If the default options are not to your preference you can easily create your own automated test battery.
To begin, create or open a patient profile and click on the green "+ Note/Test" button.
From the list of tests available, select: "Pure tone - KUDUwave test". You can have the KUDUwave connected to the laptop or you can continue in Demo mode.
Now, below the list of supplied default test formulas, you will see a button which says: “Add a new test setup / macro”.
Before clicking this button, you can pre-select a default macro, and use its settings as a base from which you can create your own macro. You do not need to select a default macro if you want to start from scratch.
After clicking here and giving your macro a suitable name, click OK and you will be taken to the first setup page.
Ambient Noise Monitoring
Your first option is to select which standard is applicable to your test. This standard is with regards to how strict you want the KUDUwave to monitor the ambient noise during your test. For example in the United States, the ANSI standard will note that any sounds louder than 49 dB SPL at 1000 Hz are too loud to present a tone at 0 dBHL. Should you not require such strict monitoring, for example during a screening test in the occupational health sector, the SANS or OSHA standards are applied and ambient noise cannot exceed 56 or 65 dB SPL at 1000 Hz respectively. Your options are listed below in the figure:
Maximum and Minimum Thresholds
The next setting is specific to the type of audiometer the KUDUwave™ is. The Prime™, Plus™ and Pro™ is a Type 3 audiometer. Check that the correct option is chosen from the list shown below:
Extended High Frequency Settings
The KUDUwave 5 software will detect if you have a KUDUwave Pro™ with extended high frequencies.
Next you need to decide whether you want to do manual testing (using the shortcuts listed here) or if you want an automatic test to be done. We have provided you with a list of automated threshold seeking methods to mimic the manual audiometery test methods used by audiologists according to ISO 8253-1. Shortened Ascending method is selected by default.
Below the method of testing is the type of tone you want presented and how long you want it presented for at a particular frequency and decibel level.
Warble tones are normally used in cases where the patient has tinnitus, read more about if tinnitus can affect hearing tests results.
The next default setting is the Stenger offset, which is set to 10, however you can increase or decrease this value. The check boxes following this setting refer to a few test pages which you can decide to include or exclude depending on consultation you have with the patient.
- Show conditioning page before test starts | This refers to the page right before testing begins, where you are able to communicate to the patient to press the response button when they hear a tone. You can demonstrate the testing environment and show them what to expect when masking is presented as well. If you have already explained everything to the patient, you can choose to skip this page and go straight to testing.
- Show the hide/unhide button on the test screen | This button allows you to hide the testing page where the cursor moves across the screen and informs the clinician how the patient is responding. If you suspect the patient is watching the screen and trying to cheat the test, use this hidden feature to help you get true results. Read more here on How To Spot A Malingering Patient In Audiometry.
- Show the self apply instruction page | This is an ideal illustration for self-test kiosks or stands, where the patient is informed how to test themselves.
- Play an end message at the end of an automatic test to indicate to the test subject that the test is finished | This is a feature still under development, where like the conditioning page can be automated and instructions are read out to the patient automatically in their native language, there will also be an automated message telling them when the test is finished.
- Automatically save the test at the end of an automatic test | In the case where patients are testing themselves, you can ensure the data is saved and recorded for safe keeping, with no risk of them exiting the test without saving first.
The default test page (shown below) shows the area across the frequencies and decibel levels where the tones are being presented. You can also see the live test and how the patient is responding to the tones presented to them.
You have the option to hide this screen during testing, or keep this test screen as the default.
Audiometer Information on the Audiogram
It is important to note that the correct information regarding the audiometer used during the test is recorded for each test done. This is important for audits to make sure the equipment was calibrated and up to date at the time the test was conducted. We have highlighted the information you will find at the bottom of each audiogram which corresponds to what you can see here in the start page.
Click Next to move onto the next page.
Setup for Automatic Testing Page
Air Conduction Frequency Selection
Here you can personalize your macro to test the specific frequencies you select in this page. Remember to select both left and right frequencies, otherwise the one ear will be skipped during testing.
Read carefully the following check box options which allow you to set the KUDUwave to retest certain thresholds if the result was worse than a specified dB level.
Bone Conduction Frequency Selection
If you have a diagnostic audiometer (Plus™ or Pro™) which has a bone vibrator for bone conduction, you should also fill in the following check boxes to do bone conduction testing.
It is important to fill in everything twice to ensure the left and right bone conduction test is done. You have the option to either do bone conduction testing every time, or make it dependent on the air conduction threshold result.
You also have the option to position the KUDUwave on the patient with the bone vibrator on the forehead before testing, or you can set the testing routine to remind you to position the bone vibrator in place before bone conduction testing commences.
Test Routines and Restrictions
During testing, the ambient noise is monitored simultaneously. You can set the test to not present tones when the noise levels exceed the decibel level stipulated for longer than 10 seconds, by checking the box. This noisy interruption of the test environment will possibly raise the threshold results incorrectly, so it is better to quieten the room and only continue testing from there on.
For the moment there is only one default testing order which begins testing at 1000 Hz, moving up to the higher frequencies first and then returning th the lower frequencies at the end of the routine.
You can also set restrictions on how low the KUDUwave much test for thresholds. By default this is set to -10 dB, however you can set it to 0 dB or even 15 dB. Again, you can do this for bone conduction as well if you have a diagnostic audiometer.
For quick automatic screening tests we have created a few default test macros which are used to identify patients with hearing disabilities by changing the minimum and maximum testable thresholds to slightly higher and lower levels respectively. This restricts the KUDUwave to only identify if the patient needs to be referred for further diagnostics, saving the screening team time and effort from doing full diagnostics on patients with normal hearing. Read more here about the different smart folders for outreach programs and school screenings.
Time Delays Between Each Tone
How the audiometry test is conducted is in the following sequence:
- The tone is presented to the patient.
- The audiologist waits a certain amount of time for the patient to respond.
- There is a slight waiting period (random) until the next tone is presented.
- Repeat the process from step 1.
This next setup section is with regards to step 3, the amount of time the KUDUwave must wait before presenting the next tone to the patient. There are two parts to this:
- Delay before randomization delay | This time period is standard for each repetition of the cycle. It is set by default to half a second and can be increased to up to 5 seconds.
- Randomization delay before next tone | This randomization tries to prevent malingering of the test results so that the patient does not know when the next tone will be presented. The larger the range from which the KUDUwave can select a random time to wait before the next tone, the better your randomization is and this decreases the chances of faked results. The minimum setting can be from 0 to 6 seconds, and the maximum setting can be from 0 to 9 seconds.
Click Next to move onto the next page.
Bone Conduction Setup Page
This last section is only relevant to those who have selected that bone conduction testing must be done in this test macro. We have preselected the recommended options for you to use when doing bone conduction testing:
To finish and save this test macro, click Next and the test you created will begin. Cancel the test if you wish to exit.
The new macro will now appear in the default list the next time you begin a pure tone test.
Read more about the default test formulas already available in KUDUwave 5.