loss can be detected with a high
degree of validity.
The simple and reliable technology ensures that hearing loss can be detected
objectively, even at an early age or in non-cooperative persons. Numerous
investigations show that, because of the early maturation of the brain in
children, it is beneficial to assess hearing loss within the first six months of life.
With early technical and therapeutic intervention, hearing-impaired children
have the potential to develop considerable speech and language skills, which
are essential for their mental and social development.
Safety Information
Explanation of
Terminology
This manual presents three types of precautionary information. The three types
of statements carry equal weight; that is, they are of equal importance to the
safe and effective use of the device. Each statement is categorized by using an
introductory word in boldface as follows:
WARNING:
Identifies conditions or practices that might present danger or
possible injury to the patient and/or user.
IMPORTANT: An instruction provided to help ensure correct clinical results
and provide quality assurance to the screening procedures.
CAUTION:
An instruction that, if not followed, can result in a condition that
could damage the device.
Other explanatory information is highlighted with the word "Note". Information
in this category is not considered precautionary.
Note: Background information provided to clarify a particular step or
procedure.
P/N 051591E

Documentation Conventions
Precautionary
Information
The following precautionary information pertains to the use of the Echo-Screen

Hearing Screener.
WARNING:
Do not use the screener if you suspect it is not functioning
properly or if any parts appear damaged. Contact Natus Technical Service or
your authorized service provider for assistance.
WARNING:
Do not attempt to plug the ear probe, ABR, or Y probe cable
into any other equipment, as unspecified damage to either component may
occur. The ear probe, ABR, and Y probe cables are patient connected cables
and must only be plugged into the Echo-Screen device.
WARNING:
care area.
Print or export data to a PC outside of the immediate patient
WARNING:
When the device battery requires replacement, always charge
batteries outside of the immediate patient care area.
CAUTION:
Use only Natus screening supplies with the Echo-Screen
device. Use of non-Natus supplies may damage the Echo-Screen device, may
affect the accuracy of screening results, and will void the warranty.
CAUTION:
Never use any type of sharp instrument on the plastic keypad.
Reliable operation of Echo-Screen device can no longer be guaranteed if sharp
instruments are used.
CAUTION:
Use only the Natus approved battery charger (REF 900729)
delivered with the Echo-Screen device. Battery chargers not approved by
Natus may not meet electrical and safety standards. Use of other chargers may
cause damage to the device and Natus is not liable for damages caused in their
use.
CAUTION:
Incorrect use of the Echo-Screen device and its accessories,
or the use of parts and accessories not supplied by Natus Medical
Incorporated, can lead to incorrect results.
Example Data and
Screen Shots
Example Data
Throughout this manual, you will find screen shots that illustrate the windows
you see when using the data management software or screening devices. In
P/N 051591E

some cases, these screen shots appear to contain patient data. This data is
fictional, having been created for illustration purposes only.
Screen Shots
The screens shown in the following pages may look different than the screens
on your particular system. Not all command buttons or on-screen choices may
be available, as software configuration allows for some features to be
assignable to custom profiles and the administrator of your system may have
configured your system differently than depicted.
Buttons,
Menus, and Fields
In this document, the names of toolbar icons, buttons, and menu options are
displayed in teal. These items are selections you can make to execute the
described functions.
Field names, checkboxes, and radio buttons are displayed in bold. These
items represent places where you can enter data or choose an option.
P/N 051591E
Overview of Screening Technology

About Otoacoustic Emissions
Congenital hearing impairment can lead to serious consequences for speech
and language acquisition, as well as for emotional and intellectual
development. Recent research has confirmed that these consequences can be
minimized if identification and intervention occur before the hearing-impaired
child reaches six months of age. In addition, technological advances make it
possible for a wide range of caregivers to perform automated screening of
infants hearing. One of these automated screening methods uses the
presence of otoacoustic emissions.
Otoacoustic emissions (OAEs) are sounds found in the ear canal that originate
from activity in the cochlea. These sounds are weak, but potentially audible,
sometimes amounting to as much as 30 dB SPL. They are created by motion
of the eardrum driven by vibrations in the cochlea, which are transmitted
through the middle ear chain. Consequently, they can be detected only when
the middle ear is operating normally. OAEs are generated only when the Organ
of Corti is in normal or near normal condition. They can emerge spontaneously,
but more commonly follow acoustic stimulation.
Note that otoacoustic emissions do not contribute to hearing, but are
by-products of an active process in the cochlea, in which motility of the outer
hair cells tunes the basilar membrane and amplifies weak sounds. They are
clinically significant in that they provide an indication of the integrity of the
cochlear amplifier (outer hair cells).
Types of OAEs
Transient Evoked
Otoacoustic
Emissions
(TEOAEs)
TEOAEs are elicited by brief stimuli such as clicks or tone bursts. They can be
recorded in nearly all persons with normal hearing. TEOAEs are highly
non-linear. Their pattern of growth is consistent with the operation of the
cochlear amplifier, which provides most gain for the low level inputs, and lends
support to the notion that OAEs arise from outer hair cell activity.
TEOAEs do not correlate with behavioral audiometric thresholds. Thus it is not
possible to predict hearing thresholds based upon TEOAE thresholds.
However, since the presence of TEOAEs correlates strongly with normal
hearing, the most common clinical application involves click stimulation at
moderate intensity levels for the purpose of hearing screening or differential
diagnosis.
The Echo-Screen system uses a binomial statistical test to give either a PASS
or REFER result. In contrast to the signal averaging technique with two buffers,
typically applied in most TEOAE instruments, the Echo-Screen device
P/N 051591E

Types of OAEs
calculates the statistical probability that an emission has been recorded, at a

succession of sampling points ranging from 6 to 12 ms after the stimulus.
The Echo-Screen device considers every data point individually. The
assumption is that for each point no time locked signal is present. This point is
then compared to the distribution of random signal which is well defined by
binomial statistics. If the assumption that each single point is random can be
rejected with 99.7% confidence, then the point is considered to be a signal (or
emission).
Each recorded sweep is assigned to one of eight quality buffers, according to
its amplitude. The statistical analysis is carried out simultaneously in each
quality buffer, and the test result will be OK if the criterion for this outcome is
met, in any of the quality buffers. A PASS result is indicated by the presence of
4 alternating peak pairs of the statistical OAE trace exceeding the 99.9%
confidence limit.
The advantage of this method over the usual averaging techniques is that the
measures are more robust in noise and measurement time can be reduced.
Because the Echo-Screen device can automatically identify and exclude
artifacts, measurement time can be dramatically shortened, a distinct
advantage especially in the case of restless infants. In addition, the statistical
criterion reduces the probability for a false negative result to less than 0.3%.
Distortion Product
Otoacoustic
Emissions
(DPOAEs)
DPOAEs are tones produced by the ear in response to two simultaneous

pure-tone stimuli denoted as primary tones. These emissions are distortion
products (DPs) in that they are not present in the pure-tone stimuli that elicits
them. The lower frequency pure-tone stimulus is represented by f1 and the
higher frequency pure-tone stimulus is represented by f2. The most frequently
measured DPOAE is at the 2f1 - f2 frequency, although the cochlea also
produces DPOAEs at other frequencies. This measurement is typically the only
one used for clinical applications.
The crucial task of the DPOAE evaluation is to discriminate the sound of the
environment the noise from the cochlear sound response the DP.
Although the distinction can never be absolutely certain, a properly designed
statistical algorithm can reduce the probability of incorrectly classifying noise as
a cochlear signal to a known probability. With the Echo-Screen device, this
probability is 0.3% for each frequency applied. Conventional criteria commonly
used in this type of device show a false pass rate that is considerably higher (up
to 10% with the frequently used 6dB SNR criterion).
The Echo-Screen device utilizes a statistical solution that makes it possible to
evaluate the spectrum specifically at the frequency of the expected DP. Thus,
no comparison with adjacent spectral lines is necessary.
During a specific time, the acoustic activity at the expected DP frequency fDP =
2f1 - f2 is analyzed by reducing the spectral component to a unit vector. Its
phase is determined mathematically. By repeating this procedure, a set of unit
vectors with different phases is obtained. These vectors can be added using the
laws of vector addition in the polar coordinate system.
P/N 051591E

Working with OAEs
The evaluation is based upon the laws of statistical distributions: It can be

shown mathematically that the vector of randomly distributed unit vectors will
not exceed a certain value with a probability of 99.7%. Spectral components of
random noise with phases that are independent of the primary tones behave
similarly. A DP with fixed phase relative to the primary phases will add a
constant value to this sum. Therefore, if the vector sum exceeds this limit, the
presence of a response can be claimed on a 99.7% confidence level.
This criterion is set up for each of four f2 frequencies applied: 2 kHz, 2.5 kHz,
3.2 kHz and 4 kHz. An overall PASS result requires 3 passes out of 4
frequencies.
Working with OAEs

Recording OAEs
Recording OAEs requires a sensitive, low-noise microphone to be sealed in the

external ear canal. Recording of OAEs elicited by an acoustic stimulus also
requires that two transducers deliver the stimuli. The microphone records the
sound present in the external ear canal. The type of signal analysis applied
depends on the type of emissions to be recorded.
OAE Applications
TEOAEs are well suited and widely accepted for the purpose of hearing
screening. The presence of TEOAEs is a strong indicator that a portion of the
audiogram has hearing threshold levels better than 25 db HL, and correlates
best with good hearing in the mid-frequency range. It is not possible to rely on
the TEOAE spectrum to predict threshold levels by frequency.
Although DPOAEs do not allow clinicians to predict behavioral thresholds,
there is a correspondence between DP-gram configurations and audiograms.
That is, in ears having sensory hearing loss, DPOAEs are reduced or
eliminated only for the f2 stimulus frequency region that coincides with the
impaired region. Therefore, DPOAEs can give a better frequency-specific
impression of cochlear integrity than TEOAEs, and they are well suited to
monitoring cochlear function.
Although OAEs have not proven to be good predictors of auditory nerve tumors,
they can provide an opportunity to document normal or near-normal cochlear
function, which makes them helpful for locating site lesion and for making
management decisions.
About AABR Technology

The Echo-Screen device delivers broadband clicks at 35 dB nhL, 45 dB nHL,
or 55 dB nHL intensity levels to the patients ears through either Echo Couplers
or an ear probe. Each click evokes a series of identifiable brain waves from the
auditory brainstem. This brainwave activity is called the ABR (auditory
brainstem response).
Like the TEOAE and DPOAE modes of the Echo-Screen device, AABR
technology uses a statistical approach for the PASS criteria which is based on
binomial statistics. Because an ABR shows different characteristic shapes
P/N 051591E

Echo-Screen Device Technology Configurations
during an individuals life period, the algorithm is optimized by pre-filtering the

measured brain signals with a typical pattern. The Echo-Screen device uses a
pattern which represents the typical waveform during the first year of life.
Nevertheless, AABR technology may also be used for older children as well as
adults. Due to sub-optimal fit it may take longer to achieve a PASS result.
A PASS result from AABR technology indicates that an electric brainstem
response to a 35 dB nHL, 45 dB nHL, or 55 dB nHL broadband stimulus could
be detected. The spectrum of the stimulus includes all frequencies between
500 and 4000 Hz, but due to filtering in the ear canal and other influences, the
main region tested is between 2000 and 4000 Hz. In this region most significant
losses can be found. A REFER result indicates that the necessary significance
level for a PASS could not be reached.
As compared to the measurement of otoacoustic emissions, ABRs discriminate
more precisely between mild and moderate hearing losses. Consequently, its
specificity for the detection of moderate hearing losses is higher.
ABRs are particularly appropriate for testing hearing in newborns, infants, and
children for the following reasons:
ABRs are not influenced by vigilance. Therefore, they can be

measured during sleep. Sleep is the ideal state for measuring ABRs
because during this state muscle potentials have the least influence
over the measurements.
Investigations show that the psycho-acoustic hearing threshold has a

strong correlation with the response threshold of the brain stem. This
means that if an ABR is measurable as a response to an acoustic
stimulus, it is safe to assume that the individual can hear the stimulus
unless there is cortical brain damage.
On the downside, care must be taken during measurement and evaluation to

avoid false results, because the amplitude of the response is frequently below
100nV and, therefore, considerably lower than that of a scalp
electroencephalogram (EEG) or electromyogram (EMG).
Echo-Screen Device Technology Configurations

The Echo-Screen system is available as a single or multi-step hearing
screener. The following models or technology configurations are available:
Model
Technology Configuration
Echo-Screen T
TEOAE technology
Echo-Screen D
DPOAE technology
Echo-Screen A
AABR technology
Echo-Screen T/D
TEOAE & DPOAE technology
Echo-Screen T/A
TEOAE & AABR technology
Echo-Screen D/A
DPOAE & AABR technology
Echo-Screen T/D/A
TEOAE, DPOAE & AABR technology
P/N 051591E
Screening Device & Components

The Echo-Screen Hearing Screener is a handheld, battery-operated device
containing a set of customized electronic components that incorporate one or
a combination of TEOAE, DPOAE, and AABR technologies. It also has an
infrared (IR) port which can be used to transfer or print screening results.
Front View
Figure 1Elements of the Echo-Screen
Graphic LC
Display
LED Indicator
OK Button
Soft Keys
Navigation Arrows
Alphanumeric
Keypad
P/N 051591E

Display & Control Panel

Keys, Terms,
Functions
Table 1.Button functions
Button
OK
Text on display
N/A
Switches on the device

Activates the selected item
Starts screening functions
OFF
BACK
SELECT
STOP
Switches off the device from the main menu

Reverts to the previous menu/display
Cursor for selecting Date/Time
Discontinues screening
N/A
Cursor for navigating the menus / scrolling up

Steps up the value of the setting in the
"Date/Time" menu
N/A
Cursor for navigating the menus /scrolling

down
Steps down the value of the setting in the
"Date/Time" menu
OK Button
Soft key right
Mode
Navigation
arrow up
Navigation
arrow down
MENU
OPT (Option)
Soft key left
Navigation
SKIP
PAUSE
Reverts to the main menu

Shows artifact and stimulus stability rate
(TEOAE)
Skips test functions (DPOAE)
Interrupts screening (AABR)
Press the navigation arrows (up or down) to scroll through the menu items.
Selected items are highlighted black.
Press OK to activate menu functions highlighted by the black bar and to confirm
selections.
The current function of the soft keys is displayed in the bottom line of the
display.
CAUTION:
Never use any type of sharp instrument on the plastic keypad.
Reliable operation of Echo-Screen device can no longer be guaranteed if sharp
instruments are used.
Data Entry
10
Use the alphanumeric keypad to enter numbers and letters. Use the arrow keys
on the keypad (< and >) to move backwards and forwards.
P/N 051591E

Top View
Figure 2Echo-Screen Top View
Infrared window
Bottom View
ABR cable socket
Ear Probe/Y Probe

cable socket
Figure 3Echo-Screen Bottom View
Connector to PC data transfer cable
P/N 051591E
11

Back View
Figure 4Echo-Screen Back View
Label with serial number
Rechargeable NiMH battery

pack
12
P/N 051591E

Ear Probe Cable
Ear Probe Cable

The ear probe cable is designed for conducting TEOAE, DPOAE, and AABR
tests. Different sized ear tips are attached to the probe tip and then inserted into
the patients ear canal for testing.
Figure 5Probe Tips
Acoustic filter
Probe tip
Probe body
Test cavity
The test cavity is used to test the functionality of the ear probe cable. The probe
tip of the ear probe cable is inserted into the test cavity.
Figure 6Test Cavity
Y Probe Cable
The Y probe cable is designed for conducting AABR tests. The colored
adapters of the cable generate clicks, which are delivered to the patients ears
through Echo Couplers. The Y probe cable is designed specifically for use with
Echo Couplers.
P/N 051591E
13

ABR Cable
Figure 7Y-Probe Cable

Blue Echo Coupler adapter
for the left ear
Red Echo Coupler

adapter for the right
ear
Connector to
Echo-Screen
ABR Cable
The ABR cable is designed for AABR tests. The cable consists of colored clips
which attach to Natus disposable snap electrodes. The cable transmits the
patients responses back to the Echo-Screen device.
Figure 8ABR Cable
14
P/N 051591E

Screening Supplies
Screening Supplies
Echo Couplers &
Snap Electrodes
Echo Couplers are designed for conducting AABR tests. They attach to the Y
probe cable and are placed over the patients ear during testing. The Echo
Couplers are designed for newborn patients and are intended for single-patient
use.
The snap electrodes are specialized low impedance electrodes designed for
AABR tests. They allow the ABR signals to be transmitted across the infants
skin to the Echo-Screen device. The sensors are coated with a conductive
adhesive.
Figure 9Echo Coupler and Snap Electrodes
Disposable Snap Electrodes

Port for one
Echo Coupler
Adapter
Skin prepping materials, such as NuPrep gel, remove surface oil or skin
debris at the sensor sites on the patient. These products lower the electrical
impedance of the skin and can improve the sensor connections. Your service
representative can provide information and options for supplies and prepping
materials.
Ear Tips
The colored ear tips attach onto the probe tip end of the ear probe cable and
are inserted into the patients ear canal for TEOAE, DPOAE, or AABR tests.
The ear tips are available in different sizes to accommodate testing with
newborns, children, and adults.
Figure 10Ear Tips
Colored Ear Tips
P/N 051591E
15

Screening Supplies
16
P/N 051591E
Setting Up the Device

Initial Setup
This section provides instructions for the initial setup of the Echo-Screen device
prior to screening.
IMPORTANT: Ensure that the Echo-Screen device has all the appropriate
settings for your facilitys protocol prior to screening patients.
Unpacking the
Echo-Screen device
Unpack the Echo-Screen system carefully. Inspect the equipment for possible
visual damage and ensure you have received all parts and accessories.
If damage has occurred, do not attempt to operate the device. Instead, contact
Natus Technical Service or your authorized service representative.
Storing the
Echo-Screen Device
The Echo-Screen device is shipped in a protective carrying case. When not in

use, the device should remain in its carrying case to prevent damage.
The Echo-Screen device should be stored between the temperatures of 0-40C
(32-104F).
CAUTION:
Extreme storage or operation temperatures may cause the
LED to crack (in extremely cold conditions) or affect the calibration of the
instrument.
Charging the Battery

Pack
The Echo-Screen device is shipped with a partially charged battery pack. Prior
to first use, the battery must be charged.
CAUTION:
Use only the Natus approved battery charger (REF 900729)
delivered with the Echo-Screen device. Battery chargers not approved by
Natus may not meet electrical and safety standards. Use of other chargers may
cause damage to the device and Natus is not liable for damages caused by
their use.
WARNING:
When the device battery requires replacement, always charge
batteries outside of the immediate patient care area.
P/N 051591E
17

Initial Setup
Removing the
Battery Pack and
Connecting the
Charger
Figure 11Releasing the Battery Pack
1. Place the Echo-Screen device on a

flat surface with the back side facing
upward.
2. Use the index finger of the other
hand to press the button of the
battery until it clicks. Slide the battery
downward to remove it from the
housing.
Figure 12Charging the Battery
The charger socket is located on the

inside of the battery pack.
3. Insert the plug of the charger into the
charger socket of the battery pack.
4. Plug the charger into a mains power
socket. Charging starts automatically.
Note: The battery pack takes approximately two hours to charge

completely.
Note: The battery pack for the Echo-Screen system allows
approximately 10 hours of continuous use once it is fully charged.
Monitoring the
Battery Charge
Process
The Echo-Screen battery charger controls the charge process automatically.

The LED on the bottom of the charger indicates when the battery is charging
and when it is fully charged. The LED will also indicate any faults evident in the
system (see Battery charging LED messages on page 19).
18
P/N 051591E

Initial Setup
Table 2.Battery charging LED messages
Battery Test
LED on
I------------------------I
* Rapid Charge: The battery pack is being

charged.
LED flashing every

1.3 seconds
I-- -- -- -- -- -- -- I
* Trickle Charge: The battery pack is fully charged.
LED flashing every

0.3 seconds
I- - - - - - - - - - - - - - I
* Fault Condition: The charger has detected a

fault.
Press the OK button to turn on the Echo-Screen device. The device

automatically runs a battery test.
If the necessary minimum voltage should drop, the change battery message
appears on the display and the Echo-Screen device switches off automatically.
If this occurs, exchange the NiMH-battery pack and recharge it as soon as
possible.
Figure 13Battery Indicator
If the battery symbol appears in the top

right corner of the display, you can no
longer activate any functions other
than navigating through the menu. If
this occurs, exchange the NiMH
battery pack and recharge it as soon
as possible.
Battery Safety
Information
CAUTION:
The charger is for indoor use only and should be protected
against moisture.
CAUTION:
Do not use the charger with non-rechargeable batteries.
CAUTION:
Keep the battery away from fire, as it can explode. Incorrect
handling, applying excessive charging current or reversing the poles, can
overcharge or destroy the battery.
CAUTION:
Do not open, alter or dismantle the battery pack.
CAUTION:
Do not place the battery pack in contact with metal objects.
CAUTION:
The battery pack terminals must not be short-circuited under
any circumstances.
P/N 051591E
19

Initial Setup
Increasing Service
Life
Battery
Replacement &
Disposal
Language,
Date/Time, Testing
Alert & Background
Light Settings
Use only the recommended battery charger unit.

Charge the battery pack at room temperature whenever possible.
Do not drop the battery pack or expose it to sharp impact.
Store in a cool, dry place.
Keep the battery pack terminals clean. (Clean with a soft cloth if necessary)
To obtain a replacement battery pack, contact Natus Technical Service or your

authorized service representative. Follow your institutions protocol for the
proper disposal of the battery pack.
Basic settings on the Echo-Screen device such as language, date/time, and

testing alert sounds can be selected and changed.
1. Power on the Echo-Screen device

and select Options from the main
menu display.
2. Select Settings 1 from the Options

menu and press OK to continue.
20
P/N 051591E

Initial Setup
Language
1. Select Language to view the

available language options for
operating the Echo-Screen system.
2. Select the appropriate language

3. Press OK to confirm and return to the
main Settings 1 menu.
Note:
You must press OK to confirm a new language setting. Pressing
(MENU) returns to the main menu display without storing the new
language setting. Pressing (BACK) returns to the Settings 1 display
without storing the new language setting.
Date / Time
1. Select Date/Time from the

Settings 1 display and press OK to
view the date and time setting.
2. Press (SELECT) to select the
appropriate date or time unit.
3. Use the up and down navigation
arrows to increase or decrease the
selected date or time value.
4. Press OK to confirm the new date
and time setting and return to the
Settings 1 menu or press (MENU)
to confirm the new date and time
setting and return to the main menu
display.
Date / Time Format
1. Select Date/Time Format from the

Settings 1 menu and press OK to
view the current format that appears
on the Date/Time display.
2. If required, scroll to select a different
format and press OK to confirm.
The new format is automatically
displayed.
P/N 051591E
21

Initial Setup
3. Press OK to return to the Settings 1 display or press (MENU) to return

to the main menu display. You can also press (BACK) to return to the
Date/Time format display.
Note: You must press OK to confirm a new date/time format. Pressing
(MENU) returns to the main menu display without storing the new
format. Pressing (BACK) returns to the Settings 1 display without
storing the new format.
Background
Lighting (display)
1. Select Backlight from the Settings 1

2. Select On or Off for the background
lighting and press OK to confirm.
If you select On, the background lights
up. If no keys are pressed, the light
automatically turns off after 20
seconds, and turns back on when a
key is pressed.
Note:
You must press OK to confirm a new backlight setting. Pressing
(MENU) returned to the main menu without storing the new setting.
Pressing (BACK) returned to the Settings 1 menu without storing the
new setting.
Sounds
1. Select Sounds from the Settings 1

menu to select the sounds that are
associated with the operation of the
Echo-Screen device.
2. Select a sound option and press OK
to confirm and return to the
Settings 1 menu.
Select this:
22
To do this:
Sounds off
Turn off all sounds.
Key click
Hear a click when a button on the Echo-Screen device

is pressed.
Pass/Refer jingle
Hear a jingle when the Echo-Screen device displays a

PASS or REFER result.
Jingle and key click
Hear a click when a button is pressed and a jingle

when the Echo-Screen device displays a PASS or
REFER result.
P/N 051591E

Initial Setup
Note: You must press OK to confirm a new sound setting. Pressing

(MENU) returns to the main menu without storing the new setting.
Pressing (BACK) returns to the Settings 1 menu without storing the
new setting.
Default Test Mode
You can designate the default test mode (TEOAE, DPOAE, or AABR) that is
used for measurements.
1. Select Default Measurement from
the Settings 1 menu.
2. Select TEOAE, DPOAE, or ABR as
the default mode.
3. Press OK to confirm and return to the
Settings 1menu.
Note: You must press OK to confirm a new default measurement setting.

Pressing (MENU) returns to the main menu without storing the new
setting. Pressing (BACK) returns you to the Settings 1 menu without
storing the new setting.
Data Input, User

Access, & Patient
Data Display
Settings
You can use the Settings 2 menu to define data input methods, user access
privileges, and patient data display modes for the Echo-Screen device.
1. Select Settings 2 from the Options
2. Select Edit mode, User mode, or

Patient list mode and press OK to
continue.
P/N 051591E
23

Initial Setup
Edit Mode
You can use Edit mode to define the default data input method for the
Echo-Screen device.
1. Select the appropriate edit mode:
Select Hold mode to hold a key
down until the character appears on
the Echo-Screen display.
Select Tap mode to tap a key
several times until the character
appears on the Echo-Screen display.
2. Press OK to confirm your selection
and return to the Settings 2 menu.
Note: You must press OK to confirm a new edit mode setting. Pressing
Pressing (BACK) returns the Settings 2 menu without storing the new
setting.
User Mode
User mode designates whether the Echo-screen device is to be operated by a

single user or by multiple users.
1. Select the appropriate user mode
setting:
Select Single (no login) if you do
not need to specify the user name or
ID. This option disables the login
function.
Select Multi (login) if multiple users
operate the Echo-Screen device.
This option enables the login
function. When the Echo-Screen
device is powered on, a user name
or corresponding ID must be selected
in order to proceed.
2. Press OK to confirm the selection
Note: You must press OK to confirm a new user mode setting. Pressing
new setting.
Note: If the Multi (login) mode is enabled, the user ID (maximum of five
characters) in included on the Echo-Screen result label printouts. The user
name (maximum of 21 characters) is not included on the label printout.
24
P/N 051591E

Initial Setup
Setting User Login

Names and IDs
Before you can use the Echo-Screen device, you must enter user login names
or IDs into a personal computer (PC) by using EchoLinkII software and then
transfer them to the Echo-Screen device. A maximum of 100 user names and
IDs can be stored in the Echo-Screen device.
To set up user login names and IDs:
1. Connect the Echo-Screen device for either wireless (infrared) or cable data
transfer. (See Transfer & Deletion of Patient Data on page 53 for details
about wireless and cable data transfer.)
2. Open the EchoLinkII software on the computer and then open Settings
from the main EchoLinkII menu.
3. Select User Login List from the Settings menu. A User Login List
appears.
4. Enter the appropriate User IDs (maximum 5 characters) and User Names
(maximum 21 characters) into the User Login List.
5. Click Upload to transfer the user names and IDs to the Echo-Screen
device.
Note: You must restart the Echo-Screen device after the upload is
complete.
Note: If any changes to the user names or IDs are required, they must be
made by using EcholinkII software and then uploaded again to the
Echo-Screen device.
Note: The Echo-Screen device prints only the User ID on the results label
printout. The User Name does not appear on the results label printout.
Patient List Mode
Patient List Mode designates how the Echo-Screen device lists patient
information on the Patient List display.
1. Select the appropriate list mode:
Select List by last names to list
patients by their last name in the
order in which they were entered into
the Echo-Screen system.
Select List by ID numbers to list
patients by their ID number in the
order in which they were entered into
the Echo-Screen system.
2. Press OK to confirm your selection
P/N 051591E
25

Initial Setup
Note: You must press OK to confirm a new patient list setting. Pressing
new setting.
ABR Configuration
Setting
You can use the ABR configuration option to set the appropriate voltage
frequency and stimulus level for AABR testing.
1. Select ABR configuration from the
Options menu and press OK to
continue.
2. Select Notch filter and press OK to

check or preset the voltage
frequency for the Echo-Screen
device.
ABR Notch Filter

Frequency
1. Select the appropriate setting:

Select 50 Hz (Europe) to use the
voltage frequency for Europe.
Select 60 Hz (US) to use the voltage
frequency for the United States.
Select Ask before test to
automatically display the ABR Notch
filter options after the AABR test
method is selected.
Note: Check the regional mains voltage frequency before changing the
setting on the Echo-Screen device.
Note: You must press OK to confirm a new notch filter setting. Pressing
Pressing (BACK) returns to the ABR Configuration menu without
storing the new setting.
26
P/N 051591E

Initial Setup
ABR Stimulus Level
1. Select Stimulus level from the ABR

configuration menu to preset the
stimulus level for AABR testing.
2. Select one of the stimulus levels
35 dB nHL, 45 dB nHL, or 55 dB
nHL or select Ask before ABR
test to allow the user to choose the
appropriate stimulus level before
each AABR test.
3. Press OK to confirm the ABR
stimulus level selection and return to
the ABR configuration menu.
Note: The 55 dB nHL stimulus level can only be used for AABR tests that
are conducted with the ear probe cable. The Y Probe cable cannot be used
for AABR tests conducted at the 55 dB nHL stimulus level.
Note: You must press OK to confirm a new stimulus level setting.
Pressing (MENU) returns to the main menu without storing the new
setting. Pressing (BACK) returns to the ABR Configuration menu
without storing the new setting.
Storing Default
Comments
Comments regarding the patients state, test environment, and so forth can be
entered or selected for each screen and stored with the results.
You can enter a maximum of 25 default comments into the EchoLinkII software
by using a personal computer (PC) and then transfer them to the Echo-Screen
device prior to testing. At the time of the test, you can select one of the default
comments.
To set up default screening comments for the Echo-Screen device:
1. Connect the Echo-Screen device for either wireless (infrared) or cable data
transfer (See Transfer & Deletion of Patient Data on page 53 for detailed
instructions on wireless and cable data transfer).
2. Open EchoLinkII software from the PC and access Settings from the main
EchoLinkII menu.
3. Select Comments List from the Settings menu. A list of 25 default
comments is displayed.
4. Revise or update the comments list as necessary.
Note:
Comments are limited to 21 characters.
5. Click Upload to transfer the comments to the Echo-Screen device.
P/N 051591E
27

Initial Setup
28
P/N 051591E
Preparing for Testing

TEOAE & DPOAE Tests
The ear probe cable is required for TEOAE and DPOAE tests.
Plug the connector of the ear probe cable into Ear Probe socket (A) located at
the top of the Echo-Screen device (see Figure 14).
When connecting the cable to the housing, the red dot on the cable connector
must be aligned with the red dot above the socket of the Echo-Screen device.
Figure 14Ear Probe and ABR Electrodes sockets
Alignment dot
Note: Use the Test Cavity to conduct a probe test prior to testing. One
probe test per day is recommended. (See Equipment Checks on page 61
for instructions on conducting a probe test).
When disconnecting the cable, grasp the sleeve of the connector and pull it out
to release it from the socket. Do not pull the connector by the cable.
AABR Tests
Connecting the ABR
Cable
The ABR cable is required for conducting AABR tests.

Plug the ABR cable into the ABR Electrodes socket (B), which is located on the
top of the Echo-Screen device (see Figure 14). Ensure that the red dot of the
ABR cable connector is aligned with the red dot above the ABR Electrodes
socket (B).
When disconnecting the ABR cable, grasp the sleeve of the connector and pull
it out to release it from the socket. Do not pull the connector by the cable.
P/N 051591E
29

AABR Tests
Connecting the Ear

Probe Cable or Y
Probe Cable
You can use either the ear probe cable or the Y probe cable for AABR tests:
If you want to insert the probe into the patients ear, the ear probe cable is
required.
If you want to conduct the AABR test by using Echo Couplers, the Y probe
cable is required. The Y probe cable connects to the Ear Probe socket of
the Echo-Screen device. When connecting the Y probe cable to the housing, the white arrow on the cable connector must be aligned with the red
dot above the Ear Probe socket of the Echo-Screen device.
Note:
Echo Couplers are intended only for use with newborn patients.
When disconnecting either the ear probe or the Y probe cable, grasp the sleeve
of the connector and pull it out to release it from the socket. Do not pull the
connector by the cable.
Checking the Test

Environment
30
Ensure that patients are screened in a quiet location.
P/N 051591E
Screening Procedure
Screening Procedure
IMPORTANT: Prior to running a test, ensure that the Echo-Screen device has
all of the appropriate settings. See Setting Up the Device on page 17 for
detailed instructions on setting up the Echo-Screen device.
Note: Before the first screen of the day, conduct a probe test to check the
functionality of the ear probe and Y probe cables. (For additional
information see Probe Test on page 61 in the Equipment Checks
chapter).
Note: For demonstration or training purposes, you can perform a quick
test without entering patient information. This test function applies to all
technology configurations (TEOAE, DPOAE, and AABR). For more
information, see Quick Test on page 59.
Step 1: Power on the

Echo-Screen device
Press the OK button to switch on the Echo-Screen device. A five-second

battery test automatically occurs.
During start-up, the LED control light lights up in red and green for
approximately one second.
Both the configuration of the device and the software version are indicated on
the display of the Echo-Screen device.
The device proceeds automatically to the main menu. The main menu grants
access to all the other menu functions.
Note: The Echo-Screen automatically powers off if no keys are touched
within approximately 10 minutes.
Skipping a Battery Test

You can go directly to the main menu display without going through the battery
test at the initial start-up of the device. To skip the battery test:
Press the OK button.

Press any button. The main menu is displayed automatically.
P/N 051591E
31

Screening Procedure
Step 2: Enter Patient

Information
1. Select Measure from the main menu

display. Press OK to continue.
2. From the Patient List display, select

the name of a patient already stored
in the device or press (ADD) to
enter information for a new patient.
3. Using the alphanumeric keypad,
enter Patient ID, Name, Date of
Birth and Patient Status. The
Patient Status is preset to
out-patient. Enter zero ("0") to
change the status to in-patient.
4. Confirm each data entry by pressing
OK. Press (CLEAR) to delete
incorrect inputs.
5. After all patient information is
entered, press OK to save the
information.
6. Review patient data and press OK to
continue.
The Patient Data display provides an overview of the information entered for
the patient:
Step 3: Prepare
Patient and Attach
Supplies
Patient ID
Name (Last, First)
Date of birth
Patient status (in-patient or out-patient)
TEOAE and DPOAE Tests

The ear probe cable is required for TEOAE and DPOAE testing. Ensure that
the ear probe cable is properly connected to the Echo-Screen device.
32
P/N 051591E

Screening Procedure
Fitting the Probe

1. Check the patients ear canal and select an ear tip that fits. You may have
to try out different sizes to find an ear tip that provides the most secure fit.
Recommended ear tip sizes for patients:
Newborns: 4 mm - 5.5 mm, Mushroom, and Tree
Children: 6 mm - 10 mm
Adults: 9 mm - 12 mm, 13.7 mm, and 17.8 mm
WARNING:
The probe tip must not be placed into the ear canal at any time
without using a proper ear tip.
IMPORTANT:
tips provided.
Accurate measurements can only be guaranteed using the ear
2. Push the ear tip onto the probe tip until it sits against the probe. Large ear
tips should be oriented so that their raised side faces the probe. Smaller
ear tips should be oriented so that their enlarged side faces the probe (see
figures below):
Figure 15Ear Tip Attachment
Large
ear tip
Small
ear tip
Correct ear tip

attachment
Incorrect ear tip

attachment
Once the ear tip is attached,

a small projection of the
probe tip should be visible.
IMPORTANT: When attaching and removing the ear tip, hold onto the
housing of the probe and not the ear probe cable itself.
P/N 051591E
33

Screening Procedure
Figure 16Probe Inserted
3. Insert the probe into the auditory

canal so that it maintains a stable
position by itself.
IMPORTANT: Ensure the probe has a snug fit. Any leakage may lead to a
prolonged test time due to distortion and excessive noise.
WARNING:
If a probe with an unsuitably sized ear tip is used or if excessive
force is applied, the ear canal may be irritated.
Note: It is acceptable to use the same ear tip for both ears. If there is
suspicion of infection in the external auditory canal, the ear tip should be
exchanged before testing continues on the other ear.
Tips for obtaining a good probe fit
It may be necessary to pull the external ear slightly backwards, similar

as for an otoscopy.
Spontaneous movements of the head can be easily compensated for

by reducing the strain on the probe cable. This can be achieved either
by forming a big loop which is loosely held with one hand close to the
head of the patient or by using the cable clip. In the latter case, attach
the cable clip to a surface that is close to the patients head (e.g.
patients shirt collar or babys blanket).
Avoid possible contact of the cable with any vibrating or gliding

surfaces during measurement.
Note: In the event of a probe error, ensure that the probe tip channels are
free and the probe is connected. See Probe Test on page 61 in the
Equipment Checks chapter and Maintenance of the Probe Tip on page 67
in the Maintenance chapter.
AABR Tests
Electrodes must be attached to the patients skin for AABR tests. In addition,
you can either insert the ear probe (as described for TEOAE & DPOAE testing)
or place Echo Couplers over the patients ear when conducting AABR tests.
Applying snap electrodes (ABR cable)

Ensure that the ABR cable is properly connected to the Echo-Screen device.
34
P/N 051591E

Screening Procedure
Figure 17Electrode Placement
1. Connect the colored sensor clips of

the ABR cable to a triplet of
disposable snap electrodes. Attach
the clips to the electrodes before
removing them from their adhesive
liner card.
2. With the colored clips attached, apply the electrodes for the AABR test to
the patient as follows:
Skin Prepping
Techniques
Sensor with white clip: vertex (high forehead)
Sensor with black clip: common (cheek)
Sensor with red clip: nape (centered, back of neck)
Skin prepping reduces electrical impedance across the patients skin, which
allows for better conductivity of the small electrical signals that constitute the
ABR. Conductivity is enhanced by moisture, for example skin fluid or saline
solution. Conductivity is impeded by dry skin or oil on the skin.
In general it is not necessary to prepare the patients skin when conducting a
test with the Echo-Screen device; however, patients with oily skin or body hair
at the sensor sites typically exhibit higher impedance and may require prepping
in order to be successfully screened.
Oily skin responds well to cleaning with mild soap and water followed
by prepping with NuPrep gel (gel for neonates).
Dry skin responds well to prepping with saline or NuPrep gel, or a

drop of saline under each sensor.
Prepping Tips
Prep the skin by creating some friction, but never using force. Be sure
you are moving the prepping pad over the skin, and not just moving the
skin under your fingers.
Always prep an area slightly larger than the sensor site.
Place infants on their side and tilt the head gently forward for easier
access to the nape sensor site. Separate the folds of the skin with one
hand and prep with the other.
A drop of saline can help rehydrate slightly dry sensors, and may add
enough moisture to adequately decrease a marginal impedance
reading.
If impedance readings are high, ensure that the sensors are attached
to the patient and cable clips are attached to the sensors. Also check
P/N 051591E
35

Screening Procedure
to see if the ABR cable is properly connected to the Echo-Screen

device.
If Nape and Vertex impedance readings are high, prep Common site
first.
Note: Alcohol can be effective for babies with very oily or sebaceous skin,
but it dries the skin as well. If alcohol use is permitted, you may need to
follow with a wet gauze wash and/or prep with NuPrep gel to rehydrate the
skin.
Applying Echo
Couplers (Y probe
cable)
Ensure that the Y probe cable is properly connected to the Echo-Screen device.
IMPORTANT: The Echo Coupler is disposable and designed for
single-patient use. Do not reuse.
Note:
Echo Couplers are designed for use only with newborn patients.
Note: Echo Couplers are intended only for use with the Y probe cable.
Do not attempt to use Echo Couplers with the ear probe cable.
Figure 18Probe Attached to Ear Coupler
Echo Coupler
1. Insert the red and blue Echo Coupler

adapters of the Y probe cable into
the side hole of each Echo Coupler
(see left). The Echo Couplers should
remain attached to their adhesive
liner.
Y Probe Cable
Echo Coupler Adapter
WARNING:
Do not insert the red and blue Echo Coupler adapters directly
into the patients ear canal. The adapters must be inserted into the Echo
Couplers prior to testing.
2. Remove the Echo Couplers from their adhesive liner and place over the
babys ears as follows:
36
Echo Coupler with red adapter:
Echo Coupler with blue adapter: Left ear
P/N 051591E
Right ear

Screening Procedure
Step 4: Start
Screening/Monitor
Progress
Select the appropriate test mode

(TEOAE, DPOAE, or ABR) from the
Measure display and press OK to
continue.
TEOAE Screening
Procedure
1. Select TEOAE from the Measure

display and press OK to continue.
Additional information such as patient
state, or testing environment can be
entered for a TEOAE test.
2. Select Comments to enter a

comment for the patient:
Select a default comment already
stored in the Echo-Screen device or
press (TYPE) to enter a new
comment.
3. Press OK to continue.
Note: A maximum of 25 default comments can be entered within

EchoLinkII software via a PC and transferred to the Echo-Screen device
prior to testing. (See Storing Default Comments on page 27 in the Setting
Up the Device chapter for instructions on storing default comments.)
P/N 051591E
37

Screening Procedure
4. Select the ear to be tested (right or

left).
5. Ensure that the probe is inserted
properly into the patients ear and
press OK to continue.
Calibration is performed before the test

begins. The test automatically begins
after calibration completes.
The test progress is displayed (see

example at left).
If the Unstable message appears,
check the probe fit.
The test can be stopped at any time by
pressing (STOP).
Press (OPT) to show the artifact

and stimulus rate values:
S: Stimulus stability rate should be at
least 80%.
A: Artifact rate should be below
20%.
If these conditions are not met and a
REFER result is obtained, you should
re-screen the patient.
If the result is PASS, the PASS
message appears before the detailed
results are displayed.
38
P/N 051591E

Screening Procedure
The detailed results are displayed as

follows:
Time: Screen duration (dependent
on ambient noise conditions)
TEOAE: Significance of the TEOAE
signal being present
A: Artifact rate
S: Stimulus stability rate
Graphical display: Illustrates the
statistical waveform with significance
limits.
If the result is REFER, detailed results
are displayed immediately after the
test.
In the case of a REFER result, you
should conduct another TEOAE test
under better conditions.
6. At the completion of the test, press
(BACK) to test another ear or
press (MENU) to view, print, or
transfer results.
DPOAE Screening
Procedure
1. Select DPOAE from the Measure

Additional information such as patient
state, or testing environment can be
entered for a DPOAE test.

Select a default comment already
comment.
P/N 051591E
39

Screening Procedure

prior to testing. (See Storing Default Comments on page 27 in the Setting
Up the Device chapter for instructions on storing default comments.)
left).
press OK to continue.
Calibration and probe fit is verified

before the test begins. If the probe
does not fit properly, the message
LEAK is displayed. Adjust the position
of the probe.
The probe fit is followed by a balance
test to make sure that the two
microphones function properly.
The screen automatically begins when
calibration is completed.
The test progress is displayed (see
example at left). At the top of the
display, the frequencies of the DPOAE
screen are shown. The test progresses
in the order of highest frequency pair
to lowest frequency pair:
3325Hz & 4000 Hz
2675Hz & 3200 Hz
2075Hz & 2500 Hz
1675Hz & 2000 Hz
40
P/N 051591E

Screening Procedure
The key note symbol indicates which

tone pair is currently in progress.
During the test, the results are
indicated by the following symbols:
checkmark (pass)
S (skipped)
R (refer)
2000 Hz
2500 Hz
4000 Hz
3200 Hz
If necessary, you can press (SKIP) to skip the current frequency. The test
will proceed to the next frequency pair.
To cancel the entire test, press (STOP).
The overall test ends successfully with
a PASS result if at least three of the
four frequency ranges could be
registered.
A PASS message appears before
detailed results are displayed.
Detailed results are displayed in order

of increasing frequencies (only for f2,
2000Hz - 4000 Hz).
6. At the completion of the test, press
(BACK) to test another ear or
press (MENU) to view, print, or
transfer results.
7.
AABR Screening
Procedure
IMPORTANT: Prior to AABR screening, verify that the ABR notch filter
frequency (50 Hz or 60 Hz) and stimulus level (35, 45, or 55 dB nHL) are set
according to your facilitys screening protocol. See ABR Configuration Setting
on page 26 of the Setting Up the Device chapter for detailed instructions on
setting the ABR configurations.
1. Verify that either the ear probe cable or Y probe cable is connected to the
ear probe socket of the Echo-Screen device.
2. Verify that the ABR cable is connected to the ABR electrodes socket of the
Echo-Screen device.
P/N 051591E
41

Screening Procedure
3. Select ABR from the Measure

display and press OK to continue.
Using the ear probe

cable (ear tips) for
AABR tests:
Additional information, such as patient state or testing environment, can be

entered for an AABR test.
2. Select a default comment already

comment.

prior to testing. (See Storing Default Comments on page 27 of the Setting
Up the Device chapter for detailed instructions on storing default
comments.)
left).
that sensors are attached to the
appropriate sites.
6. Press OK to continue. (Proceed to
Monitoring the AABR test progress
on page 44.)
42
P/N 051591E

Screening Procedure
Using the Y probe

cable (Echo
Couplers) for AABR
tests:
Additional information, such as patient state or testing environment, can be

entered for an AABR test.
2. Select a default comment already

comment.

prior to testing. (See Storing Default Comments on page 27 of the Setting
Up the Device chapter for detailed instructions on storing default
comments.)
4. Select the method for testing the ears
(Right & Left Sequential or Single
ear).
If the Single ear method is selected,
select the ear to be tested (right or
left).
5. Ensure that the Echo Couplers are placed correctly over the babys ears
and that sensors are attached to the appropriate sites.
6. Press OK to continue. (Proceed to Monitoring the AABR test progress on
page 44.)
P/N 051591E
43

Screening Procedure
Monitoring the
AABR test progress
An Impedance test is automatically

performed prior to testing:
White indicates skin impedance of
the vertex electrode (high forehead).
Red indicates skin impedance of the
nape electrode (back of neck).
White and Red impedance values
must be below 12,000 Ohms for the
test to proceed. (Optimum value is
less than 4,000 Ohms).
Balance indicates the difference of the skin impedances of the vertex

and nape electrodes. This value must be below 4,000 Ohms for the test
to proceed (Optimum value is less than 2,000 Ohms).
If impedance values are high, try the following:
Consider waiting a few minutes to see if the electrodes can build up an

optimal connection with the skin.
Prep the electrode sites and ensure that the electrodes have been
attached correctly.
Check whether the ABR cable is properly connected to the

Echo-Screen device.
Try using a new set of electrodes to lower impedance.
1. When the impedance values are acceptable, press OK to continue.

Calibration is performed before the
actual test starts.
For stimulus calibration there is a "time
out" of approximately two minutes. If
no button is pressed during this time,
the measurement is stopped. The test
automatically begins when calibration
is complete.
The test progress is displayed as the
test proceeds.
Time: screening duration
ABR: probability of detecting an
ABR signal
The measurement can be regarded as
a "race" between screen duration and
ABR. If "time" wins, the result will be
REFER. If "ABR" wins, the result will
be PASS.
44
EEG: amplitude of the total registered potential.
P/N 051591E

Screening Procedure
The lower EEG value allows an easier test. If the EEG signal is too high (due
electrical noise or muscular artifacts) the indicator light on the front panel
display will flash red. The data measured during this time will be ignored.
The time bar and the EEG are directly correlated. Therefore, if the EEG is high,
the time bar will proceed slower.
If necessary, press (PAUSE) to pause the test or press (STOP) to cancel
the test.
When the test is completed, the result
is displayed.
2. Press OK to conduct another ABR
test or view, print and transfer
results.
Status messages
during AABR test:
During the AABR screening, information about the current test conditions may
be displayed:
Stimulus high or low indicates that the test stimulus has changed
during the measurement.If stimulus high is displayed, restart the test,
and if stimulus low is displayed, adjust the probe.
A Bad conditions message is followed by a test abort. This indicates

that the test conditions are too poor for a successful measurement.
Either the patient is too restless or the electrode impedance changed
to unacceptable values. Retest the patient under better conditions or
change the electrodes.
Interference indicates electrical interference due to electro-magnetic

fields (i.e. pumps, PC etc.). Try to move away from the source of
interference prior to conducting a test.
P/N 051591E
45

Screening Procedure
46
P/N 051591E
Screening Results
Viewing Results
1. To view results, select View Results
from the main menu display.

the patient for whom you want to
view results.
4. Press OK to proceed to the Patient
Data display.
The Patient Data display indicates:
Patient medical record number

Patient name
Patient date of birth
Patient status (in-patient or
out-patient)
5. Press OK to view the test results.
The Results display shows the six
latest test results for the selected
patient, including the following
information:
Type of test (DP = DPOAE, TE =
TEOAE, AA = AABR)
Date of test
Time of test
Ear tested (R = Right, L = Left)
Result (PS = PASS, RE = REFER))
6. Scroll to select a result.
7. Press OK to view the result in detail.
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Understanding PASS & REFER
Example:
TEOAE result: REFER
Example:
AABR result: PASS

TEOAE results
Test result PASS:

A PASS result indicates the patient has normal cochlear outer hair cell function
at the time of testing. A PASS is determined by a statistical algorithm, based on
binomial statistics, ensuring a detection with high sensitivity.
Test result REFER:
If a REFER result is obtained, it is recommended that a repeat screen be
performed. A REFER may be obtained for a variety of reasons:
DPOAE Results
Excessive cerumen or vernix is in the patients outer ear canal or is

blocking the ear probe. To avoid this, always check that the probe tip
and ear canal are free of such debris. Clean the probe tip and replace
the acoustic filter when necessary. Also, change the patients ear tip
before repeating the screen.
Excessive environmental noise or restless patient. Calm the patient or

move to a different location before repeating the screen.
Patient may have a sensori-neural hearing impairment.
Test result PASS:

A PASS result indicates the infant has virtually normal outer hair cell function
in at least three out of four different frequency regions of the cochlea at the time
of testing. A single frequency pass is determined by a statistical algorithm,
based upon binomial statistics, ensuring detection with high sensitivity.
Test result REFER:
A REFER result indicates that no significant DP response could be detected in
at least two out of four frequency bands.
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P/N 051591E

Unlike TEOAEs, the result displayed for DPOAEs is specified for each
frequency tested.
Like TEOAEs the most common causes for non-detection of DPOAEs include:
Excessive cerumen or vernix is in the patients outer ear canal or is

blocking the ear probe. To avoid this, always check that the probe tip
and ear canal are free of such debris. Clean the probe tip and replace
the acoustic filter when necessary.
Excessive environmental noise or poor probe fit within the patients ear
canal. In DPOAEs, this is especially true for the lowest frequencies.
Therefore, if the two low frequency bands REFER and the two high
frequency bands PASS, it is likely due to a non-optimal screening
environment.
For the instances listed above, re-testing is recommended after improving the
test conditions.
It must be mentioned that retro-cochlear hearing losses cannot be detected
with a DPOAE test.
AABR Results
Test result pass:

An AABR PASS indicates that an electric brainstem response to a 35 dB nHL
(45 and 55 dB nHL, respectively) broadband stimulus could be detected. A
PASS result suggests a broadband hearing loss greater than 30 dB nHL (40
and 50 dB nHL respectively) can be ruled out with a 99.5% statistical
confidence. AABR technology is screening mainly the 2 - 4 kHz band which is
most important for speech development.
Test result REFER:
If the necessary significance level (99.5%) for a PASS could not be reached, the
Echo-Screen device will issue a REFER result. If a REFER result is obtained,
a repeat screen is recommended. A REFER result can be due to various
factors:
Poor signal-to-noise ratio. Ensure that the screening environment is

quiet. Also check to see if the probe is fitting well in the ear canal or that
the Echo Couplers are placed securely over the patients ears.
High impedance levels. The noise in the electrode cable depends

strongly on the impedances. Try reducing the impedance levels by
prepping the sensor sites or replacing the sensors.
Active or restless patient. If the patient is awake or active during the

AABR screen or if muscle tension exists, wait until the patient is asleep
or in a quiet state.
Electrical interference. If electrical noise is suspected due to other

equipment, you may want to screen the patient in a different location.
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Printing Results
Results from the Echo-Screen device can be printed onto a label printer via
wireless (infrared).
IMPORTANT:
Use only the label printer provided by Natus.
WARNING:
Remove the probe from the patients ear and detach the
electrodes before printing results.
Note: Tests cannot be conducted while the label printer is connected to
the Echo-Screen device.
To print results:
1. Power on the Echo-Screen device.
2. Select Print Results from the main

the patient whose results you want to
print and press OK to continue.
4. Select Print menu from the Patient

Data display and press OK to
continue.
5. Turn on the printer and confirm that sufficient labels are loaded. Also
ensure that the printers infrared (IR) dongle is positioned approximately 6
inches (15 cm) from the IR window located at the top side of the
Echo-Screen device.
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The Print Results menu includes the

following printout options described in
the following table.:
Select this:
To do this:
All Results
Print all the stored test results for the selected patient. Press
OK to print all the results for the selected patient
Single Result
List all the stored test results for the selected patient. Scroll to
select a single test result to be printed and press OK to print
it.
TEOAE Results
Print all the stored TEOAE test results for the selected patient.
Press OK to print all the TEOAE results for the selected
patient.
DPOAE Results
Print all the stored DPOAE test results for the selected
patient. Press OK to print all the DPOAE results for the
selected patient.
ABR Results
Print all the stored AABR test results for the selected patient.
Press OK to print all the AABR results for the selected patient.
Example of a printout:
TEOAE, REFER result
Additional comments can be

handwritten in the Comment space.
Note: Any comments stored for a particular patient appear on the label
printout. The comments are automatically printed on a separate label.
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Transfer & Deletion of Patient Data

Data Transfer Using Wireless (Infrared) or Cable
Test records can be transferred from the Echo-Screen device to a personal
computer (PC) via wireless (infrared) or cable connection using EchoLinkII
software. Alternately, patient information can be entered to a personal
computer via EchoLinkII software and transferred to the Echo-Screen device.
Note: EchoLinkII software is required and must be installed on the
personal computer to transfer data.
Installing EchoLinkII
Software on the PC
EchoLinkII software allows you to transfer Echo-Screen data to a personal

computer to conduct necessary data management functions.
IMPORTANT: Prior to installing EchoLinkII software, ensure that the personal
computer is utilizing Microsoft Windows 98, Windows 2000, Windows ME, or
Windows XP. A minimum of 16 MB RAM is recommended for the installation
of this software.
IMPORTANT: When installing software, contact your institutions IS
department for assistance. You may need administrative privileges to install the
software.
To install the EchoLinkII application:
1. Insert the Echo-Screen User Manual/EchoLinkII CD-Rom (REF 900757)
into the CD-ROM drive of the personal computer. Access the CD from the
appropriate directory (C,D,E, or F). The CD-ROM drive is commonly listed
as the E:drive.
2. Click on the link to download the EchoLinkII software onto your personal
computer. A series of messages guide you through the installation
process.
Note: Once EchoLinkII software is installed on the PC, access the
EcholinkII Help menu for detailed instructions on utilizing the program.
Transferring Test
Records from the
Echo-Screen Device
to a PC
To transfer data to a PC using Infrared (wireless):

1. Open the EchoLinkII program on the PC.
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2. Select Settings from the main EchoLinkII menu, and then select Options
from the Settings menu.
3. Set the appropriate hardware configuration by selecting the Infra Red
connection and the appropriate PC COM port where you will connect the
infrared adapter.
Note: Consult with your facilitys IS department to determine the
appropriate COM port connection.
4. Select Transfer/Delete from the
main menu of the Echo-Screen
device and press OK to continue.
5. Connect the infrared adapter to the
COM port of the PC.
6. Point the infrared adapter toward the
infrared window that is located at the
top of the Echo-Screen device.
7. Select Start infrared from the
Echo-Screen display and press OK
to continue. The Echo-Screen
device displays Waiting for PC.
8. Select Echo-Screen -> PC from the
main EcholinkII Patient menu to
begin the data transfer.
Note: While the data transfer is in progress, the distance between the
Echo-Screen device and the infrared adapter should not exceed
31.5 inches (80 cm).
IMPORTANT: Ensure that objects do not obstruct the path between the
infrared adapter and Echo-Screen device while the data transfer is in progress.
To transfer data to a PC using the cable:
3. Set the appropriate hardware configuration by selecting the Serial Line
PC data transfer cable.
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P/N 051591E

4. Select the appropriate baud rate. It is recommended that you try the higher
baud rate first. (The lower baud rate may be more suitable if you use a
laptop computer.)
5. Connect the data transfer cable to the Echo-Screen device. The connector
is located at the bottom of the Echo-Screen device. Connect the data
transfer cable to the appropriate PC COM port.
6. Select Echo-Screen -> PC from the main EchoLinkII Patient menu to
Transferring Test
Records from the PC
to the Echo-Screen
Device
To transfer data to the Echo-Screen device using infrared (wireless):

3. Set the appropriate hardware configuration by selecting the Infra Red
infrared adapter.
4. From the EchoLinkII Patient List, select the patient records that you want
to transfer to the Echo-Screen device. To select a patient, click in the
checkmark column corresponding to the patient(s) of choice.
main menu of the Echo-Screen
device and press OK to continue.
6. Connect the infrared adapter to the
COM port of the PC.
7. Point the infrared adapter toward the
infrared window that is located at the
top of the Echo-Screen device.
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8. Select Start infrared from the

Echo-Screen display and press OK
to continue. The Echo-Screen
device displays Waiting for PC.
9. Select PC -> Echo-Screen from the
main EcholinkII Patient menu to
Note: While data transfer is in progress, the distance between the

Echo-Screen device and the infrared adapter should not exceed
31.5 inches (80 cm).
IMPORTANT: Ensure that objects do not obstruct the path between the
infrared adapter and Echo-Screen device while the data transfer is in progress.
To transfer data to the Echo-Screen device using a cable:
3. Set the appropriate hardware configuration by selecting the Serial Line
PC data transfer cable.
4. Select the appropriate baud rate. It is recommended that you try the
highest baud rate first. (The lower baud rate may be more suitable if you
use a laptop computer.)
5. From the EchoLinkII Patient List display, select the patient records that
you want to transfer to the Echo-Screen device. To select a patient, click in
the checkmark column corresponding to the patient(s) of choice.
6. Connect the data transfer cable to the Echo-Screen device. The connector
is located at the bottom of the Echo-Screen device. Connect the data
transfer cable to the appropriate PC COM port.
7. Select PC -> Echo-Screen from the main EchoLinkII Patient menu to
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P/N 051591E

Deleting Screening
Records
IMPORTANT: The Delete data function deletes ALL records stored in the
Echo-Screen device at one time. Individual records cannot be deleted from the
Echo-Screen device. Ensure that the appropriate records are transferred to a
personal computer via EchoLinkII software prior to deletion.
main menu.
2. Select Delete data from the

Transfer/Delete display and press
OK to continue.
3. Select Delete to delete all records

select Cancel to discontinue the
operation.
4. Press OK to confirm your selection.
After 5 seconds the program returns
automatically to the main menu.
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P/N 051591E
Quick Test
The Quick test function allows you to perform a screen without entering patient
information. This function can be applied to all technology configurations
(TEOAE, DPOAE, and AABR). It is useful for demonstration or training
purposes.
Note:
No test data is saved in the Quick test mode.
To conduct a quick test:

1. Select Quick test from the main
menu.
2. Select the appropriate test mode

(TEOAE, DPOAE, or ABR) and
select OK to initiate a test.
See Screening Procedure on page 31 for detailed information about the

screening procedure.
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P/N 051591E
Equipment Checks
You can perform a variety of equipment checks/self tests on the Echo-Screen
system.
1. Select Options from the main menu
and press OK to continue.
2. From the Options menu, you can:

Run a variety of self tests (device
checks)
Check the memory used on the
Echo-Screen device
Obtain information about installed
hardware and software for the
Echo-Screen device.
The following sections provide a description of the equipment check options.
Performing Self
tests/Equipment
Checks
Select Self test from the Options

Probe Test
1. Select Probe test to check that the

ear probe cable and Y probe cable
are functioning properly.
2. Connect the cable to be tested to the
Echo-Screen device.
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61
IMPORTANT: One probe test per day is recommended for each cable prior to
screening patients.
Note: The probe tip of the ear probe cable must be inserted into the test
cavity before conducting a probe test. The Y probe cable does not need to
be inserted into the test cavity.
The following information is provided:
Cable type
Serial number of cable
Date of the last cable calibration
3. Press any key to start the self test.
If the Probe failed message

appears, a list of troubleshooting tips
is displayed.
4. Press any key to return to the Self
test display. Repeat the probe test
after conducting the appropriate
troubleshooting procedures.
Discharge Battery
Select Discharge battery from the

Self Test menu to discharge the
battery completely. It is recommended
to completely discharge a battery prior
to recharging.
Codec Test
1. Select Codec test to test the

functionality of the coder and
decoder components of the
Echo-Screen device.
2. If the Codec test OK message
appears, press any key to return to
the Self test menu.
If the Codec failure message
appears, the device switches off
automatically. Contact Natus
Technical Service or your authorized
service provider for further
assistance.
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P/N 051591E
LCD Display Test
1. Select LCD display test and press

OK to test the functionality of the
Echo-Screen display. The LCD test
passed message indicates that the
display is functioning properly.
2. Press any key to return to the Self
test menu.
Keypad Test
1. Select Keyboard test and press OK

to test the functionality of the
Echo-Screen device keypad.
2. A pattern of zeros "0" corresponding

to the Echo-Screen keypad appears
on the Keyboard Test display.
Pressing a key on the Echo-Screen
keypad changes the corresponding
"0" to a black bar. This indicates that
the key is functioning properly.
3. Press OK to return to the Self Test
menu.
Note:
Memory Used
The OK button cannot be tested.
The Memory used option provides information about the Echo-Screen

capacity for patient list memory and test result memory.
1. Select Memory used from the
continue.
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63
2. The percentage of memory allocated

to patient lists and test results is
displayed.
Press OK to automatically return to
the Options menu.
The Echo-Screen device is equipped with a permanent memory function, which

continuously stores all activated parameters and data even when the device is
in a switched off mode. Upon switching on the Echo-Screen device, the test
data is still available. A maximum of 250 records can be stored in the
Echo-Screen device.
When 80% of the Echo-Screen memory is used, the Echo-Screen device will
display a warning message. From this point on approximately 20 screens can
be carried out before the memory is completely full. After the first warning, the
Echo-Screen device will periodically display the percentage of memory used
after every five screens.
At this point data will need to be transferred to the PC via EchoLinkII software.
Once the data is transferred, it can be deleted from the Echo-Screen device.
See Transfer & Deletion of Patient Data on page 53 for detailed instructions on
data transfer and deletion.
Software and
Hardware
Information
The SW/HW information option provides information about the Echo-Screen

system hardware, as well as the software installed on the device.
1. Select SW/HW information from the
continue.
The display provides the following
information:
Type of software installed
(technology configuration)
Software version
Software release date
Serial number of the Echo-Screen
device
Date of the last calibration for the
Echo-Screen device
Recommended date for the next
calibration
2. Press OK to return to the Options
menu.
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P/N 051591E
Error Messages & Troubleshooting

The following table provides a list of error messages that the Echo-Screen
device may display during the screening process, as well as troubleshooting
procedures. Contact Natus Technical Service or your authorized service provider if you have any questions.
Error Message
Probe Error!
Cause
Cable not connected

Probe tip occluded
Solution
Cal FAIL
Stimulus level calibration failed.
Ensure the ear probe cable is

connected properly to the
Echo-Screen device.
Check probe tip and acoustic filter.
Clean and/or replace as necessary.
Check the probe housing for damage.
Ensure stable probe placement in
patients ear.
Test patient in a quiet environment.
Impedance of electrodes or balance is too

high.
Battery empty < 5.5 Volt
Replace the battery before continuing the

test.
Battery charge low
Replace the battery before continuing the

test.
Clock bat low
Clock battery discharged
Contact Natus Technical Service or your

authorized service provider (battery lifetime > 2 years).
Codec failure
Note: The device
switches off automatically after the "Codec
failure" message
appears.
Codec is defective.

authorized service provider.
Testing not possible!
Change battery
LCD test failed
Check electrodes and replace them if

necessary.
Repeat test if patient is in a quiet
state.

LED flashes, numerical

code is displayed.
Internal error code
System error
System malfunction

The calibration date has

expired. Please have
the device calibrated
soon.
Note the error code.

Contact Natus Technical Service or
your authorized service provider.

authorized service provider for calibration.
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P/N 051591E
Echo-Screen Maintenance
Cleaning the Echo-Screen Device
WARNING:
The Echo-Screen device must be powered off and
disconnected from any external current prior to cleaning. All cables should also
be disconnected from the Echo-Screen device prior to cleaning.
The Echo-Screen device can be cleaned with a damp cloth. If necessary, apply
a surface disinfectant.
Note:
Only use wiping disinfectant.
CAUTION:
Ensure that no moisture gets inside the probe or into the device
cable sockets.
CAUTION:
Never immerse the Echo-Screen device in water or other
cleaning solutions.
Maintenance of the Probe Tip

Cleaning,
Disinfection, &
Sterilization of the
Probe Tips
WARNING:
The probe tip must not be placed into the ear canal at any time
without using a proper ear tip.
Figure 19Parts of the Probe Tip
acoustic filter
probe tip
probe body
The probe tip does not usually come into contact with the skin or with secretions
from the ear canal since it is covered by an ear tip. However, if there is a large
P/N 051591E
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amount of cerumen in the ear canal, the probe tip may become occluded with
debris. If this occurs, clean or change the probe tip prior to testing.
CAUTION:
The probe body contains sensitive components. Never attempt
to clean the sound apertures in the probe housing mechanically or with liquids.
Doing so may cause damage to the probe. Contact Natus Technical Service or
your authorized service provider for a periodic cleaning of the probe body.
Probe Tip Cleaning

Procedure:
Dry cleaning
Dry cleaning must be performed if any debris (i.e., cerumen) is detected at the
probe tip. Afterwards, proceed to Wet cleaning and disinfection on page 69 or
Wet Cleaning and Sterilization on page 69.
For dry cleaning:
1. Remove the probe tip (B) by pressing the release button (A) while pushing
the probe tip carefully upwards out of the probe case.
Figure 20Removing the Probe Tip
A
2. Use the cleaning tool (C) to carefully remove the acoustic filter (D) from the
probe tip.
Figure 21Removing the Acoustic Filter
D
3. Use the cleaning tool (C) to clean the sound channels of the probe tip from
the rear.
Figure 22Cleaning the Sound Channels
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P/N 051591E

Wet cleaning and disinfection

Clean and disinfect the probe tip on a regular basis after every working day
(even if no occlusion of the probe tip is visible).
For wet cleaning:
Use a wet tissue to clean the surface.
Soak in a mild, lukewarm soap water bath (5-10 minutes).
CAUTION:
Ensure that the sound channels are completely dry before
replacing the tip onto the body of the probe. Even the smallest amount of
moisture may dissolve any residual cerumen and thus contaminate the
sensitive acoustic filter in the body of the probe.
For disinfection:
Wet Cleaning and

Sterilization
Use a chemical disinfectant of ethanol (70-80%), propanol (70-80%) or

aldehydes (2-4%).
Clean and sterilize the probe tip if it is used in an infected ear canal.
For wet cleaning:
Use a wet tissue to clean the surface.
Soak in a mild, lukewarm soap water bath (5-10 minutes).
CAUTION:
Ensure that the sound channels are completely dry before
replacing the tip onto the body of the probe. Even the smallest amount of
moisture may dissolve any residual cerumen and thus contaminate the
sensitive acoustic filter in the body of the probe.
For sterilization:
Autoclave according to the recommended standards for rubber

materials (121C/249F, 45 minutes exposure time). Probe tips can be
exposed to a maximum temperature of 150C/302F for up to 45
minutes.
CAUTION:
Changing the
Acoustic Filter
Do not exceed more than 50 sterilization cycles.
If the calibration procedure fails and the message "Probe Error!" is displayed,
the acoustic filter of the probe may be damaged or obstructed. In such a case,
the acoustic filter needs to be changed.
IMPORTANT: Acoustic filters are disposable. Do not place used filters back
into the probe accessory box. Do not attempt to clean or disinfect the acoustic
filters.
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To change the acoustic filter:

1. Remove the probe tip (B) by pressing the release button (A) while pushing
the probe tip carefully upward out of the probe case.
Figure 23Removing the Probe Tip
A
2. Use the cleaning tool (C) to carefully remove the acoustic filter (D) from the
probe tip.
Figure 24Removing the Acoustic Filter
D
Cleaning,
Disinfection and
Sterilization of Ear
Tips and Cleaning
Wire
The ear tips and cleaning wire can be used as disposables. However, if they are
reused on multiple patients, they must be wet cleaned and disinfected between
each use.
To clean the ear tips and cleaning wire, see Wet Cleaning and Sterilization on
page 69.
Note: Sterilization of ear tips is required if they are used with patients that
have infected ear canals. Sterilization of the cleaning tool is required if it is
used with a probe tip that has been exposed to an infected ear canal (see
Wet Cleaning and Sterilization on page 69).
CAUTION:
Cleaning of the Y
Probe Cable
70
Avoid exposing the ear tips to intense sunlight or UV light.
The Y probe cable should be cleaned after each working day; however, if there
is any risk of transfection, the Y probe cable should be cleaned prior to
screening a new patient.
P/N 051591E

To clean the Y probe cable:

1. Disconnect the Y probe cable from the Echo-Screen device.
2. Clean the Y probe cable and Echo Coupler adapter with an alcoholic
disinfectant tissue.
CAUTION:
Clean only with a wiping disinfectant. Ensure that no liquid
enters the Y probe cable.
CAUTION:
Maintenance of the
Battery
Do not immerse the Y probe cable in liquid.
Refer to Setting Up the Device on page 17 for detailed information on

maintenance of the battery.
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P/N 051591E
Warranty
Echo-Screen Hearing Screener Limited Product Warranty
Natus Medical Incorporated (Natus) warrants to the initial purchaser (Purchaser)
that each new Warranted Product, as defined below, purchased hereunder will be
free from defects in workmanship and materials for a specified period (Warranty
Period) of either:
a) Twelve (12) months from the date of its initial shipment to Purchaser, if purchaser
resides and utilizes the Natus device in the United States; or
b) Fifteen (15) months from the date of its initial shipment to Purchaser, if purchaser
resides and utilizes the Natus device outside of the United States.
The Warranted Product is defined as: the Echo-Screen device, the ear probe cable,
ABR cable, Y probe cable, the user manual and/or CD, Echo-Screen accessories
including any battery, battery charger and power cord provided by Natus, and any
Echo-Screen printer and related cables purchased from Natus. The carrying case
is not covered by this warranty.
Natus only obligation under this warranty is limited to repair or replacement, at
Natus option and election, of any Warranted Product (or part thereof) that Natus
reasonably determines to be covered by this warranty and to be defective in
workmanship or materials. Repair or replacement of Products under this warranty
does not extend the Warranty Period.
To request repair or replacement under this warranty, Purchasers outside the
United States should contact the Natus Authorized Distributor from whom the
Product was purchased. Purchasers in the United States should contact Natus
Technical Service at 1501 Industrial Road, San Carlos, California, 94070, USA,
telephone +1-650-802-0400, website www.natus.com. If, on the basis of the
information provided by the Purchaser, Natus reasonably believes that the defect
is covered by this warranty, Natus will authorize Purchaser to return the Warranted
Product (or part thereof) to Natus or its authorized service center. If the Product is
to be repaired rather than replaced, the Warranted Product will be repaired and
returned to the Purchaser. Natus shall determine whether to repair or replace
Products and parts covered by this warranty and all Products or parts replaced shall
become the property of Natus. In the course of warranty service, Natus may, but
shall not be required to, make engineering improvements to the Warranted Product
(or part thereof).
IMPORTANT: The warranty will become void if the probe cleaning instructions are
not strictly adhered to. If the probe is not regularly cleaned as directed in the
instructions, cerumen may result in blockage of the probe, where sensitive
components are contained and could be damaged.
Repair / After-Sales Service / Regular Checks

If the Echo-Screen is found to be defective or in some way varies from the
manufacturers specifications, an authorized dealer will repair, replace, or
re-calibrate the instrument at no cost to the purchaser while the Echo-Screen is
within the warranty period.
Service and repair of electro-medical equipment should be carried out only by the
equipment manufacturer or by authorized representatives. The manufacturer
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Echo-Screen Hearing Screener Limited Product Warranty
reserves the right to disclaim all responsibility for the operation safety, reliability, and
performance of equipment, serviced or repaired by other parties.
The annual technical control is defined in accordance with the corresponding
instructions for audiometers.
While your Echo-Screen is being calibrated, it is possible to borrow a loaner
device so that your test program can continue.
Shipping Procedures
If Natus reasonably determines that a repair or replacement is covered by the
warranty, Natus shall bear the costs of shipping the repaired or replacement
Product to the Purchaser. All other shipping costs shall be paid by the Purchaser.
Risk of loss or damage during shipments under this warranty shall be borne by the
party shipping the Product.
Products shipped by the Purchaser under this warranty shall be suitably packaged
to protect the Product. If Purchaser ships a product to Natus in unsuitable
packaging, any physical damage present in the Product upon receipt and
inspection by Natus (and not previously reported) will be presumed to have
occurred in transit and will be the responsibility of the Purchaser.
Exclusions
This warranty does not apply to the battery, or to expendable items, or to normal
wear.
This warranty applies only to instruments purchased from authorized distributors or
representatives.
This warranty does not extend to any Warranted Products (or parts thereof): (a) that
have been subject to misuse, neglect or accident, (b) that have been damaged by
causes external to the Warranted Product, including by but not limited to failure of
or faulty electrical power, (c) that have been used in violation of Natus instructions
for use, (d) that have been attached to any accessory that has not been subject to
Natus control over quality of materials and design, (e) on which the serial number
has been removed or made illegible, (f) that have been modified by anyone other
than Natus or its authorized service center, unless authorized prior to such service
by Natus. The Echo-Screen calibration is not covered under the standard warranty.
Natus makes no warranty (a) with respect to use of Echo-Screen Hearing
Screeners, any non-Natus disposable products, or any other products that are not
Warranted Products, (b) with respect to any products purchased from a person
other than Natus or a Natus-authorized distributor, or (c) with respect to any product
sold under a brand name other than Natus unless such product has been subject
to Natus control over the quality of materials and design.
This warranty, together with any other express written warranty that may be issued
by Natus, is the sole and exclusive warranty as to Natus products, extends only to
the purchaser and is expressly in lieu of any other oral or implied warranties
including without limitation any implied warranty of merchantability or fitness for a
particular purpose. Natus shall not be liable for any incidental, special or
consequential loss, damage or expense (including, without limitation, lost profits)
directly arising from the sale, inability to sell, use or loss of use of any product.
74
P/N 051591E
Technical Specifications
Operating
Conditions
Storage temperature range:

Operation temperature range:
Humidity:
Transport altitude:
0 - 40C (32 - 104 F)

5 - 35C (40 - 95 F)
20-80% rel.
0 - 12,000 ft. (0 - 3.65 km)
Technical Data
General
TEOAE
weight
size
battery
Echo-Screen incl. battery pack and probe: 1.2 lbs (550 g)

Echo-Screen incl. battery pack: 230 x 95 x 53 mm
6V 1500mAh NiMH, easily changeable. 2 batteries
supplied with device
charger
charge time approx. 2 hrs.
power consumption 1.2 W max
power management auto backlight control, auto switch off,
2-level battery voltage sense, battery saver
operating time
> 10 hrs with fully charged battery
CPU
16 bit fixed-point DSP, 22.1 MIPS
AD / DA converters 2 channels AD, 2 channels DA
resolution
16 bit
sampling rate
variable
data memory
128 kByte built-in flash memory, unlimited storage
time
real time clock
special battery, runs 2 years min.
interfaces
RS232 up to 115 kbps, infrared, modem available
display
128 x 64 dot graphic LCD w/ switchable backlight
keyboard
17 keys
sound
piezo beeper for key click and info / warning jingles
languages
up to 6 user selectable languages available on the
device. language packs can be uploaded by service
personnel
probe
ultra-lightweight probe
sampling rate
evaluation method
stimulus
click rate
display
button functions
16 kHz
Echo-Screen binomial statistics
nonlinear click sequence
approx. 60 Hz
statistical waveform, measurement progress, TEOAE
detection level, noise level
alternate display, restart, stop
P/N 051591E
75

Technical Data
DPOAE
AABR
sampling rate
evaluation method
stimulus
frame length
test frequencies
test levels
measurements
per test:
display
result display
button functions
screening: 4 frequencies one level

phase statistics diagram, measurement progress, noise
pass/refer for all tested levels and frequencies
skip test, restart test, stop
sampling rate
evaluation method
stimulus
click rate
frame length
amplifier gain
amplifier CMRR
input impedance
input bias current
10.2 kHz
binomial statistics on template-convoluted signal
35 dB nHL click
approx. 55 Hz
180 samples / 18 ms
2000
> 100dB
1010 || 55 pF
< 10 nA
amplifier noise
input bandwidth
notch filter
impedance sense
10 nV / Hz at 1kHz
70 Hz, 4kHz
digital, -40dB at 50 Hz or 60 Hz (user configurable)
current
impedance sense
signal
impedance sense
test range
impedance sense
accepted for test
impedance control
display
button functions
electrodes
Probe
76
probe plug:
probe cable:
frequency
response:
speakers:
12.8 kHz
phase statistics
primary tone pair, f2/f1 = 1.24
512 samples
f2 = 2, 2.5, 3.2, 4 kHz
screening: 59/50dB SPL
App
1 kHz square wave

1.99 k
< 12 k
before measurement, periodically within
measurement
stimulus continues during impedance control
statistical graph, measurement progress, EEG-level,
ABR detection probability
pause, restart, stop
disposable gel electrodes
12-pin
flexible, shielded cable, approx. length: 1m (3)
200 Hz to 4.2 kHz (measured in 1.5 cm3 test cavity)
type: Magnetic ED 1913/Knowles low distortion
signal Bandwidth: 1.7 bis 4.8 kHz
nominal impedance (at 1 kHz): 1,500
nominal DC resistance: 375
P/N 051591E

Technical Data
microphone:
type: Electret, EM 3046/Knowles, with integrated FET

pre-signal bandwidth: 1.7 to 6.5 kHz
front-end sensitivity: approx.-55dB rel.1V/ bar
weight:
(0.1 N/m2)
output impedance: 2,800 to 6,800 (4,400 nominal)
operating voltage: 0.9 to 20 VDC
probe body:
10 mm in diameter x 35 mm
probe tip:
3 mm in diameter x 8 mm
probe adaptor: 4 mm to 12 mm in diameter, silicone
probe incl. probe adaptor: 4g
Y Probe Cable
overall length
length of cable
connector type
speaker
Echo Coupler
1.20 m
1.10 m
ODU Minisnap PC
Knowles Electronics Type: FH-3377
disposable
Charger
front-end data:
dimensions:
Device Class
Applied Standards
100 - 240 V AC +/- 10%

50 - 60 Hz, 200 mA
supported batteries: 5 NiCd/NiMH 1-2 Ah
operating
temperature range: 0 - 40C (32 - 104 F)
storage temperature
range:
-40 - +70C
charge current:
rapid charge:
800mA +/- 6%
trickle charge:
21mA +/-15%
charge termination
(HL to EL):
-DU:approx. 0.7% with 5 cells (approx.12 mV/cell)
The -DU monitoring is activated after approx. 7 min.
following commencement of charging.
maximum charging
time:
2 1/2 hrs +/- 12%
charging control:
cell voltage is measured and detected every 107 sec.
during a zero current of 80 ms
2a (according to Council Directive 93/42/EEC Appendix IX)
Council Directive 93/42/EEC concerning medical devices (1993)

German "Medizinprodukte Gesetz" (MPG) (1994)
EN ISO 9001 (2000)
EN 13485 (2000)
EN 60601-1 + A1 + A2 (1990 / 1993 /1995
EN 60601-1-2 (1993)
P/N 051591E
77

Technical Data
Manufactured by
78
Natus Europe GmbH

Brmannstrasse 38
D-81245 Munich, Germany
P/N 051591E
List of Illustrations
Figure 1: Elements of the Echo-Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Figure 2: Echo-Screen Top View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure 3: Echo-Screen Bottom View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure 4: Echo-Screen Back View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure 5: Probe Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 6: Test Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 7: Y-Probe Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure 8: ABR Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure 9: Echo Coupler and Snap Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 10: Ear Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 11: Releasing the Battery Pack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 12: Charging the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 13: Battery Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Figure 14: Ear Probe and ABR Electrodes sockets . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Figure 15: Ear Tip Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Figure 16: Probe Inserted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Figure 17: Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Figure 18: Probe Attached to Ear Coupler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Figure 19: Parts of the Probe Tip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Figure 20: Removing the Probe Tip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Figure 21: Removing the Acoustic Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Figure 22: Cleaning the Sound Channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Figure 23: Removing the Probe Tip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Figure 24: Removing the Acoustic Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
P/N 051591E
79
80
P/N 051591E
Index
A
AABR
description 78
preparing for 3436
screening procedure 41
test results 45, 49
test setup 29
uses 1
AABR 7
ABR (auditory brainstem response) 7
ABR cable 14, 29, 34
ABR configuration setting 26
ABR Notch Filter setting 26
ABR stimulus level setting 27
acoustic filter 69
age, minimum 1
alcohol 36
alphanumeric keypad 10
automatically powers off 31
B
background lighting 22
battery
charging 1718
connecting charger 18
discharge 62
disposal 20
removing 18
replacing 20
safety 19
skipping test 31
test 19
buttons, functions 10
C
cables
ABR 14, 29, 34
cleaning 70
data transfer 54, 56
ear probe 13, 29, 30
testing 13
Y probe 13, 30, 36, 43
charging battery 1718
check equipment 61
cleaning
device 67
probe 68, 69
probe tip 67
cleaning wire 70
Codec test 62
comments 37, 40, 42, 43, 52
storing 27
configurations, technologies 8
connecting charge 18
Control Panel buttons 10
Couplers, Echo 15
D
data entry 10
data entry mode 24
data input 23
data transfer 53
date/time
format 21
setting 21
default test mode 23
deleting patient data 57
device
cleaning 67
components 9
memory 61
power up 31
setting up 17
settings 20
storing 17
technology configurations 8
unpacking 17
use 1
user interface 10
discharge battery 62
disinfecting probe tip 67
Distortion Product Otoacoustic Emissions technology.
See DPOAE technology
DPOAE
compared to TEOAE 7
description 67
preparing for 3234
test results 41, 48
test setup 29
uses 1
E
ear probe cable 13, 29, 30
ear tip 15, 3234
attachment 33
cleaning 70
recommended size 33
Echo Couplers 15, 30, 34, 36, 43
EchoLinkII software 53
Echo-Screen
back view 12
bottom view 11
elements 9
top view 11
edit mode 24
electrodes, snap 15, 34
entering data 10
equipment checks 61
error messages 65
F
filter, changing 69
P/N 051591E
81
format, date/time 21
functions, buttons 10
G
gestational age 1
good probe fit 34
H
hardware information 64
I
icons 10
infrared
printing 51
initial setup 17
intended use 1
K
keypad test 63
keys 10
L
language 21
LCD test 63
list of illustrations 79
login names 25
M
maintaining probe tip 67
manufactured by 78
memory, device 61, 63
methods, screening 1
minimum age 1
N
navigating device 10
NuPrep gel 15, 35
O
OAE
application 7
overview 5
recording 7
types 5
use in screening 1
working with 7
Otoacoustic Emissions. See OAE
P
patient
preparing AABR 34
preparing TEOAE, DPOAE 3234
patient data
deleting 57
transfer from device 53, 54
transfer from PC 55, 56
Patient Data display 32
patient information 32
patient list mode 25
patient list setting 25
power up device 31
82
printing
infrared 51
results 51
wireless 51
printout 52
probe 3234
dry cleaning 68
fitting 33, 34
wet cleaning 69
probe test 61
Q
Quick test 59
R
removing battery 18
replacing battery 20
results
AABR test 45, 49
DPOAE test 41, 48
TEOAE test 39, 48
viewing 47
S
safety
battery 19
saline 35
screening
methods 1
procedure 31
screening comments, default 27
self test 61
service life 20
setting date/time format 21
settings 20
ABR configuration 26
ABR Notch Filter 26
ABR stimulus level 27
background lighting 22
data entry mode 24
date/time 21
default test mode 23
language 21
patient list 25
sounds 22
user information 25
user mode 24
setup
AABR test 29
TEOAE & DPOAE test 29
skin preparation 15, 35
snap electrodes 15, 34
software information 64
sounds 22
specifications 75
sterilizing probe tip 67
storing comments 27
storing device 17
T
technical specifications 75
technology configurations 8
TEOAE
P/N 051591E
compared to DPOAE 7
description 56
preparing for 3234
test results 39, 48
test setup 29
uses 1
test
cavity 13
equipment 61
quick 59
starting 37
test mode 23
testing battery 19
skipping test 31
time setting 21
transferring patient data 53, 54, 55, 56
Transient Evoked Otoacoustic Emissions technology.
See TEOAE
troubleshooting 65
types of OAEs 5
U
unpacking device 17
use of device 1
user interface 10
user login information 25
user setting 24
V
voltage frequency setting 26
W
warranty 73
wire, cleaning 70
wireless 53
printing 51
Y
Y probe cable 13, 30, 36, 43
cleaning 70
P/N 051591E
83
84
P/N 051591E

P/N 051591E

Echo-Screen Reference Guide

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Medical Background Information

and Application Hints for

2010 Natus Medical Incorporated

Distributed and Supported by:

Overview of Screening Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Working with OAEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About AABR Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Ear Probe Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2010 Natus Medical Incorporated

Echo-Screen Users Guide

Setting Up the Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Preparing for Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

2010 Natus Medical Incorporated

Echo-Screen Users Guide

AABR Screening Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Transfer & Deletion of Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Error Messages & Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

2010 Natus Medical Incorporated

Echo-Screen Users Guide

Cleaning of the Y Probe Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

2010 Natus Medical Incorporated

Transient Evoked Otoacoustic Emissions (TEOAE) technology

Distortion Product Otoacoustic Emissions (DPOAE) technology

With this combination of technologies, the Echo-Screen is flexible in both

2010 Natus Medical Incorporated

Echo-Screen Users Guide

special technical skills or interpretation of results. Basic training with the

2010 Natus Medical Incorporated

Echo-Screen Users Guide

The following precautionary information pertains to the use of the Echo-Screen

Print or export data to a PC outside of the immediate patient

2010 Natus Medical Incorporated

Echo-Screen Users Guide

2010 Natus Medical Incorporated

Overview of Screening Technology

2010 Natus Medical Incorporated

Echo-Screen Users Guide

calculates the statistical probability that an emission has been recorded, at a

DPOAEs are tones produced by the ear in response to two simultaneous

2010 Natus Medical Incorporated

Echo-Screen Users Guide

The evaluation is based upon the laws of statistical distributions: It can be

Working with OAEs

Recording OAEs requires a sensitive, low-noise microphone to be sealed in the

About AABR Technology

2010 Natus Medical Incorporated

Echo-Screen Users Guide

during an individuals life period, the algorithm is optimized by pre-filtering the

ABRs are not influenced by vigilance. Therefore, they can be

Investigations show that the psycho-acoustic hearing threshold has a

On the downside, care must be taken during measurement and evaluation to

Echo-Screen Device Technology Configurations

TEOAE & DPOAE technology

TEOAE & AABR technology

DPOAE & AABR technology

TEOAE, DPOAE & AABR technology

2010 Natus Medical Incorporated

Screening Device & Components

2010 Natus Medical Incorporated

Echo-Screen Users Guide

Display & Control Panel

Table 1.Button functions

Switches on the device

Switches off the device from the main menu