ILO V6

Clinical OAE Analysis and

Data Management

User Manual for Echoport instruments

ILO V6
User Manual
Issue 17
ILO V6 User Manual

Issue 17 : September 2015

ILO V6 version v6.41.27.33 onwards

Doc Ref: MANV6-BK:17

Copyright Notice

No part of this publication may be copied by any means,

translated or distributed to third parties without the express
written permission of Otodynamics Ltd.

Copyright © 2015 Otodynamics Ltd. All Rights Reserved.

0120

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 3

Contents

1 Introduction.................................................................................... 9

2 ILO CD and software installation ................................................ 11

2.1 Minimum PC specifications............................................................. 11
2.2 ILO CD............................................................................................. 11
2.3 ILO V6 Software installation............................................................12

3 Main features of ILO V6 Clinical OAE software........................... 14

3.1 General features..............................................................................14
3.2 OAE recording.................................................................................14
3.3 Advanced functions.........................................................................15
3.4 Analysis tools...................................................................................15
3.5 Probe...............................................................................................15
3.6 Data handling .................................................................................16

4 Making use of OAEs: Key points for clinical practice.................. 17

4.1 Recording OAEs..............................................................................17
4.2 Types of OAEs.................................................................................17
4.3 Middle ear factors............................................................................18
4.4 OAEs and the nature of sensory hearing loss.................................18
4.5 Interpretation of OAEs.....................................................................19
4.6 Differential diagnosis.......................................................................20
4.7 Special applications.........................................................................20

5 Initial setup.................................................................................. 21

6 Getting to know V6 software....................................................... 24

6.1 Introduction to the main screen.......................................................24
6.2 Screen data fields ...........................................................................26
6.3 Navigating around the program.......................................................27
6.4 File menu.........................................................................................27
6.5 Tests menu......................................................................................29
6.6 Reports menu..................................................................................29
6.7 Data management menu.................................................................30
6.8 Help menu.......................................................................................30

4 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 7 Preparing for a test...................................................................... 31
7.1 Selecting the Test Mode..................................................................31
7.2 Entering patient details....................................................................32
7.3 Using a worklist...............................................................................33
7.4 Selecting the test type.....................................................................35

8 Performing a TEOAE test............................................................ 36

8.1 Choice of Stimulus...........................................................................36
8.2 Checkfit............................................................................................38
8.3 Data collection.................................................................................40
8.4 Checkfit and testing stimuli..............................................................41
8.5 Test termination...............................................................................42
8.6 OAE Response window...................................................................44
8.7 Response Waveform window..........................................................46
8.8 Saving and printing the data............................................................48
8.9 Printing configuration.......................................................................54
8.10 Formats of data stored....................................................................56

9 Spontaneous OAEs (SOAEs)...................................................... 59

9.1 What are SOAEs?...........................................................................59
9.2 How SOAEs can affect OAE measurements...................................60
9.3 Detecting SOAEs.............................................................................60
9.4 Performing an SOAE search...........................................................61

10 Performing a DPOAE test........................................................... 62

10.1 Choice of Stimulation.......................................................................62
10.2 Checkfit............................................................................................63
10.3 Setting of stimulus tones.................................................................64
10.4 Data collection.................................................................................65
10.5 DP Spectrum...................................................................................67
10.6 OAE response (SNR) display..........................................................68
10.7 Test termination...............................................................................68
10.8 OAE Response window for DPOAEs..............................................69
10.9 Saving and printing the data............................................................71

11 Advanced DPOAE measurements.............................................. 72

11.1 Changing stimulus parameters for DPOAEs...................................72
11.2 Multi-level DPOAEs.........................................................................73
11.3 Advanced DP Growth functions.......................................................74

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 5

 12 Binaural OAE measurements - introduction................................ 80

13 Regular binaural measurements................................................. 81

14 Advanced binaural OAE measurements..................................... 83

14.1 Contralateral TE suppression test...................................................83

15 Reviewing data............................................................................ 93
15.1 Examine/Compare data...................................................................94

16 Setup options.............................................................................. 96
16.1 OAE System Setup..........................................................................96
16.2 Stims (including setting new DPOAE high frequency range)........................97
16.3 Start/Stop/Score..............................................................................99
16.4 Environment..................................................................................100
16.5 Exports..........................................................................................102
16.6 Probes...........................................................................................103

17 Test protocols and stop logic .................................................... 107

18 Reporting................................................................................... 110
18.1 Operational statistics..................................................................... 111

19 Data management options........................................................ 112

19.1 Backup database........................................................................... 112
19.2 Archiving functions........................................................................ 113
19.3 Data transfer/import functions....................................................... 115
19.4 Import data files............................................................................. 118
19.5 Echocheck functions...................................................................... 119
19.6 Database maintenance..................................................................121
19.7 Re-Export to:.................................................................................124

20 Help menu................................................................................. 125

20.1 Email Dealer or Otodynamics........................................................125
20.2 Register a new license..................................................................125
20.3 About.............................................................................................125

21 Networking................................................................................. 126
21.1 LAN client/server installation.........................................................126
21.2 Independent single desktop installation that periodically transfers
data to an ILO V6 ‘data bank’ via the LAN.....................................127

6 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 22 Mode of operation..................................................................... 129
TEOAE Tests..........................................................................................129

23 Response detection................................................................... 132

Confidence levels in DPOAE tests................................................133
Confidence for multiple frequency points......................................133
Confidence levels in TEOAE tests.................................................134
Conclusions...................................................................................136

24 Index.......................................................................................... 137

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 7

8 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015
1 Introduction

1.0.a ILO V6 Clinical OAE software opens up new windows on the cochlea. Designed
by the originators of OAE technology and based on 40 years of experience
with OAEs, V6 software is an expanding suite of carefully engineered
OAE investigational facilities with proven clinical or scientific value. It also
incorporates advanced data management services.

1.0.b To gain the most clinical insights from V6 software, you need to keep in mind
the source of OAEs. The outer haircells of the organ of Corti are responsible
for healthy ears achieving high sensitivity and good frequency selectivity at low
stimulus levels. They do this by assisting the stimulus energy to pass along the
basilar membrane without loss – so that specific frequencies reach the sensory
cells at specific places. This process is often termed the ‘cochlear amplifier’,
but it’s not a perfect amplifier. During its operation it generates some distortion
and also allows stimulus frequency energy to escape. Both reach the middle
ear as vibration and this creates secondary sounds in the ear canal. Sometimes
outer hair cell energy is released without external stimulation, giving rise to
spontaneous sound emission.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 9

1.0.c The aim of clinical OAE measurements is to establish the status of the cochlea.
However, as sound stimulation and the otoacoustic responses must both pass
through the middle ear, a healthy middle ear is necessary before cochlear status
can be established. Although NOT a measure of middle ear status, unexpected
absence of OAEs indicates that the middle ear status should be examined.
Only if middle ear status is normal and technical conditions for recordings are
adequate can an absence of OAEs be taken as evidence of abnormal cochlear
function.

1.0.d To ensure your hardware is functioning correctly, it is important to conduct

regular weekly system checks. In exceptional circumstances, either an
equipment fault or failure to comply fully with the instructions in this manual may
result in unreliable test results. Results with total OAE responses greater than
40dB SPL should be considered highly suspect and not to be relied upon.

1.0.e Strong OAE responses are normally obtained from healthy ears with normal
hearing thresholds. The strength of OAE recorded depends on the stimulation
applied. Please refer to the literature on OAEs before changing stimulus
settings in ILO V6, as this could change the sensitivity of the instrument to
hearing loss. Please also note that OAEs do not provide a replacement for
the audiogram and hearing threshold cannot be reliably estimated from OAE
measurements. Auditory pathology can affect retrocochlear function and also
rarely inner hair cell sensory function. Both can result in hearing loss without
loss of OAEs.

1.0.f OAEs should therefore by viewed as one important part of the audiological
diagnostic test battery.

10 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

2 ILO CD and software installation

2.1 Minimum PC specifications

2.1.a Processor
Pentium III 1GHz or better

2.1.b Operating System

Windows 10, 8, 7 and Vista

2.1.c RAM
1024MB minimum

2.1.d Hard Disk

50MB minimum free

2.1.e CDR / DVDR

Recommended for database archiving and backup

2.2 ILO CD
2.2.a Prior to software installation, close all application programs running on your PC.

2.2.b Insert the ILO V6 CD into your CD-ROM drive. The CD will start automatically
and a menu will appear, presenting several options. Select the options using a
left mouse click. If the CD does not auto-run, click Start > Run > Browse and
select Run.exe.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 11

2.2.c Install ILO V6 - begins the ILO software installation process.

2.2.d Manuals - opens a sub menu, which gives the option to view the different ILO
software manuals. Manuals are in PDF format and require a reader to view.

2.2.e Browse CD - opens the CD so the contents can be viewed.

2.2.f Visit Website - opens the Otodynamics web site (your PC will need to be
connected to the internet).

2.2.g Register - please register this software so that we can keep you informed of
updates from time to time.

2.3 ILO V6 Software installation

2.3.a There are different ways to install and configure ILO V6, which require different
installation procedures.

• As a Desktop or Network server version

• As a network client only version

2.3.b For further information about Networking options available, see the Networking
section later in this manual.

2.3.c For standard installations follow the instructions below:

• Select Install ILO software from the CD menu.

• Follow the on screen instructions to proceed with the installation.

• You will be asked to enter a password – this will be found on the CD sleeve.

12 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 • If use of EZ•Screen 2 is required, ensure the box is checked to include this
program in the installation process.

• If the program requests a PC re-start, accept this.

• Following installation, an ILO V6 icon will be placed on your PC desktop. (If

selected an icon for EZ•Screen 2 will also be present)

2.3.d Note:
Please refer to your Echoport Manual for instructions on connecting
your hardware and installing any necessary drivers.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 13

3 Main features of ILO V6
Clinical OAE software

3.1 General features

• User-friendly Windows-compatible TEOAE and DPOAE clinical software
• Easy installation
• Flexible database management
• Operation with new and classic Otodynamics DP Echoport products
• Full Windows compatibility - runs on Windows 10, 8, 7 and Vista
• Password protected user logins and two levels of user operation
• Automatic program statistics collected
• Easy to read and interpret reports
• User programmable automated stop criteria

3.2 OAE recording

3.2.1 TEOAEs

• Quick Screen and Standard ILO nonlinear recording

• Tone pulse stimuli
• Adjustable stimulus intensity
• Real-time stimulus monitoring in ‘Checkfit’ and during test

3.2.2 DPOAEs

• DPgram with preset and custom selected stimuli

• Programmable level, level ratio, frequency ratio, points/octave, frequency
range, manual/automatic/intelligent frequency progression

14 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 • Total DP power assessment
• DP growth rate analysis
• True time domain averaging and noise statistics
• Signal-to-noise assessment against TWO standard deviations from mean
noise level

3.3 Advanced functions

• Powerful ‘synchronised’ spontaneous emission search to reveal latent
Spontaneous OAEs
• DP Growth analysis
• Binaural TEOAE and DPOAE measurements
• Contralateral TEOAE suppression analysis

3.4 Analysis tools

• TEOAE, full cross correlation, frequency analysis with reproducibility and
signal-to-noise data
• Examine/compare feature for TE-TE and TE-DP
• Response subtraction analysis
• Half-octave OAE power assessment
• Detailed spectrum analysis
• Full data table provided
• User configured ASCII output
• Waveform analysis

3.5 Probe
• Smart probe technology - carried calibration and usage data
• ILO probe design - proven and improved in 15 years of service
• Easy to use probe test with pre/post test comparison

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 15

3.6 Data handling
• Fully searchable patient database with reports
• ILO standard DTA and DPG files written and read
• Exportable data to OZ, Hi*Track, XML, ILOV5, Excel and ASCII (user
selectable data elements)
• Import of data from other V6 or EZ•Screen sites
• Integration of multiple sites, testers and machines into one database
• Ability for distributed deployment across a network
• Additional backup analysis with traditional ILOV5 software
• Automatic tracking of patients through testing and assessment

Note:
Not all features listed are available for all Echoport models. Please
check with your hardware manual.

16 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

4 Making use of OAEs
Key points for clinical practice by David T. Kemp

4.1 Recording OAEs

4.1.a Advanced OAE techniques need a sound attenuating booth, but useful OAEs
can be made in a quiet office environment. Background room noise levels of
40 dBA or below are recommended. A good probe fit helps block out external
noise, although this effect is minimal with neonate ears. Short bursts of more
intense noise (e.g. speaking to the patient, or a cough), which can be detected
and rejected by the instrumentation, are less troublesome than continuous
or reverberant sounds. Patient movement is also not a problem with OAEs
provided it does not result in cable-rub noise. Jaw action, swallowing and
vocalisations cause ear canal noises, which can prevent good OAE recordings.

4.1.b Patency of the ear canal is essential for successful recordings. Obstruction by
wax in older patients, or by fluid or birth debris in neonates, or by collapse of
the canal in the latter, prevent OAEs from reaching the ear canal and are major
causes of OAE recording failure. Sleep and sedation have minimal effects on
OAEs.

4.2 Types of OAEs

4.2.a There are two widely used OAE measurements: transient evoked OAEs
(TEOAEs) and dual-tone evoked distortion product OAEs (DPOAEs). DPOAE
measurements are better suited to advanced clinical investigation on adult
patients, even though DPOAE analysis is complex and interpretation is difficult.
The DP technique is more flexible and potentially more powerful than TEOAE
analysis, having a wider useful frequency range. Waveform-based TEOAE
measurements, as originally used in universal newborn hearing screening
programmes, are also useful as a sensitive initial screen prior to full clinical
examination. TEOAEs are also more sensitive to cochlear status changes
manifested in subtle changes in the TEOAE waveform. DPOAE instruments can
be used for screening with an appropriately low stimulus level (e.g. 65/55 dB
SPL).

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 17

4.3 Middle ear factors
4.3.a OAE detection is affected by conductive losses and OAEs will be absent if
there is effusion, glue, otosclerosis or ossicular dislocation. Moderate negative
pressure and tympanic perforations not exceeding 30% result in the attenuation
of only the lower frequency OAEs. Grommets do not greatly affect OAEs.
Absent OAEs can reappear following effective middle ear treatment or surgery if
the residual conductive loss is very small and the cochlea is normal. Large and
unusual ear canals and perforations can disturb stimulus delivery by ‘ringing’
and so prevent successful recording.

4.3.b This does not arise with neonates, but their ear canals are extremely small and
this needs to be accommodated in the selection of probe size and stimulation
intensity.

4.4 OAEs and the nature of sensory

hearing loss
4.4.a OAEs come exclusively from outer hair cells which do not themselves activate
primary auditory nerve fibres, yet a strong relationship exists between the
absence of OAEs and hearing loss. This forces a redefinition of the term
‘sensory hearing loss’.

4.4.b Sensory transmissive loss can be defined as hearing loss resulting from
dysfunction of outer sensory hair cell group. Absence of the ‘cochlear amplifier’
allows natural damping to remove most stimulus energy from the cochlear
travelling wave and lowers the resolution of the cochlear imaging mechanism.
Inefficient transmission of excitation to the inner hair cells (IHCs) causes loss of
hearing sensitivity and frequency selectivity. Since there remains a pathway for
stimulation to reach the IHCs, profound hearing loss cannot be caused by outer
hair cell (OHC) dysfunction alone. Total OHC failure is estimated to cause no
more than 60 dB hearing loss. Loss of OAEs with a normal middle ear indicates
sensory transmissive loss.

4.4.c Sensory transduction loss can be defined as hearing loss resulting from
failure of inner hair cells to respond and activate the synapsed auditory nerves.
This could give rise to any degree of hearing loss from mild to profound since
the auditory nerves themselves have no sensitivity to sound simulation. Loss of
frequency selectivity would not necessarily accompany threshold elevation in a
pure sensory transductive loss, and OAEs would be normal.

18 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

4.4.d It is clear from the high correlation between sensory loss and OAE absence
that most sensory losses are of the sensory transmissive type. This makes
sense, as the outer hair cell mechanism is both highly specialised and highly
vulnerable to degradation by excessive noise, anoxia or ototoxic agents. OHCs
selectively amplify weak stimuli which would otherwise fall below the threshold
for IHCs to trigger a neural response and as a consequence the symptoms of
sensory transmissive loss necessarily include loudness recruitment in addition
to threshold elevation and reduced frequency selectivity.

4.5 Interpretation of OAEs

4.5.a The presence of robust evokeable OAEs across the key speech frequency
range (1.0 - 4 kHz) indicates a useful degree of normal function in both the
middle ear and cochlea and further indicates that speech and language
development will not be greatly impeded by peripheral auditory dysfunction. For
clinical purposes it is useful to record OAE status as a function of frequency,
averaged over 1/2 or 1/3 octave frequency bands. Higher resolution has little
physiological meaning.

4.5.b The absence of OAEs without middle ear pathology or acoustic obstruction
strongly indicates sensory transmissive hearing loss. Depending on the type
and intensity of stimulation, OAEs can reveal threshold elevations as small as
20 dB HL and the frequency ‘resolution’ of OAEs can be as good as 1/2 octave.
The amount of threshold elevation cannot be predicted with any useful accuracy,
but if DPOAEs are present with TEOAEs absent, this suggests mild to moderate
loss only.

4.5.c OAEs are normally very stable with time and are valuable as a sensitive monitor
of changes in cochlear (and middle ear) status over time, e.g. in relation to
sudden hearing loss, Ménière’s disease or noise trauma.

4.5.d Although OAEs can differ enormously between healthy ears they are usually
quite similar in the left and right ears. Substantial left-right differences may
therefore indicate pathology.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 19

4.6 Differential diagnosis
4.6.a OAEs are expected to be present in sensory transductive, neural, central and
psychogenic hearing losses. OAEs can be either present or absent with 8th
nerve tumours, depending on whether the cochlear blood supply has been
compromised. If present, OAEs indicate the possibility of hearing recovery with
a conservative surgical approach.

4.6.b OAEs are pre-neural responses indicating healthy cochlear status and cannot
be used to detect sensory transductive or neural hearing losses. With neonates,
the absence of an OAE response in clear dry ears should be treated as a strong
risk factor for sensory hearing impairment. However, other risk factors need
to be considered before presence of an OAE is taken as evidence of normal
hearing. Hyperbilirubinemia or any risk of neurological damage requires that an
ABR test also be conducted.

4.6.c Auditory neuropathy is indicated by the presence of normal OAEs but the
absence of normal ABR responses. In such rare cases, the application of
hearing aids with high amplification may be counterproductive. In infants both
ABR and OAE testing should precede hearing aid selection.

4.7 Special applications

4.7.a OAEs can be slightly depressed by contralateral noise stimulation if the medial
cochlear efferent system is operational. The significance of the absence of this
effect is not clearly understood but may help clarify the nature of certain neural
pathologies.

4.7.b The objective nature of OAEs can be useful in the investigation and
management of inorganic hearing loss by demonstrating normal cochlear
function to the patient.

4.7.c Serious tinnitus is almost never associated with OAEs, but rather with their
absence. Spontaneous OAEs can sometimes be perceived as tinnitus and
occasionally cause unnecessary anxiety. Typically in such cases hearing
threshold is normal and the tinnitus is mild, tonal and easily maskable by noise.
Patients can be reassured by the objective demonstration of spontaneous
OAEs.

20 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

5 Initial setup

5.0.a Connect the Otodynamics OAE hardware to your PC using the cable provided.
Double-click on the ILO V6 icon created on your Windows desktop to run the
ILO V6 software. You will be required to enter a license key when running
the software for the first time. The license key can be found on the CD and/or
documentation accompanying the software. The license key may be entered
using upper or lower case letters.

5.0.b The Initial setup options screen is displayed.

5.0.c ILO V6 can be installed to run OAE tests or as a data manager for OAE data. If
you are installing a USB system set the Type field in the OAE Instrument box
to read Echoport USB OAE. If you are planning to use V6 as a data manager
then set Type to Otoport viewer.

5.0.d The User and Facility details can be entered at this point. It is important to fill
the fields listed in a bold typeface, as these are mandatory fields. The Facility
ID is a unique 3-character identifier that can be used to ensure that data
collected at different sites can be easily identified - you may choose any three
characters for this ID. The User/Operator ID is a unique 3-character identifier
field that can be used to ensure that tests performed by a particular user can be
easily identified (we suggest that the user’s initials are used, if necessary adding
a character to total three). The Global Site Name (GSN) is a unique 3-character
hardware identifier that ensures that data files collected on a particular ILO
system can be easily identified. The GSN will be found on the CD label, with

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 21

 the OAE hardware serial number. It is possible to filter patient and test data
using any combination of User/Operator, Instrument GSN and Facility ID. After
entering details in the necessary fields, click <OK> to enter ILO V6.

5.0.e Maximise the ILO V6 window if necessary.

5.0.f If you are installing V6 for use with an Echoport but have not connected the
hardware with the cable provided, the error message below will be displayed. In
this event, connect the hardware and retry.

5.0.g If you see this message and you are installing V6 to manage Otoport data go
to File > Setup Options > OAE system and set OAE System type to Otoport
Viewer / Training Mode.

22 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

5.0.h On subsequent ILO V6 sessions, an ILO Operator Login screen appears.

5.0.i New operators can be added by entering the relevant details in the User
Name, Forename and ID fields, selecting User or Advanced User privileges
and clicking on the <Add New User> button. Passwords may be entered if
required by your protocol. The User/Operator can then be selected from the
pull-down menu. Note that users do not have full access to menu options,
therefore disabling areas which include important configuration settings, which
should only be set by fully trained staff. All necessary intervention by a user
can be accessed from the main screen. There are buttons to access the probe
calibration check area and to do data downloads and transfers.

5.0.j Please remember to set the various directories to your preferred paths before
you start testing. This is especially important if you intend to create and export
records such as OZ SIMS, Hi*Track, .XML, .CSV, ASCII or GDT (option) files.
Directories can be changed from the default paths via File > Options > Export/
Import.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 23

6 Getting to know V6 software

6.1 Introduction to the main screen

6.1.a The main screen is structured to present various textual, graphical and
numerical data in an organised and digestible format. The menu bar (below the
title bar) gives access to many layers of options and functions via six main drop-
down menus; these are accessed with a mouse or by pressing the Alt key whilst
holding down the underlined key in the menu bar title.

6.1.b To the left of the screen are three stacked panels with tabs labelled This
Patient, Worklist and Review data. Clicking on the required tab will reveal the
panel, giving access to further options and data.

6.1.c The Test data box sits to the left of centre-screen and details information
about the test performed on the current patient being tested or reviewed. The
patient details are displayed in the This Patient tab. The <Start Test...>, <Start
Bilateral Test...>, <Print> and <Save> buttons sit below the Test data box.
The functions are greyed out when inactive.

24 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

6.1.d The Stimulus window displays the click stimulus presented to the ear in
‘Checkfit’ mode, showing the magnitude of the stimulus with time.

6.1.e In TEOAE mode the Response Waveform graph shows the magnitude of the
complex TEOAE waveform with time.

6.1.f The OAE Response window displays the level of OAE and the level of
noise recorded in decibel sound pressure level against frequency. There are
several display options available for this panel, specific to TEOAE and DPOAE
recordings. Please see the OAE Response window sections under Performing
a TEOAE Test and Performing a DPOAE Test.

6.1.g To the right of the OAE Response window is the noise rejection level slider.
This is used to set the level for the rejection of noisier data samples. The
associated fields to the right display the number of samples with noise below
and above the level set by the noise rejection level slider (Nlo and Nhi) and
a figure which indicates the actual reject level. Also in this table are other
measurements specific to TEOAE and DPOAE recordings. For TEOAE data the
wave Reproducibility and stimulus Stability figures are displayed. For DPOAE
data the ratio between F1 and F2 is indicated. These features are discussed
later in the manual.

6.1.h The Numerical Data panel toward the bottom right of the screen shows
technical information regarding the test performed, including the stimulus
level used, the OAE response power and the test time. The data is specific to
TEOAE and DPOAE recordings.

6.1.i Along the bottom of the screen is the Status Bar. The protocol setting mode is
shown here, along with the instrument GSN, the user 3-character ID and the
export status. It is possible to hot swap between protocol modes and log on as
different users by clicking the mouse on the relevant area.

6.1.j Note:
When using Echoport USB systems and testing neonates, it is
important to set the protocol mode to neonatal screening or neonatal
diagnostic. This will ensure the correct stimulus intensity is delivered
to the patient. When in neonatal mode, the status bar changes to
yellow.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 25

6.2 Screen data fields
6.2.a Nlo : number of data samples (sweeps) accepted and processed. Data is
accepted when the noise level is below the noise reject level set
Nhi : number of data samples (sweeps) that have been rejected. Data is
rejected when the noise level is above the noise reject level set
Repro : whole band reproducibility %
Stab : during test - displays the current stimulus stability status; post test -
represents stimulus status at test termination
Rej : noise rejection level mPa
Resp dB : relative strength of the absolute response level in dB SPL
Noise dB : relative strength of the noise after averaging in dB SPL
Stim dB : peak equivalent stimulus level
DP Level : total DP power dB SPL
L1 and L2 stim : the DP stimulus levels used in dB SPL
F2/F1 : the ratio between DP stimulus frequencies used
Test time : total recording time in seconds
Status : current type of activity

6.2.1 Bottom panel of screen

6.2.1.a Mode : test type currently selected (diagnostic, screening etc.)
GSN : Global Site Name (hardware identifier)
XXX : Operator ID
Ex=OFF : export option (Ex=OFF, OZ, Hi*Trk, CSV, XML, Ascii)

26 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

6.3 Navigating around the program
6.3.a Navigation around the program can be achieved using a combination of hot-
keys, the mouse and drop-down menus. Hot-keys for particular functions are
denoted by the letter that is underlined. Certain functions, such as <Cancel>
and <Continue>, can be selected by pressing the Esc or Enter keys.
Alternatively, use the mouse to highlight and click on the appropriate tab, button
or field, or pull-down and selected options from the toolbar. The main menu
options (File, Tests, Reports, Data Management, Help) can also be selected
by pressing the Alt key together with the key underlined.

6.3.b A summary of menu bar options follows. Many of the menu items are explained
in full detail in later sections of this manual.

6.4 File menu

6.4.1 Examine/Compare data

6.4.1.a This item is selectable when a test result is being reviewed and displayed on
the main screen. Examine/Compare data provides a method of displaying two
patient test results at a time, side by side on the screen. (See Reviewing Data
section for more information).

6.4.2 Print
6.4.2.a This opens a window on the <Print> button which gives various printing options
for the current patient.

6.4.3 Print setup

6.4.3.a The printer properties are set up here.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 27

6.4.4 Options

6.4.4.a This is a major section, allowing you to choose your OAE system, set your own
testing criteria, register and calibrate probes and specify location of files created
within the software. There are pre-set values for stimuli, protocols etc., but you
may wish to change these when you are familiar with the software. (Please see
Setup Options for full details).

6.4.5 System Checks

6.4.5.a Select <Run Diagnostics> to run all equipment system checks. These can be
printed, or sent by email to Otodynamics.

6.4.6 Logon as different user

6.4.6.a Select this to change user or add new user.

6.4.7 Exit
6.4.7.a Select this to exit.

28 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

6.5 Tests menu

6.5.a The Tests menu provides a list of test options and a short-cut to the stimuli
setup screen. The first item ‘Start test’ default action activates a secondary
menu where you can pre-select the test which commences when the <Start
Test> button on the main screen is pressed.

6.6 Reports menu

6.6.a This menu offers a number of patient report options. Reports can be filtered by
operator, instrument, facility, and date.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 29

6.7 Data management menu

6.7.a The Data management menu provides facilities for data backups, archiving and
management of files from other ILO systems.

6.8 Help menu

6.8.a The Help menu enables you to search for help on any topic in the V6 manual
and provides facilities for emailing your dealer or Otodynamics, registering a
new software license and viewing the Otodynamics website. The About option
provides information on the current ILO V6 software version.

30 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

7 Preparing for a test

7.1 Selecting the Test Mode

Always set mode to

Neonate when testing
newborns or very
young infants.

7.1.a The currently selected Test Mode is shown at the bottom of the screen. The
four test modes available are Neonate Screening, Neonate Diagnostic, General
Screening and General Diagnostic. Always choose a Neonate mode when
testing a newborn or very young infant. If a neonate is tested while in one of the
General Modes, the stimulus level during Checkfit will initially be too high. We
do not recommend that you use the automatic adjust function to correct for this.

7.1.b The Test Mode can be changed in File > Options > Start/Stop/Score (shown
above) or by a left-click on the Mode= box at the bottom of the screen, and then
choosing the correct Mode. To help identify when neonatal mode has been
selected, the status bar at the bottom of the page is coloured yellow.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 31

7.2 Entering patient details
7.2.a The demographic details of the patient are
recorded in the This Patient panel. The
minimum requirement needed to run a test is to
enter the Family name. If an ID number is not
entered at this stage, an automatic ID number
is created at the end of the test. After saving the
test and the Which ear? window is closed, an
Automatic ID box appears which allocates an
automatic ID number. This can be edited prior to
accepting the ID and is added to the ID number
field in the This Patient panel.

7.2.b Fields for Mother’s Name, Weight, Time of birth,

Status and Multiple births are only available
when in one of the two Neonate Modes. Please
refer to the EZ•Screen Manual for full details.

7.2.c Further patient details can be entered by

selecting the button next to <Start New
Patient> and entering Patient and Mother/
Guardian’s details.

7.2.d Also, risk factors and additional test history

can be added. Family name and test ID are
locked, but can be edited by selecting the lock to the right of the Family name.
However, the Family name and ID cannot be changed if another record exists
with the same data.

32 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

7.3 Using a worklist
7.3.a To help with efficiency and reduce appointment times, it may be useful to use
the Worklist feature. This allows you to enter patient details into a worklist and
select them for testing as and when required. If your screening programme
involves using a number of ILO systems which are networked in some way, then
you should consider using worklists as a method of administrating testing. The
use of worklists allows a central administrator to distribute details of the patients
to test to each ILO system and then to receive the test results from each
machine for collation. Each user can pick up a list of patients to test at the start
of each day, perform the tests and then send the results to the administrator.
Patient lists can be obtained, and results stored, over a local area network.

7.3.1 Editing the Worklist

7.3.1.a Click <Edit the worklist> button to open the editing window. Input patient
details into the relevant fields by clicking on the Family name field then using
the tab key or mouse to move between fields. Family name and ID number are
key fields and both must be completed before the patient can be moved to the
list by clicking the <Update> button. Please note that an Automatic ID option is
not available with the worklist.

7.3.1.b Note:
The ‘Sex’ field must also be completed. It is possible to save a
patient to the worklist without this field filled in, but it will not be
possible to save the record to the database.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 33

7.3.2 Editing/Deleting Patients
7.3.2.a Working from the Edit the worklist window, move the cursor line to the patient
to be edited/deleted. The patient’s details now appear in the labelled fields and
can be edited; alternatively the patient can be removed from the list by clicking
the <Delete> button. After editing, click the <Update> button, followed by <OK>
and the edited list will appear as the Worklist.

7.3.3 Selecting a Patient

7.3.3.a Click on the Worklist tab to open. Select the
operator from the drop down list arrow to the
right-hand side of the Operator field. Move the
cursor to the patient to be tested, then click
<Select this patient>. The selected patient will
appear in the This Patient panel ready to start
testing.

7.3.4 Importing worklists

7.3.4.a The <Import..> button allows worklists to be
imported from third-party tools. The format of the
import file is the standard CSV comma delimited
format. This can be written by spreadsheet
applications. The order of the data fields has to be
the same as that displayed on the worklist form
(i.e. Family name, ID number, forename etc.).
Only the Family name and ID number have to be
present, all of the other fields are optional - but if
present they must be in the correct order with all
preceding fields also present). Here are a couple
of examples of the suitable worklists to import...

Brown,1234
Smith,3366

or a more detailed list would be...

Brown,1234, Michael,James,Male
Smith,3366,Joanne,Mary,Female

7.3.4.b These files should be saved with a suitable file name, ensuring that the filename
extension is .csv. During the import you will be requested to navigate to this file
using a standard windows file selection dialogue box. Once selected, the data
will be added to the list shown in the worklist.

34 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

7.4 Selecting the test type

7.4.a Choose the type of test you wish to perform from the Tests menu - TEOAE,
DPOAE, DP Growth or Spontaneous. Please refer to the sections Advanced
DPOAE measurements - multi-level DPOAE, Spontaneous OAEs and
Binaural OAE measurements for further information on these test types.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 35

8 Performing a TEOAE test

8.0.a Connect a probe. Fit an appropriately sized probe tip and insert the probe in the
ear to be tested. Ensure that the correct Test Mode and Test Type have been
selected, as described previously in Preparing for a test.

8.0.b Transient evoked OAEs are highly individual responses which are very sensitive
to changes in cochlear status.

8.1 Choice of Stimulus

8.1.a To change the Stimulus type, either press Ctrl+S, or select Tests > Stimulus or
File > Options > Stims.

8.1.b Choose Quickscreen for the most rapid overview of cochlear status. This
stimulus is repeated 80 times per second, and its energy is biased towards
midfrequencies. It implements the nonlinear stimulus procedure for artifact
rejection. This stimulus is extensively used for newborn hearing screening
but is equally useful for the initial OAE test. Quickscreen should not used if
OAEs below 1kHz are of interest. Each accepted sweep (NLo) averages the
responses to sixteen stimuli (8 for the A waveform and 8 for B. Note: The A
and B waveforms are two interleaved measurements combined in a single OAE
result).

8.1.c Select Nonlinear click stimulation for clinical documentation of TEOAEs. This
uses a plain click stimulus (80 microsecond drive signal) repeated 50 times per
second - resulting in a 20ms response window. Each accepted sweep (NLo)
averages the responses to eight stimuli (4 for the A waveform and 4 for B).

8.1.d The differences in stimulus, response window, stimulus repetition rate and
adoption of the non-linear stimulus method mean that Quickscreen, Nonlinear
and Linear modes may yield different responses from the same ear. In
particular because Quickscreen records twice as many stimulus responses
within each sweep Quickscreen will show lower noise levels for the same sweep
(NLo) count.

8.1.e The Linear mode of TEOAE is not for regular clinical use. Normally NON-linear
TEOAE is used (as in Quickscreen) as this provides a much higher immunity
from stimulus artifact contamination. With Linear TEOAE some stimulus energy
is present mixed with the TEOAE especially at normal and higher stimulus
levels. It must not therefore be used for screening.

36 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.1.f Linear TEOAE is a specialist OAE measure. The Linear measure can record
weaker TEOAEs and TEOAEs at lower stimulus level. This is because some
TEOAE is lost in the normal nonlinear measuring process.

8.1.g Linear can be useful when tracing TEOAE to very low stimulus levels. Also
when looking for small changes in TEOAE. If TEOAE response ‘1’ is subtracted
from TEOAE response ‘2’ from the same ear and obtained with the same probe
fitting then the stimulus artifact will be cancelled. The differences between the
two responses will be clearly seen. This technique has been successfully used
to observe the effects of contralateral noise on OAEs (suppression).

8.1.h Warning:
Linear TEOAE must NOT be used for routine screening and
diagnostic applications.

8.1.i Spontaneous OAEs are described in the next section.

8.1.j Select Tone pip only after performing a click TEOAE. Tone pip TEOAEs allow
maximum stimulus energy to be concentrated on a selected frequency band.

8.1.k Click on the <Start Test> button to begin a test.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 37

8.2 Checkfit
8.2.a If the Checkfit peak stimulus level is within the range 84 ± 3 dB pe (by default),
the arrow on the peak stimulus level meter should point to the green region of
the scale. The target stimulus level can be changed via the File > Options >
Stims menu.

8.2.b The stimulus should have a clean, clear positive and negative deflection
followed by a flat line. A flat or poor stimulus may indicate that the tip or coupler
tubes are occluded by fluid or debris (please refer to the section detailing
probe care). Too much “ringing”, or oscillation, in the latter part of the stimulus
waveform could indicate that the tip is not properly fitted to the probe, the tip is
not providing an adequate seal in the ear canal or the probe is angled towards
the ear canal wall. In some adults, the “ringing” may be physiological and
caused by a particular ear canal geometry. Refit the probe and ensure that you
have the best fit possible. The stimulus spectrum should be a smooth, rounded
curve. A jagged stimulus response in the low frequencies or a sharp peak in
the mid-frequency range indicate a bad probe fit. In longer adult ear canals,
there may be a dip in the stimulus spectrum measured at the probe caused by
standing waves in the ear canal. A trough in the stimulus intensity at the probe
does not necessarily indicate a dip in the stimulus intensity at the eardrum.

8.2.c If the stimulus level remains very low, regardless of the position of the probe in
the ear, it is likely that the probe has become blocked. In this case, inspect the
probe coupler tubes and replace if necessary.

The figure below is from a healthy adult ear. The stimulus waveform panel
shows a short, biphasic click stimulus. The stimulus spectrum shows a smooth
distribution across the frequency range (the decrease towards 6kHz is the result
of eardrum reflection).

38 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.2.d A healthy newborn ear’s stimulus waveform is more oscillatory than in the
adult recording. However, the oscillation is limited and the stimulus spectrum
is smooth with no obvious peaks or troughs. With some newborns, a slightly
rounded peak may be visible in the 2-3kHz range. It is advisable to refit the
probe until you are satisfied that you have the best possible fit .

8.2.e If the stimulus level is outside the target range, this may be due to the ear canal
size being outside of the range used to set the optimum stimulus level. Click on
the <Auto-adjust stim> button or press A to automatically adjust the stimulus
level to the target level of 84 dB pe (this default value can be changed via File >
Options > Stims, if required). However, please note that it is not acceptable to
compensate for a bad probe fit by increasing the stimulus gain.

8.2.f Adjust the position of the noise rejection level slider to reject a percentage of the
noisier data samples (Nhi) and improve the quality of the data accepted (Nlo).
Click on the up and down arrows or use the up and down cursors to set the
noise reject level. The default noise reject level can be set in the File > Options
> Stims menu. If the reject level needs to be set much above 8mPa (52dB
SPL), it may not be possible to record any emissions unless the subject’s OAEs
are very strong. Under these circumstances, it is advisable to settle the baby,
minimise cable rub and/or reassess the test environment. Intermittent sources
of noise, such as background talking, may not prevent you from collecting data
during the quiet periods but sources of continuous noise, such as computer hum
and air-conditioning vents, will be a problem.

8.2.g Enabling the low cut filter will assist in the collection of data in noisy conditions.

8.2.h Click on the <Continue> button to proceed to data collection.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 39

8.3 Data collection
8.3.a During data collection, TE stimuli are delivered to the ear and OAE response
data is collected. The data is averaged and an OAE waveform is displayed in
the time domain. A Fast Fourier Transform is performed on the OAE response
and the OAE and noise energy are displayed in a frequency spectrum. The
spectrum can be displayed as a half-octave histogram, which is standard.

8.3.b As the test progresses, data is processed and various on-screen displays and
figures are updated. The absolute OAE response (Resp dB) relates to the total
OAE energy recorded across the frequency range. The OAE response is a
characteristic of the ear and there will be no significant change throughout the
recording. The absolute noise level recorded is also displayed, but this may
reduce as the noise is averaged.

8.3.c When recording OAEs it is important that the data collected is of good quality.
The OAE signal should be significantly larger than the noise floor, therefore
achieving a good signal-to-noise ratio (SNR). SNR values can be displayed by
right-clicking the mouse on the OAE response window. In half-octave mode
the OAE response histogram shows the signal and noise in half octave bands.
The noise appears red in the colour display and the signal is blue. The signal-to-
noise ratio in each of the bands is the difference between the signal and noise
values. When a valid response exceeds the noise contamination, the signal-
to-noise ratio will be positive. A dash is shown if the noise exceeds the signal.
The signal to noise ratio can be improved by increasing the recording length,
as the noise is averaged and reduced. Minimising the noise level in the test
environment will also help. (See section OAE response window)

8.3.d During data collection, two independent collections are made using
alternate pairs of stimuli. The Response Waveform panel shows these two
superimposed OAE averaged waveforms (one in white and the other in yellow).
The reproducibility figure (Repro) is derived from the correlation between
the two overlaid waveforms. A perfect recording would have a reproducibility
of 100%. The corresponding signal-to-noise ratio would be infinitely high. A
negative reproducibility figure indicates that inversion of the two waveforms
has occurred. Noise contamination in the final result causes a reduction in
reproducibility as well as signal-to-noise ratio.

8.3.e When recording OAEs, it is important to deliver a consistent stimulus and ensure
that the probe fit remains stable. Using the ‘Checkfit’ stimulus, the probe fit and
stimulus are assessed by the operator in ‘Checkfit’ and the test is started when
the best possible fit and the desired stimulus level have been achieved. During
data collection it is important to ensure the probe does not move considerably,
therefore changing the stimulus. The stimulus stability figure (Stab) represents
any change in probe fit from the start of the test, as a percentage.

40 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.3.f Also in the stimulus window is a stimulus traffic light indicator. The indicator
represents the stability figure with a colour code. If the stability figure is over
90, then the stimulus traffic light indicator is green. If the stability is over 70 it is
orange and if below 70 it is red.

8.4 Checkfit and testing stimuli

8.4.a During Checkfit the stimulus used to assess the ear is the Otodynamics Non-
Linear stimulus type. From the stimuli set, positive polarity single clicks are
captured. This stimulus results in a simple deflection of the ear drum and from
the measured pressure change in the ear canal, seen in the stimulus window,
probe fit assessments can be conducted. This stimulus type has become the
standard ‘Checkfit’ stimulus for Otodynamics products since 1988.

8.4.b During the test the stimulus changes to the selected type. When data is being
collected, there are two stimuli displayed in the stimulus window. The white
signal represents the stimulus at the start of the test and the green dashed
signal represents the current stimulus. Any difference in the traces shows how
the stimulus has changed throughout the test.

8.4.c The Otodynamics Linear stimulus type also contains some positive clicks that
are the same as the Non-Linear type. These positive clicks are captured and
displayed in the stimulus window. Therefore, if using the Linear or Non-Linear
stimulus types no differences are seen between the ‘Checkfit’ stimulus and the
testing stimulus. However, if using Quickscreen, the stimulus is different. This
stimulus type delivers single clicks of both positive and negative polarities and
there is a slight redistribution of the stimulus energy to the 2-3Khz region from
that of the other stimulus types. The stimulus waveform captured during test will
therefore differ from that of the ‘Checkfit’ stim.

8.4.d When the test is saved the stimulus shown in the stimulus window reverts to the
‘Checkfit’ stimulus.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 41

8.4.e It is not possible to measure the stimulus accurately in noisy conditions. The
stimulus stability and stimulus traffic light indicators are not updated until
accurate measurements can be taken. If there are ten noisy sweeps measured
in a row, the Stability figure turns red and the traffic light indicator becomes
crossed hatched, indicating they are unreliable. As soon as the noise level
drops to a suitable level these figures are updated.

8.5 Test termination

8.5.a To terminate the recording manually, press the <End> button. The test may also
be paused by pressing the <Cancel> button. This gives options to continue the
test, return to the ‘Checkfit’ stage or end the recording.

8.5.b If desired, the program can be configured to automatically stop the test when
specified criteria regarding the quality of the OAE have been met. See section
Test protocols and stop logic.

8.5.c If the test is not stopped by the operator or by intervention of the stop logic, it will
terminate when the specified number of low noise sweeps have been obtained.

8.5.d If the Auto stop function is disabled, it is possible for the test length to be
increased by pressing the F8 key. This will allow the test to run beyond the
specified number of timeout sweeps. (If you wish to use this function during a
bilateral tests, you must ensure that the main V6 window is active first; you may
do this by clicking on the main window). If the auto stop function is switched on,
the test will terminate as programmed.

8.5.e The figure below shows a recording from a healthy ear.

42 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.5.f The figure below shows a neonate with a large OAE. A high level of OAEs is
common in healthy newborn ears which are dry and clean.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 43

8.6 OAE Response window
8.6.a A right mouse click on the OAE Response window reveals various options
related to the test data. The options can be selected using a left mouse click.

8.6.b Show SNR values - This option displays the signal-to-noise ratio (SNR) values.
The SNR is the difference between the OAE response and the noise level and is
displayed at half octave frequencies.

8.6.c Half octave display - This groups the TEOAE response and noise energy into
half octave bands and displays them in a histogram.

8.6.d Half octave display - This groups the TEOAE response and noise energy into
half octave bands and displays them in a histogram.

8.6.e Examine Spectrum Detail - This opens a separate window which displays a
high resolution spectrum of the OAE response. The spectrum produced is often
quite irregular and there is no clinical significance to the detail seen. However,
changes in the detail may relate to changes in the cochlear status.

8.6.f A cursor is available and is controlled with a mouse. Place the mouse over
the OAE spectrum window. Values of dBSPL and KHz, relative to the cursor
movement, are displayed in the boxes at the bottom of the window. Using a left
mouse click sets a reference point on the graph. Change in cursor movement
from this point is indicated at the bottom of the screen in the fields next to Delta.

8.6.g It is possible to zoom in and out using a left mouse click and drag. Left to right
zooms in and right to left zooms out. It is also possible to scale the graph up
and down using up and down arrow keys.

44 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.6.h From the spectrum window, you can access a table which displays data for that
test. Both the spectrum graph and the data table are printable.

8.6.i View data table - This option takes you directly to a data table, which details
information about the test. Half octave data is shown.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 45

8.7 Response Waveform window

8.7.a A right-click on the Response Waveform window reveals two further options.

8.7.b Examine waveform detail - The OAE response waveform can be examined
and manipulated by using this option. During a TEOAE test, two interleaved
recordings are made. These result in the responses A and B. The A and B
waveforms can be combined to show the A and B mean, A and B difference or
splt to show the two individal waveforms as well s the default overlaid display.

A and B waveforms overlaid Mean A and B waveforms

A and B difference A and B separated

8.7.c An X-Y cursor is provided that helps to show sound pressure level at specific
latencies. Clicking and holding down the left mouse button and dragging the
selection box to the right will zoom in to display the selected area. The display
is returned to normal by clicking and holding down the left mouse button and
dragging to the left.

46 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.7.d Waveform Filter - The waveform filter allows the OAE response waveform to
be analysed using a frequency filter. The feature is useful for analysing specific
frequency components of an OAE waveform in the time domain. A filtered
OAE response can help determine the magnitude of certain OAE frequency
components at specific latencies. The filter can also be used to remove acoustic
noise from the waveform, which is often at low frequencies.

8.7.e Select the <Filter> button.

8.7.f Use the mouse to drag the sliders to the required frequency and then press
<OK>. The waveform will now be filtered to the frequency limits chosen. The
filtered OAE will only contain components between the frequency limits set, with
the response outside the limits heavily attenuated. The filter can greatly distort
OAE waveforms.

Adult OAE filtered from 2000 Hz -3000 Hz.

8.7.g The lower filter range is 50 Hz to 4000 Hz. The upper filter range is 500 Hz to
6000Hz.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 47

8.7.h Remove LF noise - This feature (Remove Low Frequency Noise) will help
when reviewing an OAE waveform that has been corrupted with noise. The
feature applies a severe filter to the waveform, attenuating frequencies below
1200 Hz and also above 4800 Hz. The probable result is a ‘cleaner’ waveform
that shows a greater correlation between the A and B response, with less noise.
However the OAE response will also be attenuated at these frequencies and a
reduction in amplitude in the OAE waveform may be seen.

8.7.i When this filter is applied the reproducibility figure is recalculated to reflect the
effect of the filter. When applied Repro is shown in italics and the repro figure
turns blue.

8.8 Saving and printing the data

8.8.a On completing a test click on the <Save> button, select the correct ear from
the pop-up prompt and then click <OK>. A message confirms that the data is
saved to disk. The save process stores the patient demographics and other test
information in the database engine. In addition, the OAE test data is stored to
disk in the standard ILO data file format (compatible with other Otodynamics
software).

8.8.b Once the data has been saved, the <Print> button is enabled. Selecting this
button will pop up a small menu which gives access to the various printing
options available to TEOAE and DPOAE data.

8.8.c Note:
If the ‘Print best data’ or ‘Print selected pair’ options combine TEOAE
and DPOAE tests, they will be printed on separate pages. These
may be viewed on the print preview screen by using the browse
buttons at the top of the screen.

8.8.1 Print this data

8.8.1.a This option prints a single ear report of the data currently displayed for a
selected patient. (Fig.1 shows the print report format).

8.8.2 Print best data (both ears)

8.8.2.a This option prints the ‘best’ data available for both the left and right ear tests on
the selected patient. Note: The ‘best’ data for the patient may not be the data
collected in the most recent assessment. (Fig. 2 shows the print report format).

48 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 Fig 1 - Print this data option

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 49

 Fig 2 - Print best data (both ears) option

50 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.8.3 Print selected pair
8.8.3.a For a selected patient, this option allows you to choose a pair of results to print
on a report. A window opens that displays two panels and allows you to choose
the data to be printed. To select a panel use the <Left panel> and <Right
panel> buttons at the bottom of the window and the live panel is highlighted by
a red line beneath it. Then, using the <Select next> and <Select previous>
buttons, all the results can be scrolled through. When the desired data is
displayed, press the return key or click on the print symbol to bring up the print
preview. (Previewing print reports is an optional setting) The data is printed in
the same orientation as chosen in the selection process.

8.8.3.b Click on the print symbol at the top of the print preview to print the data
displayed. (Fig. 3 shows the print report format).

8.8.4 Print bilateral pair

8.8.4.a V6 automatically detects if data is part of a bilateral pair. For a selected patient,
if the data in review is part of a simultaneous recording, then the Print bilateral
pair feature becomes live. The pair of bilateral results is printed side by side on
a report. (Fig. 4 shows the print report format).

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 51

 Fig 3 - Print selected pair option

52 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 Fig 4 - Print bilateral pair option

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 53

8.9 Printing configuration
8.9.a In the Environment section under Setup options, there are several options to
configure the print setup. Select File > Options > Environment.

8.9.b Monochrome Prints – will print your reports in black and white.

8.9.c Preview printouts – a print preview is presented upon selection of print type.

8.9.d Inc. DP data table print – prints a data table for DP tests that includes all test
points measured. (See fig. 5).

8.9.e Swap Left/Right Printing – for automated 2-tests per page printouts, the
orientation of the left and right ear data is swapped.

8.9.f Print setup – displays standard windows print setup options, including printer
selection.

54 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 Fig 5 - Data table

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 55

8.10 Formats of data stored
8.10.a Data is stored on the local or a networked hard-drive, as two components, the
raw OAE data file and the patient demographics with OAE test summary.

8.10.b The raw OAE data file is stored in the data file directory (as specified on the File
> Options > Environment settings). This contains all the waveform information
for a particular test. A file is created for every OAE test that is performed and
saved. Each patient will normally have several OAE data files. These data
files contain many detailed parameters related to the individual OAE test
measurement (including OAE waveforms etc.). The format of these data files is
fully backward compatible with previous Otodynamics’ OAE applications.

8.10.c The patient demographics and the OAE test summary data are stored in
an industry standard SQL database server. This database resides on either
the same PC as the program or can be on a separate PC over a network
connection. Its location is specified in the File > Options > Environment >
Database Setup menu. This database can contain vast amounts of data with
very minimal performance degradation and therefore can become a central
repository for data collected from many PCs. Each data record ‘belongs’ to
a user, a machine and a facility where it was created so that the data can be
filtered at a later date.

8.10.d The data files for export to other database management systems are saved
in the screening data transfer area directory as specified in File > Options >
Exports setup menu. A built-in database contains patient demographics and
OAE test results etc. During the OAE test save operation and using the re-
export facility it is optionally possible to save the test result to a co-operating
third party screening management package. There are several pre-set options
(accessed from File > Options > Exports ) which export data in the following
formats. For additional information on exporting data, see the Exports and Re-
export to: sections.

56 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

8.10.1 OZ
8.10.1.a This option exports to the OZ SIMS patient management software. The export
filename is OzData.bin.

8.10.2 Hi*Track
8.10.2.a This option exports to the NCHAM Hi*Track software (both DOS and Windows
versions). The export filename is EZScreen.txt.

8.10.3 CSV
8.10.3.a This options exports to comma delimited ASCII files. This file format is a
common data exchange format which can be read by spreadsheet and database
products such as Microsoft Excel. The export filename is ILOdata.csv.

8.10.4 XML
8.10.4.a The XML export is similar to CSV and is an increasingly common way of moving
data between database applications. The export filename is Eztests.xml.

8.10.5 GDT
8.10.5.a This export option is available only in Germany and is for importing and
exporting data to and from GDT compliant applications.

8.10.6 ASCII
8.10.6.a This provides an ASCII text file export. The user can select data fields to be
included in the exported file via the <Ascii export configure> button, which
accesses the Select ascii export fields panel.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 57

8.10.6.b The ASCII export data is written to the ILOAsciiExport.txt file. Data headings are
only written once, so if the export options are changed, an existing file should be
renamed or deleted, otherwise any new data will not correspond to the previous
headings.

58 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

9 Spontaneous OAEs (SOAEs)

9.1 What are SOAEs?

9.1.a Ears with high levels of otoacoustic activity can generate sound spontaneously.
These sounds or spontaneous otoacoustic emissions (SOAEs) are typically
continuously pure tones up to 30dB SPL in the sealed ear canal. Often there
is more than one tone present, and there can be ten or more. The tones
sometimes pulsate in intensity and sometimes alternate in frequency. The
mechanism of SOAEs is believed to be the same as TEOAEs except that in the
case of SOAEs the cochlea provides its own stimulus in the following way.

9.1.b Background external and physiological noise is always present in the cochlea
and there is a minute transient otoacoustic emission in response to all of these
sounds. When OAEs reach the middle ear, some are reflected back into the
cochlea - and become a second stimulus, which can result in a secondary OAE.
These are usually smaller than the original - but in the case of SOAEs they are
not. High internal reflectivity from the middle ear, combined with amplification
inside the cochlea, can result in the secondary emission being greater then the
first. The originating sound or noise re-circulates inside the cochlea. Potentially
this sound can grow and grow - but only if one more condition is precisely
met. Each re-emission must support or ‘be in phase’ with preceding emissions.
This can happen at only specific frequencies where the round trip time is
exactly a whole number of wave periods. At these frequencies there can be
‘feedback’ and continuous oscillation of the cochlea. The situation is analogous
to feedback howl in a public address system or a hearing aid. The internally
generated signal grows quickly and stabilises at a level at which physiological
activity can maintain.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 59

9.2 How SOAEs can affect OAE
measurements
9.2.a SOAEs are a sign that the cochlear amplifier is strong - not just at the precise
frequency of oscillation - but over a small range of neighbouring frequencies
(~1/2 octave). Strong TEOAEs are therefore also expected over this frequency
range, as are strong DPOAEs. At the precise frequency of the SOAEs the
TEOAE response can be greatly magnified, resulting in a sharp peak in the
TEOAE spectrum and a large amplitude, oscillatory and long lasting TEOAE
waveform. With DPOAEs the level may be unpredictably affected if the DPOAE
frequency happens to correspond to that of an SOAE - distorting the DPgram.
This is most likely at low stimulus level (less than 60dBSPL).

9.3 Detecting SOAEs

9.3.a Strong SOAEs can be detected by the spectral analysis of ear canal sound,
without any stimulus being present. However, many more and weaker SOAEs
can be detected by providing a small ‘synchronising’ stimulus and exploiting the
power of synchronous averaging after the initial transient OAE has ended. The
synchronising click interrupts the free running emissions, which then restart in a
systematic way thereby assisting capture. The stimulus may also start off quasi-
spontaneous emissions - which are near-spontaneous OAE oscillations which
can last a second or more after stimulation but do not sustain themselves in the
complete absence of stimulation.

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9.4 Performing an SOAE search
9.4.a ILO V6 software provides a means of searching for SOAEs using the
synchronised SOAE method. From the Test menu, select Start a Spontaneous
test. The example below shows results from an ear with large SOAEs which
might distort TEOAE or DPOAE responses.

9.4.b Remember - the recording of SOAEs has no direct clinical value. Approximately
50% of normal healthy young ears have some degree of SOAE activity and
50% have none. The purpose of performing an SOAE search is to determine
the reason for very peaky TEOAE or DPOAE results. In research SOAEs have
been used to detect minute physiological changes in cochlear function.

9.4.c Note:
Stimulus stability is not recorded during SOAE tests, so the stimulus
stability displayed on screen will always read 100%.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 61

10 Performing a DPOAE test

10.0.a Connect a DPOAE probe and if it is being used for the first time, follow the
instructions under Setup Options, Probes for registering the probe. Fit an
appropriately sized probe tip.

10.0.b Ensure that the appropriate Mode is selected in File > Options > Start/Stop/
Score. Protocol modes can also be changed from the status bar at the bottom
of the main screen. Choose from Neonate screening, Neonate diagnostic,
General screening and General diagnostic. Also ensure all options are
correctly set prior to starting a test - see Setup Options section. When testing
a neonate, double-check that Neonate Mode is shown at the bottom of the
screen. If a neonate is tested while in one of the General Modes, the stimulus
level during Checkfit will initially be too high. To help identify when ILO V6 is in
neonatal mode, the status bar at the bottom of the page is coloured yellow.

Always set mode to Neonate

when testing newborns or
very young infants.

10.0.c Distortion Product OAEs are complex phenomena. The response obtained is
governed by the condition of the cochlea and also by the precise configuration
of the stimulus.

10.1 Choice of Stimulation

10.1.a Use the lower level stimulus for sensitive detection of abnormal function. Use
the higher level stimulus for recording DPOAEs which come from cochlear hair
cells but do not necessarily mean that the hearing is within 30dB of normal.

10.1.b Use f2/f1 ratios near to 1.2 to obtain maximum strength of DPOAEs. The level
difference between f1 and f2 is important. f1 level should not be lower than the
f2 level. See Setup Options for further information.

10.1.c Either click on the <Start New Patient> button if this is the first test to be
performed on this patient or select the patient from the patient database through
the Review data panel if the patient has been previously tested. Input or
edit the patient details as required. Further patient details can be entered by
selecting the button next to <Start New Patient>.

62 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

10.1.d To begin a measurement, select the Tests menu and choose the type of test to
be performed - for DPOAE screening select DP OAE.

10.1.e The test will automatically adopt the default stimulus - which can be examined
or changed in File > Options > Stims, or Tests > Stimuli setup, or by pressing
Ctrl+S. Full details are given in the Setup Options section of this manual.

10.1.f Fit the probe in the ear then click on <Start Test> to commence Checkfit.

10.2 Checkfit

10.2.a The Checkfit process for DPOAEs is similar to that for TEOAEs. A repeated
click is presented by the probe to the ear canal. For further details, see
Performing a TEOAE test, Checkfit.

10.2.b With DPOAE checkfit, a checkfit click stimulus is supplied at a preset level in
order to ‘sense’ the size of the ear canal and display the effect of adjusting
the probe fit. The click is not used in the DP measurement process. Any
difference in ear canal size will be automatically adjusted for before the DPOAE
measurement begins. It is therefore not essential for the click stimulus to reach
its target level in checkfit and the <Auto-adjust stim> button has been disabled
accordingly. Once you have achieved the best fit possible and are satisfied that
noise levels are suitable to begin recording (see Performing a TEOAE test,
Checkfit), press <Continue> or hit the Enter key.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 63

10.3 Setting of stimulus tones
10.3.a The next stage of the test procedure is the automated setting of the stimulus
tones. They are set to the levels selected in the stimuli setup. Immediately
following Checkfit, sustained tones or chirps are presented to the ear in order
to accurately measure the ear canal frequency response. Individual ear canal
geometries can vary greatly, so when performing DPOAE tests it is necessary to
adjust and set the stimulus tones at each frequency tested.

10.3.b It is important to note that most probes measure the ear canal sound some
distance from the ear drum at the probe tip. This means there is always an
unavoidable and ‘unmeasured’ discrepancy between set and actual stimulation.

10.3.c In some ears, the frequency response is very undulating, due to standing
waves and acoustic resonance. The equipment will detect this by the frequency
specific notch or peak in the frequency response. If the notch or peak requires
a large adjustment in order to deliver uniform sound, the correction factor will be
withheld. A standing wave notch or peak at the probe may NOT indicate a notch
at the eardrum. In general this technique provides a more uniform ear drum
sound level.

10.3.d Therefore it is possible there will be discrepancies between the requested (set)
dB SPL stimulus values and the sound recorded by the probe. For frequencies
above 5000Hz, the target L1 and L2 levels rather than the levels recorded by
the probe will be displayed when the levels recorded by the probe microphone
are unreliable. An asterisk beside the stimulus level indicates that the target
level and not the level recorded by the microphone is shown.

10.3.e Small deviations in stimulus level are important as they can lead to a substantial
change in DPOAE sound level. The deviations are quite frequency specific so
performing higher resolution measurements (i.e. more than 3 points per octave)
can reveal the limited extent of such anomalies. Also, if the desired stimulus
levels are not achieved during standard DP gram measurements, performing
DP growth tests at specific frequencies can help ascertain the robustness of the
DPOAE. (See Advanced DPOAE measurements).

10.3.f When recording DPOAEs for quantitative assessment, it is important to be

cautious of the effects of ear canal fitting and stimulus adjustments.

10.3.g It can be useful to view the DP data table to check for the actual DP stimulus
levels obtained during the recording. (See section OAE response window for
DPOAEs).

64 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

10.3.h Note:
The calibration method used for DP stimuli has been enhanced
in versions 6.41.27.0 and 6.41.27.32 onwards. If necessary for
comparison with data recorded on earlier versions, the software
can be switched to use the older calibration methods. Contact
Otodynamics for full instructions.

10.4 Data collection

10.4.a During the recording of a DPgram the top right panel will show a graphic of a
moving wave. It appears when the DP stimulus is being applied to the ear. The
wave will typically show a modulated oscillatory pattern (see illustration) and this
modulation is an indication of the acoustic interaction (beats) between the two
stimulus frequencies being applied.

10.4.b The period of the waves will change corresponding to the frequencies actually
being applied to the ear and the modulation related to the frequency ratio f2/
f1 being applied at that time. The display is for indication only to serve as a
reminder of the stimulus settings which have been selected. The amplitude
of the wave shown will change with stimulus level - but does not display the
true range of intensities the machine is capable of delivering. For this see the
numerical readouts on the screen.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 65

10.4.c As a recording is made, data at each pair of test frequencies is collected. At
each frequency the amplitude at the 2F1-F2 DP frequency is recorded and
displayed on the DP-Gram as the signal at the Frequency F2. The 2F1-F2 DP
is believed to be produced mainly in the F2 region of the cochlea; the DP is
most dependent on the condition of the cochlea around F2, so F2 is used as
the nominal frequency. The noise level at frequencies adjacent to 2F1-F2 is
averaged and displayed as the noise level at F2. The solid red represents this
mean noise plus 1 standard deviation (mean+1sd), the hatched red represents
the mean+2sd.

Right clicking on the data chart allows the data to be displayed as a bar chart,
line chart (DP Gram) or as a histogram showing averaged response and the
noise level in half-octave bands between 1kHz and 6kHz. The signal-to-noise
ratio for each band can be viewed on the histogram in the same manner as in
the TEOAE test.

10.4.d The manual test point selection buttons only become active when the minimum
number of loops has been exceeded by the test.

10.4.e Once activated, this button enables a lower frequency point to be selected.

10.4.f Once activated, this button enables a higher frequency point to be selected.

10.4.g When one of the manual buttons has been used, the <Auto mode> button
becomes active and, if selected, returns the test to the previously active
automatic sweep mode.

10.4.h Under the OAE response graph, numerical data is displayed. As the test is
running, the current level of DPOAE energy for the frequency band being
sampled is displayed. Also, the achieved level of stimulus tone is shown in the
F1 and F2 stim boxes, for the specific frequency being sampled. An asterisk
beside the stimulus level indicates that the target level and not the level
recorded by the microphone is shown (see section 10.3). On conclusion of the
test, the total DP energy is reported and the target stimulus settings are shown.

66 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

10.5 DP Spectrum

10.5.a Pressing the ‘S’ key whilst a test is running will toggle a DP spectrum graph
On and Off. A DP Spectrum is useful for observing the progress of a DPgram.
Specific sources of noise can be identified. When the test has finished, the
window can be closed or minimised in the usual manner.

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10.6 OAE response (SNR) display

10.6.a When making DPOAE recordings, it is possible to view the data in a signal-
to-noise (SNR) display. The noise level is normalized to zero dB and the dB
level is therefore displayed in dB SNR. This helps the operator to see the level
of SNR achieved at various frequency points. The normalized mode can be
particularly useful when recording DPOAEs at 8 pts/oct as it is not possible to
display the SNR figures at this resolution.

10.6.b To toggle the SNR display on and off, press the ‘N’ key.

10.6.c The option is ONLY available during the test.

10.7 Test termination

10.7.a To terminate the recording manually, press the <End> button. The test may also
be paused by pressing the <Cancel> button. This gives options to continue the
test, return to the ‘Checkfit’ stage or end the recording.

10.7.b If desired, the program can be configured to automatically stop the test when
specified criteria regarding the quality of the OAE have been met. See section
Test protocols and stop logic.

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10.8 OAE Response window for DPOAEs

10.8.a A right mouse click on the OAE Response window reveals various options
related to the test data. The options can be turned on and off using a left mouse
click.

10.8.b Show SNR values - This option displays the signal-to-noise ratio (SNR) values.
The SNR is the difference between the OAE response and the noise level and
is specified at the frequencies tested. If the area on the graph is too small to
clearly display the SNR figures, they are shown as a small dot.

10.8.c DP line chart - This changes the view of the DP gram to a line graph format.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 69

10.8.d DP bar graph - This changes the view of the DP gram to a bar graph format.

10.8.e DP ½ oct power display - This groups the DPOAE response energy into half
octave band powers and displays them in a histogram. This option can ONLY
be applied to data following a test and is not available during recording. The
OAE response window is titled DP ½ oct power.

10.8.f Examine Spectrum Detail - This opens a separate window that shows the DP
result in line graph format.

10.8.g A cursor is available and is controlled with a mouse. Place the mouse over
the OAE spectrum window. Values of dBSPL and KHz, relative to the cursor
movement, are displayed in the boxes at the bottom of the window. Using a left
mouse click sets a reference point on the graph. Change in cursor movement
from this point is indicated at the bottom of the screen next to Delta.

10.8.h It is possible to zoom in and out using a left mouse click and drag. Left to right
zooms in and right to left zooms out. It is also possible to scale up and down
using up and down arrow keys.

10.8.i From the spectrum window, it is possible to access a table which displays data
for that test. Both the spectrum graph and the data table are printable.

70 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

10.8.j View data table - This option takes you directly to a data table, which details
information about the test. Data is displayed for all the frequencies tested,
including the measured stimulus levels and the DPOAE response at 2F1-F2.
Alternative DPOAEs are also listed (2F2-F1, 3F1-2F2, 3F2-2F1, 4F1-3F2). An
asterisk beside the stimulus level indicates that the target level and not the level
recorded by the microphone is shown (see section 10.3).

10.9 Saving and printing the data

10.9.a This data can now be saved and printed. (See Performing a TEOAE test,
Saving data and Printing data).

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 71

11 Advanced DPOAE
measurements

11.1 Changing stimulus parameters for

DPOAEs
11.1.a ILO V6 software allows for the programming of stimulus frequencies f1 and
f2 and their levels L1 and L2. The ratio f2/f1 is set by default to 1.2:1. The
level and frequency of f2 largely determines the audiological significance of
the response. DPgrams with L2 of 70dBSPL are less sensitive to threshold
elevation than TEOAEs. For comparable sensitivity, L2 should be 60dBSPL or
less.

11.1.b The levels of stimuli f1 and f2 , L1 and L2 respectively can be set at different
levels. Equal levels of L1 and L2 provide optimum responses when levels
of 70dB SPL and above are used. As L2 is lowered, L1 should also be
lowered but by a much smaller amount. For DPgrams sensitive to even small
abnormalities, levels of L1=65dBSPL and L2=50dBSPL are often used.

11.1.c Higher stimulus levels can be useful in that if good DPOAEs are obtained but
not at low levels of stimulation - cochlear function can be said to be present
even though not completely normal. (See Multiple level DPOAEs below,
also Gorga MP, Neely ST, Dorn PA. Distortion product otoacoustic emissions
in relation to hearing loss. In: Robinette RM, Glattke T (eds). Otoacoustic
Emissions - Clinical Applications (Second Edition). New York: Thieme, 2002;
243-72.)

11.1.d Although the frequency of f2 largely determines which part of the cochlea
DPOAEs relate to (and hence its relation to hearing), the frequency ratio f2/f1
contributes significantly to this. Frequency ratios smaller than 1.2:1 generate
reduced amplitude DPOAEs. Very small ratios (e.g. 1.05:1) lead to the
involvement of more sections of the basilar membrane around the DP (2f1-f2)
frequency place.

11.1.e Before changing DP stimulus settings the user should be referred to the
literature and select well documented stimulus settings (e.g. Boerge P, Jansen
TH, J.Acoust Soc Am 2002;111:1810-18).

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11.2 Multi-level DPOAEs
11.2.a DPgrams may be obtained for multiple stimulus intensities. This has several
advantages. Unusual features (peaks or troughs) can be confirmed as being
either a robust feature of the ear or alternatively as very specific to particular
stimulus frequencies and levels and therefore of lesser significance.

11.2.b It is also known that DPgrams made with lower levels of stimulation are more
sensitive to pathology than those with high stimulus levels. When DPOAEs
are found at higher stimulus levels but not lower stimulus levels, the suspicion
of significant hearing loss is increased and the suspicion of a severe loss is
reduced.

11.2.c Multi-level DPOAE measurements can be made at a single frequency using

the V6 DP Growth function. Select the Test menu, then start DP Growth test.
Select the (f2) frequency of observation and the intensity step interval.

11.2.d Healthy ears tend to show a shallow linear growth of DP decibel level with
stimulus level. Ears with threshold elevation tend to show a more steep rise.
However, isolated departures for a shallow linear rise are quite common and the
growth function should not be used as a diagnostic indicator. It is useful as a
validator of observed DPOAEs. Artifactual (instrumentation distortion) DPOAEs
appear abruptly with high level stimulation.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 73

11.2.e Although the growth of DPOAE level has been shown to be correlated to
hearing threshold (see Boerge P, Jansen TH, J. Acoust Soc Am 2002; 111:1810-
18), the prediction of actual hearing threshold for an individual from DPOAE
measurements is not possible with any clinically useful accuracy.

11.3 Advanced DP Growth functions

11.3.1 Background
11.3.1.a The intensity of DPOAE grows with stimulus level but in a complex way.
The levels of frequency 1 (L1) and frequency 2 (L2) are both important and
an increase in just one can cause a decrease in DPOAE. Frequency 2
(the higher stimulus frequency) determines the ‘place’ of the cochlea being
tested. Frequency 1 is responsible for creating the DPOAE by interacting with
frequency 2 as it passes over the ‘F1’ place. There is a ‘best level’ for L1 and
it is usually above L2. The lower the intensity of L2, the more L1 needs to be
raised above L2. At the higher stimulus levels (e.g. 70dBSPL) L1=L2 gives
nearly the maximum DPOAE, but when for example L2 = 50dBSPL an L1 of
around 60dBSPL gets the best DPOAE level. This effect was first identified
and studied by A.M. Brown in the 1980s. It is believed to be due to the way the
cochlea travelling wave changes shape with stimulus level.

11.3.2 Interpretation of DPOAE growth rate

11.3.2.a DPOAE typically grows at a rate of 1dB for each 1dB increase in stimulus
intensity – but this can vary greatly. Artefactual DPOAE (e.g. from a defective
probe or equipment) tends to grow much more rapidly than this. So DPOAE
growth can be used to identify artefacts. Testing a cavity is the normal way to
detect such artefacts but it is good practice to perform a growth measurement
also on an ear since acoustic conditions can be quite different from those of a
test cavity.

11.3.2.b It has been observed that DPOAE growth rates tend to increase in steepness
with threshold elevation. This also means that weak stimulation will produce
little DPOAE. Research has been conducted to determine if the audiometric
threshold can be determined by finding the lowest level of stimulation for which
a DPOAE can be recognized. Results do not support the precise prediction
threshold - but there is a modest correlation between individual threshold and
the lowest level stimulation which produces a DPOAE. This supports the
reasonable hypothesis that an ear which produces strong DPOAEs for small
stimulations is a good ear with no damage to the peripheral mechanism - neither
the middle ear nor the outer hair cells in the organ of Corti - and this can form
the basis of a useful test for certain diagnostic applications.

74 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

11.3.3 Choosing DPOAE growth parameters
11.3.3.a As explained above, the choice of stimulus levels is important and will greatly
affect the form of the growth function for an ear. In this software the user may
pre-program the individual values of L1 and L2 to be used, either by editing a
table or by providing the parameters for a simple formula. The default setting
is for L1 and L2 to be equal and change by equal amount. Use of the default
setting is unlikely to be optimum for your purposes and Otodynamics strongly
advises you to consult the literature on DP growth rate and adopt an L1, L2
formula which has been demonstrated to provide the information you require.

11.3.3.b DPOAE growth rate recording is sometimes viewed on a dB OAE vs. dB L2

display. This is most common with the L1=L2 stimulus paradigm. Formula
based paradigms (L1>L2) are commonly viewed on a microPascal(uPa) vs. dB
L2 display. This allows for the visualization of the F2 level which fails to produce
any DPOAE.

11.3.3.c The DPOAE growth test can be performed with various step sizes. A small step
size will give greater resolution of detailed features but will take longer. During
the test the operator may manually control the time spent on each level so as
to optimize the overall quality of the recording by spending more time on the
moderate and lower levels.

11.3.3.d The V6 program will automatically draw a line through the data points of a DP
growth recording performed with formula or table based L1, L2. The purpose
of this is to provide a simple measure of the position and angle of the DPOAE
growth function for reporting purposes.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 75

11.3.3.e Also on the display are numerical parameters characterizing the recording -
these parameters are:

DP=0@L2=xx dB SPL - the level of stimulus where it is predicted/estimated

that no measurable DPOAE will be produced.

dB80 - the actual or predicted level of DPOAE generated at L2=80dBSPL.

SLOPE - the rate of growth of DPOAE from DPs in microPascals per dB

increase in F2.

R – (R2) A measure of the quality of the fit of the best fit line to the data, i.e. how
closely the line fits the data points.. A value of R2 close to 0 indicates that the
line is a very poor fit to the data. A value close to 1 indicates that the line is a
very good fit. A low R2 value means that information depending on the fit of the
line to the data, such as DP=0 and Slope, are unreliable.

11.3.3.f Each of these parameters will be specific to the actual values of L1 and L2 set
by the operator in the table or formula. Examples of typical values can be found
in the OAE literature.

11.3.3.g dB80 relates to the strength of the OAE. SLOPE relates to the quality of the
cochlea with slopes below 1 and high dB80 being commonly found in a very good
cochlea. DP=0@L2= xx dBSPL can be considered as a threshold but is not
equivalent to the threshold of hearing and should not be used as an alternative
to audiometric threshold measurement.

11.3.3.h This data is related by the formula:

OAE uPa = SLOPE (L2-L2intercept)

and dB80=20 log (SLOPE(80-L2Intercept)/Pref)

Where Pref = 20 microPascals

L2 intercept = the stimulus level at frequency 2 (f2), where the DP Growth
regression line cuts the L2 (dB SPL) axis on the OAE response graph.

76 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

11.3.4 Performing DP Growth functions using the formula or table
based methods
11.3.4.a To perform DP Growth tests using the formula mode or table based L1, L2,
select Tests > Start a DP Growth test from the Menu.

11.3.4.b At the bottom of the parameters window, check the box for Use formula mode.

11.3.4.c The level of L1 is now determined by the formula below:

L1 = (A * L2) + B dB SPL.
A is a variable factor between 0 and 2
B is a variable value between -50 and 80 in dB SPL.

11.3.4.d Either type in the chosen parameters or use the up/down arrows provided.

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 77

11.3.4.e Click on the Advanced tab to view the levels of L1 and L2 derived from the
formula. It is possible to manually edit the table to further customize L1 and L2
levels.

11.3.4.f If customised table based entry is desired, the stimulus levels set can be
programmed under 1 of 5 test paradigms. To save a specific set of stimulus
levels, select a paradigm, edit the table as desired and click <Save paradigm>.
To load a test paradigm, select the one desired and click <Load paradigm>.

11.3.4.g Stimulus levels entered that are not whole numbers will be rounded to the
nearest integer.

11.3.4.h The highest level of L1 or L2 available is 80 dB SPL. If the variables used

in the formula result in the level of L1 to be over 80 dB SPL, the levels are
automatically clipped to the maximum permissible. If values are added to the
table above 80 dB SPL, these are also clipped.

11.3.4.i When the desired parameters have been set, (see Choosing DPOAE growth
parameters above) press <OK>. The test sequence will begin with the
‘Checkfit’ procedure as standard. (See Performing a DPOAE test for more
details) When the probe fit is satisfactory press <Continue> to begin the test.

11.3.4.j The DP tones will be delivered and reduced in accordance with the levels of L1
and L2 stipulated by the formula or table. A best fit trend line is drawn when
sufficient DPOAE data points have been collected. The trend line represents the
fall in DPOAE response with decrease in stimulation, showing the DP growth
function. A weighting factor is incorporated depending on the signal-to-noise
level at each level tested.

11.3.4.k To represent the data as clearly as possible, the graph will automatically re-scale
on the ‘Y’ axis - either from 0-50 microPascals or from 0-100 microPascals.

11.3.4.l When you are satisfied with the data collected, press <End> to terminate the
recording.

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11.3.5 Saving and printing
11.3.5.a To save the test, click the <Save> button. Select the correct ear from the pop
up prompt and click <OK>. A message will appear to say the data has been
saved to disk.

11.3.5.b To print the data select the <Print> button and choose <Print this data>.

11.3.5.c Note:
Only the single page test report is suitable for DPOAE growth tests.

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12 Binaural OAE measurements -
introduction

12.0.a In large part, our ears operate independently. For example, you can follow quiet
speech with one ear while loud noise is being played in the other. For very high
intensity sound can cross over the head and mask sounds in the other ear
directly - but physiologically there is very little ‘cross talk’. This means OAEs
can be recorded simultaneously in left and right ears which can save time.

12.0.b Binaural hearing is very important - not only for knowing the direction of a
sound, but also for attending to specific sounds in a background of noise. This
is called the cocktail party effect and it demonstrates that there is a powerful
neural processor comparing the signals from each ear. It helps build up a
three-dimensional image of our sound environment so we can attend to just the
sounds we want to.

12.0.c In 1991, Collet discovered that this binaural integration has a very small effect
on OAEs. Contralateral noise suppresses TEOAEs by one or two dB - not
enough to alter a screening result - but enough to show that the neural circuitry
was active. Other contralateral suppressors were tried, but it seems that
irregular sounds are most effective. There is also an ipsilateral effect, where the
neural signals generated by an ear begin to affect its OAE response.

12.0.d The study of binaural interactions with OAEs is still evolving and readers are
referred to the literature for the latest facts.

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13 Regular binaural measurements

13.0.a The ILO292 USB-II accommodates two probes and can record from left and
right ears simultaneously.

13.0.b It is possible to perform both TEOAE and DPOAE recordings bilaterally. To

begin a Bilateral Test select the <Start Bilateral Test...> button. This will
commence the test procedure that has been selected as the default test. This
can be chosen via Tests>’Start Test’ default action.

13.0.c Alternatively from the Tests menu, select Bilateral tests and either Start a
bilateral TE test or Start a bilateral DP test.

13.0.d Notes:
1 TE tests set to Stim Type Spontaneous should not be used for
bilateral recording.
2 If bilateral results recorded in V6 are opened for viewing in
EZ•Screen, the stop reasons listed may not be valid.

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13.0.e For regular TEOAE or DPOAE bilateral recordings, both ears receive the
same test. When completed, both responses are saved by one <Save>
operation. During recording the probe socket used for each ear is identified
on the data collection windows. When saving bilateral recordings, a simple
matrix appears which allows the operator to assign the ear to the probe used.
The probe sockets are labelled on the front of the ILO 292 USB-II system, with
probe socket 1 on the right and probe socket 2 on the left. Once saved, each
recording can be recalled separately but they are identified in the database as
belonging to a simultaneously recorded pair.

13.0.f The binaural and monaural OAE responses of an ear can be compared using
the Examine/Compare data panel. In particular the difference function
(<-Diff> button) will reveal if the response has changed as a result of binaural
stimulation. The effects of contralateral stimulation are best revealed by
using Linear TEOAE recording - although this mode is not suitable for regular
screening or diagnostic use.

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14 Advanced binaural OAE
measurements

14.0.a Research enabled ILO292 USB-II systems can perform additional tests of
specialist and research interest.

14.0.b V6 software provides an automated contralateral suppression recording mode.

14.0.c The OAE recorded from an ear can be influenced by sound presented to the
opposite ear. This effect is known as contralateral suppression or the cochlea
reflex and it is believed to be controlled by the nerve pathway which runs from
the inner hair cells of the cochlea via the cochlear nucleus to the outer hair cells
which are responsible for OAEs.

14.1 Contralateral TE suppression test

14.1.a This mode operates by making two separate OAE recordings: one of the OAE
recorded when a suppressor (masker) is presented to the opposite ear (test
1), and one recorded with no suppressor (test 2). The recording of each test
is switched regularly so the effect of any slow changes in recording conditions
(for example changes in probe fit) can be minimized as such changes will have
equal influence on both of the tests.

14.1.b Differences between the two results can then be ascribed to the masker. The
suppression effect is small so the OAE must be measured as accurately as
possible in order to record it. Good recording conditions and longer test times
(more sweeps included in each test – see Timeout(sweeps) below) will aid
accurate measurement.

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14.1.1 Setting contralateral suppression parameters
14.1.1.a To begin a TEOAE contralateral recording from the menu system, select Tests
> Bilateral Tests > Start a contralateral TE suppression test. This opens a
window which allows the masker parameters to be selected.

14.1.2 Setting masking parameters

14.1.2.a Setting masker level

14.1.2.b The masker level can be set so that a consistent level is achieved in all ears
(Absolute Level – dBpe SPL), or set relative to the hearing threshold of the
contralateral ear (Sensation Level – dBSL).

14.1.2.c If <Set absolute level masker> is selected then the masker presented will
be at a fixed level for all subjects.

14.1.2.d Set the level required in the Masker Level (dB peSPL) box.

14.1.2.e If <Set sensation level masker> is selected then masker presented will be
relative to the hearing threshold of the subject.

14.1.2.f Set the level above threshold at which you wish to present the masker in the
Masker level (dB) box.

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14.1.2.g With either setting method care should be taken that the suppressor level is
not set so high that the middle ear reflex is activated. Triggering the middle
ear reflex will also influence the OAE recorded.

14.1.2.h Before the test starts you will be required to find the hearing threshold for
your patient. Find the subject’s threshold by adjusting the sound level with
the up and down buttons then presenting the sound using <Present masker
now> or by pressing the space bar. The standard procedure used to find
hearing threshold in pure tone audiometery is recommended (for example
see: www.thebsa.org.uk/docs/RecPro/PTA.pdf). When threshold has been
found select <OK>. The masker level presented will be set relative to the
threshold that was found.

14.1.2.i Masker type sets the type of sound presented to the contralateral ear. Options
are broadband noise, narrowband noise of 1, ½ or ¼ octave or a tone. If
narrowband or tone suppressors are chosen then the (centre) frequency must
also be set. Broadband (white) noise is generally more effective a suppressor
than narrowband noise or a tone.

14.1.2.j Masker centre frequency sets the frequency of the sound presented to
the contralateral ear within the range 500-4000Hz. If Broadband (white) is
selected then the Masker Centre Frequency is greyed out as there is no need
to select a frequency for broadband noise.

14.1.2.k Setting Masker switching

14.1.2.l During testing, data collection switches between the Masker On and Masker
Off conditions. Use the radio buttons to select the required switching
method.

14.1.2.m If Masker On/Off time (sec) is selected then data is collected in each
condition for a fixed period of time before switching to the other condition
regardless of the number of sweeps accepted. For example, Set to 15s
might mean that that 55 sweeps (NLo) are collected in 15 seconds with the

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 masker and then 52 sweeps are collected in 15 seconds without the masker
(because the second period was noisier and more sweeps were rejected).
Switching on a time basis means the time spent in each of the final test
results will be equal, but the NLo count in each test may not be.

14.1.2.n If Masker On/Off time NLo count is selected then a fixed number of
sweeps are collected in each condition before switching to the other
condition regardless of the time this takes. For example, Set to 60 might
mean that 60 sweeps (NLo) are collected in 18 seconds with the masker and
then 60 sweeps are collected in 15 seconds without the masker (because
fewer sweeps were rejected and so less time was required to reach 60
accepted sweeps). If this method is selected then the NLo count in each
of the final test results will be equal, but the time on in each test may be
different.

14.1.2.o Stimulus Level dBpe sets the stimulus presentation level in the test ear.
Lower stimulus levels have been found to be more effective in demonstrating
suppression. If this method is selected, the NLo count in each of the final test
results will be equal, but the time on in each test may be different.

14.1.2.p Stimulus Type sets the stimulus presented to the test ear and the time window
used to record the response. The options available (Quickscreen, Nonlinear,
Linear and Tone Pip) are described in full in Performing a TEOAE test.

14.1.2.q The Linear TEOAE is not suitable for regular screening or diagnostic use
because it can contain stimulus artefacts. Stimulus artefacts are not influenced
by cochlear changes so will be equal in the ‘with’ and ‘without’ noise conditions.
Therefore such artefacts should not influence comparisons between these
conditions and this recording mode may be more sensitive to contralateral
suppression.

14.1.2.r Timeout (sweeps) sets the number of good quality low noise sweeps (NLo)
which must be recorded before the test stops.

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14.1.3 Performing a TEOAE contralateral measurement
14.1.3.a Once the parameters have been chosen, press <OK> to begin the test
procedure. During Checkfit, both the TE stimulus and the masker will be
delivered continuously.

14.1.3.b The TE stimulus delivered to the test ear (Probe 1) is displayed on the main
screen and the masking stimulus delivered to the contralateral ear (Probe 2) is
displayed on the smaller OAE response with masker window.

14.1.3.c Press <Continue> to start the recording.

14.1.3.d The TEOAE response in both windows is recorded from the test ear (Probe 1).
The main window displays the TEOAE response without the masker and the
small window displays the TEOAE response from the same ear with the masker
on.

14.1.3.e The test can be manually terminated by pressing <End>; otherwise it will
automatically stop once the specified number of data sweeps have been
collected. The results must be saved before they can be reviewed for evidence
of suppression.

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14.1.4 Saving and printing the data
14.1.4.a As with other Bilateral recordings, one Save operation will store both
measurements. Press <Save> and associate the left or right ear to the
probe used (Probe 1 is the test ear probe, Probe 2 the Masker probe for the
contralateral ear). The results are saved as a pair within the database for
easy retrieval and analysis.

14.1.4.b To print contralateral suppression data, select the <Print> button. Using
the <Print Bilateral pair> option is recommended. The masked and un-
masked results are displayed together on a single page. The suppressed
result is identified by the masking stimulus, which is detailed at the top of the
page. A representation of the masker waveform can be seen under ‘Checkfit
stimulus’.

14.1.5 Reviewing TEOAE contralateral measurements

14.1.5.a After a TEOAE contralateral recording, the patient tested remains loaded
ready for the measurements to be assessed. Select the Review tab to
browse all the recordings for the patient.

14.1.5.b To load a patient previously tested, again select the Review tab. The Filters
at the bottom can be used to narrow the patient search and then select
Browse. Select the patient required. All the results for the patient can be
observed using the Browse these tests arrows.

14.1.5.c The suppressed result is identified by the masking stimulus displayed in the
Stimulus window. The masker parameters used are also displayed.The Stim
level displayed on in the Numerical Data on the suppressed result refers to
the Masker level, not the stimulus evoking the OAE in the test ear.

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 Stimulus display for the ‘Suppressed’ result. The Masker is displayed instead of the
stimulus evoking the OAE.

Stimulus display for the unsuppressed result. The stimulus evoking the OAE is
displayed.

14.1.5.d Note:
Echoport firmware version 1.0.0.4 or later is required to run this
test. If you are running an earlier version, contact Otodynamics for
information on updating.

14.1.6 Analysis of TEOAE contralateral measurements

14.1.6.a The binaural and monaural OAE responses of an ear can be compared using
the Examine/Compare data panel. In particular, the difference function,
(<-Diff> button) will reveal if the response has changed as a result of binaural
stimulation.

14.1.6.b Select File > Examine/Compare data from the menu. Maximise the window.

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14.1.6.c Data is displayed in the left panel for the chosen patient. If the data is part of
a pair of results the <load pair> button can be used to load the simultaneous
recording into the right-hand panel.

14.1.6.d Alternatively, manually browse through the results using the <Select next> and
<Select previous> buttons. The live panel is denoted by the red highlight line.
Choose the live panel using the <Left panel> and <Right panel> buttons.

14.1.6.e With a contralateral pair of results in view, observe the OAE response value
(Resp) and any change in the OAE waveform. In the half octave OAE response
panel, the right-hand panel half octave level is displayed as a series of asterisks
on the left-hand panel. Any difference can then clearly be seen.

14.1.6.f Press the <Diff> button to subtract the stimulus and OAE waveform on the
right panel from the stimulus and OAE waveform on the left panel. The FFT
calculation is then performed on the difference waveform, showing any change
in OAE level on a frequency spectrum. This can also be observed in the half
octave display mode. Using the difference function will help establish if any
suppression of the OAE has occurred and at what frequencies. Observe the
OAE waveform generated and the OAE response panel. Also observe the
difference in response, calculated in dB SPL (Resp).

14.1.6.g To analyse the waveform in greater detail, right click on the Response
Waveform panel and select Examine waveform detail. Maximise the window.

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14.1.6.h The OAE response difference waveform can now be examined and
manipulated. During a TEOAE test, two separate interleaved recordings are
made. These result in the responses A and B. The A and B waveforms can be
combined to show the A and B mean, A and B difference or split to show the two
individual waveforms as well as the default overlaid display. Use the buttons at
the bottom of the screen.

14.1.6.i An X-Y cursor is provided to identify sound pressure levels at specific latencies.
Clicking and holding down the left mouse button and dragging the selection box
to the right will zoom in and display the selected area. The display is returned to
normal by clicking and holding down the left mouse button and dragging to the
left.

14.1.6.j Methods of normalising the difference response to the OAE response size
have been published in the literature. Users are strongly advised to consult the
literature before commencing contralateral suppression experiments.

14.1.7 Waveform Filter

14.1.7.a The waveform filter allows the OAE response or difference waveforms to be
analysed using a frequency filter. (See section Response waveform window
in Performing a TEOAE Test for more details)

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14.1.8 Printing the difference waveform
14.1.8.a It is possible to print the difference waveform in the standard single page
TEOAE test report format. In Examine and compare, select <– Diff> to display
the difference waveform. Close the Examine and compare window and the
difference waveform will be displayed on the main V6 screen. Select <Print>
and Print this data. The data file is named TempDiffdata.dta.

92 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

15 Reviewing data

15.0.a Click on the Review data tab. Input a name or

partial name and/or ID number into the Search
fields and click the <Find matches> button.
Any matches will be listed and you will be able
to scroll through the various matches using the
top set of or arrows on this panel (TIP:
use the left and right cursor keys). This is also
the method for selecting previous patients when
performing re-tests.

15.0.b Below this is the list of data files associated with

whichever patient is currently being reviewed.
Again it is possible to scroll through the various
tests using the lower or arrows to
display and print the appropriate test results
(TIP: use the page-up and page-down keys).

15.0.c The <Browse> button of the Review data panel

provides you with a full list of all the patients
stored in the patient database. This list can
be filtered using the Family name and/or ID
number and/or User/Machine/Facility filters.
This window can be dragged wider to show
additional fields. Select <Configure ... > to
show the Notes and Date of birth fields in the
browse window and to choose a Compact view.

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15.0.d Patient details can be changed retrospectively. Click on the This patient panel,
enter the family name and ID number and click on the button to the right of the
<Start new patient> button. Patient details can now be edited and are updated
in the This Patient panel. Note the family name and ID number are locked. Click
on the lock button next to the family name field and a warning message appears
stating that you can now edit these fields. This should be done with caution as
all data can be over-written.

15.1 Examine/Compare data

15.1.a This item is available when a test result is displayed on the main screen. Initiate
the feature from File > Examine/Compare data or press Ctrl+E.

15.1.b Examine/Compare data provides a method of displaying two tests for a patient,
side by side on the screen. It is possible to view all the tests conducted on the
selected patient in either panel. To select a panel, use the <Left panel> and
<Right panel> buttons at the bottom of the window. The live panel is denoted
by the red highlight line. Use the <Select next> and <Select previous>
buttons to scroll through the tests. The arrow keys on the keyboard may be
used instead of the buttons on the window. The OAE data levels on the right
panel are overlaid on the left panel as a series of asterisks. For TEOAE tests
the data can either be overlaid at half octave frequencies or on a high resolution
spectrum and for DPOAE tests, asterisks are displayed at all frequencies tested.

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15.1.c For TEOAE data, the ‘difference’ function will subtract the right panel stimulus
and OAE waveform from the left panel stimulus and OAE waveform. Load
data into the left and right panel and select the <-Diff> button. The difference
waveform is displayed and the FFT calculation is then performed, showing any
change in OAE level on a frequency spectrum. This can also be observed in
the half octave display mode. The feature is useful when trying to observe
small changes in the OAE response, perhaps when monitoring a patient over
time. The subtracted data will be displayed in the live panel, denoted by the red
highlight line and will be labelled TempDiff.

15.1.d It is not possible to subtract DPOAE data.

15.1.1 Comparing bilateral measurements

15.1.1.a If the patient being reviewed has undergone a bilateral measurement, the V6
software will automatically detect if a file being reviewed has a pair from a
simultaneous recording.

15.1.1.b As a bilateral result is loaded into the Examine/Compare window, the <load
pair> button becomes live. If activated, the other recording from that pair will be
loaded automatically into the adjacent window.

15.1.1.c A printout of the Examine/Compare data window can be obtained by using the
Print icon button. For further information on analysis of data, see sections OAE
response window and OAE waveform window in Performing a TEOAE test
and also see the OAE Response window section in Performing a DPOAE
test.

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16 Setup options

16.0.a All options should be correctly set prior to running a test. Click on File >
Options to display the Setup Options window. A summary of all the pages
within the Setup Options window are described below. Images showing all
default settings are also shown.

16.1 OAE System Setup

16.1.a This page of the options dialogue permits ILO V6 to be configured for use
with USB hardware or as a data manager or OAE demonstrator for training
purposes.

16.1.b This page also includes an option to allow the data files on this PC to be shared
by other network connections.

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16.2 Stims (including setting new DPOAE high frequency range)

16.2.a Use this page for TEOAE and DPOAE stimulus and frequency range setup.
The Noise reject level is common to both DP and TE tests and sets the level of
noise at which sweeps are rejected. Range is 0 to 50 mPa.

16.2.1 TEOAE measurement

16.2.1.a Timeout (sweeps) are the number of accepted stimulus sets presented to the
ear before the test terminates. The range is 50 to 1000. Target stim can have
a value in the range of 40 to 90dBSPL (see section 8.2.a for further details).
Stim type can be set to Quickscreen, Nonlinear, Linear, Spontaneous or Tone
pip. See sections 8.1 and 9.1 for a detailed description of each stim type. Note:
Quickscreen records twice as many stimulus responses within each sweep as
Linear or Nonlinear modes. This means that for the same number of sweeps,
Quickscreen will show lower noise levels.

16.2.2 DPOAE measurement

16.2.2.a The adjustment of each stimulus level or selection of the preset values can
be used to set the stimulus tones. Two preset buttons are provided for quick
selection of 65dB/55dB and 70dB/70dB levels. The number of testing points
per octave can be set to a value of 1, 2, 3, 4 or 8. A Timeout (mins) can be set
to end the DPOAE measurement after a specific time. The Auto-stop feature
must be checked in Setup options > Start/Stop/Score in order for the DPOAE
timeout to function. End frequency sets the highest L2 frequency used for DP
testing and can be set to 6, 8 or 10.5kHz.

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16.2.2.b The presentation of the tones can be changed to one of three options:

16.2.2.c Cyclic up: The test starts at the lowest frequency and progresses through to
the higher frequencies. When the test has completed, the minimum number
of loops (Setup options > Start/Stop/Score), the manual selection buttons
become active.

16.2.2.d Cyclic down: The test starts at the highest frequency and descends through
to the lower frequencies. When the test has completed the minimum number
of loops (Setup options > Start/Stop/Score), the manual selection buttons
become active.

16.2.2.e Intelligent: The test starts and runs through the minimum number of loops and
then chooses test tones where the response is lowest and attempts to improve
the response by receptively testing.

16.2.2.f Note:
Hardware must be present to change some of these settings.

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16.3 Start/Stop/Score
16.3.a Start, stop, pass and scoring criteria can be set up for each protocol. Neonate
protocols allow for the addition of Mothers name, Weight (kg), Time of birth,
Status and Multiple births when entering details in the This Patient panel.
These fields are greyed out for the General protocols. Test protocols, stop logic
and scoring are discussed later in this manual.

Neonate Screening Mode Neonate Diagnostic Mode

General Screening Mode General Diagnostic Mode

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16.4 Environment

16.4.a The Environment panel is used to configure a variety of sections of ILO V6.

16.4.b A Local Area Network (LAN) data file server is setup here. See Data transfer/
import functions in the Data management options section.

16.4.c The primary and secondary data file directories can be set. The primary
directory is the location were ILO V6 reads and writes data files. These files
store the necessary data in order to create an OAE profile for a patient. The
secondary file is a read-only directory. This is useful if another data source is
available that you want to review in ILO V6. For example, data that is collected
in the earlier ILO-V5 software.

16.4.d In the top left-hand side are settings about the display of ILO V6 graphics, which
can be activated or deactivated by checking or un-checking the box respectively:

16.4.e Show No OAE icon - this is a cross symbol that can be activated and displayed
if no OAE is found.

16.4.f Half octave spectra - this is a setting for a TEOAE test. This activates a
display of a half octave spectrograph for the OAE response. If unchecked a
high resolution spectrograph is shown. This setting can be changed using a
right mouse click on the OAE response window.

16.4.g DP line graph - This changes the view of the DP gram to a line graph format.

16.4.h DP Bar Graph – This changes the view of the DP gram to a bar graph format.

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16.4.i DP ½ octave power - This setting groups the DPOAE response energy into half
octave bands and displays them in a histogram. This option can only be applied
to data following a test and is not available during recording. The OAE response
window is titled DP ½ oct power.

16.4.j All the DP graph options settings can also be changed using a right click on the
OAE response window.

16.4.k Hesitation Hints - These are prompts that appear when the mouse is hovered
over a particular function button to indicate how that functions works.

16.4.l Below these features are several colours schemes that can be applied.

16.4.m V6 can be run in different languages, which can be selected in this section.

16.4.n Printing options are available here:

Monochrome print – prints a black and white report.

Preview printouts – displays a print preview on selection of the report type.

Inc. DP data table print – for DP results an additional data table will be
printed.

Swap Left/Right Printing - for automated two-tests per page printouts, the
orientation of the left and right ear data is swapped.

16.4.o End of test sound – If selected, sounds will be played at the end of the test
- a single beep for an OAE ‘pass’ result and a double beep for all other test
outcomes. Note: Test sounds are not available for bilateral tests.

16.4.p Patient ID input mask - This allows configuration for different ID number
formats, associated with each patient record. ILO V6 then enforces the input
of ID codes to the specified program format. The NHS input mask can be
overridden if necessary.

16.4.q Database setup - This feature allows the configuration and setup of the
database. The database can be run locally on the PC being used or can be
set up to and run from a server PC on a local area network (LAN). This can be
advantageous if there are several PCs running ILO V6 and you want the data to
be stored in a single location.

16.4.r If you select to run the database on a server, then the server PC name must be
added and the connection can then be confirmed. The directory path for the
database can also be set for either the local or server PC.

16.4.s Printer setup - The printer setup options can be configured here. The options
available are standard Windows settings which are applicable to whatever
printer is set as the default Windows printer on that PC.

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16.5 Exports

16.5.a In this section the directories and configuration settings for any export or import
files are set.

16.5.b It is possible to set-up V6 to export test results in different formats. Data can
be saved to Hi*Track (EZScreen.txt), OZ (OzData.bin), CSV (ILOdata.csv), XML
(EZtests.xml) or Ascii (ILOAsciiExport.txt) formats. See the section Formats of
data stored under Performing a TEOAE test for more information. If an export
type is selected the appropriate file is written after each test is completed and
the test is saved. That file is then updated with new data after each subsequent
save.

16.5.c It is also possible to create export files for various sets of data using the
Re-Export tests feature. See Re-Export to: in the Data Management section

16.5.d The directory to which the export files are written can be configured in this tab.
It may be useful to export the files directly to floppy disk for transfer to another
system.

16.5.e The Ascii export configuration is setup in this area. See Formats of data stored
for more information.

16.5.f There are two additional user settings for export files. The first is to only
capitalise the first letter of the patient name when it is exported. V6 holds all
patient names within its database in capital letters. This feature therefore allows
users to export data with names in a more conventional format.

16.5.g It is possible to write different OZ export files for each user, making it easy to
identify and associate each file to various individuals. If selected the file name
written is userIDOZData.bin.

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16.6 Probes

16.6.a Probe performance is critical to OAE test results. Otodynamics probes store a
unique ID number and a set of calibration results so that probe performance can
be monitored. Before using a new probe it should be registered with your PC
and a calibration check should be run and saved. Calibration tests should be
run on all probes at regular intervals (weekly is recommended).

16.6.b Before using a new or different probe for testing, probes should be read,
registered and a calibrated check performed.

16.6.c There are three different ways in which the probe registration and calibration
facility can be entered.

By selecting File > Options > Probes.

By pressing the small probe button on the main screen next to the Save
button.

By beginning a test with an unregistered probe. V6 will prompt the user to

register a new probe when a test is started.

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16.6.1 Registering a probe
16.6.1.a Check that the probe is connected to the OAE system. If your equipment has
two probe sockets connect your probe to the socket marked 1.

16.6.1.b Open the probe registration and calibration screen.

16.6.1.c The probe ID number will appear in the Unique ID box. If the probe was
connected after the probe registration and calibration window was opened then
click on the <Read probe ID> button.

16.6.1.d Type a name into the User assigned probe name box. The probe serial number
(printed on the white sleeve on the probe cable) is frequently used.

16.6.1.h Click the <Register this probe> button.

16.6.1.i Run the probe calibration test as described below.

16.6.2 Probe calibration test

16.6.2.a Note:
It is important to ensure the first calibration check is accurate as it
will be used for reference. So, for the first calibration check on a
probe repeat the test and ensure the values are within +/- 0.5dB. If
the response has changed, refit the probe, ensure the environment is
quiet and repeat the test. After two repeatable results check that the
values are within the absolute levels shown below. If they are, select
<Save>. This records these values as a reference so that any future
change in probe performance can be noted.

16.6.2.b Check that the probe is connected to the OAE system. If your equipment has
two probe sockets, connect your probe to the socket marked 1 (it is not possible
to run probe calibration tests in socket 2. If you are running bilateral tests you
will need to remove the probe connected to socket 2 and re-connect it to socket
1 in order to run the calibration test).

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16.6.2.c Remove the tip from the probe and place the cavity on a flat surface. Insert the
probe into the test cavity at a 90 degree angle to the top of the cavity, between
the screws, as shown below left. Press the probe firmly into the cavity until the
shoulder of the probe touches the top of the cavity. When released, the probe
will rise a little to its natural position and the shoulder may no longer touch the
cavity. Inserting the probe at the wrong angle or with the probe head over one
of the screws may result in incorrect test results.

P O
16.6.2.d Select the <Run calibration test> button in the <Probes> area (via File >
Options > Probes or click on the blue probe symbol on the main test screen).

16.6.2.d The probe response at 1, 2 and 4kHz will be measured (for dual channel UGD
probes the response will be measured for both channel A and channel B. UGS
probes (used for TEOAE testing only) have just a Channel A and no Channel B.
For these probes the Channel B area will be blank)

16.6.2.e Relative limit check

5.6.2.f Results will be shown in red if they are different from the saved value by more
than the set tolerance limits. Default limits are +/- 2dB at 1kHz, +/- 2dB at 2kHz
and +/- 3dB at 4kHz. You can set your own limits for the calibration test using
the <Set limits…> button beneath the probe response data.

16.6.2.g Absolute limit check

16.6.2.h Check that the new calibration values are within the range:

1kHz = 71.0dB to 83.0dB

2kHz = 74.0dB to 86.0dB
4kHz = 71.0dB to 83.0dB
6kHz = 54.0dB to 68.0dB

16.6.2.i If no results are shown in red and all results are within the absolute limits the
probe has passed the calibration check.

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16.6.2.j If the results fail either check, the probe coupler tubes should be inspected for
debris. Replace the coupler if necessary and repeat the probe test by selecting
<Run calibration test>, ensuring the ear piece is firmly inserted in the test
cavity. Contamination of the coupler tubes typically reduces the levels of the
higher frequencies first. Loose coupling to the test cavity can reduce the low
frequency response and may artificially enhance the mid-frequency response.

16.6.2.k If the values of the calibration results show 36dB or lower at all frequencies
then there is a problem with the test. This may be due to the probe not being
connected correctly or to internal wire breakage. Check the probe connection.

16.6.2.l If the results remain outside the relative limits, but within the absolute limits
listed above, this indicates there have been changes in the probe but that these
changes are not large enough to invalidate testing.

16.6.2.m If calibration results at any frequency remain outside the Absolute limits
the probe should not be used for testing. Please contact Otodynamics’
support department. It may be possible for the probe calibration to be adjusted
if the probe is returned to Otodynamics.

16.6.2.n Statistics on the currently selected probe can be viewed on the left-hand side
of the panel. The <View cal history> button brings up a graphical display of
the saved results associated with the selected probe’s calibration checks. It is
possible to print this graph if you wish.

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17 Test protocols and stop logic

17.0.a If desired the test termination decision can be automated. The software will end
the test when specified criteria have been achieved. (File > Options > Start/
Stop/Score) Check the box Enable Auto stop and see below for more details.

17.0.b Further automation is also configurable in this section. The Enable Auto Start
feature will begin the test if the minimum number of good ‘Checkfit’ sweeps
has been completed and if the stimulus level is correct. The test save box will
automatically appear following a test, if the Enable auto save box is checked.
Also the patient can be automatically scored if the Enable Auto scoring box is
checked.

17.0.c It is the responsibility of the audiologist or physician to set appropriate pass/refer

criteria for the test. The previous gold standard for hearing screening - the ABR
- accepted a proven wave V response of normal latency to the selected level
of the click stimulation as sufficient proof of normal auditory function. By the
same standard, any technically valid OAE response within the speech range in
response to a click stimulus could be reasonably accepted as proof of adequate
cochlear function. In practice, most screening programmes set more stringent
criteria than this. It is common to require OAE responses to be 3 or 6dB above
the noise in two, three or more half-octave bands between 1 and 4kHz. This
exceeds the stringency of the ABR test, and results in a higher refer rate.
However, the widespread acceptance of multi-frequency pass criteria for OAEs

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 must be taken to indicate an underlying dissatisfaction with the non-frequency
specific nature of screening ABR. It remains to be seen if such stringent multi-
frequency OAE pass criteria persist and yield tangible benefits.

17.0.d The Start/Stop/Score menu includes many flexible options that can be
configured to ensure a consistent minimum quality of OAE recording. The
software will not end the recording until the criteria have been met, or the
number of timeout sweeps has been reached.

17.0.e The Options are:

• Minimum signal-to-noise ratio in each half-octave band

• Minimum number of bands required for a pass
• Selection of bands to be mandatory
• Minimum number of good quality data sweeps required
• Minimum valid OAE band (the minimum OAE level required in each band)
• Minimum OAE response level
• Minimum number of DP loops (minimum number of completed frequency
sweeps)
• Minimum waveform reproducibility

17.0.f The default number of bands for a pass is three in the screening modes
and four in the diagnostic modes. It is possible to specify which bands are
mandatory bands in the pass criteria. The low frequency bands are dominated
by physiological and background noise, especially in newborns whose ear canal
walls and skulls are very thin relative to those of an adult. Therefore, to ensure
that high frequency losses are not missed, you may decide to make the 4kHz
band a mandatory band. A default signal-to-noise ratio of 6dB has been used
in all but the 1kHz band which is often dominated by noise. A 6dB threshold is
generally employed in a number of screening programs; a threshold of 3-6dB
may also be statistically valid under certain circumstances.

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17.0.g For TEOAE recordings, if the stop criteria are not met, data collection will stop
after the designated number of low noise sweeps has been reached (Nlo 260
is default). DPOAE recordings will terminate after the specified timeout. These
options can be edited in File > Options > Stims.

17.0.h You can save different stop criteria for all four modes (Neonate Screening,
Neonate Diagnostic, General Screening and General Diagnostic). The specified
stop criteria are mainly applicable to both TEOAE and DPOAE recordings. The
minimum reproducibility is applicable to TEOAE tests only and the minimum
number of DP loops for DPOAE test only. The protocol can also be changed by
clicking on the left-hand mouse button on Mode on the status bar at the bottom
of the main screen and selecting the relevant mode from the pop-up menu. The
mode cannot be changed if a test is currently running.

17.0.i Editing and saving of the pass/refer criteria and the automation options are
password protected. The software installation password is required.

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18 Reporting

18.0.a Reports are accessed from the menu bar. There are the options to print all
Patients tested or just those that have been referred, passed, to retest,
unscored and incomplete. The Start and End dates can be specified and will
affect the number of patients shown on the list. The list can also be sorted by
family name, date of birth, or ID number. The patient records can be filtered by
operator, system or facility. The <Refresh data> button will update the list with
patients currently being tested. Various reports can be printed either directly by
clicking on the print button or indirectly via <Preview> button. Each report can
be exported into XML or CSV data formats.

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18.1 Operational statistics

18.1.a This section delivers information about various operational statistics within
the program. Details on the Database, the Operators and the Probes stored
are accessed. Analysis of the database may help determine when a back up
or archive is required. The Operator section gives an overview of the tests
completed and performance of the tester. The Probe section details the probes
stored and the intensity of use for each probe.

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19 Data management options

19.0.a There are many built in data management facilities as shown.

19.1 Backup database...

19.1.a The backup process creates a compressed archive of the entire patients’
demographics and results database to a specified file name. The backup can be
invoked from the data management menu. However, ILO V6 performs backups
as an automatic process so that in normal use it would not be required for the
user to explicitly perform a backup. The automatic backups are performed
whenever more than 200 patients have been added since the last backup, or
if one month has passed since the last backup. The automatic backups are
invoked as ILO V6 starts. The actual backup process is performed from within
a separate ‘program’ and can continue without interrupting normal ILO V6
operation (this backup program is visible as a tray icon on the task bar).

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19.2 Archiving functions

19.2.a Archiving is the process of creating a copy of the current data in a secondary
location. Once the archive is complete it is then possible to remove this data
from the primary data store if it is no longer required. Furthermore, it is possible
to re-import data that has been archived and removed from the primary data
store if it is desirable to re-examine the data at a later date.

19.2.1 Archive data...

19.2.1.a To archive data click on Data management > Archive functions > Archive
data.... Select the required filters from the various field drop-down menus in
order to specify the group of patients to archive. Click on the <Check number
matching criteria> button to ensure the correct group has been selected.
Click to check/tick the Enable database archive and/or the Enable raw data
archive field which will activate the <Archive the files> button. Note that the
<check number matching criteria> button also has to be selected to activate
the <Archive the files> button. Click this button to archive the files. The <Purge
archived files> button is now activated. Click on this to purge all archived files.

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19.2.2 Re-import from an archive

19.2.2.a Archived data can be re-imported by selecting Data Management > Archive
functions > Re-import from an archive. The archive log is displayed. Highlight
the archive file you wish to re-import and click on <Import selected archive>.

19.2.3 View archive log

19.2.3.a The archive history can be viewed by selecting Data management > Archive
functions > View archive log which brings up the View archive history
window. This window will have a vertical scroll when there are more archives
than can be shown at one time. Each item in the list shows the details of the
archive that was performed on that occasion. Colour highlighting is used to
indicate whether that particular archived data file is available for re-import back
in to the master database.

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19.3 Data transfer/import functions...

19.3.1 Transfer ILOv6/EZ data to server...

19.3.1.a It is possible to collect ILO V6/EZ•SCREEN data on a standalone PC (typically a
notebook computer with one of the ILO Echoport family of instruments) and then
transfer this data to another ILO V6 using a LAN connection. The advantages
to this mode of operation are that data can be collated on a single departmental
PC, or data can be placed on a more ‘secure’ PC so that patient information is
not left on a vulnerable notebook PC which resides in public areas.

19.3.1.b First, on the ILO V6 server, ‘data file sharing’ needs to be enabled on the first
page of the options dialog. This starts an ‘ILO data file service’.

19.3.1.c The transfer is initiated from the data collection ILO V6. First ensure that there
is a working LAN connection to the destination ILO V6 server. Invoke the
‘transfer database/data files’ window using either the small button at the bottom
of the main screen (next to the save button), or using the Data management
> Data transfer/import functions > Transfer ILOV6/EZ data to server menu
selection.

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19.3.1.d The left hand panel contains a set of selections which can be used to filter the
data that is transferred. For example it may be a requirement to only transfer
data collected by one of the users, or for a particular window of dates. Once
these selections have been made, select the <Check number matching
criteria> button. This will count the number of patients, tests and raw data files
that would be transferred using this selection of filter criteria.

19.3.1.e Next type the name of the ILO V6 server. Then press the <Check server is
ready for data> button. If the server is present and ready to receive data then
the <Transfer Now!> button will be enabled. Please note that both the <Check
number matching criteria> and the <Check server is ready for data> buttons
have to be pressed before the <Transfer Now!> button is enabled.

19.3.1.f During the transfer the progress of the database and the raw data files is
displayed at the top of the window.

19.3.1.g Once the transfer is complete, the data is no longer present on the local PC.
The data is now safely on the ILO V6 server and can be accessed there or
via an ILO V6 client which is connected to the same LAN. It is now safe to
disconnect this ILO V6 from the LAN and to collect some more OAE data. If you
experience any difficulties, please check that the ‘Full local path to database file’
has the correct path and filename (oaedata.fb).

19.3.2 Import/Synchronize ILOV6/EZ database...

19.3.2.a Click on Data management > Import/Synchronize EZ Screen data to call up

Import data from EZ Screen window. Data can be imported either locally or
from a remote server. If you select This computer, select the source database,
otherwise select Remote Server, select server name and full pathname of
database file. In both cases there is the option of synchronization of data which
is activated by clicking on the Full 2-way synchronization of data box.

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19.3.2.b Note:
These functions are dependent on the database type imported or
synchronised. You can find the database type in the Help > About
area. V6 databases are either Interbase (before 6.40.26.0) or
Firebird (later versions). The import function will not work for the
server option unless the server version is Interbase. Do not use
the synchronise option unless both databases are from the same
EZ•Screen / V6 installation versions. It is possible to Import data
from older software versions, but not newer versions.

19.3.3 View transfer history

19.3.3.a A history of data transferred across the network is displayed when View
Transfer History is selected. The history shows: the number of patients and
tests and data files transferred; the date and time of each transfer; the database
filters used to select the transferred records; the ID of the user who initiated the
transfer; and the name of the server to which the records were transferred.

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19.4 Import data files...

19.4.a It is possible to import some data files from ILOV5 software into the ILOV6
database for storage, review and analysis.

19.4.b Prior to importing data files, copy the required files to the V6 primary data file
folder, using Windows Explorer. This is specified in V6 under File > Options >
Environment > Primary data file and the default location is C:\Program Files\
Otodynamics\ILO4win\DtaFiles.

19.4.c Click on Data management > Import ILO V5 data… This will open the V6
primary data file folder. Select the files to import and click <Open>. Now the
data can now be viewed in ILOV6 in the usual way.

19.4.d Note:
If ILOV6 is configured to export information to an alternative patient data
management system, an option is given prior to the import process to
allow the new data to be automatically added to the export file.

19.4.e Current file types that can be imported are:

TEOAE Quickscreen
TEOAE Non-Linear
TEOAE Tone-pip
DPOAE

19.4.f Note:
The ILOV5 data files do not contain a patient gender or protocol
mode information. On import to V6, the gender default is male and
the protocol mode is neonatal screening. It is possible to change the
gender by editing the additional patient details.

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19.5 Echocheck functions

19.5.a Echochecks can store up to 96 tests in their internal non-volatile memory. This
data contains the test outcome and various conditions of the test, and can be
downloaded to ILO V6 using the supplied serial lead.

19.5.1 Download and import Echocheck data...

19.5.1.a This section is accessed via Echocheck functions > Download and import
Echocheck data. Connect the data download lead between the Echocheck
and the serial COM port on the PC. Ensure the Echocheck is switched off,
select the user to be associated with the data and click the <Download data>
button. Select the appropriate COM port to which the Echocheck is attached
and press OK. The Autostart facility on the Echocheck will be activated and the
data will be downloaded and then erased. See note below on earlier versions
of Echochecks.

19.5.1.b The data downloaded shows the test result and all the statistics collected. It is
necessary to manually enter the patient name, ID number, gender details and
date of birth in order to complete the record, prior to importing the test to the ILO
V6 database.

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19.5.1.c To do this enter or select the details in the fields at the top of the window, select
the appropriate test result and use the ‘copy to selected row’ button to add the
details. The same details can be added to multiple tests and a clear button has
been provided to flush the fields ready for different patient information.

19.5.1.d Data can also be saved in Hi*Track, OZ , CSV, XML, ASCII or GDT format,
provided the export option is selected prior to data transfer in File > Options >
Exports/Imports. This is indicated at the bottom left of the Echocheck data
download window. When all of the data has the required patient information,
the test data can be imported into ILO V6 by clicking on the <Import data>
button.

19.5.1.e The data is now incorporated within the ILO V6 database and can be reviewed
in the same manner as other results, via the review panel. (See the Reviewing
data section). The ‘stop reason’ in the Test Data panel indicates the result of
the test. There is no OAE waveform data collected with the Echocheck.

19.5.1.f Please note that versions of Echochecks earlier than March 2000 (serial
numbers before EC2003000) will not have the Autostart facility. If you are not
sure, click on the <Download data> button and if the Echocheck does not start
up within the first two seconds, switch the Echocheck ON manually. If there
is more than a ten second delay, a communication with the Echocheck…
message will be displayed.

19.5.2 Continue editing downloaded Echocheck data

19.5.2.a It is possible to download Echocheck data and import it into the ILO V6
database at a later stage. Select Data Management > Echocheck functions
> Continue editing downloaded Echocheck data. It is possible to filter the
results using the Echocheck ID, so that only data from a specific Echocheck is
displayed. (The Echocheck ID is part of the unit’s serial number displayed on its
back) It is then necessary to add patient details to the results prior to the import.
(See section Download and Import Echocheck data). The data can now be
imported by pressing the <Import> button.

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19.5.3 View imported data details

19.5.3.a A history log is available showing all the downloaded and imported data.

19.5.3.b It is possible to filter the data shown by date, using the start and end drop down
calenders. The data can also be sorted by Date of test, Family name, Operator
ID and Echocheck ID. The table can be printed and a print preview feature is
provided. To convert the table to a different format to view in other programs,
select Export to XML or Export to CSV. If the results are shown in red it
indicates that they have not been imported into the main EZ•Screen database.
(To import data go to Data management > Echocheck functions > Continue
editing downloaded Echocheck data...). To erase the Echocheck log, select
<Purge Echocheck log>.

19.6 Database maintenance

19.6.1 Database validation...

19.6.1.a This function can be accessed via Data management > Database
maintenance > Database Validation. The process will read the entire
database, check for any data integrity errors and make several attempts to fix
these if present.

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19.6.2 Recovery from backup...
19.6.2.a Previous backups of the database can be recovered by clicking on Data
management > Database maintenance > Recovery from backup. A
message is displayed warning the user that all data since the last backup will be
lost if this procedure is continued. The user is asked to enter a password before
proceeding with recovery.

19.6.3 Purge training mode data...

19.6.3.a If training mode data is saved to the database, it will invalidate operator
statistics. A warning is raised on the exit of ILO V6 to inform the user of the
presence of training mode data. At this point an option to purge the data is
raised. The files can also be erased via Data management > Database
maintenance > Purge training mode data.

19.6.4 User/Password management

19.6.4.a The need for passwords is disabled at installation and is only activated when it
is required. If password protection is not required then there is no further action
necessary to be able to access all functions of both ILO V6 and EZ•Screen
software.

19.6.4.b The first user will be assigned full administrative rights as an Advanced User.
Additional Users or Advanced Users may be added to the Operator Login list,
with or without passwords.

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19.6.4.c Administration of passwords and user rights
is achieved via the Data Management >
User Password Management menu.

19.6.4.d An Advanced User may add, change or

remove passwords in this User Management
screen. In the column headed “UserType”
the letters “A” and “S” denote “Advanced
User” and “(Standard) User” respectively.

19.6.4.e By clicking in the relevant cells, it is possible

to change the Forename, the FamilyName,
the Password and the UserType. It is not
possible to change the UserID as this may
be linked to any tests which may have been
performed. The changes become effective
immediately so that the next user will need to
be advised of the password that will allow access.

19.6.4.f Routine changes of passwords should be undertaken at regular intervals as

required by the user’s institution/hospital.

19.6.5 Configure Hi*Track Users

19.6.5.a ILO V6 integrates with Ht*Track by sending patient demographics in the
Hi*Track data format prior to performing a ‘merge’ into Hi*Track. However,
Hi*Track uses a series of pre-defined ‘pick lists’ for certain fields. One of
these pick lists is used to define the current screener name (the person who
performed the test), and another lists the possible screening sites or hospitals.
As ILO V6 also uses a list of operators/screeners and sites, it is necessary to
match the two lists against each other. The menu item Data management >
User/Password management > Configure Hi*Track users displays a double
list for both the users and sites. On the left-hand side of the dialog are the ILO
V6 lists, and the Hi*Track ones are shown on the right. For every item on the
ILO V6 list it is possible to select the matching item from the Hi*Track list and
then press the arrow button to ‘link’ them together. Once this is done, when ILO
V6 exports data to Hi*Track the data will now contain the correct Hi*Track codes
for the screener and hospital site.

19.6.6 Remove unused Users/Machines

19.6.6.a This section enables the user to purge unused Users and Machines from the
ILO V6 database.

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19.7 Re-Export to:
19.7.a Within ILO V6’s extensive data management options it is possible to export sets
of data into other data formats for viewing using different data management
systems. There are two ways of doing this:

19.7.b Select Export data to: ‘data format type’, under Setup options and Exports/
Imports. See sections Setup options, Exports and Formats of data stored
for more details.

19.7.c Select Re-Export to:- ‘data format type’ under Data Management. Note that
the type of export file needs to be set in the Setup Options > Exports/Imports
tab.

19.7.d When using the first method, ILO V6 writes and updates an export file after each
test that is saved. The Re-export feature allows the user to export various sets
of files at any time from the database.

19.7.e Note:
Records which have been archived will not be included in the Re-
export file. Archived records will automatically be removed from the
export file if the Re-export function is used.

19.7.f The ‘Export type’ and ‘Export location’ are set in the ‘Exports/Imports’ section
of ‘Setup Options’. You are given the flexibility to choose between which dates
files are exported and under which operator the tests were performed.

19.7.g After performing the filtering, the relevant number of tests is displayed. You are
now ready to export the files by pressing <Do Export Now!>.

19.7.h The export file has now been written to the specified export location.

124 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

20 Help menu

20.0.a Clicking on the Help Contents or Search for Help On ... functions will open the
V6 manual.

20.1 Email Dealer or Otodynamics

20.1.a Click on Help from the menu bar and select the relevant option from the drop-
down list. This facility is provided as a quick and easy way to directly email
either Otodynamics technical support - [email protected] - or your
local dealer.

20.2 Register a new license

20..2.a Please contact Otodynamics for a new license key. This can then be typed in at
Help > Register a new license.

20.3 About
20.3.a This contains information relating to the current version of the software.

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21 Networking

21.1 LAN client/server installation

21.1.a The easiest way to configure a LAN installation is to setup the ILO V6 server
installation first. The procedure for this is identical to the single desktop
installation discussed earlier in the manual.

21.1.b To configure one or more client ILO V6s, run the ILOv6Setup installation
from the Otodynamics CD. During the setup select the ‘Network client only
installation’. When ILO V6 is run for the first time the same dialog for initial setup
appears. This time, in addition to the user and machine details it is important to
set the server name for the ILO V6 server. When the name has been entered
into the dialog there is a button that will test the connection to this server.

21.1.c Once this setup is complete the patient demographics and test result summaries
are stored on the ILO V6 server. The client PC performs the test and passes
all of the patient information to the server PC. Therefore the responsibility for
database backup and archiving now belongs to the server. If ILO V6 is run on
the server, then auto backups of the database will take place at either monthly
intervals or whenever 200 patients have been added to the database (whichever
is sooner). If ILO V6 is never or rarely run on the server then someone must
make a point of running ILO V6 so that a database backup can occur.

21.1.d At the end of each test, a data file is also saved. The ‘raw’ data file contains
the details of the test (as opposed to a summary which is stored in the patient
database). These raw data files are stored in the ‘c:\program files\otodynamics
\ilo4win\dtafiles’ folder on the local PC by default. If you wish these files to
also be stored on the ILO V6 server then the following two settings need to be
changed:

21.1.e First, on the ILO V6 server, ‘data file sharing’ needs to be enabled on the first
page of the options dialog. This starts an ‘ILO data file service’.

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21.1.f Secondly, on the ILO V6 client PC the ‘data file folder’ and ‘data file server
name’ need to be set to point to the ILO V6 server. Enable the ‘Use LAN data
file server’ setting, then type in the name of the ILO V6 server. Now it is possible
to test this connection using the button provided. During this test if a Win9x
PC is found then the EZ-dtafiles share name will be auto entered in the ‘data
file folder’, and if an NT, Win2k or WinXP server is found then it will be auto-
configured for the ‘ILO data file service’.

21.1.g Now all of the patient demographics and the raw data files will be stored on the
ILO V6 server. This data is now accessible from the ILO V6 server, or other
ILO V6 clients that are also connected to the server. A typical use for this kind
of configuration is to have the OAE screener collecting data using an ILO V6
client. All of the data is stored on the departmental server which has had ILO V6
installed (so as to provide the database and data file service). The audiologist
also has an ILO V6 client (or sits at the ILO V6 server) so that they can review
the OAE tests. With this kind of deployment it is possible to have multiple ILO
V6 clients collecting and storing data on the same ILO V6 server - simply repeat
the client configuration described above.

21.2 Independent single desktop installation

that periodically transfers data to an ILO
V6 ‘data bank’ via the LAN
21.2.a This configuration consists of a combination of the single desktop installation
and the LAN installation detailed above. The OAE screener uses a single
desktop installation. They collect data and store it locally on their PC (so that this
PC contains the patient demographic information and the raw data files). During
this data collection phase, when the screener is performing OAE tests there is
no requirement for the PC to have a network connection.

21.2.b The principle of operation is that the screener collects a series of tests on their
standalone ILO V6 PC. This data is held on their PC for immediate review if
required. However, periodically the data is transferred or moved via the LAN to
a more secure version of ILO V6 (typically running on the departmental server).
When the data has been transferred it is no longer present on the screener’s
PC BUT it can be reviewed from the ILO V6 server PC or any ILO V6 clients
that are connected to this server. This departmental ILO V6 server is setup as
described above.

21.2.c The process of transferring the data from the screener’s ILO V6 to the
departmental server is described in the section Transfer EZ-screen data to
server under Data Management.

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21.2.d Note:
If the ILO V6 server is ‘behind’ a firewall the following ports need to
be allowed through for ILO V6 clients to communicate. In software
prior to revision v6.38.0.0, port 3050 is required for the patient
database. Port 3051 is required for revision v6.38.0.0 onwards.
Also, port 3049 is required for the ‘ILO data file service’.

128 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

22 Mode of operation

TEOAE Tests
Parameter Description

Stimulus Idle
80µs positive broadband square wave pulse with an intensity of
intensity of 84dB pe (peak equivalent) in a 1cc cavity (64dBpe in 1cc
if neonate mode is set).
Adjusted
80μs positive broadband square wave.
Test
300μs biphasic broadband triangular pulse (Quickscreen)
80μs alternating broadband square wave (Linear and
Non-Linear)
2ms cosine filtered sine wave of selected frequency (Tone pip)

Waveform sample rate

20kHz - Quickscreen
25kHz – All other types

Stimulus pattern
Non-Linear and Tone pip
Each sweep presents 4 stimuli for each to the two response buffers
(8 stimuli in total). The stimulus presentation pattern is:
XXXY
Where: Y = -3X
Quickscreen
Each sweep presents 8 stimuli for each to the two response buffers
(16 stimuli in total). The stimulus presentation pattern is:
X X X X X X -Y -Y
Where: Y = -3X
Linear
Each sweep presents 4 stimuli for each to the two response buffers
(8 stimuli in total). The stimulus presentation pattern is:
XXXX
Spontaneous
Each sweep presents 1 stimulus for each to the two response buffers
(2 stimuli in total).

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Response buffer averaging
The responses from each stimulus in a sweep are summed and
averaged. The polarity of stimuli in all types is periodically alternated.
Averaging this stimulus pattern removes artefacts which scale
linearly leaving only the OAE signal which is non linear.
These sub averages are alternately added to two separate averages.
These separate averages are referred to as waveforms A and B.

Signal and noise calculation

Measures of signal and noise levels are based on the correlation and
differences between waveforms A and B.

Stimulus repetition rate

Quickscreen
One stimulus every 13ms, approximately 80 stims per second.
Linear, Non Linear and Tone pip
One stimulus every 20.48ms, approximately 49 stims per second.
Spontaneous
One stimulus every 80ms, approximately 12 stims per second.

Response window
Quickscreen: 2.5-12.5 ms
Linear, Non-Linear: 2.5-20ms
Spontaneous: 21-81.9
Tone pip < 2kHz: 4-20ms
Tone pip > 2kHz: 3-20ms
Cosine filtered with rise (after start of stimulus) and fall time of 2ms.

Response frequency bands

Half octave, centres at 1, 1.4, 2, 2.8 and 4kHz.

Response frequency range

400-6400Hz

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DPOAE Tests
Parameter Description

Checkfit stimulus
80μs positive broadband square wave pulse with an intensity of
84dB pe (peak equivalent) in a 1cc cavity (64dBpe in 1cc if neonate
mode is set).

Sample rate 25kHz

Sample buffer 81.9ms (gives 2048 points)

FFT frequency bin

25Hz

DP Noise calculation
DP noise from the five spectral points above and the five points
below the DP frequency. In the ‘Rapid’ noise mode, the mean of
these points gives the noise level. In the ‘Standard’ noise mode the
mean of these points plus two standard deviations gives the noise
level.

Noise rejection calculation

The noise level for noise reject is calculated from the difference
between consecutive 80ms samples.

Frequency ratio
F2 = 1.22 F1

DP signal reported
The distortion product 2f1-f2 is reported at the nominal
frequency f2.

Response frequency range

400-10500Hz

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23 Response detection

OAE response detection is based on the Signal to Noise ratio (SNR) at each
test frequency (for DPOAE tests) or across a specific frequency range (for
TEOAE tests). Dependent upon the statistical nature of the noise, even with
the probe in a cavity, there is a finite probability that data at the measurement
frequency appears above the noise and will be considered as a ‘signal’ (i.e. a
positive SNR). For both test types the larger the SNR the greater the confidence
that the signal detected is not a noise artefact.

The number of required frequencies for a screening pass influences the SNR
required for a given level of confidence. Once the level of confidence and
number of frequencies is decided the necessary SNR can be computed.

By running many repeat cavity tests the occurrence rates of different SNR
levels in these tests were used to generate the confidence levels shown in the
tables reported below. These confidence levels can then be used to determine
positive predictive value and the negative predictive value (NPV or false pass
rate) which gives an essential measure of the chances of missing an ear with a
significant hearing impairment.

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 Confidence levels in DPOAE tests
The SNR achieved determine the confidence that a DPOAE has been detected
in a test at a single frequency. The table below shows the SNR required
to achieve a given confidence level (V6 reports noise levels based on the
mean+2sd):

Confidence for single frequency points

SNR required for single frequency
Confidence Rapid (mean) Standard (mean +2sd)
99% 10dB 4dB
99.9% 12dB 6dB
99.99% 16dB 10dB

Confidence for multiple frequency points

Screening tests acquire confidence that OAEs are present by testing across
multiple frequency points. As the chance of an individual point passing is
independent of other test points the probability of a given number of passes
amongst a number of tests points can be derived.

In addition to the selected Noise Mode and the SNR, the number of pass
frequencies required and the number of frequencies tested are needed to
determine the confidence level achieved. The four tables below detail this data
for the two types of noise mode and for 4 and 6 point test paradigms.

Standard (mean +2 Std) based SNR values

for four test points
Minimum SNR required
Confidence 2 of 4 points 3 of 4 points 4 of 4 points
99% 2dB 0dB 0dB
99.9% 3dB 2dB 0dB
99.99% 6dB 4dB 0dB

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 Standard (mean +2 Std) based SNR values
for six test points
Minimum SNR required
Confidence 2 of 6 pts 3 of 6 pts 4 of 6 pts 5 of 6pts 6 of 6pts

99% 2dB 0dB 0dB 0dB 0dB

99.9% 4dB 2dB 0dB 0dB 0dB

99.99% 6dB 3dB 1dB 0dB 0dB

For example, if a test protocol is selected that requires 2 bands out of 6

tested and a 99.9% confidence is desired then a SNR of at least 4dB must be
specified.

Confidence levels in TEOAE tests

In the case of TEOAE measurements, data points are aggregated in to
frequency bands. Normally this banding is performed as some proportion
of octaves. Because of this logarithmic banding of data there is a frequency
variance in the SNR required for any given level of confidence. This leads to a
more complex table for the SNR required for a single band. Furthermore, this
additional complexity is factored into the multiband tables found below.

Confidence for a single ½ octave band

Minimum SNR required for confidence Average of
level in a single band all bands
Confidence 1kHz 1.5kHz 2kHz 3kHz 4kHz
99% 7dB 5dB 4dB 4dB 2dB 5dB
99.9% 11dB 8dB 6dB 6dB 4dB 8dB
99.99% 14dB 9dB 7dB 8dB 7dB 11dB

134 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

 Confidence for multiple ½ octave bands
Most TEOAE test criteria test across all five ½ octave bands, between 1-4kHz:

Minimum SNR required for confidence level

Confidence 2 of 5 bands 3 of 5 bands 4 of 5 bands 5 of 5 bands
99% 2dB 0dB 0dB 0dB
99.9% 4dB 2dB 0dB 0dB
99.99% 8dB 4dB 2dB 0dB

However, in some screening protocols the 1kHz band is not used (for example
in the UK newborn hearing screening programme). The table below shows the
data for this situation where only 4 bands are analysed.

Minmum SNR required for confidence level

Confidence 2 of 4 bands 3 of 4 bands 4 of 4 bands
99% 2dB 0dB 0dB
99.9% 3dB 1dB 0dB
99.99% 5dB 3dB 1dB

Note:
All of the above data were derived empirically from laboratory studies
using Otodynamics equipment in the presence of noise recorded from
real clinics.

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 Conclusions
How to use this data in relation to OAE screening?
The test confidence percentage is a statistical indicator of how likely the test will
correctly identify an ear with no OAE in response to the selected type and level
of stimulus. Typically the population under test has a low prevalence of ears
with no OAE. Therefore when considering the effect of a given pass protocol on
the test outcome, it is more useful to examine the false pass rate or negative
predictive value, as this indicates the likelihood of a subject with no OAE
erroneously being identified as having a normal OAE.

False pass rate (or Negative Predictive Value NPV)

The false pass rate for a test depends on both the confidence in the results of
an individual test and the incidence of the disorder tested for. The incidence of
permanent hearing loss (>40 dB HL) has been estimated:

Neonate: 1-6/1000 (0.1-0.6%)*

At aged 3: 1.07%
Aged 9-6: 2.05%**

* www.asha.org/public/hearing/Prevalence-and-Incidence-of-Hearing-Loss-in-Children/
** Fortnum et al BMJ 2001;323:536

The incidence rate of OAEs being falsely detected for those tested in a
population with the stated prevalence rates (assuming all ears with significant
hearing loss have absent OAEs) is estimated below:

Incidence of permanent hearing loss

Confidence 0.1% 1% 2%
99% 1 in100,000 1 in 10,000 1 in 5,000
99.9% 1 in 1,000,000 1 in 100,000 1 in 50,000
99.99% 1 in 10,000,000 1 in 1,000,000 1 in 500,000

136 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

24 Index

A D
ABR 20 Database maintenance 121
Absolute limit check 105 Database server 56
Analysis 89 Database setup 101
Archive data... 113 Database validation... 121
Archive log 114 Data collection 39,65
Archiving 113 Data file directory 56
ASCII 57 Data management 112,113
Ascii export configure 57 Data transfer/import functions... 115
Auditory neuropathy 20 dB80 76
Automatic backups 112 Debris 38
Automatic ID 32 Defragment and re-tune... 122
Auto stop 42,107 Diff 90,95
A and B difference 46,91 DP ½ octave power 70
A and B mean 46,91 DP Bar graph 70
A and B waveforms 46,91 DPgram 65
DPOAEs 62
B DPOAE growth rate 74
DPOAE measurements 17
Backup database... 112 DPOAE screening 63
Bilateral tests 81 DP ½ octave power 101
Binaural integration 80 DP Bar Graph 100
DP Growth functions 74
C DP Growth test 73,77
Checkfit 38,41,63 DP line chart 69
Click 38 DP line graph 100
Cochlear status 20 DPOAE stimulus and frequency range
Cocktail party effect 80 setup 97
Configure Hi*Track Users 123 DP Spectrum 67
Contralateral noise stimulation 20 DP spectrum graph 67
Contralateral recording 84
Contralateral stimulation 82
Contralateral suppression parameters 84
Contralateral TE suppression 83
CSV 23,57,120
Cyclic down 98
Cyclic up 98

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E H
Echocheck data 119 Half octave bands 40,107
Echocheck functions 119 Half octave display 44
Effusion 18 Half octave spectra 100
Environment 100 Hesitation Hints 101
Equipment system checks 28 Hi*Track 23,120
Ex=OFF 26 Higher frequency point 66
Examine/Compare data 27,89,94 Histogram 40
Examine Spectrum Detail 44,70 Hot-keys 27
Examine waveform detail 46 Hyperbilirubinemia 20
Exit 28
Export 26,56 I
Exports/Imports 102
EZScreen.txt 57 ID number 32
Eztests.xml 57 ILOAsciiExport.txt 58
ILOdata.csv 57
ILO Operator Login 23
F
Import/Synchronize ILOV6/EZ database...
f2/f1 65,72 116
F2 intercept 76 Importing worklists 34
Facility 21 Import data from EZ Screen 116
Family name 32 Import ILOv5 data... 118
File > Options > Stims > Timeout 109 Installation 12
Filter 47 Intelligent 98
Find matches 93
Fluid 38 L
Formats of data stored 56
Frequency selectivity 9 LAN installation 126
License key 21,125
Linear stimulus 41
G
Load pair 90,95
GDT 23,57,120 Lower frequency point 66
General diagnostic 62
General screening 62
Global Site Name 21,26
Glue 18
Grommets 18
GSN 21,26

138 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015

M P
Mandatory bands 108 Pass criteria 107
Mandatory fields 21 Passwords 23
Masking 84 Patient demographics 56
Masking parameters 84 Patient ID input mask 101
Middle ear status 10 PC specifications 11
Mode 26,109 Peak stimulus level 26,38
Multi-frequency pass criteria 107 Print 27
Printer setup 101
N printing 48
Print best data (both ears) 48
NCHAM 57 Print bilateral pair 51
Negative pressure 18 Print selected pair 51
Neonate diagnostic 62 Print setup 27
Neonate screening 62 Print this data 48
Network 56 Probe calibration test 104
Networking 126 Probe fit 39
Nhi 26,39 Probes 103
Nlo 26,39 Protocols 107
Noise 17,39,40 Purge archived files 113
Noise contamination 40 Purge Echocheck log 121
Noise dB 26 Purge training mode data... 122
Noise rejection 25,26,39
Noisy data 48
R
Non-Linear stimulus 41
Re-import from an archive 114
O Recording time 26
Recovery from backup... 122
OAE response (SNR) display 68 Registering a probe 104
OAE Response window 44,69 Rej 26
Operational statistics 111 Relative limit check 105
Operator ID 26 Remove LF noise 48
Oscillation 38,59 Remove unused Users/Machines 123
Ossicular dislocation 18 Reports 110
Otosclerosis 18 Repro 26
OZ 57,120 Reproducibility 26,40
OzData.bin 57 Response 26,40
OZ SIMS files 23 Response Waveform 40,46
Resp dB 26
Retrocochlear function 10
Review data 62,93
Ringing 18,38
Risk factors 32

ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015 139

S T
Save 48 Target range 39
Scoring 99 Target stim 97
Search fields 93 Target stimulus level 38
Select ascii export fields 57 TEOAE contralateral measurements 88
Sensitivity 9 TEOAE measurements 17
Sensory function 10 Test termination 42,68
Sensory transmissive loss 18 Test time 26
Setting DPOAE frequency range 97 Timeout (sweeps) 97
Setup Options 96 Tinnitus 20
Show No OAE 100 Transfer ILOv6/EZ data to server... 115
Show SNR values 44,69 Tympanic perforations 18
Signal 40
Signal-to-noise ratio 44,69,108 U
Slope 76
SNR values 44 User 21
SOAEs 59,60 User/Operator ID 21
Software installation 12 User/Password management 124
Spontaneous OAEs 20
Spontaneous otoacoustic emissions 59 V
Spontaneous sound emission 9 View archive log 114
Stab 26 View data table 45,71
Stability 42
Start/Stop/Score 99
W
Status 26
Stim dB 26 Waveform Filter 47,92
Stimulation 62 Waveforms 40
Stimuli 40 Worklist 33,34
Stimulus 38,62,129,131
Stimulus frequencies 72 X
Stimulus gain 39
Stimulus intensity 38 XML 23,57,120
Stimulus level 38
Stimulus response 38
Stimulus setup 97
Stimulus spectrum 38
Stimulus stability 42
Stimulus tones 64
Stimulus traffic light indicators 42
Stimulus waveform panel 38
Stop logic 107
Synchronization of data 116
System Checks 28

140 ILO V6 Clinical OAE Software Manual • Issue 17 • September 2015