Chartr EP Operation Manual 7-60-0820-En

Auditory Evoked Potential
System
User Manual
Doc. No. 7-60-0820-EN/06
Part No. 7-60-08200-EN
Copyrightnotice
No part of this documentation orprogram may be reproduced, stored in a retrieval system, ortransmitted, in any form orby any
means, electronic, mechanical, photocopying, recording,or otherwise,without the prior written consent of GN Otometrics A/S.
Copyright© 2015, GN Otometrics A/S
Published in Denmark byGN Otometrics A/S, Denmark
All information, illustrations, and specifications in this manual are based on the latest productinformation available at the time of
publication. GN Otometrics A/Sreserves the right to make changes at any time without notice.
Registered trademarks and Trademarks
MADSEN Itera II,MADSEN OTOflex 100, OTOsuite,AURICAL FreeFit, AURICAL Visible Speech, MADSEN Astera², MADSEN Xeta, ICS
Chartr 200 VNG/ENG, ICS Chartr EP 200, OTOcam 300, MADSEN AccuScreen, MADSEN AccuLink, ICS AirCal, AURICAL Aud,
AURICAL HIT, ICS Impulse, OTObase and MADSEN Capella²are either registered trademarks or trademarks of GN Otometrics A/S.
Versionrelease date
2015-07-30
112647
Technicalsupport
Please contact your supplier.
2 Otometrics - ICS Chartr EP 200

Table of Contents
1 Introduction 8
1.1 Intended Use 8
1.2 Intended User 8
1.3 About this manual 8
1.4 Typographical conventions 9
1.4.1 Navigating this manual 9
2 Getting Started in ICS Chartr EP 200ICS Chartr EP 200 10

2.1 ICS Chartr EP 200 Work Session 10
2.1.1 Starting an ICS Chartr EP 200 Work Session 10
2.1.2 Ending an ICS Chartr EP 200 Work Session 11
2.2 ICS Chartr EP 200 Main Window 13
2.2.1 New Test Tab 14
2.2.2 Review Tab 16
2.2.3 Settings Tab 17
2.2.4 Toolbar 18
2.3 Menu Bar 20
2.3.1 File Menu 21
2.3.2 Database Menu 22
2.3.3 Setup Menu 23
2.3.4 Test Menu 24
2.3.5 Edit Menu 26
2.3.6 Waveform Menu 27
2.3.7 Page Menu 30
2.3.8 Display Menu 32
2.3.9 Calibration Menu 33
2.3.10 Help Menu 34
2.4 Waveform Page 35
2.4.1 A and B Cursors 36
2.4.2 Waveform Handles 36
2.4.3 Accepts/Rejects and Cursor Information 36
2.4.4 Waveform Information 37
2.4.5 Waveform Bank Buttons 38
2.5 Calculation Box 38
2.6 Waveform Page Comments Box 38
3 Establishing and Maintaining Records 39

3.1 Patient Information 39
3.1.1 Patient Selection Dialog Box 39
3.1.2 Patient Information Dialog Box 40
3.1.2.1 Patient Information Tab 40
3.1.2.2 Physician Order Tab 42
3.1.3 Establishing a New Patient Record 42
3.1.4 Accessing Existing Patient Information 44
3.1.5 Deleting a Patient Record 46
3.2 Physician Information 47
3.2.1 Referring Physician Dialog Box 47
3.2.2 Establishing a New Physician 48
3.2.3 Editing Referring Physician Information 49
Otometrics - ICS Chartr EP 200 3

3.2.4 Deleting a Physician Record 50
3.2.5 Working with Physician Orders 51
3.3 Facility Records 52
3.3.1 Establishing the Test-Site Facility 52
3.3.1.1 Facility Setup Dialog Box 52
3.3.1.2 Setting up the Test-Site Facility 53
3.3.2 Establishing Referring Facility Information 54
3.3.2.1 Add Referring Facility Dialog Box 54
3.3.2.2 Establishing a New Referring Facility 55
3.3.2.3 Editing Referring Facility Information 55
3.3.2.4 Deleting a Referring Facility Record 56
3.4 Establishing Operator Information 57
3.4.1 Add Operator Dialog Box 57
3.4.2 Establishing a New Operator 58
3.4.3 Editing Operator Information 59
3.4.4 Operator Login 60
3.4.5 Deleting an Operator Record 61
4 Data Collection 63
4.1 Overview 63
4.2 Preparing for Data Collection 63
4.2.1 Listening Check 63
4.2.2 Prepare the patient 63
4.2.3 Connect the electrodes 63
4.2.4 Reduce noise sources 64
4.3 Collecting Data 64
4.4 Accessing Collected Data 65
4.5 Vestibular Evoked Myogenic Potential (VEMP) 66
4.5.1 Connect VEMP Monitor 66
4.6 Bone Oscillator 67
4.7 Working with Trial Setting Options 69
4.7.1 Selecting Trial Setting Parameters 70
4.7.2 Creating a New Protocol 77
4.7.3 Modifying a Protocol 77
4.7.4 Creating a Linked Protocol 78
4.7.5 Restoring Default Trial Settings 79
4.8 Selecting ASSR Trial Setting Parameters 79
4.8.1 ASSR Threshold Search 80
4.8.2 ASSR Modulation 81
4.8.3 ASSR Channels 82
4.8.4 ASSR Stimulus 83
4.9 Collecting and Monitoring ASSR Data 84
4.9.1 ASSR Symbols 84
4.9.2 ASSR Artifact Display 85
4.9.3 ASSR Data Collection Function Keys 85
4.9.4 ASSR Data Collection 86
4.9.5 ASSR Assign Threshold 87
4.10 ASSR Audiogram Correction Factors 88
5 Data Analysis 90
5.1 Introduction 90
5.2 Review Tab 90
5.3 Trial Data 91

5.4 Working with Waveforms 92
5.4.1 Viewing Waveform Pages 92
5.4.2 Selecting Waveforms 93
5.4.3 Positioning Waveforms 93
5.4.4 Moving Waveforms from Page to Page 94
5.4.5 Using the Waveform Pop-Up Menu 94
5.4.6 Adding Comments to Waveforms 97
5.4.7 Removing Waveforms 98
5.5 Marking Waveforms 98
5.6 Waveform Operations 100
5.6.1 Overlaying Waveforms 100
5.6.2 Merging Waveforms 100
5.6.3 Spreading Waveforms 100
5.6.4 Smoothing Waveforms 101
5.6.5 Inverting Waveforms 102
5.6.6 Adding Waveforms 103
5.6.7 Subtracting Waveforms 104
5.7 Working with ASSR Data 104
5.7.1 To access ASSR data 104
5.7.2 ASSR Merge Multiple Searches 106
5.8 Data Graphs 107
5.8.1 Click Normative Data 107
5.8.2 Tone-Burst Normative Data 110
5.8.3 PediGram Data 110
6 Working with Reports 114

6.1 Overview 114
6.2 Accessing the Word Processor 114
6.2.1 Word Processor Functions 115
6.2.2 Word Processor Menus 115
6.2.2.1 File Menu 116
6.2.2.2 Edit Menu 116
6.2.2.3 Format Menu 117
6.2.2.4 Tools Menu 117
6.2.2.5 Help Menu 118
6.2.3 Word Processor Toolbar 118
6.2.4 Word Processor Ruler Bar 119
6.3 Using Find and Replace 119
6.3.1 Find Option 119
6.3.2 Replace Option 120
6.4 Working with Text 120
6.4.1 Modifying Fonts 120
6.4.2 Formatting Paragraphs 121
6.5 Using Word Processor Spell Check 122
6.6 Using Macros 124
6.6.1 Defining Macros 124
6.6.2 Inserting Macros 126
6.7 Printing a Report 127
6.7.1 Print Report Dialog Box 127
6.7.2 ASSR Print Report Dialog Box 129
6.7.3 Print Setup Dialog Box 131
6.7.4 Customizing the Report Template 132

7 Exporting, Importing, and Archiving Records 134
7.1 Overview 134
7.2 Exporting Patient Records 134
7.3 Reviewing Exported Database Patient Records 135
7.4 Importing Patient Records 136
7.5 Archiving Patient Records 136
7.6 Working with Archived Patient Records 138
8 Calibration and External Trigger 140

8.1 Calibration for ICS Chartr EP 200 140
8.2 External Trigger 140
9 Troubleshooting 142
9.1 Overview 142
9.2 Test Fixture 142
9.3 Fuse Replacement 144
9.4 Database Repair Utility 144
10 Safety 146
10.1 Symbols Used 146
10.2 Warning Notes 146
10.3 Manufacturer 149
10.3.1 Responsibility of the manufacturer 149
11 Technical Specifications 150

11.1 ICS Chartr EP 200 System 150
11.2 ICS Chartr EP 200 and MCU 90 XP (tower) Specifications 151
11.2.1 System Capabilities 151
11.3 Accessories and Cables 152
11.4 Guidance and manufacturer’s declaration tables 154
11.5 MCU 90 XP (tower) Specifications 158
11.6 ASSR Specifications 159
App. 1 Data Collection Reference 160

App. 1.1 Test Room Setup 160
App. 1.2 Supplies Required 160
App. 1.3 Electrode guidelines 160
App. 1.4 Skin Preparation 160
App. 1.5 Electrode wire connections 161
App. 1.6 Electrode Montages 161
App. 1.6.1 1 and 2-Channel Recordings 162
App. 1.6.2 Tips for TM (tympanic membrane) ECochGtrode 164
App. 1.6.3 Tips for Tiptrodes 165
App. 1.6.4 Auditory Steady State Response (ASSR) 166
App. 1.6.5 Vestibular Evoked Myogenic Potential (VEMP) 168
App. 1.7 Modifying Normal Hearing Level Thresholds 173
App. 1.8 Checking Electrode Impedance 174
App. 1.9 Using the New Test Tab 175
App. 1.10 Using the Settings Tab 176
App. 2 Keyboard Shortcuts 179

App. 2.1 Menu/Submenu Options 179
App. 2.2 Word Processor Keyboard Shortcuts 180

App. 3 Function Keys 181
App. 3.1 During Data Collection 181
App. 3.2 Data Collection Paused 181
App. 3.3 New Test Tab (all but VEMP) 182
App. 3.4 New Test Tab - VEMP only 182
App. 3.5 New Test Tab - ASSR only 183
App. 3.6 Continue (Resume) Data Collection 183
App. 3.7 Review Tab 184
App. 3.8 Review Test Tab - ASSR only 184
App. 3.9 Before reviewing Patient Data from another Database 185
App. 3.10 Review Patient Data from another Database 185
App. 3.11 Before selecting an Archived Patient Record 185
App. 3.12 Review Archived Patient Data 185
App. 4 Normative Data 186

App. 4.1 Toneburst Normative Data 194
App. 5 Customizing the Word Processor Report 198

App. 5.1 Overview 198
App. 5.2 Default Page Layout and Design 198
App. 5.3 Database Information 199
App. 5.4 Customizing the Report Template 200
App. 5.5 Report Template Database Tags 201
App. 5.5.1 Patient Report Database Access Tags 201
App. 6 Error Messages 203

App. 6.1 Startup Error Messages 203
App. 6.2 Database Error Messages 204
App. 6.3 Data Collection / Testing Error Messages 205
App. 6.4 Review / Waveforms Error Messages 207
App. 6.5 Report, Printing, and Word Processing Error Messages 209
App. 6.6 Calibration Error Messages 210
App. 6.7 Other Error Messages 212
App. 7 Setting up the Hardware 213

App. 7.1 Setting up the ICS Chartr EP 200 Hardware 213
App. 7.2 Setting up the MCU 90 XP (tower) Hardware 214
App. 7.3 Chartr EP 200 Back Panel 214
App. 7.4 Chartr EP 200 Remote Control 215
App. 8 Installing/Reinstalling ICS Chartr EP 200 Software 216

App. 8.1 Installing ICS Chartr EP 200 Software 216
App. 8.2 Uninstalling ICS Chartr EP 200 Software 234
App. 8.3 Reinstalling ICS Chartr EP 200 Software 235
App. 8.4 Demo Database 235
App. 9 Troubleshooting Noise 236
App. 10 Glossary 238

1 Introduction
1 Introduction
The ICS Chartr EP 200 system is a sophisticated, yet easy-to-use auditory evoked potential (EP) system that operates in a
Windows operating system environment. While using the system is easy, it requires a familiarity with the Windows oper-
ating system and the ICS Chartr EP 200 software. GN Otometrics highly recommends that operators read this manual prior
to attempting tests.
1.1 Intended Use

The ICS Chartr EP 200 system is indicated for auditory or vestibular evoked potential testing as an aid in detecting hearing
loss, hearing and vestibular related functions, and lesions in the auditory pathway.
The ICS Chartr EP 200 VEMP monitor is a biofeedback device capable of monitoring a muscle at rest or in function by
means of surface electromyography.
1.2 Intended User

This manual describes the use of the device in combination with the software. Readers are assumed to have prior know-
ledge of the medical and scientific facts underlying the procedure. For this reason, the examination methods are men-
tioned only to the degree that is necessary for a correct, safe application of the ICS Chartr EP 200 system.
1.3 About this manual

This is your guide to using the basic functions required for navigating in the ICS Chartr EP 200 program. This includes key
features such as printing test results, handling patient and user administration, and data and test device management.
Access to digital version

All information in this manual is accessible whenever you are logged into the ICS Chartr EP 200 program. Use one of these
Help options to display the digital version:
• Select Open from the Help menu
• Click the button available in many dialog boxes

• Press the keyboard F1 key
• Click the on-screen function key button F1
Safety
This manual contains information and cautions which must be followed to ensure the safe performance of the ICS Chartr EP
200 system.
Caution • Local government rules and regulations, if applicable, should be followed at all times.
Safety information is stated where it is relevant, and general safety aspects are described in Chapter Safety ► 146.

1 Introduction
1.4 Typographical conventions

The use of Warning, Caution and Note
To draw your attention to information regarding safe and appropriate use of the device or software, the manual uses pre-
cautionary statements as follows:
Warning • Indicates that there is a risk of death or serious injury to the user or patient.
Caution • Indicates that there is a risk of injury to the user or patient or risk of damage to data or the device.
Note • Indicates that you should take special notice.
1.4.1 Navigating this manual

Window icons and functions to select are shown in bold type, as for instance in:
• Click Help

2 Getting Started in ICS Chartr EP 200ICS Chartr EP 200

This section is designed to orient you to the ICS Chartr EP 200 program. The section includes detailed descriptions of the
Main window and the menu bar commands, along with information on using the function keys and dialog boxes.
Note • Please review the information in App. 9 Troubleshooting Noise ► 236 if ICS Chartr EP 200 is installed on
a networked workstation.
2.1 ICS Chartr EP 200 Work Session

During an ICS Chartr EP 200 work session, the operator may choose to review patient records, conduct new tests, or
modify system, test, and database records.
2.1.1 Starting an ICS Chartr EP 200 Work Session

The Operator Login dialog box is the starting point for an ICS Chartr EP 200 work session. An operator must be selected to
access the Main Window.
To start a ICS Chartr EP 200 work session

1. Press the Power button on the computer to turn on the system and display the Windows Desktop.
Fig. 1 ICS Chartr EP 200 Icon
2. Double-click (ICS Chartr EP 200 icon) on the Desktop to display the Operator Login dialog box.
Alternative: Click the Start button on the task bar and select Programs> GN Otometrics > ICS Chartr EP 200 to dis-
play the Operator Login dialog box.

Fig. 2 Operator Login Dialog Box
3. Click on an operator name to select it and click OK . In the ICS Chartr EP 200 Main Window that displays, the selected
operator's name is listed on the title bar.
If an operator is not on the list, click New to display the Add Operator dialog box. Type the requested information in
the text boxes and click OK . The new operator's name is listed on the title bar.
Note • See Establishing Operator Information ► 57 for information on how to set up an operator.
2.1.2 Ending an ICS Chartr EP 200 Work Session

The system automatically saves the patient information from the work session when the application closes.
Warning • Failure to properly close the application may result in data corruption. The next time you open ICS
Chartr EP 200, the system will display an error message warning that the application was not closed properly.
To end an ICS Chartr EP 200 session

1. Select File > Exit on the Menu bar to display the End Chartr EP Session dialog box or:
– press F12 on the keyboard,
– click F12 Exit on the Function Key bar, or
– click the Close button on the Title bar.

Fig. 3 End ICS Chartr EP 200 Session Dialog Box
2. Click OK.

2.2 ICS Chartr EP 200 Main Window

The ICS Chartr EP 200 main window is the primary workspace. Testing and review activities are performed directly from
the main window. Other activities, such as entering and modifying patient data, are done in dialog boxes that sit on top of
the main window. The main window displays after the Operator Login dialog box at the beginning of a work session.
Fig. 4 ICS Chartr EP 200 Main Window
Areas displayed with or without Function/Purpose

patient selected
A Title bar View patient and operator names
B Menu bar Select program options
C Toolbar Quick access and labeling waveforms
D Function/Operation keys Select program options
E Status bar View program information
F Maximize/Minimize Close buttons Toggle between testing and review modes

Additional areas displayed with Function/Purpose

patient selected
G Ongoing EEG box Display EEG waveforms during data collection
H Tabs - Review, New Test, and Settings Select a tab to review data, select a protocol, or change protocol set-
tings
I Test Lists - New or Review Depending on tab selected, displays test procedures available (New
Test tab) or performed (Review tab).
J Calculation box View waveform calculations
K Waveform data Displays the number of accepted sweeps and the number of rejected
sweeps during collection. Displays Cursor A location (ms), Cursor B loc-
ation (ms), the difference between Cursor A and B latency (A – B), the
difference between Cursor A and B amplitude (Av – Bv), the EMG value
(VEMP only), the Interaural Wave V (IT5), and the Asymmetry Ratio
(VEMP only).
VEMP monitoring is available only if the VEMP monitor application has
been included.
L Waveform work area View collected waveforms
M X-axis labels (area indicated by gray When waveforms with the same sweep time and delay are displayed,
rectangle) the X-axis divisions are labeled in ms
N Waveform bank numbers Select waveform by number
O Waveform page comments box Type comments to be saved with waveforms
2.2.1 New Test Tab

Select the New Test tab to access the testing mode and begin a patient test session. The New Test tab contains a
sequenced list of established procedures and protocols.
Note • Not all protocols are available in ICS Chartr EP 200 Limited.
The highlighted item indicates the current test.

Fig. 5 New Test Tab
To conduct a test, select a procedure and click or press F12 Collect or select Test > Collect on the menu bar.
Note • Chapter Data Collection ► 63 provides information on how to conduct patient tests. See Creating a New
Protocol ► 77 for information on how to establish protocols, and Modifying a Protocol ► 77 for information on
how to change trial settings.

2.2.2 Review Tab

Select the Review tab to begin a review session. Click the EP button to view the EP protocols, or click the ASSR button to
view the ASSR protocols. The Review tab has two main elements, the Physician Order list and the Trial/Channel list.
Fig. 6 Review Tab - EP / Review Tab - ASSR
Patient test results are stored in the database by physician order date. The system assigns the current date and time to a
physician order when a new patient is added to the database. Tests are conducted under that physician order until an oper-
ator creates a new physician order. Multiple physician orders may be created for each patient.
Click the drop-down arrow to see a list of physician orders for the patient. Click on a physician order date to display the Tri-
al/Channel list. This list contains test procedures (ABR, ECochG, etc.) and associated trials. Click the + sign in front of a trial
to display the Channels. Double-click on a Channel to display the test results in the Waveform Page or click on a channel
and press the Enter key to display the results.
Note • See Data Analysis ► 90 for information on the Review mode.

2.2.3 Settings Tab

Select the Settings tab to see a subset of trial settings for the currently selected protocol. Each button on the Settings tab
displays the current value for the trial setting.
Fig. 7 Settings Tab
Click a button to display a pop-up menu of available values. Click on a value to select it and change the trial setting. The
Stimulus button does not have a pop-up menu. Click the Stimulus button to toggle between Tone and Click. Select Syn-
chronous Masking to automatically adjust masking levels when the stimulus level is increased or decreased. The masking
level difference is set up in the Trial Settings.
• If a trial setting value is changed during a test, the system discards the current test results and restarts the test using
the new settings.
Note • Results from completed trials are not discarded.
• Once a trial setting value is changed, the change is applied to the currently selected trial setting, but is not saved to
the database.

2.2.4 Toolbar
The buttons on the toolbar offer quick access to a variety of program functions.
Fig. 8 Toolbar for ABR protocol
Fig. 9 Toolbar for VEMP protocol
The set of buttons change according to the protocol being used. For example the set of markers are different for some pro-
tocols. If you don't know the purpose of a particular button, place the cursor over the button to see a brief descriptive
name or refer to the following list. Click on a button to activate the function.
Button Name Function
Font Set the default font for demographic, facility, and report inform-
ation. This may be required for central European character sets.
Open New Display the Add Patient dialog box; create a new patient record.
Open Existing Display the Patient Selection dialog box; open a patient record.
Print Report Print a report; display the Print Report dialog box.
Cut Delete the selected waveform.
Copy Make a duplicate of the selected waveform and store it on the Clip-
board.
Paste Place the copy of the waveform on the Clipboard at the cursor.
Previous Page Display the waveform page constructed just before the current
page.
Next Page Display the next waveform page or a blank waveform page.
Markers Place a marker label on a selected waveform.

(The available markers vary depending on the procedure that gen-
erated the selected waveform. For a list of the markers available for
a given procedure, see Marking Waveforms ► 98.
Clear Markers Clear all markers on the selected waveforms.

Shaded Normative Data When selected, areas on the selected wave that correspond to the
normative data built into the system are indicated by hatched shad-
ing. Date of birth and gender information are taken from the
patient's database entry.
Split Screen Split the waveforms such that waveforms with the left ear stim-
ulated are on the left side and waveforms with the right ear stim-
ulated are on the right side.
Grid Display vertical grid lines.
Continuous Stimulation Continue the audio tone after a protocol ends. Click again to dis-
continue the tone. This is ideal for unsedated infants and children.
Continue Trial Enable data collection (number of sweeps) beyond the set limits.
Click again to discontinue the option. Do not use Continue Trial
with linked (sequential) protocols.
Merge New Waveform Merge waveforms automatically at the beginning of a trial. Merge
will sort and order the waveforms on a page based on the ear stim-
ulated, the collection channel, the stimulus intensity, and the tone
frequency.
Interaural Display the latency difference between Wave V of a left waveform

Wave V and right waveform. Waveforms selected must be collected using an
ABR click protocol and must have Wave V marked.
Asymmetry Ratio Display the asymmetry ratio for a left VEMP waveform and a right
VEMP waveform. Waveform selected must be collected using a
VEMP protocol and have P1 and N1 marked.
Asymmetry Ratio is available only if the VEMP monitor option has

been purchased.
Normalized Display the normalized asymmetry ratio. (Normalized by dividing out

Asymmetry Ratio the EMG levels.)
Normalized Asymmetry Ratio is available only if the VEMP mon-

itor option has been purchased.

Decrease or increase Decrease (+) or increase (-) the display scale used for the waveform.
waveform display scale The defaults are stored in the Trial Settings. An increase or
decrease will change based on the built-in defaults.
Sets display scale Displays the window to set the display scale:
See Using the Waveform Pop-Up Menu ► 94 for information

about the display scale.
Help Display the User Manual
2.3 Menu Bar

The Menu bar is located at the top of the Main Window.
Fig. 10 Menu Bar
Each menu contains related options and commands. Many of the commands may also be accessed by using the function
keys or the toolbar buttons.

2.3.1 File Menu

The File Menu options allow the operator to perform actions such as open and close patient records, change physician
orders, print reports, and perform database maintenance activities.
To access the File menu, select File on the menu bar or press Alt+F on the keyboard. After the menu displays, click on a
menu option or type the underlined letter in the option name to select the option.
Note • The > symbol indicates more options are available for this item. Click on the item to display another menu
with more options.
Fig. 11 File Menu
New Patient Display the Add Patient Information dialog box; establish a new patient record.
Existing Patient Display the Patient Selection dialog box; select a patient from the list of patients in the data-
base.
Delete Patient Display the Delete Patient dialog box; remove a patient record from the database. An open
patient record cannot be deleted. Close the patient record before attempting to delete the
record.
Close Patient Close and save the active patient record. (Only available when a patient record is open.)
Printer Setup Display the standard Windows’ Print Setup dialog box; select a printer and printer options for
printing ICS Chartr EP 200 reports.
Print EP Report Print a copy of the active patient report. (Only available when a patient record is open.)
Print ASSR Report Print a copy of the ASSR report for the active patient. (Only available when ASSR trial results
are available and a patient record is open.)
Logout (Switch Oper- Display the Select Operator dialog box.
ator)
Exit Close the open patient record, quit theICS Chartr EP 200 program, and return to the Windows
Desktop. The system automatically saves all waveform pages.

2.3.2 Database Menu

The Database Menu options allow the operator to perform patient database activities.
Fig. 12 Database Menu
Open Main Database Open the current (not archived) database and view patient records.
Open Archived Database or Expor- Open a previously archived database and view patient records. (Only available
ted Patient when patient records are closed.)
Open Floppy Disk Patient Read the patient database from a 3½” floppy disk.
Export Patient to Database Send the current patient record to an archived database. (Only available when a
patient record is open.)
Import Patients from Database Send the database information for a patient from an archived database to the cur-
rent system.
Export Patient to Floppy Disk Send the current patient record to a floppy disk. (Only available when a patient
record is open.)
Import Patients from Floppy Disk Send the database information for a patient from a floppy disk to the current sys-
tem.
Archive and Start New Database Save the current patient database and send it to a storage location. (Only avail-
able when patient records are closed.)
Convert Database to Latest Version Convert a previously stored database to the main database (active database).

2.3.3 Setup Menu

The Setup Menu options allow users to enter and modify information about the facility as well as establish new operators,
referring physicians, and referring facilities. Some options are only available when patient records are closed.
Fig. 13 Setup Menu
Edit Facility Info Display the Facility Setup dialog box.

Add New Protocol Display the Add New Protocol dialog box; establish a new trial protocol.
Edit Current Protocol Display the Edit Protocol dialog box; modify the parameters for a previously
established protocol.
Delete Protocol Display the Delete Protocol dialog box; remove a protocol from the test tab.
Add New Operator Display the Add Operator dialog box.
Edit Existing Operator Display the Operator Selection dialog box. Select an operator and display the
Edit Operator dialog box.
Delete Operator Display the Operator Selection dialog box. Select an operator. The system
prompts to confirm deletion. (Only available when related patient records are
archived.)
Add New Referring Facility Display the Add Referring Facility dialog box; set up a new referring facility.
Edit Existing Referring Facility Display the Select Referring Facility dialog box. Select a facility and display the
Edit Referring Facility dialog box.
Delete Referring Facility Display the Select Referring Facility dialog box. Select a facility. The system
archived.)
Add New Referring Physician Display the Add Referring Physician dialog box.

Edit Existing Referring Physician Display the Select Referring Physician dialog box. Select a physician and display
the Edit Referring Physician dialog box.
Delete Referring Physician Display the Select Referring Physician dialog box. Select a physician. The system
archived.)
2.3.4 Test Menu

The Test Menu provides access to testing options and is only available when a patient record is open. This menu is used to
initiate testing and change some test options. The testing options can also be operated using the toolbar and function keys.
In addition, operators can change the Trial Settings and display the Test Parameters list.
Fig. 14 Test Menu
Impedance Display the Impedance dialog box and check electrode performance status.
Continuous Stimulation Activate or deactivate the continuous stimulation option. (Pressing Ctrl+T on the
keyboard also activates this option.) A check mark indicates the option is selec-
ted.
Start EEG Start display of EEG response (or press F9 Start EEG).
Stop EEG Stop display of EEG response (or press F9 Stop EEG).
Collect Start collection of patient data. This is the same as pressing the F12 function key
on the screen or the keyboard.

Reset Cancel the trial in progress, reset the sweep counts back to zero, and restart the
current test (or press F9 Reset). (only in test mode)
Stop Stop the current test (or press F11 Stop). (only in test mode)
Pause Temporarily stop the current test. (only in test mode)
Resume Restart a paused test. (only in test mode when a test is paused)
Extend EP Sweeps Extend the active trial by increasing the maximum sweeps (or press F10 Increase
Sweeps). (only in test mode)
Extend ASSR Test Extend the active trial by increasing the search time.
Skip ASSR Test Skip the intensity chosen and move to the next intensity based on the minimum
step set in trial settings.
Continue EP Trial Activate or deactivate the continue trial option; allows the operator to continue
the trial after the maximum sweeps has been reached. A check mark indicates
the option is selected.
Cancel Continued Trial Stop the current test and do NOT save the data.
Save Continued Trial Stop the current test and save the collected waveforms. (or press F11 Save) (only
in test mode when the Continue Trial option is selected.)
Artifact Level Display artifact levels that can be set by the user (100% artifact level equals the
full range). Reduce the artifact percentage to reject more artifact. (Only available
in Chartr EP 200)
Merge New Waveforms Merge waveforms at the beginning of a trial. Merge will sort and order the wave-
forms on a page based on the ear stimulated, the collection channel, the stim-
ulus intensity, and the tone frequency.
Start VEMP Monitor Start the collection of EMG.
Stop VEMP Monitor Stop the collection of EMG.

2.3.5 Edit Menu

The Edit menu provides access to editing options for modifying patient records in the database and the patient inform-
ation report. In addition, you can use this menu to copy, paste, and delete selected waveforms in the waveform work area.
This menu is only available when a patient record is open.
Fig. 15 Edit Menu
Report Open the ICS Chartr EP 200 Word Processor and display the Patient Information portion of the
report. Edit the report in the Word Processor. See Printing a Report ► 127 for more inform-
ation.
Patient Info Display the Edit Patient Information dialog box; edit patient demographic information and phys-
ician order information.
New Physician Order Display the Add Physician Order dialog box; establish a new physician order for the active
patient. (Only available when a patient record is open.)
Cut Delete the selected waveform(s) and place on the Clipboard. Use the Paste option to copy
items from the Clipboard to the same or another Waveform Page.
Note • The Clipboard is a temporary storage location. When a new selection is cut or
copied, it replaces the previous Clipboard content. The content is inserted when Paste
is selected and can be pasted as many times as desired.
Copy Save a copy of the selected waveforms, associated text, and markers to the Clipboard and retain
the original. Use the Paste option to copy waveforms from the Clipboard to another location.
Paste Place the contents of the Clipboard on the current page. Waveform markers associated with a
waveform are moved or copied with the waveform.
Delete Delete the selected waveform(s) from the waveform page.
Note • Waveforms are deleted only from the current waveform page. The original
waveform data is always available from the Review tab.
Select All Select all waveforms on the current waveform page.

2.3.6 Waveform Menu

The Waveform menu allows operators to initiate action on selected waveforms and to perform various related activities
such as display normative data or add a label. This menu is only available when a patient record is open.
Note • See Data Analysis ► 90 for information on how to work with waveforms.
Fig. 16 Waveform Menu
Overlay All Select and superimpose all of the waveforms.

Overlay Selected Superimpose only the currently selected waveforms.
Spread Create equal vertical distance between all the waveforms on the current page.
Merge Sort and order all waveforms on the current page according to the tone
frequency, ear stimulated, the collection channel, and the stimulus intensity. See
Section 5 for more information.

Asymmetry Ratio Display the asymmetry ratio for a left VEMP waveform and a right VEMP wave-
form. Waveform selected must be collected using a VEMP protocol and have P1
and N1 marked.
(AmpL - AmpR)
100 x
(AmpL + AmpR)
Asymmetry Ratio is available only if the VEMP monitor option has been pur-
chased.
Normalized Asymmetry Ratio Display the normalized asymmetry ratio by dividing out the EMG levels.
(AmpL/Left EMG) - (AmpR/Right EMG)
100 x
(AmpL/Left EMG) + (AmpR/Right EMG)
Normalized Asymmetry Ratio is available only if the VEMP monitor option has
been purchased..
Interaural Wave V Display the latency difference between Wave V of a left waveform and right wave-
form. Waveforms selected must be collected using an ABR click protocol and
must have Wave V marked.
Add Combine from two to nineteen selected waveforms. The resultant waveform
represents a weighted sum of the component waveforms and displays as a new
waveform.
Subtract Subtract two waveforms. The second selected waveform is subtracted from the
primary (first) selected waveform. The result of the subtraction displays as a third
waveform.
Smooth Impose a weighted average on selected waveforms. The effect is to reduce the
noise in the waveform. Select the amount of smoothing to be applied from the
list (7 points, 11 points, 13 points, 17 points, or 23 points), where 7 points is the
least amount of smoothing and 23 points is the greatest amount of smoothing.
The smoothing is imposed on the selected waveforms and displays on the wave-
form page. The original waveform data is unchanged.
Unsmooth Return the selected waveforms to their original pre-smoothed state.
Invert Reverse the polarity of the display of the selected waveform(s). Select Invert
again to revert the polarity to its original state.

Text Display the Waveform Text dialog box. Use the dialog box to enter information
about a specific waveform.
Fig. 17 Waveform Text Dialog Box
Normative Data Display the Normative Data dialog box. See Data Analysis ► 90 for more inform-
ation.
Display Scale Display the Display Scale dialog box. Use the drop-down list to change the ver-
tical display scale (in microvolts) of the selected waveform. The vertical display
scale makes the amplitude excursions smaller or larger.
Left Labels Display waveforms labels on the left side of the waveform workspace.
Right Labels Display waveforms labels on the right side of the waveform workspace.
Hide Labels Do not display waveform labels.

2.3.7 Page Menu

The Page menu allows the operator to work with the elements of the Waveform page workspace. This menu is only avail-
able when a patient record is open.
The page number displays in the bottom right-hand corner of the waveform page and indicates which waveform page is cur-
rently displayed and how many waveform pages exist in the patient record (e.g., Page 3 of 6).
Select Page on the menu bar or press Alt+P on the keyboard to display the Page menu.
Fig. 18 Page Menu
Pre- Display the previous waveform page.

vious
Next Display the next waveform page. This page may contain previously collected waveforms or may be blank.
Go To Display the Go To Page dialog box. Type the desired page number in the Page text box and click OK.
Page
Fig. 19 Go To Page Dialog Box
New Display a new blank page as the last page of the waveform pages for the current patient.
Clear Remove all the waveforms from the current page but do not delete the page.
Delete Delete the current waveform page.

Split Split the waveform display work area vertically as shown.
Fig. 20 Split Waveform Work Area

2.3.8 Display Menu
Fig. 21 Display Menu
Grid Place a grid on the waveform work area.

Change Font Select the default font for demographic, facility, and report information.
Shaded Normative Data When selected, areas on the selected wave that correspond to the normative data
built into the system are indicated by hatched shading. Date of birth and gender
information are taken from the patient's database entry.
PediGram Display the Tone-Burst Wave-V Thresholds dialog box, PediGram tab. See Data Ana-
lysis ► 90 for more information.
EP Test Parameters List Display the Test Parameter dialog box to view the settings for all waveforms col-
lected for the patient. Use the Print Report dialog box to print the list.
Fig. 22 Test Parameters Dialog Box
ASSR Test Parameters List Display the ASSR Test Parameter dialog box to view the settings for all ASSR data col-
lected for the patient. Use the Print ASSR Report dialog box to print the list.

ASSR Threshold Search Limits Display a line where upper and lower limit of the threshold search were set in the
trial settings.
ASSR Responses Display negative, positive, and skipped responses.
ASSR Thresholds Display where the response threshold is located.
Apply ASSR Correction Factors Apply the correction factors to the ASSR thresholds.
Merge Multiple ASSR Searches Create a merged audiogram by combining test results from various dates and times.
See ASSR Merge Multiple Searches ► 106.
Export Waveform to Text Files Save data to ASCII text files.
2.3.9 Calibration Menu
Fig. 23 Calibration Menu
Hardware Tone Calibration Calibrate the audio board for a 1-kHz tone using the primary transducer.
ASSR Hardware Calibration Calibrate the ASSR hardware.
Frequency-Specific Tone Calibration Calibrate all frequencies of each applicable transducer type.
Hardware Masking Calibration Calibrate the audio board for masking.
ANSI Hearing Level Thresholds Edit the ANSI values which define 0 dB HL for all transducers and frequencies.
Normal Hearing Level Thresholds Edit the values which define 0 dB nHL for all transducers and frequencies.
nHL/SPL Conversion Table Display the normal hearing level thresholds in dB SPL.
ASSR Audiogram Correction Factors Display a table of the ASSR correction factors (dB HL).
Export Tone Exports the calibration file.
Import Tone Imports the calibration file.

2.3.10 Help Menu
Fig. 24 Help Menu
The Help Menu provides access to the ICS Chartr EP 200 Operator's Manual. Select Help on the Menu bar, press Alt+H or
F1 on the keyboard, or click the F1 Help function key to access the Help menu.
Open Display Operator’s Manual

About Display the About ICS Chartr EP 200 dialog box with software version and date information. If you call
GN Otometrics Customer Support for assistance with a software problem, you will be asked to access this
information.

2.4 Waveform Page

The Waveform Page is the focus of most activity during evoked potential testing. It displays the waveforms during col-
lection and is used to mark and position waveforms for printing.
Waveforms display on a Waveform page and each page may contain up to 20 waveforms. A colored Bank button located at
the bottom of the waveform page is associated with each waveform on the page.
Fig. 25 Waveform Page
A. Number of Accep- E. Waveform Handle I. Interaural Wave V

ted Sweeps F. Waveform Inform- J. Asymmetry Ratio (for VEMP)
B. Number of Rejec- ation for Selected K. Normalized Asymmetry Ratio (for VEMP)
ted Sweeps Wave If Normalized Asymmetry Ratio was chosen, an “N”
C. Cursor Information G. Waveform Bank appears in front of the ratio to indicate it has been nor-
D. Cursor (A) button malized.
H. Waveform Page
number
Waveform colors
No ear selected Black
Left ear stimulated Blue

Right ear stimulated Red

Binaural ear stimulation Green
Selected waveform Orange
Currently collecting data Magenta
2.4.1 A and B Cursors

Two cursors, A and B, are used to measure amplitude and latency and to position the waveform marker labels. Move the
active cursor along the selected waveform by dragging the cursor with the mouse or by pressing the right or left horizontal
arrow keys. To select a cursor, click on the A or B handle, or press the a or b keys on the keyboard. The active cursor is
dark gray the inactive cursor is light gray. In Figure 47, cursor B is the active cursor.
2.4.2 Waveform Handles

Click on a Waveform Handle to select a waveform. The color of the handle will change from white to yellow to
indicate the selected waveform is primary. Press and hold the Control (Ctrl) key on the keyboard, then click on
another waveform handle to select additional waveforms. The primary waveform handle will remain yellow and
the secondary selected waveform handles will be blue.
Note • You may also click on the associated Bank button to select the waveform. See Data Analysis ►
90 for more information on how to work with waveforms.
Move selected waveforms up and down the page (or across in the case of a split page) by dragging and dropping
the handle to a new location. You may also move selected waveforms by pressing the up and down arrow keys
on the keyboard.
To deselect the primary waveform, hold the Control (CTRL) key and left click.
2.4.3 Accepts/Rejects and Cursor Information

The Accepted/Rejected Information line is located along the top of the Waveform page.
Fig. 26 Accepts/Rejects and Cursor Information
The first two items are the Sweeps Accepted/Rejected counters indicating the number of accepted and rejected sweeps
for the test in progress. This is followed by the latency and amplitude information that includes the absolute latency (in
milliseconds) at each cursor (A and B), the time between A and B cursors (|A – B|), and the voltage difference (amplitude)
between the A and B cursors (|Av – Bv|).
EMG The µV of the electromyograph for the selected side (only for VEMP protocol).
Interaural The difference in the latency of Wave V for a left and right waveform.
Wave V

Asymmetry Display can be either the asymmetry ratio or the normalized asymmetry ratio
Ratio If Asymmetry Ratio was chosen, the calculated differences between the amplitude of the right and left
VEMP displays.
(AmpL - AmpR)
100 x
(AmpL + AmpR)
If Normalized Asymmetry Ratio was chosen, an “N” appears in front of the ratio to indicate it has been
normalized.
(AmpL/Left EMG) - (AmpR/Right EMG)

100 x
(AmpL/Left EMG) + (AmpR/Right EMG)
To activate you must mark a right and a left waveform then highlight each (click one waveform then
choose the second by holding down the Ctrl key and selecting the second waveform)
Asymmetry Ratio and Normalized Asymmetry Ratio are available only if the VEMP monitor option is
included in your installation.
2.4.4 Waveform Information

The Waveform Information line is located below the Waveform work area, just above the Bank buttons.
Fig. 27 Waveform Information
The information on this line, from left to right, is:

• Procedure name – indicates the procedure name for the selected waveform.
• Trial/Channel number – the number to the left of the decimal represents the chronological number of the test and
the number to the right refers to the channel number collected.
• Horizontal scale, milliseconds per scale division
• Vertical scale, microvolts per scale division
• Stimulus intensity in dB nHL
• Stimulus type and polarity
• Number of sweeps accepted and rejected
• Stimulus repetition rate
• Number of smoothing points used
• Waveform page number and total number of pages
In Fig. 27 ► 37, the information line indicates that the selected waveform is record 1.1 (first trial/set of waveforms col-
lected, channel 1). The display scale is 1.5 msec per division on the x axis and 0.20 µVolts per division on the y-axis. The
stimulus intensity for this recording is an 80 dB nHL rarefaction click. 1555 samples were accepted and 0 samples were
rejected. The stimulus repetition rate is 21.7 clicks per second. This is the first page of eight waveform pages for this
patient under the active physician order.

2.4.5 Waveform Bank Buttons

The Waveform Bank buttons are located along the bottom of the waveform page. Each waveform page can hold up to 20
waveforms and has 20 Bank buttons.
Fig. 28 Waveform Bank Buttons
The number on each button is matched to the waveform handle number on the right-hand side of each waveform. Colored
buttons indicate the button is associated with a waveform. Click on a Bank button to select the corresponding waveform.
2.5 Calculation Box

The Calculation box is located on the left side of the window below the Waveform Bank buttons.
Fig. 29 Calculation Box; Collection Mode
The Calculation box shows one of two displays depending on the current operational state of the program. When col-
lecting data and marking waveforms, this box displays latency (absolute and interpeak interval) and amplitude information
for the selected waveform on the current waveform page. In Review mode when a channel is selected in the Review tab,
the box displays the stimulation and acquisition parameters for the selected wave.
2.6 Waveform Page Comments Box

The Waveform Page Comments box is located on the lower right side of the Main Window below the Waveform Bank but-
tons.
Fig. 30 Waveform Comments Box
Comments relating to the displayed waveform page can be typed in this area. Once typed, the information is saved with
the waveform page. The comments will be included as part of the printed report for this patient.
Place the cursor in the box and begin to type. The Comments box will accept approximately 250 characters per waveform
page. To delete or correct a comment, place the cursor in the comment box and press the Backspace key on the keyboard
as needed.

3 Establishing and Maintaining Records

3.1 Patient Information
3.1.1 Patient Selection Dialog Box

The Patient Selection dialog box contains a list of all of the patients in the database. Use this dialog box to open an existing
patient record and display the test results.
Access this dialog box from the Main Window using the File > Existing Patient option on the Menu bar or the F3 Existing
Patient function key.
Fig. 31 Patient Selection Dialog Box
Note • Data in each column can be sorted in ascending or descending order. Click on the Patient Name heading
box to sort the Patient Name list alphabetically. Click on the Date Last Tested heading box to sort the list chro-
nologically. Click on the Test Data heading box to sort by records with and without test results. Click the heading
box again to change the order.

Information Area
Patient Name Displays a list of all patients in the database. Click the desired patient name to highlight it from
the list of existing patients.
Last Tested Indicates the last date on which the patient was tes ted. Patient test records are maintained and
sorted by this date.
Test Data Indicates the type of data (ENG/VNG, EP only).
Birthdate Lists the date of birth (month/day/year) for each patient.
Buttons
OK Open the selected patient record.
Cancel Exit this dialog box without selecting a patient.
3.1.2 Patient Information Dialog Box

ICS Chartr EP 200 patient records contain personal information, physician order information, and test result data. Patient
information is entered and maintained using various forms of the Patient Information dialog box:
• Add Patient Information dialog box allows operators to setup and enter information for a new patient.
• Edit Patient Information dialog box allows operators to modify an existing patient record.
Fig. 32 Add Patient Information Dialog Box, Patient Information Tab
3.1.2.1 Patient Information Tab

The information from the Patient Information tab is stored in the database. It is used to track patient status and generate
reports.
The Patient Information dialog box contains the following:
Last Name Required. Type the last name of the patient.

First Name Required. Type the first name of the patient.

Birthdate Required. Indicate date of birth:

Month Type the 1- or 2-digit month of birth.
Day Type the 1- or 2-digit day of birth.
Year Type the 4-digit year of birth.
Gender Required. Select the gender: male or female. A dot indicates the selected
option.
Address Type the street address.
City Type the city name.
State Type the state or 2-digit state code.
Zip Code Type the zip code, up to 15 digits.
Country Type the country name.
Phone Number Type the telephone number.
Identification Type identifying information such as a social security number.
Weeks at Birth Type the number of weeks of fetal development on the date of birth.
Buttons
OK Accept the information in both tabs of this dialog box and save it to the database.
Cancel Close the dialog box without saving newly entered information.

3.1.2.2 Physician Order Tab

The Physician Order tab is on both the Add and Edit Patient Information dialog boxes.
Fig. 33 Edit Patient Information Dialog Box, Physician Order Tab
Referring Physician Click the desired physician name from the list of referring physicians to select a
physician.
Referring Facility Click the desired facility from the list of referring facilities.
Referring Notes Type any notes provided by the referring physician or facility for the named patient.
Physician Order Date System supplies the current date and time. This becomes the physician order date
and is used to sort test records for the patient.
Buttons
OK Accept the information in both tabs of this dialog box and save it to the database.
Cancel Close the dialog box without saving information added to either tab.
3.1.3 Establishing a New Patient Record

A patient record must be established for each patient and all test results and review session results are attached to the cor-
responding patient record. Each patient record may contain multiple physician orders and multiple test sessions.
The ICS Chartr EP 200 program assigns a Physician Order date when the patient record is established. Test records and res-
ults are organized by the physician order date and test session date. A test session is an uninterrupted series of tests or pro-
tocols run on a patient.

To establish a new patient record

1. Access the Add Patient Information dialog box.
– From the Main Window, select File > New Patient from the Menu Bar, or
– Click F2 New Patient, if available, or
– Press F2 on the keyboard.
2. Cursor will start in the Last Name text box. Type the last name of the patient.
Keyboard alternative: press Tab to move the cursor to the next text box and from one button to the next; press
Shift + Tab to return to the previous text box.
3. Place the cursor in the First Name text box and type the first name of the patient. Last and First Names , Birthdate,
and Gender are required. All other items are optional.
4. Continue moving from one text box to the next until all of the patient information requested or available is entered.
5. Click the Physician Order tab and scroll through the list of Referring Physicians. Click on the desired physician name to
highlight it.
Note • If the physician is not listed, you will need to add the physician to the database. See the procedure
Establishing a New Physician ► 48, for more information.
6. Scroll through the list of Referring Facilities and click on the desired Referring Facility name to highlight it.
Note • If the facility is not listed, you will need to add the facility to the database. See the procedure Estab-
lishing Referring Facility Information ► 54, for more information.
7. (Optional) Type any notes or information in the Referring Notes text box.
8. Click OK The information entered in both tabs is saved.

3.1.4 Accessing Existing Patient Information

The patient information portion of a patient record can be modified using the Edit Patient Information dialog box.
To edit existing patient information

1. Select File > Existing Patient on the Menu bar or click F3 Existing Patient to display the Patient Selection dialog box.
2. Scroll through the list of patients and click on the desired patient's name to highlight it. Click Edit and Patient Info to
edit the selected patient's personal information.
Fig. 34 Edit Patient Information Dialog Box, Patient Information Tab
3. Place the cursor in the first text box that needs to be edited and type the correction.
4. Continue moving from one text box to the next until the patient information is correct.
5. Click the Physician Order tab to display the Physician Order dialog box and make any required changes, additions, or
deletions.

Fig. 35 Edit Patient Information Dialog Box, Physician Order Tab
6. Click OK The information entered in both tabs is saved.

3.1.5 Deleting a Patient Record

Use the following procedure to completely remove all of the information (personal and test results) for a patient from the
ICS Chartr database.
Caution • Once a patient record is deleted, it cannot be restored.
To delete a patient record from the database

1. Select File > Delete Patient from the Menu bar to display the Delete Patient dialog box.
Fig. 36 Delete Patient Dialog Box
2. Scroll through the list and click on a patient name to highlight it.
3. Click OK.

Fig. 37 Delete Patient Confirmation Message
4. Click Yes.
Note • If a patient also has VNG/ENG data, only the EP data will be deleted and the patient will remain in the
existing patient list.
3.2 Physician Information

Referring Physician information is stored in the ICS Chartr database. The physician order date and the test session date are
the basis for retrieving multiple records for the same patient.
This section contains a description of the Physician Information dialog box and provides procedures for:
• Establishing a New Physician
• Editing Physician Information
• Deleting a Referring Physician
• Working with Physician Orders
3.2.1 Referring Physician Dialog Box

Referring physician information in the ICS Chartr database includes the physician's name, address, and contact information.
The information is entered and maintained through Setup > Add New or Edit Referring Physician dialog box. Use the:
• Add New Referring Physician dialog box to setup a new physician in the database.
• Use the Edit Referring Physician dialog box to modify the physician information.

Fig. 38 Add Referring Physician Dialog Box
Last Name Type the last name and degree, if desired, of the referring physician.
First Name Type the first name of the referring physician.
Address Type the street address of the physician.
Identification Type any identifying information related to the physician.
Phone 1 Type the primary phone number.
Phone 2 Type another phone number, if available.
Fax Type the fax number, if available.
Email Type the email address, if available.
Buttons
OK Save the referring physician information in the database and close the dialog box.
Cancel Close the dialog box without saving the information.
3.2.2 Establishing a New Physician

The following procedure provides instructions for setting up a new referring physician in the database. The information is
entered on the Add Referring Physician Information dialog box.
To establish a new referring physician in the database

1. Select Setup > Add New Referring Physician to display the Add Referring Physician dialog box.

2. Cursor starts in the Last Name text box. Type the referring physician's last name and degree.
3. Place the cursor in the First Name text box and type the first name of the referring physician.
4. Continue moving the cursor from one text box to the next until you have entered all of the referring physician inform-
ation requested.
5. Click OK.
3.2.3 Editing Referring Physician Information

Use this procedure to edit the information in the database for a previously entered referring physician.
To edit referring physician information

1. Select Setup > Edit Existing Referring Physician on the Menu bar to display the Select Referring Physician dialog
box.
Fig. 39 Select Referring Physician Dialog Box
2. Scroll through the list of referring physicians and click on the desired physician name to highlight it.
3. Click OK.

Fig. 40 Edit Referring Physician Dialog Box
4. Place the cursor in a text box that contains information that needs to be changed, added, or deleted and type or
delete as needed.
5. Continue moving from one text box to the next until you have updated all of the existing physician information.
6. Click OK.
3.2.4 Deleting a Physician Record
Caution • Once a referring physician record is deleted, it cannot be restored.
Use this procedure to delete all information about a referring physician from the database. The delete a physician record
option is only available from the Setup Menu and cannot be accessed during patient testing or data analysis.
To delete a referring physician from the database

1. Close any active patient records and access the Main Window .
2. Select Setup > Delete Referring Physician to display the Select Referring Physician dialog box.
3. Click on a physician's name to highlight it and click OK .

Fig. 41 Delete Referring Physician Prompt
4. Click Yes The information is deleted from the database.
3.2.5 Working with Physician Orders

In the ICS Chartr EP 200 program, data collection results are organized by the physician order date. A physician order binds
the patient data, report, and identifying information together in the database. For each patient, data collection sessions
are conducted under the most recent physician order until a new physician order is established.
A physician order date is established for each patient when the patient record is added to the database using the Patient
Information dialog box. This dialog has two tabs, Patient Information and Physician Order. On the Physician Order tab, the
operator must select the referring physician. The system automatically assigns the current date and time as the physician
order date.
Although a physician order is automatically created when a new patient record is established, you may need to create a
new physician order when retesting a patient. Once a new physician order is established, data collection (test) results will
be run and maintained under the new order.
Note • See Data Analysis ► 90 for information on using the Physician Order Date during a date review session.
The following procedure explains how to add a physician order to an active patient record using the Add Physician Order
dialog box.
To add a new physician order to a patient record

1. Open the Patient record and display previous data collection results in the Main Window.
2. Select File > New Physician Order to display the Add Physician Order dialog box.

Fig. 42 Add Physician Order
3. Click on a physician name in the Referring Physician list to highlight it. If the Referring Physician or the Referring Facil-
ity is not listed, they must be added to the database before continuing.
4. Click on a facility name in the Referring Facility list to highlight it.
5. Type any related referring notes or comments in the Referring Notes text box.
6. Click OK.
Note • The new order created includes the current date and time. The date and time display on the
• Physician Order text box of the Review Tab, and

• the Physician Order tab of the Patient Information dialog box.
3.3 Facility Records

ICS Chartr database contains two types of facility records for the
• test-site facility, and
• the facilities that refer patients to the test site (referring facilities).
3.3.1 Establishing the Test-Site Facility

The name, address, and contact information for the test-site facility is entered and maintained in the Facility Setup dialog
box.
3.3.1.1 Facility Setup Dialog Box

The database record for the test-site facility is created and maintained in the Facility Setup dialog box. Select Setup> Edit
Facility Info to display the Facility Setup dialog box.

Fig. 43 Facility Setup Dialog Box
The information on the Facility Setup dialog box includes:

Practice Name Type the name of the practice or clinic as it will display in reports.
Address Type the street address of the practice as it will display in reports.
City Type the name of the city in which the practice is located as it will display in reports.
Type the name (or abbreviation) of the state in which the practice is located as it will dis-
State
play in reports.
Type the up to 15-character zip code identifier for the practice as it will display in
Zip Code
reports.
Type the name of the country in which the practice is located as it will display in
Country
reports.
Phone Number Type the primary telephone number of the practice as it will display in reports.
Fax Type the fax number of the practice.
Email Type the email address of the practice.
ENG/VNG Report Type the report header that will appear at the top of each ICS Chartr ENG/VNG Patient
Header Report.
EP Report Header Type the report header that will appear at the top of each ICS Chartr EP Patient Report.
OK Save the settings and exit the dialog box.
Cancel Exit the dialog box without saving the settings.
3.3.1.2 Setting up the Test-Site Facility

The Facility Setup option on the Setup menu is used to enter and maintain information on the test-site facility. The name
of the test-site facility appears on all patient reports. The name, address, and telephone number appear on the word-pro-
cessed patient report.

To setup the test-site facility

1. Select Setup> Edit Facility Info on the menu bar to display the Facility Setup dialog box.
2. Place the cursor in the Practice Name text box and type the name of the facility.
3. Place the cursor in the Address text box and type the street address for the facility.
4. Complete the requested information in the remaining text boxes by placing the cursor in a text box and typing the
indicated information.
Keyboard alternative: Press the Tab key to move the cursor from one text box to the next or click on a text box to
place the cursor.
5. Click OK.
3.3.2 Establishing Referring Facility Information

The name, address, and contact information for the referring facility is entered and maintained in the Add Referring Facil-
ity and Edit Referring Facility dialog boxes.
This section provides a description of the dialog boxes and the procedures for managing referring facility information,
including:
• Establishing a New Referring Facility
• Editing Existing Referring Facility Information
3.3.2.1 Add Referring Facility Dialog Box

The Add Referring Facility dialog box is usually accessed by selecting Setup> Add New Referring Facility from the menu
bar on the main window.
Fig. 44 Add Referring FacilityDialog Box
Name Type the name of the referring facility.

Address Type the street address of the facility. Multiple lines may be entered in the text
box.


Phone Number Type the facility’s telephone number.
Contact person Type the name of the contact person for the facility.
Buttons
OK Accept the information in this dialog box and save it to the database.
3.3.2.2 Establishing a New Referring Facility

Use the following procedure to enter referring facility information in the Add Referring Facility dialog box.
To establish a new referring facility

1. Select Setup> Add New Referring Facility on the Menu bar to display the Add Referring Facility dialog box.
Fig. 45 Add Referring Facility Dialog Box
2. Place the cursor in the Name text box and type the name of the referring facility.
3. Continue moving the cursor from text box to text box until all of the facility information requested is entered.
4. Click OK.
3.3.2.3 Editing Referring Facility Information

Use this procedure to edit previously entered referring facility information.

To edit referring facility information

1. Select Setup> Edit Existing Referring Facility on the Menu bar to display Select Referring Facility dialog box.
2. Scroll through the list of referring facilities and click on the desired facility name to highlight it.
3. Click OK.
Fig. 46 Edit Referring Facility Dialog Box
4. Place the cursor in a text box that contains information that needs to be changed and type or delete as needed.
5. Continue moving from one text box to the next until all the existing facility information is updated.
6. Click OK.
3.3.2.4 Deleting a Referring Facility Record

Use this procedure to delete all information about a referring facility from the database. This option cannot be accessed
during patient testing or data analysis.
Caution • Once a referring facility record is deleted, it cannot be restored.
To delete a referring facility from the database

1. Close all patient records and access the Main Window .
2. Select Setup> Delete Referring Facility to display the Select Referring Facility dialog box.

Fig. 47 Select Referring Facility Dialog Box
3. Click on a Referring Facility name to highlight it and click OK .
Fig. 48 Delete Referring Facility Prompt
4. Click Yes.
3.4 Establishing Operator Information

Operators must login to the system and operator information is included in the database. The name of the operator per-
forming patient tests is included as part of the patient record.
• Use the Add Operator dialog box to establish a new operator.
• Use the Edit Operator dialog box to modify information for a previously established operator.
This section includes a description of the Operator Information dialog box and provides procedures for:
• Establishing a New Operator
• Editing Existing Operator Information
• Operator Login
3.4.1 Add Operator Dialog Box

The Add Operator dialog box is used to enter information for a new operator. It is accessed by selecting Setup > Add New
Operator from the Menu bar on the Main Window.

Fig. 49 Add Operator Dialog Box
Last Name Type the last name and degree of the operator.
First Name Type the first name of the operator.
Address Type the street address of the operator. Multiple lines may be entered.
Phone Number Type the operator’s telephone number.
Identification Type any identifying information, such as a social security number, etc.
Buttons
OK Accept the information in this dialog box and save it to the database.
3.4.2 Establishing a New Operator

The process for establishing a new operator in the ICS Chartr EP 200 program includes entering the name, address, and con-
tact information for the operator.
Use the following procedure to enter operator information.
To establish a new operator

1. Select Setup > Add New Operator from the Menu bar to display the Add Operator dialog box.

Fig. 50 Add Operator Dialog Box
2. Place the cursor in the Last Name text box and type the last name of the operator.
3. Place the cursor in the First Name text box and type the first name of the operator.
4. Continue moving the cursor from one text box to the next and typing information until all of the requested operator
information available is entered.
5. Click OK.
3.4.3 Editing Operator Information

Use this procedure to modify previously entered operator information.
To edit existing operator information

1. Select Setup > Edit Existing Operator on the Menu bar to display the Operator Selection dialog box.

Fig. 51 Operator Selection Dialog Box
2. Scroll through the list of operators and click on a name to highlight it.
3. Click OK.
Fig. 52 Edit Operator Dialog Box
4. Place the cursor in the text box where information needs to be updated or edited and make the changes.
5. Continue moving from one text box to the next until all of the required modifications are entered.
6. Click OK.
3.4.4 Operator Login

The following procedure describes the operator log in process. Only operators whose information is already in the data-
base may log in.

To login as operator or select an operator during a test session

1. Select File > Logout (Switch Operator) on the menu bar to display the Operator Login dialog box.
Fig. 53 Operator Login Dialog Box
2. Scroll through the list of operators and click on an operator name to highlight it.
Note • SeeEstablishing a New Operator ► 58 to add an operator not found on the list.
3. Click OK. The operator's name appears on the title bar of the main window.
3.4.5 Deleting an Operator Record

Use this procedure to delete all information about an operator from the database. The delete operator option cannot be
accessed during patient testing or data analysis.
Note • It is not possible to delete an operator until all patient/test data associated with the operator is archived.
To delete an operator from the database

1. Close any open patient records and access the Main Window.
2. Select Setup > Delete Operator to display the Operator Selection dialog box.

Fig. 54 Operator Selection Dialog Box
3. Click on an Operator name to highlight it.
Fig. 55 Delete Operator Prompt
4. Click Yes. The information is deleted from the database.

4 Data Collection
4 Data Collection
4.1 Overview
The ICS Chartr EP 200 data collection process involves making sure the system is ready, the electrodes are properly
applied to the patient, and the operator is aware of the full range of features and options available.
This section provides information on preparing for data collection. It also provides information and instructions for modi-
fying trial settings and creating new protocols.
Note • The procedures in this section assume that patient-related information is already entered in the database
as described in Establishing and Maintaining Records ► 39 and the system is setup and ready for operation as
described in App. 7 Setting up the Hardware ► 213.
4.2 Preparing for Data Collection

For information about setting up for data collection, refer to App. 1.1 Test Room Setup ► 160 and App. 1.2 Supplies
Required ► 160.
Before preparing the patient, turn on the Chartr EP 200or the MCU 90 XP (tower) unit and launch the ICS Chartr EP 200
software.
Perform listening checks routinely to ensure that the equipment is functioning properly.
4.2.1 Listening Check

1. Using a person who has auditory thresholds below 10 dB, make sure he/she can hear a very faint sound for each stim-
ulus type, and transducer at 0 to 5 dB.
2. If the person cannot hear the stimuli, additional technical assistance is available. Please contact GN Otometrics using
email (hotline@gnotometrics.dk) or by calling the hotline in Denmark (+45 45 755 442).Please contact your local sup-
plier.
4.2.2 Prepare the patient

EP tests are best performed on a patient who is quiet, comfortable, and cooperative. If the patient is active, the test time
may be longer and the test results may be compromised by a high level of noise (acoustic or myogenic) during the record-
ing. Follow these guidelines:
• Ensure the patient iscomfortable lying supine on a table or reclined in a comfortable chair with head and leg support.
• Instruct the patient to keep his/her eyes closed and relax.
• Turn off the lights to encourage relaxation.
• Let the patient know that sleeping is the optimal state.
4.2.3 Connect the electrodes

In order to obtain clean, accurate recordings, prepare the skin at the electrode site. Refer to App. 1.4 Skin Preparation
► 160.
Position the Chartr EP 200 preamp on the patient.

4 Data Collection
Note • The ICS Chartr EP 200 system is supplied with a lanyard and a shoulder harness. The lanyard is used to
hang the preamp around the patient’s neck and rest on the patient’s chest. However, if the patient has an
implantable device (e.g., pacemaker), this is not the best option as the pacemaker may add noise into the EP tra-
cings. The shoulder harness is used to drape the preamp over the patient’s shoulder or over the back of the
patient’s chair/recliner.
Properly position the electrodes on the patient. Refer to App. 1.6 Electrode Montages ► 161.
Connect the electrode wires into the ICS Chartr EP 200 preamplifier or the MCU 90 XP (tower) patient cable. Refer to
App. 1.5 Electrode wire connections ► 161.
4.2.4 Reduce noise sources

During data collection, turn off devices that emit noise:
• Make sure all cell phones and pagers are off (not just silenced).
• Turn off any fluorescent lights.
• Set dimmer switches fully off, not in a mid position.
Refer to App. 9 Troubleshooting Noise ► 236 for additional information about reducing environmental noise.
4.3 Collecting Data

The ICS Chartr EP 200 system is capable of simultaneously recording up to two channels during data collection. The ICS
Chartr EP 200 Limited option is capable of recording one channel during data collection. The placement of electrodes var-
ies depending on the test and the number of channels used for collection.
There are several ways to activate and manage a data collection session:
• Click on a function key button located along the bottom of the main window.
• Press the corresponding function key on the keyboard.
• Select the corresponding option under the Test Menu on the menu bar.
While collecting data, perform listening checks routinely to ensure that the equipment is functioning properly. Refer to
App. 1.6 Electrode Montages ► 161. To modify the normal hearing level threshold, refer to App. 1.7 Modifying
Normal Hearing Level Thresholds ► 173.
Each trial produces at least one waveform. Each waveform is displayed in the waveform area of the main window as the
test is being conducted.
The procedure for collecting data applies to all procedures and protocols:
1. Open the patient record and make sure you are collecting data under the correct Physician Order.
2. Create a Physician order under the Physician Order tab on the Patient Information dialog box if this is a new patient.
3. Modify the patient data in the Patient Information dialog box, if needed.
4. Select Edit > New Physician Order on the Menu bar to display the Add Physician Order dialog box if you need to add
a new physician order for this patient.
5. Prepare the patient for data collection:
– Make sure the electrodes and transducers are properly applied to the patient.
– Make sure the electrodes are properly connected.

4 Data Collection
– Click F7 Impedance Test to display the Impedance Test dialog box and confirm electrode activity. Refer to App.
1.8 Checking Electrode Impedance ► 174.
6. Click F4 to access the New Test tab and click on a protocol. Refer to App. 1.9 Using the New Test Tab ► 175.
7. Click F4 to access the Settings tab, check the current settings, and make any needed changes. Refer to App. 1.10
Using the Settings Tab ► 176.
8. Click the Continuous Stimulation toolbar button to select (depress) it if stimulating between collected waveforms is
needed.
9. Click Start EEG to select (depress) it and show data in the Ongoing EEG Window. This will also start stimulation.
10. Examine the EEG activity to make sure it is acceptable to begin testing. If the EEG activity is not acceptable, determ-
ine and eliminate the source of the problem. For example, is the patient moving or is there a source of electrical
noise nearby?
11. Click F12 Collect to start data collection and display the results in the waveform work area of the main window.
12. Monitor the patient and review the data collection status as the test progresses.
13. Make adjustments as needed during data collection.
Alternative: Many of these options for adjustments are also available on the Test Menu on the menu bar.
– Click F12 Pause/Resume to temporarily stop data collection. Monitor the EEG display.
– Click F12 Resume to proceed with the current test.
– Click F11 Stop to end the current test before the maximum number of sweeps is reached. Collection will stop
automatically when the maximum number of sweeps set in Trial Settings is reached.
– Click F9 Reset to delete the EP data in the current collection buffers, reset the sweep counters to zero, erase the
collected waveforms, and restart the test.
– Click F10 Increase Sweeps to continue the active trial by extending the number of sweeps beyond the set limits
for this trial.
– Click the Continue Trial button on the toolbar to provide an opportunity to extend data collection beyond the
limits for this trial, even after the maximum number of sweeps has been reached. Click the button again to dis-
continue this option.
– Click the Merge New Waveforms button to select it and automatically merge the waveforms with like para-
meters at the beginning of the trial. Click the button again to discontinue this option.
– Click the Next Page button between tests to move to another waveform page. All waveforms on the current page
will be saved.
– Click on a waveform handle and drag it to move the waveform up or down on the work area.
14. Repeat Steps 6 through 13.
15. Select File > Close Patient to close and save the patient record.
16. Remove the electrodes from the patient.
4.4 Accessing Collected Data

All trial setting and collection information is saved with the collected waveform. After data are collected, the waveforms
and all the associated data can be viewed using the Review tab. During a data collection session, the operator can move
from page to page to see the collected waveforms. If needed, the operator can type a comment in the Comments Box
below the waveform work area.

4 Data Collection
The test parameters can be viewed in the Waveform Information Panel under the Review tab, or in the Test Parameters
dialog box.
All waveforms and associated data can be included in the patient report and printed. See Data Analysis ► 90 for inform-
ation on reviewing and analyzing waveforms and reviewing ASSR data. See Working with Reports ► 114 for information
on preparing a Patient Report and printing waveforms.
Some or all of the collected waveforms may be printed as part of the patient report.
Note • See Data Analysis ► 90 for information on working with collected waveforms. See Working with Reports
► 114 for information on preparing and printing a patient report.
4.5 Vestibular Evoked Myogenic Potential (VEMP)

Proper placement of the electrodes on the sternocleidomastoid (SCM) ensures accurate data collection. Have the patient
turn their head left or right and downward. The SCM should bulge. Place the electrode on the middle and most bulbous
part of the SCM. The right and left SCM electrodes should be symmetrical (at the same level) on the patient's neck. Refer
to App. 1.6.5 Vestibular Evoked Myogenic Potential (VEMP) ► 168.
Why is monitoring tonic EMG activity important?
Note • VEMP monitoring is available only if the VEMP monitor option is included in your installation.
The sternocleidomastoid must be contracted in order for a response to be recorded. The VEMP is an amplitude measure,
and therefore, the influence of the tonic level of the EMG must be taken into account.
“The tonic state of the SCM muscle is a critical parameter in the recording method of the VEMP. Thus, controlling the
level of tonic EMG would appear to be a prerequisite for the accurate interpretation of the VEMP.”1
“The (VEMP) reflex amplitude scales in proportion to tonic EMG activity and should therefore be normalized to the
level of EMG activity.”2
Due to patient variability, it is recommended that the first VEMP run be collected with the EMG values set wide open
(e.g., 0 for min and 999 for max). Position the patient to contract the SCM and collect one run. The average EMG will be
displayed in the calculation box (bottom left). Then set the min to 20 µV below the average and the max to 20 µV above
the average (e.g., if average is 85 µV, then the min = 65 µV and the max = 105 µV).
The min and max values should be the same when collecting data from the left and right SCM to ensure that the EMG
value is similar on both sides. The response average will only include sweeps when the EMG is in between the min and
max values or “Good” range. If the EMG is in the “Low” or “High” range, those sweeps will be rejected.
4.5.1 Connect VEMP Monitor

The Chartr EP 200 VEMP monitor assesses the level of tonic EMG and displays if the level is adequate or inadequate.
The monitor light will display the following based on the EMG level:
1Akin FW, Murnane OD, Panus PC et al. (2004) The influence of voluntary tonic EMG level on the vestibular-evoked myo-
genic potential. J Rehab Res Dev 41(3B):473-480.
2Welgampola MS & Colebatch JG (2005) Characteristics and clinical applications of vestibular-evoked myogenic poten-
tials. Neurology 64:1682-1688.

4 Data Collection
Low (blue) - EMG level is below the Min value

Good (green) - EMG level is between Min value and the Max value
High (amber) - EMG level is above the Max value
Fig. 56 Connect VEMP Monitor to Preamp
4.6 Bone Oscillator

The bone oscillator is used for those tests that require bone conduction stimulus. The bone connection box is connected
to the audio stimulator board via the labeled port on the MCU 90 XP (tower) computer and to the bone oscillator and
insert phones.
Fig. 57 Bone conduction headphone connections.
To connect the Bone Oscillator
Note • This step applies only to tests that require bone conduction stimulus.

4 Data Collection
1. Connect bone oscillator to the Chartr EP 200 preamplifier.
Fig. 58 Connect Bone Oscillator to Preamp
2. Place bone oscillator on patient. Place left or right masking insert in ear (optional).

4 Data Collection
Fig. 59 Place Bone Oscillator on Patient
Bone conduction ABR provides a differential diagnosis of the type of hearing loss (sensorineural, conductive, or mixed).
To obtain clean bone conduction ABR recordings, it is best to have separation between the preamp and the patient’s
head/bone oscillator. The bone conductor cable should be away from the electrode leads as much as possible.
The system default is a 2-channel protocol to be used without masking. The contralateral response will not have a Wave I
present and a slightly longer latency for Wave V. Wave I is not always present in the ipsilateral response.
4.7 Working with Trial Setting Options

The ICS Chartr EP 200 data collection procedures and protocols are listed under the New Test tab on the main window.
The ICS Chartr EP 200 default (Otometrics-supplied) procedures are:
• ABR (Auditory Brainstem Response)
• ASSR (Auditory Steady State Response)
• ECochG (Electrocochleography)
• VEMP (Vestibular Evoked Myogenic Potential)
• ALR (Auditory Late Response)
• AMLR (Auditory Middle Latency Response)
• P300 (optional)
Note • ECochG, AMLR and P300 protocols are not available in the ICS Chartr EP 200 Limited version. ALR is
provided only for 40 Hz. Optional ALR procedures are available.
Trial settings for the various protocols are supplied by Otometrics. The names are based on the general auditory evoked
potential procedure.
Each facility may modify the Otometrics-supplied trial settings (see Modifying a Protocol ► 77) and/or create new pro-
tocols (see Creating a New Protocol ► 77). Once a facility changes a protocol, it replaces the Otometrics-supplied default
settings. Click on Default Settings in the Trial Setting to return the protocol to the manufacturer default.

4 Data Collection
If needed, individual operators may create new protocols and/or modify the Otometrics-supplied or facility-modified pro-
tocols. This section provides operator instructions for modifying existing protocols/trial settings and creating new pro-
tocols.
4.7.1 Selecting Trial Setting Parameters
Note • This section applies to all EP procedures except ASSR. See Selecting ASSR Trial Setting Parameters ► 79
for ASSR-specific information.
Trial settings and procedures are established in the Add New Protocol or Edit Protocol dialog boxes. Using this dialog, an
operator may modify test, stimulus, intensity, channel, acquisition, and other parameters. During a data collection session,
the parameters in the dialog boxes may be temporarily overridden using the Settings tab on the Main Window.
Trial settings modified and saved by operators are catalogued under an operator name. With this feature, each operator is
able to create test protocols tailored to his or her preferences. If changes are made under the Default Operator, the
changes will apply to all operators.
To display the Edit Protocol dialog box for all EP procedures except ASSR, highlight a protocol or trial setting on the New
Test tab and click F5 Trial Settings. You may also select Setup > Edit Current Protocol on the menu bar.

4 Data Collection
Fig. 60 Edit Protocol Dialog Box, VEMP (500 Hz Tone Burst) Test
The protocol name is listed on the title bar. The trial settings are listed in the upper-left corner of the dialog box. In the
example, the trial settings are under the protocol ABR: (Pediscreen). The 80 dB Right trial is selected (highlighted) and the
stimulus, channel, and acquisition display parameter settings for that trial are shown.
Each trial setting in the list has a corresponding tab in the dialog box that lists all of the parameters for that trial setting.

4 Data Collection
Fig. 61 Trial Setting Buttons, Edit Protocol and Add New Protocol Dialog Boxes
Move Up Move the selected trial setting up one position.

Move Down Move the selected trial setting down one position.
Add as New Display the Add New Trial Settings dialog box. Type a new trial settings name. The new trial
setting is now sequentially linked to the list of trial settings for this protocol.
Note • See Creating a New Protocol ► 77 for instruction on how to add a new pro-
tocol not linked to another protocol.
Rename Current Display the Rename Trial Settings dialog box. Type a new name or correct an existing trial set-
ting name.
Update Current Apply any trial setting parameter changes to the current trial setting before using it as a tem-
plate for a new trial setting.
Note • This only needs to be done if you make changes to the current trial setting
before adding a new trial setting.
Caution • There is no undo for this action!

4 Data Collection
Delete Current Display a prompt to confirm the deletion. Select Yes to delete the trial setting; select no to
return to the Trial Settings dialog box without deleting the trial setting.
Default Settings Restore the protocol to the facility or Otometrics -supplied default settings.
Save Display the Save Protocol As dialog box. Select a procedure from the list and change the name
of the protocol, if needed. All changes to the protocol are saved permanently to the database
and will be available the next time ICS Chartr EP starts.
OK Apply the trial setting parameter changes and close the Trial Settings dialog box. Any changes
to the protocol will be lost when ICS Chartr EP is shutdown or another operator logs in.
Cancel Exit the Trial Settings dialog box and discard any changes to the protocol.
The Stimulus parameter settings on the Add New/Edit Protocol dialog boxes are located to the right of the Trial Setting list
and buttons. Each trial setting in the Trial Setting list is represented by a tab. Click on the tab to display all of the Stimulus,
Channels, and Acquisitions parameters for the selected trial setting.
Fig. 62 Add/Edit Protocol Dialog Box, Stimulus Parameters
Note • VEMP monitor is an available only if the VEMP monitor option is included in your installation.
Parameter Settings, Stimulus
Stimulus Description Options

Parameter
Left/Right Ear Stimulus Ear to which stimulus will be delivered On or off
Left/Right Ear Masking Ear to which masking noise will be On or off

delivered

4 Data Collection
Stimulus Description Options

Parameter
Left/Right VEMP mon- Side to which VEMP EMG monitoring will The VEMP monitor settings are available in the
itor be measured. Chartr EP Limited version only if the VEMP mon-
itor option has been purchased.
On or off
Stimulus Intensity of stimulus to be delivered Minimum and maximum intensity varies with
intensity transducer, stimulus type, normal hearing level
threshold, hearing level threshold (ANSI), and
calibration
Masking Intensity of white noise masking to be 0-100 dB SPL

intensity delivered
Synchronous Masking When selected (checked), the system main- None

tains the masking level difference set in
the Trial Settings when stimulus intensity
is changed
Transducer Method of stimulus delivery Bone conductor, headphones, insert phone
Polarity Direction of stimulus Alternating, condensation, rarefaction
Click 100 msec click None
Tone Tone burst Frequency, envelope, ramp, and plateau
Frequency Tone burst frequency; P300 trials have fre- 100, 125, 200, 250, 300, 400, 500, 600, 700,
quent and rare settings 750, 800, 900, 1k, 1.5k, 2k, 3k, 4k, 6k, 8k Hz
Envelope Shaping characteristics for the envelope of Linear, Hanning, Blackman, Gaussian
tonal stimuli
Ramp Duration of rise and fall portions of tonal Minimum = .25

stimuli; P300 trials have frequent and rare Maximum = 340 cycles
settings
Plateau Duration of peak portion of tonal stimuli; Minimum = 0

P300 trials have frequent and rare settings Maximum = frequency * 1.35
The Channels parameter options on the Add New/Edit Protocol dialog box are located to the right of the Stimulus para-
meters. The Acquisition parameters on the Add New/Edit Protocol dialog box are located below the Channel parameter
options.

4 Data Collection
Fig. 63 Add/Edit Protocol Dialog Box, Channels and Acquisition Parameters
Parameter Settings, Channels
Channels Parameter Description Options
Mode When set to Off, no data will be

Note • The 2nd channel is not available in the
collected from this channel
Chartr EP Limited version.
on or off for channels 1, 2
Amplifiers; Gain Amplification factor for each chan- 1k, 2k, 3k, 5k, 10k, 20k, 30k, 50k, 100k, 200k, 300k,
nel (Chartr EP (USB)and 500k
MCU 90 XP (tower) configuration)
Amplifiers; Gain Amplification factor for each chan- 1.5k, 2.5k, 7.5k, 15k, 25k, 75k, 150k, 250k, 500k
nel (additional for Chartr EP (USB)
only)

4 Data Collection
Channels Parameter Description Options
Amplifiers; Gain Amplification factor for each chan- 50, 100, 200, 300, 500
nel (additional for MCU 90 XP
(tower) only)
Filters; High Pass Filter out low frequency noise on 0.2 Hz, 0.3 Hz, 0.5 Hz, 1 Hz, 1.5 Hz, 2 Hz, 5 Hz, 10 Hz, 20
each channel (Chartr EP (USB) con- Hz, 30 Hz, 50 Hz, 100 Hz, 150 Hz, 200 Hz, 500 Hz, 1000
figuration) Hz
Filters; High Pass Filter out low frequency noise on 0.002 Hz, 0.005 Hz, 0.01 Hz, 0.05 Hz, 0.1 Hz, 0.2 Hz, 0.5
each channel (MCU 90 XP (tower) Hz, 1 Hz, 2 Hz, 5 Hz, 10 Hz, 50 Hz, 100 Hz, 200 Hz,
configuration) 500 Hz, 1000 Hz
Filters; Low Pass Filter out high frequency noise on 15 Hz, 30 Hz, 50 Hz, 75 Hz, 100 Hz, 150 Hz, 250 Hz, 300
each channel Hz, 500 Hz, 600 Hz, 1 kHz, 1.5 kHz, 2 kHz, 3 kHz, 5 kHz,
10 kHz, 25 kHz (only for MCU 90 XP (tower) con-
figuration)
Notch Presence of 50/60 Hz notch filter On or Off

on each channel
Artifact Presence of artifact rejection on On or Off

each channel
Electrode Switching When selected (checked), elec- On or Off

trode switching is enabled. It is
only available for 1 channel pro-
tocols. See
App. 1.6 Electrode Montages
► 161 for the appropriate mont-
age to be used with electrode
switching
Parameter Settings, Acquisition
Acquisition Parameter Description Options
Sweep time (ms) Duration of collection window or Minimum = 5 msec

epoch Maximum = 9000 msec (non-P300); 1000 / rate (P300)
Sweeps Maximum number of sweeps 1-9999

collected per collection run
Display Specify the default display scale to 0.20, 0.30, 0.40, 0.50, 0.80, 0.90, 1.00, 2.00, 4.00,
Scale (µV) be used when collecting EP pro- 40.00, 100.00, 200.00
tocols

4 Data Collection
Acquisition Parameter Description Options
Delay (ms) Collection onset time re: onset of Minimum = -650 msec
stimulus Maximum = +650 msec (non-P300); -2 msec (P300 /
bone conductor or headphone); -1 msec (P300 / insert
earphone)
Rate Presentation rate of stimulus Minimum = 0.2 / sec

(stimuli/second) Maximum = 180 / sec (non-P300); 1000 / sweep time
(P300)
External Trigger Provides manual control (extern- The external trigger is not available in the ICS Chartr EP
ally) over stimulus rate 200 Limited version.
On or off
VEMP Monitor Minimum EMG value that will res- Min(µV)

ult in an accepted sweep and dis- Max(µV)
play “good” on the monitor
Maximum EMG value that will res-
ult in an accepted sweep and dis-
play “good” on the monitor
4.7.2 Creating a New Protocol
Note • If a new protocol is created under the Default Operator, the protocol will be available for all subsequently
added operators.
1. Access thetab and highlight the protocol that is most similar to the one to be created.
2. Select Setup > Add New Protocol.
3. Make modifications to the protocol trial settings.
4. Click OK.
5. Choose the Procedure (e.g., ABR, ECochG, etc.). The procedure name determines the label set used for marking the
waveforms.
6. Change the protocol name.
7. Click OK. The new protocol will be listed in the New Test tab section under the procedure selected in step 5.
4.7.3 Modifying a Protocol

Operators may modify the facility protocols and trial settings using the Edit Protocol dialog box.
Note • If changes are made under the Default Operator, the changes will modify protocols for all subsequently
added operators.

4 Data Collection
To edit an existing protocol

1. Access the New Test tab and highlight the protocol to be edited.
2. Click F5 Trial Settings.
3. Make desired changes.
4. Click Save.
5. Click OK.
To change a protocol name

3. Click Save.
4. Change the protocol name.
5. Click OK. The protocol will be listed in the New Test tab with the new name.
To delete a protocol
Note • Manufacturer default protocols cannot be deleted.
1. Access the New Test tab and highlight a protocol.

2. Select Setup > Delete Protocol.
3. Highlight the protocol to be deleted.
4. Click OK.
5. Click Yes if want to delete the protocol.
4.7.4 Creating a Linked Protocol

To create a linked (sequential) protocol
3. Make changes.
4. Click Add as New.
5. Change the trial settings name.
6. Click OK. Protocol will display in the left top panel on the Trial Settings window.
To change the name of a test in a linked (sequential) protocol

3. Click Rename Current.
4. Change the trial settings name.
5. Click OK. The protocol will be added to the list of protocols in the Edit Protocol window.

4 Data Collection
To delete a test from a linked (sequential) protocol

3. Highlight the protocol to be deleted from the list of protocols in the Edit Protocol window.
4. Click Delete Current.
5. Click Yes.
4.7.5 Restoring Default Trial Settings

Use this procedure to restore protocol and trial settings back to the protocols and trials settings established by your facility
as defaults.
1. Login as the default operator.
4. Click Default Settings.
5. Click Yes.
4.8 Selecting ASSR Trial Setting Parameters

ASSR trial settings and procedures are established in the ASSR Add or Edit Protocol dialog boxes. Using these dialogs, an
operator may modify test, stimulus, intensity, channel, acquisition, and other parameters. During a data collection session,
the parameters in the Add New/Edit Protocol dialog boxes may be temporarily overridden using the Settings tab on the
Main Window.
Trial settings and protocols modified and saved by operators are cataloged under an operator name. With this feature,
each operator is able to create test protocols tailored to his or her preferences.
To display the Edit Protocol dialog box for ASSR procedures, highlight an ASSR protocol or trial setting on the New Test
tab.
Fig. 64 New Test tab with ASSR Protocols
Click F5 Trial Settings.
Note • Notice that the protocol name is listed on the title of the dialog box.

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Fig. 65 Edit Protocol - ASSR Dialog Box (Trial Settings)
4.8.1 ASSR Threshold Search

The threshold search options are shown in the box in the upper-left corner of the dialog box.

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Fig. 66 ASSR Threshold Search Options
Method Select a search method; Quick Search or Straight Descent.

Upper Limit Set the maximum dB HL (between 0 and 120 db HL). The maximum value is trans-
ducer dependent.
Lower Limit Set the minimum dB HL (between 0 to 120 db HL). The minimum value is trans-
ducer dependent.
Minimum Step Set the minimum step interval (5 or 10 db HL).
Response Confidence Set a percentage between 50 and 99.
Batch Size Maximum number of frequencies that can run at one time in one ear.
4.8.2 ASSR Modulation

The ASSR Modulation options are located in the box below the Threshold Search box on the Edit Protocol-ASSR dialog
box.

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Fig. 67 ASSR Modulation Options
Audiometric Frequency Frequency used during collection.

FM Modulation Select a unique modulation value (Hz) (right, left ears) for each frequency for
each ear. The system will prompt to change your selection if a value is used more
than once.
Max Search Time (minutes) Set the maximum search time (from 1 to 45 minutes) to be used at each intensity
before declaring a negative ASSR.
Amplitude Modulation (Modifying the modulation setting is not recommended.) Set the percentage of
amplitude modulation (from 0 to 100) to be applied.
Frequency Modulation (Modifying the modulation setting is not recommended.) Set the percentage of
frequency modulation (from 0 to 25) to be applied.
4.8.3 ASSR Channels

The ASSR Gain/Filter options are located in the box in the upper-right corner of the Edit Protocol - ASSR dialog box.
Note • ASSR data collection always uses channel 1.

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Fig. 68 ASSR Channel Options
Amplifier Gain Set the gain. 200k is the ASSR default. Options are: 50, 100, 200, 300, 500, 1k, 2k, 3k, 5k, 10k,
20k, 30k, 50k, 100k, 200k, 300k. Options 50, 100, 200, 300, and 500 are only available in the
MCU 90 XP (tower).
High Pass Filter (Modifying these filter settings is not recommended.) Set the high pass filter value. 65 Hz is the
default. Options are: 0.002 Hz, 0.005 Hz, 0.010 Hz, 0.050 Hz, 0.100 Hz, 0.200 Hz, 0.500 Hz, 1 Hz,
2 Hz, 5 Hz, 10 Hz, 50 Hz, 65 Hz ASSR, 100 Hz, 200 Hz, 500 Hz, 1 kHz.
Low Pass Filter (Modifying these filter settings is not recommended.) Set the low pass filter value. 105 Hz is the
ASSR default. Options are 15 Hz, 30 Hz, 50 Hz, 75 Hz, 100 Hz, 105 Hz ASSR, 150 Hz, 250 Hz, 300
Hz, 500 Hz, 600 Hz, 1 kHz, 1.5 kHz, 2 kHz, 3 kHz, 5 kHz, 10 kHz, 25 kHz.
Notch Filter Enable filtering of power-line interference. This should be used only when testing in an area
with a lot of electrical noise. A check indicates the Notch Filter is enabled.
4.8.4 ASSR Stimulus

The ASSR Stimulus options are located in the box below the ASSR Modulation Options in the Edit Protocol - ASSR dialog
box.

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Fig. 69 ASSR Stimulus Options
Transducer Select a transducer (insert phone, bone conductor, headphones).

Masking Select the ear to which masking noise will be delivered. Only one ear can be
selected. Set the masking intensity (0 - 100 dB HL in increments of 5 dB HL).
Audiometric Frequency (right/left) Select the audiometric frequencies to be applied. Options are 250 Hz, 500 Hz, 1
kHz, 2 kHz, 4 kHz, and 8 kHz to each ear. A check indicates the option is selected.
By default, only the middle four are selected.
Select All Click to select all six audiometric frequencies for each unmasked ear.
Deselect All Click to clear all of the audiometric frequency selections for both ears.
4.9 Collecting and Monitoring ASSR Data

All ASSR data collection activities are controlled and monitored from the Main Window.
4.9.1 ASSR Symbols

The ASSR Symbols that display in the data collection area of the Main Window indicate status and progress during the test.
Left ASSR threshold
Right ASSR threshold
No Threshold found

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Positive ASSR
Negative ASSR
Skipped
In progress
Halted
Search limits
Additional ASSR information that displays on the Main Window during ASSR data collection includes:
• Response confidence and elapsed time.
• Artifact Percentage
• Current threshold searching progress by frequency
• Current ASSR trial setting parameters (in the Calculation Box).
Note • ASSR response thresholds are estimates of audiometric thresholds only. Correction factors may be needed
to obtain a true audiometric threshold.
4.9.2 ASSR Artifact Display

An artifact is a voltage difference that is too large to be measured accurately. Artifacts can be caused by muscle activity,
magnetic or electrical interference from nearby equipment or transducers, loose electrodes, increased neurologic activity
due to situations such as wakefulness. Artifacts are usually temporary.
Artifacts directly affect the efficiency of an ASSR test. The more artifacts present during data collection, the less usable
data available to search for ASSRs. To prevent inaccurate data from affecting ASSR detection, the ICS Chartr EP 200 pro-
gram detects and discards measurements containing artifacts.
During data collection, the Artifact Display, located below the ASSR symbols, provides information on the efficiency of the
ASSR test in progress. The display shows the percentage of measurements in the preceding 10 seconds that were discarded
due to artifacts. The display is updated once per second, even when a test is paused.
The display shows the percentage of artifact detected:
• Numerically: 5%, 7%, 12%, 15%, etc.
• Descriptively: high, medium, low
• Graphically: via a color coded bar
A low artifact level (green, less than 10%) is ideal for ASSR detection, provided the EEG fills a significant portion of the
Ongoing EEG window.
4.9.3 ASSR Data Collection Function Keys

During ASSR data collection, use the function keys to pause or stop data collection, if needed.

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Fig. 70 Function Keys During ASSR Data Collection
Select F8 Extend Test to display the Extend Test dialog during ASSR data collection. Select the extend test option for the
right ear, left ear, or both ears (check mark) to increase the data collection time by 60 seconds for the selected ear(s) at
the current intensities and frequencies.
Note • If F8 is selected during data collection, the system pauses until the dialog box is closed. The Extend Test
option must be repeated to extend the time for data collection at each step.
4.9.4 ASSR Data Collection

1. Click the New Test tab.
2. Select an ASSR protocol.
Fig. 71 Main Window, New Test Tab - ASSR Selected
3. Click F12 Collect to begin ASSR data collection.

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Fig. 72 Monitor ASSR Data Collection
4.9.5 ASSR Assign Threshold

Use the ASSR popup menu to assign a threshold to a positive ASSR response. Right-click in the ASSR display area to display
the ASSR popup menu.

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Fig. 73 ASSR Right-click Popup Menu
Assign Threshold Determine which intensity is the patient’s threshold. A threshold can only be assigned to a
positive ASSR response.
Clear Threshold Clear the current threshold so that another intensity level can be determined.
Skip Intensity Cease data collection for current intensity. This feature is used to decrease test time when
the operator determines that further data collection will not result in a positive ASSR
response.
4.10 ASSR Audiogram Correction Factors

The ASSR Correction Factors Table provides the currently selected dB HL values for each frequency for each applicable
transducer. The ASSR Correction Factors table is available through the Setup Menu. Select Setup > Calibration > ASSR Cor-
rection Factors .

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Fig. 74 ASSR Correction Factors Dialog Box
Note • The ASSR Correction Factor for each audiometric frequency can be edited.
The correction factors defined in the ASSR Correction Factors dialog box are used to correct the audiograms in the display
and the printed reports when the Apply Corrections Factors option is selected. When correction factors are applied, the
ASSR thresholds detected within the search limits and shown in the displayed and printed audiograms are reduced by the
amount indicated. The applied correction factors are also listed on the printed report and in the Calculation Box.
Transducer Select Insert Phone, Bone Conductor, or Headphones.

Correction Factors Type the dB HL value for each frequency or click the Default button to use the system default
settings. Confirm the change when prompted.
OK Save and apply the indicated transducer and values.
Cancel Close the dialog box without saving the changes.
Default Replace the listed values with the system default values. Confirm the change when prompted.

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5 Data Analysis
5.1 Introduction
With the Review tab selected, theICS Chartr EP 200 program provides many options for positioning and manipulating wave-
forms to aid in analysis of test results. For example, waveforms can be marked for latency and amplitude measurements,
added to other waveforms, subtracted from another waveform, inverted, smoothed, placed at a particular position on the
page, and moved from one page to another.
Fig. 75 Waveform Area
This section provides information and instructions for working with and analyzing collected waveforms.
5.2 Review Tab

All test data is saved in raw form and is available for review. Select the Review tab to display waveforms and related inform-
ation on the Waveform Page.

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Fig. 76 Review Tab
In the Review tab, data collection results are organized by physician order. The most recent physician order displays when
the tab is selected. Click the drop-down arrow to display all of the physician orders associated with the patient's record.
All of the trials and channels collected under a physician order are grouped by trial and channel number.
Click on a channel to select it and display information about the trial settings that were used during data collection in the
Calculation Box. Double-click on a channel to add the associated waveform to the waveform page. Each Waveform Page dis-
plays up to a maximum of 20 waveforms.
The channel displays the waveform with two numbers (e.g., 5.1). The first number represents the order it was collected.
The second number represents the channel. So, typically 5.1 is the fifth waveform for the left ear and 5.2 is the fifth wave-
form for the right ear.
5.3 Trial Data

Information about the trial settings used and the data collection results for each selected channel displays in the Cal-
culation Box located under the Review tab on the Main Window. Click on a channel in the Review tab to highlight it and
display the associated trial data in the Calculation Box.

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Fig. 77 Calculation Box with Trial Data
The Calculation Box information describes the trial settings in effect during data collection and the number of accepted
and rejected sweeps. As an example, the trial data for the selected ABR trial, includes:
Procedure Name ABR

Test Date / Time August 6, 2008 at 4:05 PM
Ear (stimulated) Left
Intensity 80 dB nHL
Channel ipsi
Transducer Insert phone
Stimulus Click (A = alternating, C = condensation, R = rarefaction)
Sweeps Accepted 1081; Rejected 0
Masking Right, 30 dB
Rate 21.1/s
Gain 100 K
Low Pass Filter 100 Hz / 3 kHz
The information in the Calculation Box may vary depending on the type of trial and the results. Latency and amplitude data
display when a marked (labeled) waveform is selected.
5.4 Working with Waveforms

All waveforms display on a waveform page in the Waveform Area of the main window. Each waveform page holds up to a
maximum of 20 waveforms.
TheICS Chartr EP 200 program provides multiple ways to work with displayed waveforms. For example, operators can:
• Select and position waveforms on the page
• Place waveform markers on a selected waveform
• Copy waveforms onto the same or to another page
• Merge two or more waveforms on a page
5.4.1 Viewing Waveform Pages

During a data collection session, collected waveforms are assigned to a waveform page. A maximum of 20 waveforms may
be assigned to each page. The system automatically creates waveform pages as needed during the session.
When data is not being collected, the operator may easily view any waveform page and may create new pages or delete
existing pages as needed.

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Note • The Waveform Pages are numbered and the number displays in the lower right corner under the Wave-
form Area (e.g., Page 3 of 7).
There are several ways to access a specific waveform page-using the mouse, the keyboard function keys, or menu options.
• Using the mouse:
– Click the Previous Page / Next Page buttons on the Toolbar.

– Click function keys F10 Previous Page or F11 Next Page to display the preceding or next waveform page.
• Using the keyboard:
– Press F10 on the keyboard to display the previous waveform page.
– Press F11 on the keyboard to display the next waveform page.
• Using the menu options:
– Select the Page > Next or Page > Previous options on the Page menu.
– Select Page > Go To Page to display the Go To Page dialog box. Type the desired page number and click OK to
display the requested waveform page.
5.4.2 Selecting Waveforms

The waveform handle (the numbered box to the immediate right of a waveform) changes color when the corresponding
waveform is selected.
• The handle of the first selected waveform is yellow.
• Handles selected after the first waveform are blue, if more than one waveform is selected.
One or more waveforms can be selected at a time using the mouse, the keyboard, and menu commands. To select one
waveform:
• Click on the waveform handle to highlight it.
• Click on a colored Bank button below the waveform work area to select the corresponding waveform.
• Press the corresponding numeric key(s) on the keyboard as follows:
– Press a number key (between 1 and 9) to select a waveform numbered between 1 and 9.
– Press number key 0 to select a waveform numbered 10.
– Press the Shift key and the number key that corresponds to the second digit to select a waveform between 11
and 20. (For example, press Shift + 8 to select waveform number 18.)
To select multiple waveforms, press and hold the Control (Ctrl) key on the keyboard while selecting a waveform.
Use one of these methods to select all of the waveforms on a waveform page:
• Press Ctrl + A on the keyboard.
• Select Edit > Select All from the Menu bar.
• Hold the Control (Ctrl) key on the keyboard and click on each waveform handle on the page.
To deselect the currently selected waveform:
• Press Ctrl + left click on the handle to remove the highlighting.
5.4.3 Positioning Waveforms

Waveforms may be easily moved and repositioned using the mouse or keyboard. If the Split Page viewing option is selec-
ted, waveforms may be moved from one section to another using the mouse.

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Use one of these methods to position a waveform on a waveform page work area or move on a split waveform page work
area:
• Using the mouse, place the cursor over a waveform handle, then click and hold the mouse button and move (drag) the
selected handle to a new location. Release the mouse button. The mouse cursor changes to a hand during dragging.
• Using the keyboard, press the Up / Down arrow keys to move the primary waveform up or down on the page.
5.4.4 Moving Waveforms from Page to Page

From one to twenty selected waveforms can be moved (copied) from one page and placed (pasted) on another page at one
time. A waveform can be pasted an unlimited number of times.
Note • All of the data associated with a waveform, including waveform markers, are copied with the waveform.
The position of a waveform on the original page is maintained on the new page. However, an operator may move any wave-
form as needed on any page.
To copy selected waveforms to another page using the mouse and keyboard
1. Select one or more waveforms on a page.
2. Press Ctrl + C to copy the waveform(s) to the clipboard.
3. Go to the desired waveform page.
4. Press Ctrl + V to paste the waveforms on the page.
To copy selected waveforms to another page using the Tool bar buttons
2. Click the Copy button to copy the selected waveform(s) to the clipboard.
3. Go to the desired Waveform Page.
4. Click the Paste button to place the waveform on the current page.
To copy selected waveforms to another page using Menu options

2. Select Edit > Copy to copy the selected waveform(s) to the clipboard.
3. Go to the desired page.
4. Select Edit > Paste to paste the waveform(s) on the page.
5.4.5 Using the Waveform Pop-Up Menu

The Waveform Pop-up menu provides quick access to many of the options and commands available on the Toolbar and the
Waveform Menu. To display the Waveform Pop-up menu, place the cursor over the Waveform Page Work Area and click
the right mouse button.

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Fig. 78 Waveform Pop-up Menu
Use the Waveform Pop-up Menu to manipulate and combine one or more selected waveforms or to place markers on
selected waveforms.
This menu can also be used to delete selected waveforms or display the Display Scale dropdown menu.

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Fig. 79 Display Scale Dropdown Menu
The Display Scale dropdown menu indicates either the current scale used for the primary waveform on the current page
or the default scale for the current page if the page is empty. Select Display Scale to change the display scale µV:

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5.4.6 Adding Comments to Waveforms

An operator may add text comments to each waveform using the Waveform Text dialog box.
Fig. 80 Waveform Text Dialog Box
Place the cursor in the large white text area on this dialog box, then type any comments you have about the selected
waveform. The information you type in this text box will be saved with the waveform and printed with the waveform on
the patient report.
If needed, use the Edit Pop-up Menu to perform editing functions on the text in the Waveform Comments box.
Note • Put the cursor in the text box and click the right mouse button to display
the edit pop-up menu.
Fig. 81 Edit Pop-up Menu

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To add text to a selected waveform

1. Click on a waveform handle to select the waveform.
2. Select Waveform > Text on the Menu bar to display the Waveform Text dialog box.
3. Place the cursor in the large text box and type the information you want to be printed with the waveform in the
patient report.
4. Click OK.
Note • An asterisk will appear in the upper right hand corner of the waveform handle to indicate that the wave-
form has comments.
5.4.7 Removing Waveforms

Selected waveforms can be cut or deleted from a waveform page using the cut or delete options.
• The Cut option temporarily places the selected waveform on the Clipboard and removes it from the waveform page. A
cut waveform can be pasted on the current page or another page. However, if another waveform is cut or copied, you
will not be able to retrieve the first waveform.
• The Delete option removes the waveform permanently from the page and does not place it on the Clipboard. Deleted
waveforms cannot be re-pasted. The system will prompt to confirm a deletion.
There are several ways to cut or delete a selected waveform:
• To delete a selected waveform using the Menu options:
– Select Edit > Cut to remove the waveform from the waveform page and temporarily place it on the Clipboard.
– Select Edit > Delete to display a system prompt confirming the deletion. Click Yes to delete the waveform.
• To delete a selected waveform using the keyboard, press the Del or Delete key on the keyboard to display a system
prompt confirming the deletion. Press Enter or click Yes to delete the waveform.
• To cut or delete a selected waveform using the mouse, click the Cut button on the Toolbar to temporarily place
the waveform on the Clipboard.
5.5 Marking Waveforms

Waveform Marker label buttons display on the Toolbar at the top of the Main Window. The same markers can also be
accessed through the Waveform Pop-up menu.
Fig. 82 ABR Marker Label Buttons on Toolbar
The available markers vary depending on the procedure that generated the selected waveform as shown.
Marker Labels
1 2 3 4 5 6 7 8 9 10 11 12
ABR I II III IV V VI I’ II III’ IV’ V’ VI’

5 Data Analysis
ECochG BL SP AP I II III IV V VI
ALR P1 N1 P2 N2 P3 N3
AMLR Po Na Pa Nb Pb
VEMP P1 N1 P2
P300 P1 N1 P2 N2 P3 N3
Use the Toolbar Marker buttons or the Waveform Pop-up menu to place markers on a selected waveform at the location of
the active cursor (A or B).
Once the marker labels are in place, the system displays the marked latency and amplitude information for the waveform
in the Calculation Box. The latency and amplitude data are saved with the raw waveform.
Fig. 83 Calculation Box with Latency and Amplitude Data
Toolbar Marker buttons, representing active markers on a waveform, are depressed when the waveform is selected. Active
markers are indicated by a check mark on the Waveform Pop-up menu. Deleting a marker removes the label from the
waveform, removes the check mark from the item on the Waveform Pop-up menu, and releases the depressed marker but-
ton.
The following procedures provide instruction for adding and removing marker labels from waveforms.
To add a marker label to a waveform

1. Click the Waveform handleof a waveform to highlight it.
2. Click on Waveform Cursor A or B to activate it.
3. Click on a position on the waveform to move the active waveform cursor to that location.
You may also select and drag the active cursor directly or use the left/right arrow keys to move to the desired loc-
ation.
4. Click on the desired Marker on the Toolbar to place the marker label on the waveform at the active cursor.
After a marker is assigned to a waveform, the marker button remains depressed until the marker is removed from
the waveform. Click on a depressed marker button to remove that marker label from the selected waveform.
5. Repeat Steps 3 and 4 for each marker you want to place on the waveform.
6. Repeat Steps 1 through 5 for each waveform, as needed.
To delete a marker(s) from a waveform using the Toolbar

1. Select the waveform that contains the marker to be deleted.
2. To remove one marker, click the Marker button on the Toolbar that corresponds to the marker.
3. To remove all markers, click on the Clear Markers button.
To delete a marker(s) from a waveform using the Waveform Pop-up Menu

1. Click on the waveform handle of the waveform that has a marker to be deleted to select the waveform.

5 Data Analysis
2. Place the cursor over the waveform area and click the right button on the mouse to display the Waveform Pop-up
menu.
3. Click on the marker with a check mark that you want to remove. This will remove the corresponding marker label
from the waveform and the check mark from the menu item.
5.6 Waveform Operations

The ICS Chartr EP 200 program provides several methods for manipulating waveforms on a waveform page, including over-
laying, merging, spreading, inverting, and smoothing. In addition, a new waveform can be created by adding or subtracting
selected waveforms.
5.6.1 Overlaying Waveforms

From two to twenty waveforms can be superimposed on each other. The waveforms will be superimposed at the location
of the first selected waveform.
To superimpose waveforms on a waveform page

1. Select all of the waveforms you wish to superimpose.
2. Select Waveform > Overlay Selected on the Menu bar or the Waveform Pop-up menu to overlay the waveforms.
To overlay all of the waveforms on the active waveform page

• Select Waveform > Overlay All on the Menu bar or the Waveform Pop-up menu or
• Press Ctrl + O on the keyboard.
5.6.2 Merging Waveforms

The waveforms on a waveform page can be sorted and ordered using the Merge option. The resulting placement of the
waveforms is based on the ear stimulated, the collection channel, the stimulus intensity and the tone frequency / click
(click is treated like another tone frequency). Waveforms with the same frequency are grouped together. The Merge
option is not available if both P300 and non-P300 waveforms are on the same page.
In Example A, data from left ear ipsilateral stimulation is in the left column and data from right ipsilateral stimulation is in
the right column. In Example B, data from right ipsilateral stimulation is in the left column and data from right contralateral
stimulation is in the right column.
LI80 RI80 RI80 RC80
LI60 RI60 RI60 RC60
LI40 RI40 RI40 RC40
Fig. 84 Examples of Merging
To merge waveforms, select Waveform> Merge on the Menu bar or on the Waveform Popup menu.
5.6.3 Spreading Waveforms

All of the waveforms on the active Waveform Page can be distributed at equal intervals on the page. The waveforms are
spread vertically while maintaining their current relative position to each other.

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There are several ways to spread all of the waveforms on a waveform page:
• Select Waveform > Spread on the Menu bar or on the Waveform Pop-up menu or
• Press Ctrl + S on the keyboard.
5.6.4 Smoothing Waveforms

Unsmoothed waveforms are displayed with 600 points. The more points used, the finer the resolution; however, this can
cause data to appear noisy, especially when using window/epoch of 50 ms or less. In order to make the data look com-
parable to the commonly used 256 points display for windows/epochs of 50 ms or less, the data collected with win-
dows/epochs of 50 ms or less has a default of 7 point smoothing. The waveform can be unsmoothed after collection, if
desired.
From one to twenty waveforms can be smoothed at a time. The amount of smoothing applied depends on the smoothing
option selected (between 7 and 23 points).
• 7 points provides the least amount of smoothing.
• 23 points provides the maximum amount of smoothing.
After a waveform is smoothed, the trial and channel information for that waveform in the waveform information line is
changed to indicate the presence and the amount of smoothing.
Fig. 85 Smoothing Status Display
To smooth one or more selected waveforms

1. Select the waveforms to be smoothed.
2. Select Waveform > Smooth > [x points] on the Menu bar or Waveform Pop-up menu to display the smoothing
options.
3. Select a value from 7 to 23 points to smooth the selected waveforms.

5 Data Analysis
Note • Keyboard alternative: Press Ctrl + F on the keyboard to smooth the waveform by 7 points. This keyboard
option is not available for the other values.
To unsmooth smoothed waveforms

1. Select the desired waveforms.
2. Select Waveform > Unsmooth on the Menu bar or Waveform Pop-up Menu.
Note • You may also press Ctrl + U on the keyboard to remove the smoothing from the selected waveforms.
5.6.5 Inverting Waveforms

A selected waveform on a waveform page may be inverted. The inverted status is indicated in the Status Line below the
waveform page.
Fig. 86 Inverted Waveform Status Display
Note • When a waveform is inverted, that waveform on all of the waveform pages will also be inverted.
To invert a waveform
1. Select the waveform you want to invert.
2. Select Waveform > Invert on the Menu bar or press Ctrl + I on the keyboard to invert the waveform.

5 Data Analysis
5.6.6 Adding Waveforms

From two to nineteen waveforms on a page can be added together. The added waveform represents the weighted average
of the component waveforms. Thus, waveforms with more accepted sweeps have more weight in the added waveform.
The resulting summed waveform will be placed in the first unused waveform bank on the waveform work area of the cur-
rent page. If a waveform bank is not available on the page, the addition will not be completed.
Note • Only waveforms that result from the same trial setting parameters should be added together.
The lower information status display indicates:

• Display scales of the added waveform. The accepts and rejects are displayed in the upper information panel only dur-
ing a test.
• The summed status of the added waveforms is listed in parenthesis, for example, (5.2 + 1.2 + 5.1).
Fig. 87 Addition Status Display
The markers from the first selected waveform of the component waveforms will be maintained on the added waveform.
To add two or more waveforms

1. Select the waveforms to be added.
2. Select Waveform > Add on the menu bar or press Ctrl + + on the number pad to create a new waveform that is the
weighted sum of the added waveforms.
Note • You may also use the Waveform Pop-up menu options to add the selected waveforms.

5 Data Analysis
5.6.7 Subtracting Waveforms

One waveform can be subtracted from another waveform. The waveform selected second will be subtracted from the first.
The resulting waveform will be placed in the first unused waveform bank on the waveform work area. If a waveform bank is
not available on the current waveform page, the subtraction will not be completed.
Note • Only waveforms that result from the same trial setting parameters should be subtracted.
Fig. 88 Subtraction Status Display
Markers from the first selected waveform of the component waveforms will be maintained on the new waveform.
To subtract one waveform from another waveform

1. Select the waveforms to be subtracted.
2. Select Waveform > Subtract on the menu bar or press Ctrl + - on the keyboard to create the new waveform.
Note • You may also use the Waveform Pop-up menu options to subtract the selected waveforms.
5.7 Working with ASSR Data
5.7.1 To access ASSR data

1. Open an existing patient record.
2. Select the Review Tab in the Main Window and click the ASSR button.

5 Data Analysis
Fig. 89 Review Tab, ASSR
3. Select the Physician Order Date to display the ASSR test results collected under that order.
4. Select a test to see the corresponding trial setting details in the Calculation Box on the Main Window.

5 Data Analysis
Fig. 90 Main Window with ASSR Data
5.7.2 ASSR Merge Multiple Searches

With the patient file open, click ASSR to display the list of various test dates/times on the review tab.
Follow these steps to combine tests into one audiogram:

1. Select Display > Merge Multiple ASSR Searches from the menu bar to display the list of tests.

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2. Highlight the tests you would like to combine (test parameters must be the same or errors will occur)
3. Click OK to create the merged audiogram.
5.8 Data Graphs

The ICS Chartr EP 200 program provides these types of data graphs:
• Click Normative Data
• Tone-Burst Normative
• PediGram Data
Note • To use the normative data, birthdate and gender must be entered.
5.8.1 Click Normative Data

The ICS Chartr EP 200 program provides a graphic representation of click normative data for Latencies I, III, and V and for
Interpeak Intervals I-III, III-V, and I-V. The click normative data can be viewed online and/or printed as part of the patient
report (see Section 6, Printing a Report). The normative data is based on the following publication and personal com-
munication by Michael P. Gorga, Ph.D. 1 2, et. al. from Boys Town National Institute for Communication Disorders in Chil-
dren.
1Gorga, M.P., Reiland J.K., Beauchaine, K.A., Worhington, D.W., Jesteadt, W. (1987) Auditory brainstem responses from
graduates of an intensive care nursery: normal patterns of response: Journal of Speech and Hearing Research, 30, 311-
318.
2Gorga, M.P., Kaminiski, J.R., Beauchaine, L.L., Jesteadt, W., Neely, S.T. (1989) Auditory brainstem responses from chil-
dren three months to three years of age: normal patterns of response. Journal of Speech and Hearing Research, 32,
281-288.

5 Data Analysis
Fig. 91 Sample Click Normative Data Graph
To view the click normative data graphs, select at least one ABR waveform (with marker labels) on a waveform page. The
selected waveforms should have, as a minimum, one of these markers or pairs of markers:
Latency / Interpeak Interval Marker

Latency I I
Latency III III
Latency V V
Interpeak Interval I - III I & III
Interpeak Interval III - V III & V
Interpeak Interval I - V I&V
In addition, the stimulus intensity for the selected waveform must be in the normative data range (0-100 dB nHL) and
normative data for the current patient's age must be available.
Note • See App. 4 Normative Data ► 186, Normative Data for more information.
If one or more of the above items are missing, the system will advise you that normative data is not available for the selec-
ted waveforms.

5 Data Analysis
Fig. 92 No Normative Data Available Message
On the data graphs, the data points are indicated by an x for the left ear stimulated and a • for the right ear stimulated.
• If the data point's location is in the upper boundary area with an arrow pointing up, the value is beyond the upper
limit of the graph. For example, Latency III is greater than 10 ms.
• If the data point's location is in the lower boundary area with an arrow pointing down, the value is outside the lower
limit of the graph. For example, Latency III is less than 2 ms.
To view the Click Normative Graphs for an active patient

1. Place the appropriate latency and amplitude marker labels on one or more selected waveforms.
2. Click on the waveform handle(s) to select the marked waveform(s).
Keyboard alternative: Ctrl + A will select all waveforms.
3. Click F8 Normative Data, select Waveform > Normative Data from the menu bar, or use the waveform popup
menu to display the Normative Data dialog box.
Fig. 93 Normative Data Dialog Box

5 Data Analysis
4. Click on a Normative Data Selection option to display the corresponding data graph for the selected waveform(s).
5. Repeat Step 4 for each type of data graph you want to view.
6. Click OK.
5.8.2 Tone-Burst Normative Data

Tone-Burst Normative Data graphs compare Latency V data against normative data. collected by Tom Littman, Ph.D. CCC-A,
Virginia Mason Medical Center, Seattle, Washington. The waveform's stimulus intensity must be in the normative data
range and normative data for the current patient's age must be available.
To view the tone-burst normative data graphs, place the appropriate markers on selected tone-burst waveforms. Select the
marked waveform(s), then select F8 Normative Data to display the Tone-Burst Normative Data dialog box. Select a fre-
quency to view the corresponding data for the selected frequency.
Fig. 94 Tone-Burst Normative Data Dialog Box
5.8.3 PediGram Data

The OtometricsPediGram information is consolidated on the PediGram graph and the PediGram Threshold Table.
• The PediGram graph displays the estimated hearing level threshold (dB nHL) by ear for each tone burst frequency. The
thresholds are determined by searching for the ABR waveform with both the lowest stimulus intensity and a Marker V
label. On the PediGram, the resulting stimulus intensity threshold is indicated by the type of transducer and ear used
during data collection.
• The PediGram Threshold Table provides a list of parameters for all channel data used as thresholds on the PediGram.
To display the PediGram graph, select Display > PediGram on the menu bar or select F4 Pedigram.

5 Data Analysis
Fig. 95 Tone-Burst Wave V Thresholds Dialog Box, PediGram Tab
PediGram data for the ear stimulated and the transducer used are indicated by a symbol. The vertical bars highlight typical
frequencies tested.
PediGram Symbols
PediGram Collected Data
Symbol Color Location (Side of grid line) Transducer Ear
Red Left side Insert Phone Right
Blue Right side Insert Phone Left
Red Left side Bone Conductor Right
Blue Right side Bone Conductor Left
Red Left side Headphones Right
Blue Right side Headphones Left

5 Data Analysis
Click on the PediGram Threshold Table tab to display the threshold reference information. This table provides a list of the
parameters used for all data used as thresholds on the PediGram.
Fig. 96 Tone Burst Wave V Thresholds Dialog Box, PediGram Threshold Table Tab
Each listing on the PediGram Thresholds Table corresponds to a data point on the PediGram graph and provides the fol-
lowing information.
(1st column) Displays the Trial and Channel Number (Trial.Channel) of the corresponding raw or smoothed
waveform.
Add - indicates data derived by waveform addition.
Sub - indicates data derived by waveform subtraction.
Frequency Displays the tone frequency in Hz or kHz.
Ear Indicates the ear stimulated:
Left - indicates left ear
Right - indicates right ear
Note • Only data for the left or right ear is shown on the PediGram Threshold Table.
Data collected while both ears are stimulated cannot be shown in this format.
Transducer Displays the type of transducer used to stimulate the patient; insert phone, bone conductor,
or headphones.
Waveform Formula Displays the formula used to produce derived data by channel and trial, for example:
(2.1 + 3.1) - indicates channel data added to obtain data.

5 Data Analysis
(2.1 - 3.1) - indicates channel data subtracted to obtain data.

N/A - indicates raw data.
Intensity (nHL) Displays the stimulus intensity as dB nHL.
Intensity (SPL) Displays the stimulus intensity as dB SPL.
OK Close the dialog box.

6 Working with Reports

6.1 Overview
The report writing features of the ICS Chartr EP 200 program for Windows are extensive. Reports can be set up to include
patient information and test results.
There are two elements to each report:
• The patient information portion of the report is system generated. The operator may edit or modify the patient
information by using the ICS Chartr EP 200 word processor.
• The test results portion of the report is system generated according to the options selected by the operator.
This section provides information on how to access and use the word processor to modify the patient information portion
of the report and procedures for generating and formatting the test results report.
6.2 Accessing the Word Processor

The ICS Chartr EP 200program retrieves patient information from the patient record in the database and creates a patient
report. The operator may use the word processor included in ICS Chartr EP 200 program to modify the patient information
portion of the report. In addition, the operator may add test result summary information to the report.
The operator may generate the patient information portion of a report and activate the word processor by:
• Pressing F6 Report if available on the Function Key bar, or
• Selecting Edit > Report from the Menu bar

Fig. 97 Patient Report in the Word Processor
6.2.1 Word Processor Functions

The ICS Chartr EP 200 word processor includes many standard Windows functions for editing text, including basic cut,
copy, paste, and delete operations.
To modify patient information in a report, the operator may need to use one or more of these word processor capabilities:
• Text formatting by font and paragraph.
• Tabs (programmable).
• Spell checking.
• Creating and applying macros.
The word processor spell checking option can be set to one of five dictionaries, American English, British English, French,
German, or Spanish.
6.2.2 Word Processor Menus

Many of the word processor functions are accessed through options on the Word Processor Menu bar. The menu bar
options are:
• File
• Edit
• Format
• Tools
• Help

Some menu options have keyboard shortcut equivalents. The shortcuts are listed next to the option on the menu.
6.2.2.1 File Menu

The word processor File Menu options allow the operator to create a new document, save a report file, save the report as
a rich text format (.rtf) file, and exit the report mode. Files may be saved in the default folder or in a folder selected by the
operator.
Note • Rich text format files can be opened in most Windows word processors and Internet browser applications.
These files retain their font and format attributes regardless of the application used to view the file.
Fig. 98 Word Processor File Menu
New Use the report template file to create a new report.
Save Save the report in the database.
Save As Save the report as a rich text file. Once saved, the report may be opened in most word pro-
cessing programs.
Print EP Report Displays print options for the full report.
Print ASSR Report Displays print options for the ASSR report.
Print Setup Displays the printer setup options.
Exit Exit the word processor; prompts operator to save changes.
6.2.2.2 Edit Menu

The word processor Edit Menu options allow the operator to perform the following editing functions: Undo, Cut, Copy,
Paste, Clear, Find, and Replace.

Fig. 99 Word Processor Edit Menu
Undo Clear the most recent action.
Cut Copy the selected text to the clipboard (for temporary storage) and delete from the report.
Copy Place the selected text on the clipboard for temporary storage (does not delete the selected text from the
report).
Paste Place the clipboard information in the document.
Clear Delete the selected text.
Find Display the Find dialog box.
Replace Display the Replace dialog box.
6.2.2.3 Format Menu

The word processor Format Menu options allow the operator to assign font and/or paragraph attributes to selected text.
Fig. 100 Word Processor Format Menu
Font Display the Fonts dialog box.

Paragraph Display the Paragraph Format dialog box.
6.2.2.4 Tools Menu

The word processor Tools Menu options allow the operator to conduct a spell check; select the dictionary that the spell
checker will use; and define and use macros.

Fig. 101 Word Processor Tools Menu
Spell Check Initiate a spell check.
Dictionary Options Display the Dictionary Options dialog box.
Define Macro Display the Define Macro dialog box.
Get Macro Display the Get Macro dialog box.
6.2.2.5 Help Menu

The Help menu options allow the operator to access help information on how to use the word processor and access a list
of keyboard shortcuts.
Fig. 102 Word Processor Help Menu
Open Access the User Manual.
6.2.3 Word Processor Toolbar

The word processor toolbar provides easy access to most of the editing and formatting functions available in the word pro-
cessor. Many of these functions can also be accessed through the menu bar.
Fig. 103 Word Processor Toolbar
Use the toolbar elements to:
Assign a font to selected text. Click the drop-down arrow to display a list of avail-
able fonts.
Assign a font size to selected text. Click the drop-down arrow to display a list of
available font sizes.
Assign bold (B), italic (I), or underline (U) style to selected text. Select a section
of text, then click on a button to apply the format to the selected text.
Assign paragraph justification to selected text. Place the cursor within a para-
graph and click a button to change the justification.

6.2.4 Word Processor Ruler Bar

The word processor ruler bar allows the operator to set tabs and adjust the page margins. It is located below the Toolbar.
Fig. 104 Word Processor Ruler Bar
First click anywhere in the text of the report to display the triangles. The two small triangles on the left side of the ruler
bar indicate the paragraph's left margin. Click and drag the triangles to adjust the left margin. Click and drag the top tri-
angle to indent only the first line of a paragraph. The larger single triangle on the right side of the ruler bar indicates the
paragraph's right margin. Click and drag this triangle to adjust the right margin.
6.3 Using Find and Replace

The Find option allows the operator to search a report to locate a specific word, number, or phrase. The Replace option
allows the operator to find a specific word, number, or phrase and replace it with another (operator-defined) word, num-
ber, or phrase. Both options are accessed from the word processor Edit Menu.
6.3.1 Find Option

To use the word processor Find option
1. Select Edit > Find (from the word processor Edit Menu) to access the Find dialog box.
Fig. 105 Find Dialog Box
2. Type the search word(s) and/or number(s) in the Find what text box.

3. Select the Match case option if the search is to be case sensitive. A check mark indicates the option is selected.
4. Select Up or Down to set the direction of the search in the document starting at the current cursor position. A dot
indicates the option is selected.
5. Click Find Next to move the cursor to the next occurrence of the Find what text string.
6. Click the Close button or Cancel to close the Find dialog box.
6.3.2 Replace Option

The replace search option starts at the current position of the cursor and goes to the end of the report. Place the cursor at
the beginning of the report to search the entire report.
To use the word processor Replace option

1. Select Edit > Replace (from the word processor Edit Menu) to access the Replace dialog box.
Fig. 106 Replace Dialog Box
2. Type the word(s) and/or number(s) to be replaced in the Find what text box.
3. Type the word(s) or number(s) that will replace the found text string in the Replace with text box.
4. Click Find Next to locate the next occurrence of the text string listed in the Find what text box in the report.
5. Click Replace to substitute the Replace with text string for the found text. Click Replace All to replace each occur-
rence of the Find what text string with the Replace with text string.
6. Click the Close button or Cancel to close this dialog box.
6.4 Working with Text

The ICS Chartr EP 200 word processor allows the operator to easily manipulate and format the text elements in the
patient information report by changing font and paragraph characteristics.
6.4.1 Modifying Fonts

By modifying font types, styles, and sizes, the reports produced within the ICS Chartr EP 200 word processor can be cus-
tomized to meet your requirements. Fonts are changed and modified using the Fonts dialog box. Select Format > Font to
display the Fonts dialog box.

Note • Use the Font button on the toolbar to change the default font used for the report. This may be
required for central European character sets.
Fig. 107 Fonts Dialog Box
Fonts List of fonts that can be applied to the selected text. Scroll through the list and click on a font to select
it.
Sizes List of font sizes that can be applied to the selected text. Scroll through the list and click on a number to
select it. You may also type a font size in the text box.
Attributes Select all of the font attributes that will apply to the selected text. A check mark indicates an option is
selected.
Normal - Apply the normal font style.
Bold - Apply the bold font style.
Italic - Apply the Italic font style.
Underline - Add an underline to the text.
Strike Out - Add a strike out line to the text.
Position Select one of the following positions for the font placement on the line:
Normal - Place text on standard text line.
Superscript - Place text above the standard text line and reduce the font size.
Subscript - Place text below the standard text line and reduce the font size.
OK Apply and save the font settings and exit the Font dialog box.
Cancel Exit the Font dialog box without applying and saving the changes.
6.4.2 Formatting Paragraphs

The format characteristics that are applied to selected paragraph(s) in the report can be changed using the Paragraph
Format dialog box. Select Format > Paragraph to display the dialog box.

Fig. 108 Paragraph Format Dialog Box
Line spacing Select from the available options to set the distance between selected lines on the report:
Single line, One and a half lines, Two lines. A dot indicates the selected option.
Free Enter a line spacing value other than a single line, one and a half lines, or two lines. The
default value changes based on the Line Spacing option selected.
In inches Click to display line spacing options in inches (1/4, 3/8, 1/2); then select a value. The Free
value changes for each option.
Alignment Select one of these paragraph alignment options: Left, Right, Centered, or Justified.
Indents Type the left and right margin distance in inches for all the lines in the paragraph. Type the dis-
tance the first line will be indented relative to the rest of the lines of the paragraph.
Distances Type the top and bottom margin distance in inches to be applied to the paragraph.
OK Apply and save the paragraph formatting options and exit the Paragraph Format dialog box.
Cancel Exit the Paragraph Format dialog box without saving the changes.
6.5 Using Word Processor Spell Check

Spell Check is a word processing option that checks the report for spelling errors. The spell checker uses the active or
default dictionary.
To access the spell check option, select Tools > Spell Check to display the following dialog box.

Fig. 109 Spell Checking Document Dialog Box
Syntax Displays possible misspelled word(s) from the report in red text.
Suggestions Displays suggested correct spellings for the word(s) in red in the Syntax area.
Undo Edit Change the previously corrected word in the report back to the original form.
Ignore Skip the currently highlighted word(s) in the report (listed in red in the Syntax area) and move
to the next possibly misspelled word.
Ignore All Skip the currently highlighted word(s) in the report (listed in red in the Syntax area) through-
out the report.
Add Add the currently highlighted word in the report (listed in red in the Syntax area) to the cus-
tom dictionary.
Change Replace the currently highlighted word in the report (listed in red in the Syntax area) with the
highlighted word in the Suggestions area.
Change All Replace the currently highlighted word every time it appears in the report (listed in red in the
Syntax area) with the highlighted word in the Suggestions area.
Quit Close and exit the Spell Check option.
To spell check a report

1. Select Tools> Spell Check from the Menu Bar to display the Spell Checking Document dialog box.
2. Look at the word(s) in red text in the Syntax area and decide whether changes are needed in the report.
3. Look at the word(s) listed in the Suggestions area and click on a word to highlight it.
4. Click Change to change the existing word(s) in the report to the Suggested word(s) or click Change Allto change all
occurrences of the misspelled word(s) in the report to the suggested word(s).
5. Click Ignore or Ignore All to skip the word(s) in the Syntax area and not change it in the report.

6. Click Add to add the word(s) in the Syntax area to the current custom Dictionary. Once a word is added, the Spell
Checker will not consider it misspelled.
7. Repeat steps 1 through 6 for each word that displays in red in the Syntax area. When the spell checker finishes the
report, the buttons turn gray and the Quit button changes to Done.
8. Click Done or Quit to close the spell checker and return to the report and display this message. Click OK .
Fig. 110 Spelling Check Complete Message
6.6 Using Macros

Word processor macros are operator-defined shortcuts that can be used to insert strings of text within a patient report and
from one report to another.
All macros defined in Default Operator will be available to all operators. Macros defined by a particular operator will be
available only to that operator. Check the macros available and make changes as needed.
6.6.1 Defining Macros

Macros are established in the Define Macro dialog box.

Fig. 111 Define Macro Dialog Box
Drop-down list Type an alphanumeric name (up to 12-characters) for a new macro or select an existing macro
from the drop-down list.
Text box Type the text for the macro or edit existing macro text.
Done Exit the dialog box and save any changes.
Save Save the currently displayed macro.
Delete Delete the currently displayed macro.
Default Replace the current operator macros with the macros defined for the Default Operator.
To define a word processor macro

1. Select Tools > Define Macro to display the Define Macro dialog box.
2. Type an alphanumeric name (up to 12-characters) for the macro.
3. Type the text in the text box. Press the Enter key on the keyboard to start a new line of text.
Note • Add new macros by typing a new macro name and typing over any words in the text box.
4. Press Save to save the macro name and text.

5. Click the drop-down arrow to see a list of macro names.
6. Press Done to exit the dialog box.

6.6.2 Inserting Macros

Once a macro is defined, the operator may insert the macro text anywhere within the word processor portion of a patient
report. Macros are inserted using the Get Macro dialog box.
Fig. 112 Get Macro Dialog Box
Drop-down list Displays a list of existing macro names.

Text box Displays the text attached to the selected macro name.
Insert Place the macro text at the cursor position in the word processor patient report.
Cancel Exit the dialog box without inserting the macro in the patient report.
To insert a macro in a patient report

1. Place the cursor at the location you want to insert text in the patient report.
2. Select Tools > Get Macro or press Ctrl+M to display the Get Macro dialog box.
3. Click the drop-down arrow and click on a macro name to select it from the list of macros.
4. Check the macro text and make sure it is correct.
5. Click Insert to place the macro text at the cursor position in the patient report.
Note • Macro text will be assigned the font and paragraph attributes that are active at the point of insertion. For
example, if the cursor is on a line that is Times, bold, 12 pt., and centered the macro text will display as Times,
bold, 12 pt., centered. Once the macro is in the report, the operator may change the font and paragraph attrib-
utes.

6.7 Printing a Report

The content of printed reports will vary based on the options selected prior to printing the report. Printed reports can
include the word processor report page (patient information) and the test results for selected tests.
Note • The report includes information about the test-site facility that is added according to the procedure in
Establishing the Test-Site Facility ► 52:
The name of the test-site facility appears on all patient reports.
The name, address, and telephone number appear on the word-processed patient report.
Test data and result options that can be placed in printed reports include the option to print:
• None, all, or the current waveform page
• PediGram data and the PediGram Thresholds Table
• Normative data
• The Test Parameters List
Page numbers can be included or excluded for each page. In addition, all of the report pages can be previewed on-line
prior to printing.
Selected report options for printing will be saved and already selected next time the print report dialog is accessed.
6.7.1 Print Report Dialog Box

Reports can be printed on either Letter or A4 size paper. Printer paper size is established during printer setup, typically
from the Printer Properties dialog box. Reports always print in the Portrait mode on Letter or A4 paper, even if another
option is selected during printer set up.
The elements that will be included in a patient report are established in the Print Report dialog box. To display the Print
Report dialog box select File > Print EP Report from the Main Window menu bar or from the word processor report.

Fig. 113 Print Report Dialog Box
The options on the Print Report dialog box include:
Waveform Page Select one of the following options (a dot indicates the selected option):
None - Do not include waveform pages in the report.
Current - Include the current waveform page for the active patient in the report.
All - Include all of the waveform pages for the active patient in the report.
Normative Data Select items to include the click or tone burst normative data graph(s) for the active patient in
the report.
Options Select the options to be included in the report:
PediGram - Select to include PediGram Data from the current test session.

PediGram Threshold Table - Select to include the PediGram Threshold Table in the report.
Test Parameters List - Select to include a list of the test parameters from the current test ses-
sion.
Word Processor Report - Select to include the patient information (word processor report)
along with the test results.
Print Page Numbers - Select to include the page number on each page of the report.
Waveform Width Use the slider bar to adjust the thickness of the waveform.
Buttons
Select All Place a check mark in front of all of the listed Normative Data options.
Clear All Remove the check mark in front of all selected Normative Data options.
Print Send the report directly to the printer.
Preview Displays the Print Preview mode. Display each page of the report as it will be printed.
Printer Setup Displays the Windows' Print Setup dialog box.
Cancel Exit the dialog box without printing the report.
6.7.2 ASSR Print Report Dialog Box

ASSR Data results can are printed using the ASSR Print Report Dialog Box.
With ASSR data displaying in the Main Window, select File > Print ASSR Report to display the ASSR Print Report dialog
box.
Selected report options for printing will be saved and already selected the next time the print report dialog is accessed.

Fig. 114 ASSR Print Report Dialog Box
The options on the ASSR Print Report dialog box include:
ASSR Threshold Select one of the following options (a dot indicates the selected option):
Searches
Current - Include only the current ASSR search results.
All - Include all ASSR search results for this patient.
ASSR Audiograms Select to include left and/or right ear data in the report.
Audiogram Options Select one or more of the following options:
Show ASSR Thresholds - Include the threshold settings used during data collection in the
report.
Apply Correction Factors - Include any data correction factors used during data collection in
the report.
Show Threshold Search Limits - Include the threshold limits used during data collection in
the report.

Show Positive/Negative Responses - Include both positive and negative response results in
the report.
Show Legend - Include the ASSR symbol legend in the report.
Show Grid - Display grid on in the data area of the report.
Report Options Select one or more of the following options:
Trial Settings List - Include a list of the trial settings used during data collection in the report.
Test Parameters List - Include a list of the test parameters used during data collection in the
report.
Word Processor Report - Include the word processor portion of the report with the ASSR
report.
Print Page Numbers - Add and print the page number on each page of the report.
Print Click to send the ASSR report for the current patient to the printer.
Preview Click to view the ASSR report prior to printing.
Printer Setup Click to view the Printer Setup dialog to choose printer specific options.
Cancel Click to cancel the report without printing or saving the report.
6.7.3 Print Setup Dialog Box

Options for printing documents are set in the Windows' Print Setup dialog box. Many programs on the computer will use
the options established in this dialog box. To access this dialog box from the Main window select File > Printer Setup.
Note • The appearance of this dialog box may vary depending on the type of printer being used to print reports.

Fig. 115 Print Setup Dialog Box
Use the options in this dialog box to select a printer, if other than the default is required.
6.7.4 Customizing the Report Template

Within a patient report, the placement of the information on the page, the font selection and sizes, and the paragraph
styles are all predefined in a Report Template.
The information and format of each report may be changed in the ICS Chartr EP 200 word processor. However, the tem-
plate must be changed in order to implement a global change that will apply to all of the reports produced at a work-
station or at a facility.
Report templates cannot be changed while working in ICS Chartr EP 200 for Windows. Use a standard word processing pro-
gram, such as Word, WordPerfect, or WordPad (included with Windows), to make changes to the report template.
To access and modify the report template
Note • The file name of the report template is template. The file extension is .rtf (rich txt format). This format
can be opened and displayed in a variety of word processing aplications.
1. Close the ICS Chartr EP 200 program and access the Windows Desktop.
2. Click the Windows Explorer icon or select Start, Programs, Windows Explorer to open Windows Explorer.
3. Expand the Program Files Folder.
4. Expand the ICS Medical Folder (under Program Files) to display the ICS CHARTR EP for Windows Folder.
5. Click on ICS CHARTR EP for Windows to display the contents.

Fig. 116 template.rtf in Windows Explorer
Note • You may also open this file in another word processing application.
6. Locate and double-click the template.rtf (for English) file to open the file in a word processing program.
Warning • DO NOT change any of the brackets (< >) or the information in the brackets. It must remain exactly as
written in order to retrieve information from the database. You may however, delete these items, change the
font and paragraph characteristics, or change their placement on the page.
7. Make changes to the font selection and size, as desired. Make changes to the paragraph appearance as desired.
8. Make changes to the placement of data on the page as desired.
Note • A logo can be added to the template. Insert the logo into the template and move it to the desired location.
The logo should be smaller than 500 KB.
9. Use the font icon on the Toolbar to change the font used for the report.
10. Save the changes made to file template.rtf (for English) and save the file as Rich Text Format (.rtf). Any other format
will not work with the ICS Chartr EP 200 software.
11. Close the file and exit the word processing program.

7 Exporting, Importing, and Archiving Records

7.1 Overview
The ICS Chartr EP 200 program saves all patient records to a database. The database typically resides on the hard drive of
the workstation. It may also reside on a file server in a networked environment.
When the number of patient records approaches the operating limits of the system, (i.e., the hard drive runs low on free
space), the patient records can be archived and moved to an off-line storage media, such as a CD or another hard drive.
The archived patient records can be accessed from off-line storage at a later time.
Some facilities may want to archive records on a regular, scheduled basis. Regardless of the reason for the archive, the pro-
cess used to archive the records is the same.
This section provides information on how to transfer individual patient records to other workstations and how to archive,
store, and retrieve database records. The section is organized as follows:
• Exporting Patient Records
• Reviewing Exported Database Patient Records
• Importing Patient Records
• Archiving Exported Patient Records
• Working with Archived Patient Records
7.2 Exporting Patient Records

Individual patient records can be transferred from one system to another via a CD or flash drive for review and analysis.
To export a patient record to the desktop, a CD, or a flash drive

1. Click F3 Existing Patient or select File> Existing Patient on the Menu bar to display the Patient Selection dialog box.
2. Select the patient whose records will be transferred and click Open.
3. Select Database > Export Patient to Database to display this dialog box.

Fig. 117 Save Export As Dialog Box
4. Browse to the location the data should be stored.

5. Click Save to export the patient record. When the export process is complete, the following dialog box displays.
Fig. 118 Patient Record Exported Message
6. Click OK.
7.3 Reviewing Exported Database Patient Records

Patient records that have been exported to a database can be reviewed and analyzed on any ICS Chartr EP 200 work-
station.
To review a patient record in an exported database

1. Select Database > Open Archived Database or Exported Patient . The Open File dialog will allow you to select an
archived database or an export database.
2. Select the desired database and click OK to display the Patient Selection dialog box containing a list of the patient
records on the storage medium.
3. Select the desired patient record to view.
4. Select File > Close Patient to close the active patient record when finished.

7.4 Importing Patient Records

Data in an archived database or exported patient database can be returned to the original database for storage or viewing.
To import a patient record from a database file

1. Select Database> Import Patients from Database. The Open File dialog will allow you to select the archived data-
base or export database containing the patient records you wish to import.
Fig. 119 Open Archive/Export Database Dialog Box
2. Click OK to display the Import Patient Selection dialog box containing a list of the patient records in the archive/-
export database.
3. Select the desired patient record(s) to be imported. Click OK to import the patient record(s).
To import patient records into ICS Chartr EP 200 systems

1. Select Database > Import Patients from Database.
2. Select the database (*.mdb) and click Open. A prompt “operator specific information will not be imported.” displays.
Click OK.
3. Highlight all patients (select the top case on the list, hold the Shift key, and left click on the bottom case) and click
Import.
4. Click OK.
7.5 Archiving Patient Records

The ICS Chartr EP 200program includes an archiving option that allows the operator to archive all of the existing patient
records in the database. The archived records can be easily retrieved. Once retrieved, the operator has access to all of the
patient records contained in the archive.

Note • Operator, referring physician, and other non-patient records are archived with the patient records and are
copied to the new empty database on the hard drive or server. We recommend that you also save the archived
database to an external medium (CD-ROM, DVD, etc.).
Typical reasons for archiving records include:

• System Requirements
When the storage capacity of the database is full, system resources are impacted. This will affect the ability of the sys-
tem to successfully conduct, review, and analyze tests.
• Periodic Storage
It is a good practice to schedule archives of patient records on a regular basis, for example, archiving monthly,
quarterly, or annually.
Caution • When the database capacity is reached, the system will prompt the operator to create an archive. No
further testing or data entry can be done until the existing patient data is archived and a new database is star-
ted.
To archive patient records

1. Select File > Close Patient to close an open patient record and clear waveform data from the Main Window .
2. Select Database > Archive and Start New Database.
Fig. 120 Database Menu
3. Select a destination folder for the archive if other than the default destination folder.

Fig. 121 Select Archive Destination Dialog Box
4. Type a name for the archive in the File name text box if other than the default name.
– The system automatically assigns a name, based on the year, month, and day, to the archive. (Example: chartr_
2008_Feb_08_144732_archive.mdb is an archive created February 8, 2008). The archive file extension is always
.mdb.
– For consistency and accuracy, we recommend that you use the default archive destination folder and default nam-
ing conventions. However, you may assign a name and store an archive in a folder of your choosing.
5. Click Save to store the archive file in the destination folder. A message will display announcing that the database
archive was successful and the archived database may now be moved to another storage medium.
The archived file may now be moved to an off-line storage option. Once copied to a new destination, the archived data-
base on the hard drive could be deleted in order to free up disk space.
• Use Windows Explorer to copy the archived database to another hard drive or to another destination on the network.
• Use the instructions supplied by the manufacturer to copy the archived database to another storage option.
7.6 Working with Archived Patient Records

Archived patient records can be accessed from the ICS Chartr EP 200 system and reviewed at any time.
To view an archived database

1. Select File > Close Patient to close an open patient record and clear waveform data from the Main Window .
2. Select Database > Open Archived Database or Exported Patient to display the Open Archive/Export Database dia-
log box. If the archived database being worked with has been moved to an external medium, it will need to be
restored to the hard drive before performing this step.

Fig. 122 Select Archive Source Dialog Box
3. Select the archived file to be opened. Make sure it displays in the File name text box.
4. Click Open to display the Patient Selection dialog box.
5. Select a patient from the list of available patients and click Open to open the selected patient's record.
6. Work with the patient records as needed.
7. Select File > Close Patient to close the patient record.
Be careful when working with archived information. The only on-screen indication that the record is from an
archived file is that the Database > Open Archived Database or Exported Patient option, from the Empty Main win-
dow is preceded by a check mark.
8. Select Database > Open Main Database to exit the archived database and return to the active database. See the pro-
cedure Archiving Patient Records ► 136 for instructions on how to move an archived database off line again.

8 Calibration and External Trigger

8.1 Calibration for ICS Chartr EP 200
GN Otometrics recommends, but does not require, calibration of its equipment. Typically equipment used to test hearing
is calibrated annually. Calibration of the ICS Chartr EP 200 system must be performed by the manufacturer or by an author-
ized GN Otometrics representative. Repair of ICS Chartr EP 200 systems must be performed by the manufacturer or by an
authorized GN Otometrics representative.
Please contact GN Otometrics using email (hotline@gnotometrics.dk) or by calling the hotline in Denmark (+45 45 755
442).Please contact your local supplier.
The database and calibration setup options are accessed through the Calibration menu option.
8.2 External Trigger

The external trigger capability can be used to enable the ICS Chartr EP 200 system to accept control signals from or
provide control signals to external devices, thus synchronizing the system with the external device. External devices might
be strobe light assemblies, electrical stimulators, cochlear implant equipment, etc.
For the Chartr EP 200 system, connect the trigger cable (part no. 8-71-88200) to the rear panel of the Chartr EP 200 box.
Fig. 123 External Trigger Symbol
To connect to the MCU 90 XP (tower), access to the external trigger feature is provided through an optional female DB-9
connector mounted on a computer card slot bracket installed in one of the MCU 90 XP (tower) slot positions. (Connector is
available from GN Otometrics).
Pin Signal
1 Ground
7 (100 s, 5V Pulse)
8 EXT TRIG IN
(5-25V Pulse, - Trig)
Fig. 124 External Trigger

Slot

When the external trigger is enabled, the stimulus rate specified in the trial settings dialog box is disabled.
The external trigger input will trigger the system on the falling edge of a control signal that has an amplitude of +5V to
+25V. The following events will happen upon detection of the trigger signal:
• When a “0” or negative acquisition delay is used, the system will immediately begin data acquisition and sim-
ultaneously provide an external trigger output pulse. An audio output will occur based on the amount of negative
delay entered, either immediately (“0”) or at some moment later.
• When a positive acquisition delay is used, the system will immediately provide an external trigger output pulse and
audio output. Data acquisition will begin after the entered positive delay has occurred.
External trigger output is an output pulse with duration of 100 microseconds and amplitude of +5V. The system will
provide a trigger output signal:
• At the start of data acquisition when either a “0” or negative stimulus delay is used.
• At the beginning of an audio output when a positive delay is used.
• Immediately when an external trigger input signal is detected (when an external trigger is enabled in the Trial Settings
dialog box).
Refer to document 7-45-00650 “Electrical Auditory Brainstem Response (EABR) using the Chartr EP 200” for more inform-
ation. (This document was included with the product when purchased.)

9 Troubleshooting
9 Troubleshooting
If unable to restore proper function to the ICS Chartr EP 200 system components, do not attempt to repair the system.
Repair of the ICS Chartr EP 200 system must be performed by the manufacturer or by an authorized GN Otometrics rep-
resentative. Please contact GN Otometrics using email (hotline@gnotometrics.dk) or by calling the hotline in Denmark
(+45 45 755 442).Please contact your local supplier.
9.1 Overview
The ICS Chartr EP 200 system does not require extensive troubleshooting capabilities. This section provides information
that will help ensure the proper function of system components.
• Test Fixture
The test fixture included with the ICS Chartr EP 200 system is used to check the working condition of the auditory
stimulus board and data collection (A/D board) portions of the system.
• Fuse Replacement
Fuses are located on the Isolation Transformer and may occasionally need to be replaced. Follow the instructions in
the fuse replacement portion of this section to replace those fuses.
• Database Repair Utility
This section also provides information to follow while attempting to repair a corrupted database. Use the database
repair procedure only if the system prompts with an error message when an operator is attempting to access or save
information to the database.
See App. 6 Error Messages ► 203 for lists of commonly encountered Error Messages. Additional technical assistance is
available. Please contact GN Otometrics using email (hotline@gnotometrics.dk) or by calling the hotline in Denmark (+45
45 755 442).Please contact your local supplier.
9.2 Test Fixture

The ICS Chartr EP 200 system includes a test fixture that allows you to check the working condition of the auditory stim-
ulus board and data collection (A/D board) portions of the hardware system.
The test fixture checks the working condition of the auditory stimulus and data collection portions of the Chartr EP 200
hardware.
To use the test fixture for the Chartr EP 200 hardware

1. Make sure the PC is turned off.
2. Unplug the electrodes, earphone cable (labeled Phone), and the bone oscillator (labeled Bone) from the Chartr EP 200
preamp and plug in the test fixture cable.
3. Plug the test fixture into the electrode jacks of the preamp and the transducer connector.

9 Troubleshooting
Fig. 125 Plug Test Fixture into Preamp
4. Turn on the PC and double-click the ICS Chartr EP 200 icon to display the Operator Login dialog box.
5. Select an Operator and click OK to display the main window.
6. Select File> New Patient to start a patient record. Type a Patient Name and Birthdate, then click OK to return to
the main window.
7. Click the New Test tab and select the ABR: System Diagnostic protocol.
8. Click F12 Collect function key to run the test.
9. Check the results.
– If the test did not produce a noise-free sinusoid,additional technical assistance is available. Please contact GN Oto-
metrics using email (hotline@gnotometrics.dk) or by calling the hotline in Denmark (+45 45 755 442).Please con-
tact your local supplier..
– If the test produced a noise-free sinusoid, select File> Delete Patient, click on the patient record you created in
step F, and click OK to delete the record.
10. Return the equipment to operating status.
– Close the ICS Chartr EP 200 program and turn off the PC.
– Unplug the test fixture from the Preamp and reconnect electrodes, earphones, and bone oscillator.
– Turn on the PC and double-click the ICS Chartr EP 200 icon to start an EP work session.
To use the test fixture for the MCU 90 XP (tower) system

1. Make sure the PC is turned off.
2. Replace the earphone cable, labeled STIM, with the test fixture cable on the back of the computer.
3. Plug the patient cable into the test fixture. Align the Ch 1 active electrode input (yellow) on the patient cable with
the yellow-labeled (top) side of the test fixture.
4. Turn the computer on and double-click the ICS Chartr EP 200 icon on the Desktop to display the Operator Login
dialog box.
5. Login as operator and click OK to display the main window.
6. Select File> New Patient to start a new patient record. Type any patient name and birthdate, then click OK to open
the patient record.
Note • You will delete the new patient record at the end of this diagnostic test.

9 Troubleshooting
7. Click the New Test tab and select the ABR: System Diagnostic protocol from the list to highlight it.
8. Click F12 Collect to run a test.
9. Check the results.
– If the test did not produce a noise-free sinusoid, GN Otometrics using email (hotline@gnotometrics.dk) or by call-
ing the hotline in Denmark (+45 45 755 442)your local supplier.
– If the test produced a noise-free sinusoid, select File> Delete Patient, click on the patient record you created in
step F, and click OK to delete the record.
10. Return the equipment to operating status.
– Close the ICS Chartr EP 200 program and turn off the PC.
– Unplug the test fixture from the patient cable and the back of the computer. Reconnect electrodes, earphones,
and bone oscillator.
– Remove the Patient Electrode cable from the Test Fixture.
– Turn on the PC and double-click the ICS Chartr EP 200 icon to start an EP work session.
9.3 Fuse Replacement

The fuses are located in the fuse holder assembly on the power entry module on the rear panel of the Powertronix Isol-
ation Station. To access the fuses, the fuse holder assembly must be carefully removed from the power entry module.
Note • IMPORTANT! Replace failed fuses only with fuses identified by the fuse rating label located on the unit
next to the power entry module assembly.
1. Locate the power entry module on the rear panel of the Isolation Station and find the fuse holder assembly.
2. Remove the line cord and note the voltage indicated on the fuse holder assembly.
3. Use a flat-blade screwdriver to remove the fuse holder assembly from the power entry module.
4. Expose the fuse by carefully prying up on the small clip that is molded into the holder assembly and sliding the fuse
block out of the holder.
5. Replace the failed fuses. Use slow-blow fuses.
– For 115Vac systems use 250V 5A fuses (5 x 20 mm)
– For 230Vac systems use 250V 3.15A fuses (5 x 20 mm)
6. Slide the fuse block into the holder assembly while making sure the clip “latches” the fuse block assembly.
7. Reinstall the fuse holder assembly into the power entry module. Check that the proper voltage is displayed.
8. Reconnect the line cord to the power entry module.
9.4 Database Repair Utility

A Database Repair Utility attempts to correct ICS Chartr database problems. Use this utility only when instructed by an
error message while attempting to access or save information to the database.

9 Troubleshooting
Warning • Do not run this utility unless necessary. Running the repair program on a database that is not exper-
iencing problems may actually corrupt the database.
To run the Database Repair Utility

1. Select File > Exit to close the ICS Chartr EP application.
2. Click Start and select GN Otometrics > Chartr Database Repair to access the Database Repair Utility and display this
prompt.
Fig. 126 Chartr Database Repair Prompt
3. Click Yes to repair the database or click No to close the Database Repair Utility without repairing the database. No fur-
ther operator action is required.
4. Restart the application after the database repair is completed.
Note • If you continue to have database problems, technical assistance is available. Please contact GN Oto-
metrics using email (hotline@gnotometrics.dk) or by calling the hotline in Denmark (+45 45 755 442).Please con-
tact your local supplier.

10 Safety
10 Safety
This User Manual contains information and warnings, which must be followed to ensure the safe performance of the ICS
Chartr EP 200 system. Local government rules and regulations, if applicable, should also be followed at all times.
10.1 Symbols Used

Complies with Type BF requirements of EN60601-1.
Consult user manual for warnings and cautions.
Complies with Medical Devices Directive 93/42/EEC and RoHS Directive (2011/65/EC).
The switch alternates between On and Stand-by mode. Green – the switch is On (pushed in) and the USB con-
nection unit is ready. Blue – the switch is in Stand-by mode (pushed in) with no USB connection. Clear – the
switch is Off (pushed out).
Electronic equipment covered by the Directive 2002/96/EC on waste electrical and electronic equipment
(WEEE).
All electrical and electronic products, batteries, and accumulators must be taken to separate collection at the
end of their working life. This requirement applies in the European Union. Do not dispose of these products
as unsorted municipal waste.
You can return your device and accessories to Otometrics, or to any Otometrics supplier. You can also con-
tact your local authorities for advice on disposal.
Chartr EP 200 is marked with this symbol to indicate it is suitable for direct current.
Symbols on the Chartr EP 200 back panel. See Appendix D.
10.2 Warning Notes

GN Otometrics ICS Chartr products are not designed to be used in conjunction with any devices not approved by GN Oto-
metrics. Summation of combined unapproved parts could result in increased electrical leakage. All parts of the ICS Chartr
EP 200 system are suitable for use within the patient environment.

10 Safety
Equipment connected to the displayed connectors must be certified to rel-

evant EN/IEC safety standards, e.g., EN/IEC 60950. Mains connected equip-
ment – except EN/IEC 60601-1 certified equipment – must be powered
from isolation transformer.


The Chartr EP 200 should only be connected to power adapter type

FW73623M/15 from Friwo. For continued protection against fire hazard,
replace fuse with the same type and rating only.
Equipment
Note 1: There are no user-serviceable parts inside the Chartr EP 200 box or the MCU 90 XP (tower) box. For
the sake of safety, and in order not to void the warranty, the box should only be opened and ser-
viced by authorized service personnel. In case of defects, please make a detailed description of the
defect(s) and get additional technical assistance. Please contact your local supplier.Do not use a
defective instrument.
Note 2: Keep ICS Chartr EP 200 system away from liquids. Do not allow moisture inside the instrument.
Note 3: Do not use the instrument in the presence of flammable anesthetics (gases).
Note 4: Unwanted noise may occur if the ICS Chartr EP 200 system is exposed to a strong radio field. Such
noise may interfere with the process of recording correct measurements. Many types of electrical
devices, e.g., mobile telephones, may generate radio fields. We recommend that the use of such
devices in the vicinity of the ICS Chartr EP 200 system is restricted as much as possible.

10 Safety
Note 5: It is recommended to install the unit in an environment that minimizes the amount of static elec-
tricity. For example, anti-static carpeting is recommended.
Note 6: No parts may be eaten, burnt, or in any way used for purposes other than evoked potential testing.
Note 7: The ICS Chartr EP 200 system can be disposed of as normal electronic waste, according to local reg-
ulations.
Note 8: For safety reasons, accessories connected to the equipment's outlet fittings must be identical to
the type supplied with the system.
Note 9: To comply with EN 60601-1-1, the computer, printer, etc. must be connected to the isolation trans-
former.
Note 10: Connection to network or modem components may compromise the safety or effectiveness of this
system. Use fiber-optic or wireless network connections to install the computer on a network.
Note 11: The device is disconnected from the mains by removing the plug of the isolation station from the
wall outlet.
Note 12: Avoid accidental contact between connected but unapplied parts (electrodes including connections)
and other conductive parts including those connected to protective earth.
Note 13: GN Otometrics ICS Chartr products are not designed to be used in conjunction with any devices not
approved by GN Otometrics. Summation of combined unapproved parts could result in increased
electrical leakage. All parts of the Chartr EP 200are suitable for use within the patient environment.
Note 14: Accessory equipment connected to the analog and digital interfaces must be certified to the
respective IEC standards (i.e., IEC 950 for data processing equipment and IEC 60601-1 for medical
equipment.) Furthermore all configurations shall comply with the system standard IEC 60601-1-1.
Everybody who connects additional equipment to the signal input part or signal output part con-
figures a medical system, and is therefore, responsible that the system complies with the require-
ments of the system standard IEC 60601-1-1. If in doubt, consult the technical service department
or your local representative.
Note 15: The Chartr EP 200 needs to be installed and put into service according to the EMC information
provided in this manual. Portable and mobile RF communications equipment can affect medical
electrical equipment. The Chartr EP 200 may be interfered with by other equipment with CISPR
emission requirements.
Note 16: The use of accessories and cables other than those specified in the Accessories list of this manual
may result in increased emissions or decreased immunity of the Chartr EP 200.
Isolation Transformer (Powertronix Isolation Station)
Note 17: The isolation station should not be placed on the floor.
Note 18: The isolation station should be plugged directly into an outlet. Extension cords or power strips
should not be used in combination with the isolation station.
Note 19: Only the Chartr EP 200 or MCU 90 XP (tower) power supply, laptop/computer power supply, and
deskjet printer power supply should be connected to the isolation station. Do not connect any other
devices to the isolation station. Connecting other equipment to the isolation station can overdrive
the isolation station resulting in a blown fuse or damaging the isolation station beyond repair.
Note 20: Do not connect the Chartr EP 200 or MCU 90 XP (tower) directly to the wall outlet. By not using the
isolation station, you put the patient at risk to be exposed to power surges or electrical shock.

10 Safety
Patient Care
Note 21: Do not touch non-medical parts, such as the laptop/computer or printer and the patient at the
same time.
Note 22: Do not allow electrodes or electrode leads to contact conductive parts of the equipment or the
earth.
Note 23: While the patient who has a pacemaker or other implantable device is not at harm during testing,
these devices may interfere with the process of recording correct measurements.
Note 24: Exposure to electromagnetic fields can result in interference with the process of recording correct
measurements. The Chartr EP 200 and MCU 90 XP (tower) amplifiers are sensitive to electrical dis-
turbances. Avoid static discharges and electromagnetic fields.
Note 25: Conductive parts with patient connection must not be in contact with other conductive parts at any
time. No defibrillators or high-frequency surgical equipment should be applied to the patient when
connected to the Chartr EP 200 or MCU 90 XP (tower) at any time. Connecting a patient to high-fre-
quency surgical equipment while using the Chartr EP 200 or MCU 90 XP (tower) may result in burns
at the site of the electrode contacts.
Note 26: Immediately discontinue device use if skin irritation or discomfort occurs.
10.3 Manufacturer
GN Otometrics A/S
Hoerskaetten 9, 2630 Taastrup
Denmark
( +45 45 75 55 55
7 +45 45 75 55 59
www.otometrics.com
Distribuidor Autorizado no Brasil

GN Resound Produtos Médicos LTDA
Rua do Paraiso, 139 - 6/8 E 9 andar
São Paulo - SP 04103-000
Brasil
( 11 3016 8387 ou 11 3016 8389
10.3.1 Responsibility of the manufacturer

The manufacturer is to be considered responsible for effects on safety, reliability, and performance of the equipment only
if:
• All assembly operations, extensions, re-adjustments, modifications or repairs are carried out by the equipment man-
ufacturer or personnel authorized by the manufacturer.
• The electrical installation to which the equipment is connected complies with EN/IEC requirements.
• The equipment is used in accordance with the instructions for use.
The manufacturer reserves the right to disclaim all responsibility for the operating safety, reliability and performance of
equipment serviced or repaired by other parties.

11 Technical Specifications
11.1 ICS Chartr EP 200 System
Safety
The ICS Chartr EP 200 system, including the laptop and printer, is designed to meet medical power isolation standards
and other applicable medical standards.
Interface
USB to PC
Type Identification
Chartr EP 200 is Type 1073 from GN Otometrics A/S
Power Supply
AC/DC Adapter: Type: FW7362M/15 from Friwo

Input: 100-240 VAC / 50-60 Hz / 700-350 mA
Output: 15V DC / 2.6A
Isolation Transformer
Powertronix Isolation Station from GN Otometrics A/S.

AC/DC Adapter: X1ATWFHNOC1
Input Voltage: 115 (120) / 230 (240) VAC – 50/60Hz
Input Current: 2.6A / 1.3A
Leakage Current: < 100-A
Output Voltage: 115 (120) / 230 (240) VAC
Output Current: 2.5A / 1.25A
Operating Mode
Warm-up time: <2 min

Mode of operation: Continuous
Operating Environment
Temperature: +15° C to +35° C (59° F to +95° F)

Rel. Humidity: 30 to 90%, non-condensing
Air Pressure: 600 hPa to 1060 hPa
Operations at temperatures below –20° C (-4° F) or above +60° C (140° F) may cause permanent damage.

Storing and Handling
Temperature: -20° C to +60° C (-4° F to +140° F)

Rel. Humidity: <90%, non-condensing
Air Pressure: 500 hPa to 1060 hPa
Dimensions
Chartr EP 200 (HxWxD): 4.9 cm x 34.2 cm x 28.7 cm (2” x 13.6” x 11.3”)

Preamp 3.0 cm x 9.9 cm x 16.4 cm
(1.19" x 3.88" x 6.44")
VEMP monitor 2.9 cm x 6.2 cm x 9.5 cm

(1.13" x 2.44" x 3.75")
Weights
Chartr EP 200 box 2.7 kg (5 lbs 7 oz)

Preamp 0.27 kg (9.5 oz)
VEMP monitor 0.13 kg (4.5 oz)
Calibration
None required, but recommended annually.
Standards
Safety: EN 60601-1, UL60601-1, CAN/CSA-C22.2 NO 601.1-M90

Chartr EP 200 EN 60601-1, Class II, Type BF, IPXO
Power Supply: EN 60601-1, Class II, IPXO
System: EN 60601-1-1
EMC: EN 60601-1-2
11.2 ICS Chartr EP 200 and MCU 90 XP (tower) Specifications
11.2.1 System Capabilities

Performance Characteristics
Analysis time 5.0 - 9000 msec

A/D resolution 16-bit (12-bit MCU 90 XP (tower))
Artifact rejection 100% full scale
Points per trace 600

Amplifiers
Channels 2
Gains Chartr EP 200 - x1,000 - x500,000
MCU 90 XP (tower)) - x50 - x500,000
Analog Filters
Low pass Chartr EP 200 - 15 Hz to 10 kHz, 12 dB/octave

MCU 90 XP (tower) - 25 kHz
High pass Chartr EP 200 - 0.2 - 1kHz, 6 dB/octave
MCU 90 XP (tower) - DC, 0.002 - 1 kHz, 6 dB/octave
Miscellaneous
Noise level <1.5 uV RMS (0.1 Hz - 5 kHz)

Input impedance >10 Mohm
CMR ratio >90 dB at 50/60 Hz
Stimulators
Stimuli Click, tone burst

Parameters for tonal Programmable - frequency, intensity, rise/fall time, plateau duration, envelope shape
stimuli
Rate 0.2 to 180/sec
Intensity Chartr EP (USB) - 0 dB to +132 dB SPL
MCU 90 XP (tower) - 128 dB SPL
Masking White noise, programmable
Transducers TDH-49 earphones, insert earphones, bone conduction transducer
11.3 Accessories and Cables

Skin Preparation
NuPrep Gel 7590030-3
Ten20 Conductive Paste 7590480-3
Electrode Gel Signa 7590024
Electrode Skin Prep Pads 7590031
Gauze Pads 8-62-43000
Q-Tips 8-62-43001

Electrodes and Electrode Leads
Five snap lead package (24 inch) 7590319-24-5
Five snap lead package (40 inch) 7590319-40-5
Safety Jumper, qty 3 7590490-3
Electrocochleography TipTrode Electrode Lead Cable, with tubing 7590513
Five reusable electrode package (48 inch) 7590450
Snap disposable electrodes, qty 20 8-64-21602
Snap Differential electrode (VEMP), qty 20 8-64-21600
Eartips
Foam Eartip, 3A, Standard, qty 50 80A4820900
Foam Eartip, 3B, Small, qty 50 80A4821000
TipTrode, Adult Gold Foil, qty 20 7590511
TipTrode, Child Gold Foil, qty 20 7590512

Cables/Cords
Preamp Cable 7-08-50700
USB cable, 2 meter 8-71-79200
Power cord, US w/plug (UL approved) 7-08-017
Power cord. CH w/plug 7-08-027
Power cord, EU (straight) 7-08-07500
Power cord, UK (straight) 7-08-07501
Power cord, US (straight) 7-08-07502
Power cord, AUS (straight) 7-08-07503
CD Mains Cord HO5VV, CHI 7-08-07504
Power cable, standard w/ "Schuko" plug 8-71-240
Power cord, DK w/plug 8-71-290
Power cord, UK w/plug 8-71-80200
Power cord, AUS w/plug 8-71-82700
Power cord, CHI w/plug 8-71-86400
Mains Adaptor Cables, EU 7-08-10500
Mains Adaptor Cables, UK 7-08-10501
Mains Adaptor Cables, US 7-08-10502
Mains Adaptor Cables, AUS/CHI 7-08-10503
Mains Adaptor Cables, SWISS 7-08-10505
Mains Adaptor Cables, DK 7-08-10506
11.4 Guidance and manufacturer’s declaration tables

• ICS Chartr EP 200 is part of a medical electrical system and is thus subject to special safety precautions. For this reason,
the installation and operating instructions provided in this document should be followed closely.
• Portable and mobile high-frequency communication devices, such as mobile phones, may interfere with the func-
tioning of ICS Chartr EP 200.

Guidance and manufacturer's declaration - electromagnetic emissions for all equipment and systems
ICS Chartr EP 200 is intended for use in the electromagnetic environment specified below. The user of ICS Chartr EP 200
should ensure that it is used in such an environment.
Emissions test Compliance Electromagnetic environment - guidance
RF emissions Group 1 ICS Chartr EP 200 uses RF energy only for its internal function. Therefore, its RF
CISPR 11 emissions are very low and are not likely to cause any interference in nearby
electronic equipment.
RF emissions Class B ICS Chartr EP 200 is suitable for use in all environments, including domestic
CISPR 11 environments and those directly connected to the public low-voltage power
Harmonic emis- Class A supply network that supplies buildings used for domestic purposes.
sions IEC 61000-3-2
Voltage fluc- Complies
tuations/flicker
emissions IEC
61000-3-3

Guidance and manufacturer's declaration - electromagnetic immunity for all equipment and systems
Immunity test IEC 60601 Compliance level Electromagnetic environment - guid-
test level ance
Electrostatic discharge +/- 6 kV contact +/- 6 kV contact Floors should be wood, concrete or
(ESD) +/- 8 kV air +/- 8 kV air ceramic tile. If floors are covered with
IEC 61000-4-2 synthetic material, the relative humid-
ity should be at least 30 %.
Electrical fast tran- +/- 2 kV for power supply +/- 2 kV for power supply Mains power quality should be that of a
sient/burst IEC 61000-4- lines lines typical commercial or hospital envir-
4 +/- 1 kV for input/output +/- 1 kV for input/output onment.
lines lines
Surge IEC 61000-4-5 +/- 1 kV line(s) to line(s) +/- 1 kV line(s) to line(s) Mains power quality should be that of a
+/- 2 kV line(s) to earth +/- 2 kV line(s) to earth typical commercial or hospital envir-
onment.
Voltage dips, short inter- >95% dip in 0.5 cycle >95% dip in 0.5 cycle Mains power quality should be that of a
ruptions and voltage vari- 60% dip in 5 cycles 30% 60% dip in 5 cycles 30% typical commercial or hospital envir-
ations on power supply dip in 25 cycles >95% dip dip in 25 cycles >95% dip onment.
input lines IEC 61000-4- in 5 seconds in 5 seconds If the user of the ICS Chartr EP 200
11 requires continued operation during
very long power mains interruptions, it
is recommended that the ICS Chartr EP
200be powered from an unin-
terruptible power supply or battery.
Power frequency 3 A/m Swept Magnetic Fields Power frequency magnetic fields should
(50/60 Hz) magnetic field per AAMI be at levels characteristic of a typical
IEC 61000-4-8 location in a typical commercial or hos-
pital environment.

Guidance and manufacturer's declaration - electromagnetic immunity - for equipment and systems
that are NOT life-supporting
Immunity test IEC 60601 Compliance level Electromagnetic environment - guidance
test level
Conducted RF 3 Vrms 150 kHz 3 Vrms Portable and mobile RF communications equipment should
IEC 61000-4-6 to 80 MHz be used no closer to any part of ICS Chartr EP 200, including
Radiated RF 3 V/m 80 MHz cables, than the recommended separation distance calculated
3 V/m
IEC 61000-4-3 to 2,5 GHz from the equation applicable to the frequency of the trans-
mitter.
Recommended separation distance:
d = 1.17
d = .5 (80 MHz to 800 MHz)
d=1 (80 MHz to 2.5 GHz)
where P is the maximum output power rating of the trans-
mitter in watts (W) according to the transmitter manufacturer
and d is the recommended separation distance in metres (m).
Field strengths from fixed RF transmitters, as determined by
an electromagnetic site survey, a should be less than the com-
pliance level in each frequency range. b
Interference may occur in the vicinity of equipment marked
with this symbol:
Note 1: At 80 MHz and 800 MHz the separation distance for the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflec-
tion from structures, objects and people.
a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile
radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To
assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be con-
sidered. If the measured field strength in the location in which ICS Chartr EP 200 is used exceeds the applicable RF com-
pliance level above, the ICS Chartr EP 200 should be observed to verify normal operation. If abnormal performance is
observed, additional measures might be necessary, such as reorienting or relocating ICS Chartr EP 200.
b Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

Recommended separation distances between portable and mobile RF communications equipment

and ICS Chartr EP 200
The ICS Chartr EP200 isintended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the
ICS Chartr EP 200 can help prevent electromagnetic interference by maintaining a minimum distancebetween portable and mobile RF communications equip-
ment (transmitters) and the ICS Chartr EP 200as recommended below, according to the maximum output power of the communications equipment.
Separation distance according to frequency of transmitter m

Rated maximum output 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz
power of transmitter W d = 1.17 d = 1.17 d=1
(V1=3) (E1=7) (E1=7)
0.01 0.117 0.050 0.10
0.1 0.369 0.158 .316
1 1.167 0.50 1.00
10 3.689 1.58 3.16
100 11.667 5.00 10.00
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters
(m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output
power rating of the transmitter in watts (W) according to the transmitter manufacturer.
Note 1: At 80 MHz and 800 MHz the separation distance for the higher frequency range applies.
Note 2: The ISM (industrial, scientific and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz;
13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
Note 3: An additional factor of 10/3 has been incorporated into the formula used in calculating the recommended sep-
aration distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range
80 MHz to 2.5 GHz to decrease the likelihood that mobile/portable communications equipment could cause inter-
ference if it is inadvertently brought into patient areas.
Note 4: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from structures, objects and people.
11.5 MCU 90 XP (tower) Specifications

Size
22.2 cm x 38.1 cm x 43.2 cm

(8¾” (W) x 15" (H) x 17" (D))
Weight
7 Kg (25 lbs.)
Power Supply
External supplied medical grade 120 or 240 volts built-in

Monitor
17-inch VGA
11.6 ASSR Specifications

Transducer Insert phone, headphones, bone conductor
AM Depth 50 - 100%, in 5% steps
FM Depth 0 - 25%, in 5% steps
Threshold Search / 0 - 120 dB HL (insert phones)
Upper Limit 0 - 110 dB HL (headphones)
0 - 60 dB HL (bone oscillator)
5 dB Steps
Threshold Search / Same options as upper limit
Lower Limit
Minimum Step Size 5 or 10 dB HL
Channel Gain Standard ICS Chartr EP 200 settings
High Pass/Low Pass Fil- Exclusive ICS Chartr EP 200 Narrow Filters for RapidASSR™
ters Standard ICS Chartr EP 200 settings
Per Ear / Frequencies 250, 500, 1000, 2000, 4000, 8000 Hz
to test
Per Frequency tested, 20 - 105 Hz, in 1 Hz steps
Per Ear Modulation Fre-
quency
Response Search Time 1 - 30 minutes
Data Collection Test impedance of patient electrode connections, displays waveform during collection, dis-
plays ongoing EEG, stores waveforms, presents corrected and uncorrected tone data graphs.

App. 1 Data Collection Reference

App. 1.1 Test Room Setup
Position the chair or table where the patient will be tested away from any devices or sources that cause electrical artifact
(e.g., computer monitors).
Try out the chair or table sitting or lying there for awhile. Are you comfortable? Ensure pillows and blankets are available
to ensure patient comfort.
App. 1.2 Supplies Required

The following supplies should be available in the test area:
• NuPrep™, electrode prep, or other skin prep materials
• Gauze pads or cotton swabs for application of skin prep
• Electrodes (non-disposable or disposable)
• Electrode jumper
• Conductive paste for non-disposable electrodes
• Cotton balls and/or tape for adhering the electrodes in place
• Disposable insert earphone eartips for adults and pediatrics
App. 1.3 Electrode guidelines

Electrodes that are not properly cared for will result in noisy, inaccurate data, and high impedances, and can also cause
trending in the waveform (the rising or falling of the waveform away from the baseline). These guidelines help ensure bet-
ter electrode performance:
• Braid or tape electrodes together to reduce noise and for better performance.
• Use non-disposable electrodes of the same metal type (e.g., silver, gold, etc.).
• Be aware that non-disposable electrodes do not last forever. Replace the electrodes if noisy recording persist or
impedances are high.
• Check the expiration date if disposable electrodes do not adhere.
• Use clean electrodes. To clean paste off of non-disposable electrodes, use a soft toothbrush (i.e., infant toothbrush)
and some warm water. Do not leave electrodes soaking in water for hours. Handle the electrode wires with care as
not to break them.
• Verify that the chloride has not chipped off of silver chloride electrodes. To re-chloride the electrodes, place only the
cup of the electrode into a small amount of chlorine bleach. Soak electrodes for only 20 minutes. Do not let the wires
touch the chlorine bleach.
App. 1.4 Skin Preparation

To prepare each site, use electrode prep on a cotton swab or gauze and scrub the area where the electrode will be
placed. Remember the electrode is not that large, so it is more efficient to accurately scrub the small area where the elec-
trode will be placed than to scrub haphazardly on a large surface area.

• If using non-disposable electrodes, fill the cup of the electrode with a pea-sized amount of conductive paste. Place the
electrode on the prepared site and then secure it with a little cotton or tape. When using a Cz placement, it is best to
use non-disposable electrodes. If the patient has a lot of hair product, place an alcohol pad at the electrode site for a
minute to dissolve the hair product.
• If using disposable electrodes, it is best to use a dry prep. The use of alcohol can dry out the skin too much and cause
the electrode not to adhere. If using a wet prep, wipe the skin clean of excess moisture before placing the disposable
electrode.
App. 1.5 Electrode wire connections

Below are the proper connections of electrode wires into the Chartr EP 200 preamplifier or the MCU 90 XP (tower)
patient cable for 1 and 2 channel recordings for ABR, ECochG, and VEMP.
Note • VEMP monitor is an available option.
Fig. 127 Connection to Chartr EP 200 preamplifier or to MCU 90 XP (tower) patient cable
Apply the electrodes to the patient. Use an appropriate electrode/transducer combination for the data being collected
and the patient's status. The system applies labels to collected waveforms based on the stimulated ear.
App. 1.6 Electrode Montages

This section provides basic information on applying electrodes to a patient and checking for proper electrode functioning.

Note • This section does not cover the recommended electrode placement for all types of EP procedures. Nor
does it provide information on applying all of the types of electrodes available. Refer to the electrode man-
ufacturer's instructions for more information.
The montages presented here are commonly used for data collection. These are not exclusive and other montages may be
appropriate for data collection.
App. 1.6.1 1 and 2-Channel Recordings
1-Channel recordings should only have 3 electrodes connected to the patient preamplifier (Ch 1 ACT, Ch 1 REF, and GND -
ground). Channel 2 electrode jacks are not used. Jumpers should not be connected. Leaving a jumper or electrode lead
connected can result in inaccurate data and may introduce noise into the recording.
AUDITORY BRAINSTEM RESPONSE MONTAGES
Fig. 128 1-Channel ABR

ELECTRODE SWITCHING ON
When performing bone conduction ABR, always place the reference electrode and the ground on the front of the earlobe.
Caution • If an alternative montage is used with Electrode Switching ON, the data collected will be inaccurate.


ELECTRODE SWITCHING OFF
Manually Switching Electrodes is Required


Wave V Enhanced for Infants
Channel 1 - IPSI Recording
Channel 2 - NAPE Recording

Wave V Enhanced for Infants
Channel 1 - IPSI Recording
Channel 2 - NAPE Recording
App. 1.6.2 Tips for TM (tympanic membrane) ECochGtrode
Always perform an otoscopic inspection before placing the TM electrode. Make sure that the ear canal is clear of ceru-
men. Do NOT place the TM electrode if the patient has a tympanic membrane perforation. To assist in reducing imped-
ance, place 2cc of saline into the ear canal and then drain the ear. Do NOT place saline in the ear if planning to perform
VNG/ENG calorics on the same day.

Instruct the patient that a small flexible tube will be inserted into the ear. The patient may feel a little pressure and may
hear a “thud” when the end of the electrode touches the tympanic membrane.
Place a very small amount of conductive gel over the hydrogel end of the TM ECochGtrode making it slick and less sticky.
Too much conductive gel can plug the insert or make removal difficult.
The ear canal should be in direct light when placing the electrode. Using a microscope or head lamp is appropriate.
After the TM ECochGtrode is in place, secure the cable to the patient so that the weight of the cable does not pull the
electrode out of the ear.
Insert the foam ear tip into the ear and on top of the TM ECochGtrode tubing. Hold the tubing of the TM ECochGtrode
when inserting the foam ear tip so that the electrode is not pushed against the patient's tympanic membrane.
Electrode impedance will be very high for the TM ECochGtrode (>20 kOhms) and will result in a large inter-electrode
impedance difference. Because the TM ECochGtrode is closer to the neural generation source, the inter-electrode imped-
ance is less of a problem. Verify that artifact rejection is OFF.
After data collection, remove the foam ear tip, then the TM ECochGtrode. Inspect the ear canal and the tympanic mem-
brane. There may be a small amount of residual electrode gel on the tympanic membrane. The tympanic membrane may
be inflamed where the electrode was placed. The gel residue will dry and exude from the ear canal. The tympanic mem-
brane inflammation should abate within a few hours.
Fig. 133 1-Channel ECochG with Tiptrode (Horizontal Montage)
App. 1.6.3 Tips for Tiptrodes
The Tiptrode consists of two components: the ear tip/electrode and the connector/cable assembly. The electrode is the
foam ear tip wrapped with gold foil. The connector/cable has an insulated alligator clip for attaching the ear tip/electrode
to the tubing for transmitting auditory stimuli and an insulated wire to conduct the electrode signal.
Attach the ear tip/electrode to the connector. Squeeze the metal clip open and then slide the ear tip/electrode on mak-
ing sure that the alligator clip is touching the gold foil.
Connect the tubing to the output of the insert earphone.

Remove the tubing that is currently on the insert earphone and replace it with the tubing on the Tiptrode. Do NOT
double the length of the tubing by attaching the two sets together.
Red tubing goes to the right insert phone and blue tubing to the left insert phone.
Attach the electrode lead wire to the patient cable. See montages for electrodes placement options.
App. 1.6.4 Auditory Steady State Response (ASSR)
Fig. 134 AUDITORY STEADY STATE RESPONSE MONTAGES

2-CHANNEL ABR with ASSR Following

Fig. 135 ASSR

(only a 1-CHANNEL Recording)
Fig. 136 ASSR with Linked Mastoids

(Only a 1-CHANNEL Recording)

App. 1.6.5 Vestibular Evoked Myogenic Potential (VEMP)
Fig. 137 2-Channel VEMP with Sternum Placement

VEMP Monitoring OFF
Binaural or Monaural Stimuli

Fig. 138 2-Channel VEMP with Sternoclavical Junction Placement

VEMP Monitoring OFF
Fig. 139 2-Channel VEMP with Sternum Placement

VEMP Monitoring ON

Fig. 140 2-Channel VEMP with Sternoclavical Junction Placement

VEMP Monitoring ON

Fig. 141 1-Channel VEMP-RIGHT

VEMP Monitoring ON

Fig. 142 1-Channel VEMP-LEFT

VEMP Monitoring ON
Fig. 143 2-Channel OVEMP

VEMP Monitoring OFF

App. 1.7 Modifying Normal Hearing Level Thresholds

Making modifications to the normal hearing level thresholds table will change the output stimulus. After performing a
listening check, if required, follow these steps to modify the normal hearing level threshold.
1. Select Calibration > Normal Hearing Level Thresholds from the Menu bar to display the Normal Hearing Level
Thresholds dialog box.
Fig. 144 Normal Hearing Level Thresholds Dialog Box
2. Click the Transducer drop-down arrow and select the transducer from the list.
3. Place the cursor in the corresponding dB HL text box corresponding to a specific tested frequency and type the new
value.
Note • Click the Default button if you want to restore the preset Hearing Level defaults for each frequency.
The system will prompt with a message asking you to confirm the change. Click Yes to restore the defaults.
4. Add the correction factor to the provided value. For example, if the lowest level that can be heard is 20 dB, the cor-
rection factor is 20 dB.
5. Repeat Step 3 and 4 for each frequency that requires modification.
6. Place the cursor in the Click text box and type the new value.
7. Repeat Steps 2 through 5 for each applicable transducer.

8. Click OK.
Fig. 145 Normal Hearing Level Thresholds Message
9. Click Yes. The new normal hearing level thresholds standards are saved for your facility.
App. 1.8 Checking Electrode Impedance

After the electrodes are connected and periodically during data collection, conduct an electrode impedance test to check
the electrode connection. This is done to ensure a good connection.
The Impedance Test dialog box displays the impedance for the Ground and each active channel: Ground, Channel 1 Act-
ive and Reference, and Channel 2 Active and Reference electrodes in kOhms. ICS Chartr EP 200 systems also display the
impedance for the VEMP Monitor (left and right) in kOhms.
Note • VEMP Monitor is available only if the VEMP monitor option is included in your installation.
Fig. 146 Impedance Test Dialog Box
Note • The VEMP monitor settings are available only if the VEMP monitor option is included in your installation.

If a jumper is used for any inputs, these values will be similar. If no electrode is placed in the Electrode Connector, the
value will read Open. The test will continue to read the impedance values from each electrode until OK is selected.
The readable Maximum Impedance value = 80 kOhms
Use the impedance values as a guide. In most cases, impedance values should be below 5 kOhms with less than 2 kOhms
differences within individual electrodes. However, there will be some patients for whom it is not possible or desirable to
obtain a low impedance value, and acceptable EP waveforms will still be obtained.
To check the electrode impedance

1. Place the electrodes on the patient in the correct positions for the tests to be conducted.
2. Connect the electrode cables to the corresponding port.
3. Click F7 Impedance to display the Impedance Test dialog box.
4. Read the values for each active channel. Make sure there is an impedance reading for each active channel and the
ground. Adjust the electrodes if necessary.
5. Repeat Steps 3 and 4 periodically during the data collection session.
App. 1.9 Using the New Test Tab

The New Test tab on the main window contains a list of all of the established procedures and protocols available to the
operator.
The selected or active protocol is highlighted. Once selected, the operator may also view the trial setting parameters asso-
ciated with the protocol using the Settings tab or the F5 Trial Settings function key.

Fig. 147 New Test Tab
On the list, a + sign in front of an item means it can be expanded to show individual items associated with it. A – sign
means the list is completely expanded. Click on a + sign to expand the listing to each sub-item. Click on a – sign to collapse
the individual items back to the previous level.
To select a protocol before beginning a test:
• Using the mouse, click on the protocol name.
• Using the keypad, use the mouse to place the cursor in the New Test tab then press the up and down arrow keys to
move through the list.
App. 1.10 Using the Settings Tab

The Settings tab provides a quick summary of the trial setting parameters. Operators may use the Settings tab to view and,
if needed, change trial setting parameters just prior to or during data collection.
Changing a trial setting parameter on the Settings tab during a test will cause the current test to reset. The changes to the
trial setting parameters will stay in effect as long as the application is running and another operator does not log in. The
modified trial settings are saved with the collected data.

Note • If you want the changes to be saved for future use, use the Edit Protocol dialog box to save the trial set-
tings.
Fig. 148 Settings Tab
Note • VEMP monitor settings are available only if the VEMP monitor option is included in your installation.
Use the following procedure to make changes to the trial setting parameters before or during data collection. This pro-
cedure assumes that a patient record is open.
To modify a trial setting parameter using the Settings tab

1. Click the New Test tab and select the protocol that you want to modify.
2. Click the Settings tab to display the current settings for the selected protocol.
3. Click on a Trial Setting button to toggle between two options or to display a pop-up menu with multiple options.

Fig. 149 Settings Tab Pop-up Menu
4. Click on a Pop-up menu option to select it and place it on the Settings tab. A check mark indicates the option is selec-
ted.
5. Repeat steps 1 and 2 until you are satisfied with the trial setting parameters.
Note • The selected trial setting parameters will be saved with the collected waveforms and recalled each time
the waveform is reviewed. The trial settings will not be saved for use on other patients. To save modified trial
settings, make and save the changes in the Edit Protocol dialog box.

App. 2 Keyboard Shortcuts

Table App. 2.1 Menu/Submenu Options ► 179 provides a description of the keyboard actions for ICS Chartr EP 200
menu/submenu options. Table App. 2.2 Word Processor Keyboard Shortcuts ► 180 contains a description of the key-
board shortcuts for the word processor utility.
App. 2.1 Menu/Submenu Options

Key 120Submenu Alternative Function
Ctrl+- Waveform / Subtract Subtract the two selected waveforms on this page.
Ctrl++ Waveform / Add Add the selected waveforms on this page.
Ctrl+A Edit / Select All Select all waveforms on this page.
Ctrl+B Test / Collect Start collection of data.
Ctrl+C Edit / Copy Copy selected waveform to clipboard.
Ctrl+D Waveform / Display Scale Access the Display Scale dialog box.
Ctrl+E Test / Reset Reset sweeps to 0.
Ctrl+F Waveform / Smooth 7 Smooth the selected waveforms 7 points.
points
Ctrl+G Page / Go to Page Display the Go To Page dialog box.
Ctrl+H Waveform / Hide Labels Do not show the applied waveform labels.
Ctrl+I Waveform / Invert Invert the primary waveform.
Ctrl+J Test / Cancel continued cancel continued trial option.
trial
Ctrl+K Test / Stop Stop collection of data.
Ctrl+L Waveform / Left Labels Display the waveform labels on the left side.
Ctrl+M Test / Pause / Resume Pause or resume data collection.
Ctrl+O Waveform / Overlay All Overlay all waveforms on this page.
Ctrl+R Waveform / Right Labels Place the waveform labels on the right side.
Ctrl+S Waveform / Spread Spread all waveforms on this page.
Ctrl+T Test / Continuous Stim- Activate the Continuous Stimulation option.
ulation
Ctrl+U Waveform / Unsmooth Unsmooth the selected waveform.
Ctrl+V Edit / Paste Paste object, waveform, etc.

Key 120Submenu Alternative Function

Ctrl+W Test / Extend EP Sweeps Add additional sweeps to collection.
Ctrl+X Edit / Cut Remove the selected waveforms from the Waveform Page and place on
clipboard.
Ctrl+Y Test / Save continued trial Save continued trial data.
Ctrl+Z Test / Impedance Start impedance test.
Del Edit / Delete Delete the selected waveform
App. 2.2 Word Processor Keyboard Shortcuts

Key Function
Ctrl+C Copy selected text to the clipboard.
Ctrl+F Display the Find dialog box.
Ctrl+H Display the Replace dialog box.
Ctrl+M Display the Get Macro dialog box.
Ctrl+S Save the report.
Ctrl+V Paste data from the clipboard at the cursor location.
Ctrl+X Remove selected text from the report and place it on the clipboard.
Ctrl+Z Undo the previous action.
Del Remove the selected text from the report.

App. 3 Function Keys

The ICS Chartr EP 200 program function keys provide keyboard access and control during testing and while reviewing wave-
forms. The function keys are located along the bottom of the main window.
Fig. 150 ICS Chartr EP 200 Program Function Keys
To use a function key either press the keyboard equivalent key or place the cursor over the on-screen function key button
and single click the primary mouse button.
The actions of many of the function keys change depending on the mode or situation that is in use and the activities being
performed. The following tables show the function keys organized by mode or situation.
App. 3.1 During Data Collection

Function Key Action Function
F1 Help Access ICS Chartr EP 200 Help.
F6 Report Open the word processor and display the patient information portion of the report.
F8 Normative Display the Normative Data dialog box and review results for selected waveform(s).
Data
F9 Reset / Stop the current test and reset the sweep counter back to zero, deleting the trial in
Cancel progress, or the trial last completed. The system will prompt to verify that the user
wants to delete the trial.
Stop the current trial and discard collected data (only available when Continuous Trial
option is enabled).
F10 Increase Increase maximum sweeps for the current trial.
Sweeps
F11 Stop Stop the current trial.
F12 Pause Pause the current trial.
App. 3.2 Data Collection Paused



Data
F9 Reset / Discard data collected for the current trial, reset the sweep counter to zero, and
Cancel restart the trial. The system will prompt to verify the deletion of the trial.
F10 Increase Increase maximum sweeps for the current trial.
Sweeps
F11 Stop Stop the current test.
F12 Resume Continue the paused test.
App. 3.3 New Test Tab (all but VEMP)

F2 New Patient Display Add Patient Information dialog box.
F3 Existing Patient Display Edit Patient Information dialog box.
F5 Trial Settings Display the Edit Protocol dialog box; review and/or modify trial setting.
F6 Report Open the word processor and display the patient information portion of the
report.
F7 Impedance Run the electrode impedance test before a trial begins.
F8 Normative Data Display the Normative Data dialog box and review results for selected waveform
(s).
F9 Start EEG / Stop Start or stop the EEG display (not available for P300/ASSR).
EEG
F10 Previous Page Go to the waveform page in front of the current page.
F11 Next Page Go to the waveform page that follows the current page.
F12 Collect Begin trial.
App. 3.4 New Test Tab - VEMP only

F1 Help Access ICS Chartr EP Help.


F5 Trial Settings Display the Edit Protocol dialog box; review and/or modify
trial setting.
F6 Report Open the word processor and display the patient information
portion of the report.
F8 Normative Data ABR only. Display the Normative Data dialog box and review
results for selected waveform(s).
F9 Start / Stop VEMP Start or stop the VEMP monitor (applies only to those systems
Monitor where the VEMP monitor application is included)
F10 Previous Page Go to the waveform page in front of the current page.
App. 3.5 New Test Tab - ASSR only

F5 Trial Settings Display the Edit Protocol dialog box; review and/or modify trial setting.
App. 3.6 Continue (Resume) Data Collection

80 Key Action Function
F8 Normative Data Display the Normative Data dialog box.
F9 Reset / Cancel Stop the current trial and reset. / Cancel and continue trial.


F10 Extend Sweeps Increase maximum sweeps for the current trial.
F11 Stop End the trial and save the current test results.
F12 Pause Pause the current trial.
App. 3.7 Review Tab

F1 Help AccessICS Chartr EP 200 Help.
F3 Existing Display Edit Patient Information dialog box.
Patient
F4 PediGram Display Tone-Burst Wave-V Threshold dialog box showing PediGram data that has been
collected and marked.
Data
F10 Previous Go to the waveform page in front of the current page.
Page
App. 3.8 Review Test Tab - ASSR only


App. 3.9 Before reviewing Patient Data from another Database

F12 Exit Exit ICS Chartr EP 200 program.
App. 3.10 Review Patient Data from another Database

F8 Normative Data Display the Normative Data dialog box and review results for selected waveform(s).
F10 Previous Page Go to the waveform page preceding the current page.
F11 Next Page Go to waveform page after the current page.
App. 3.11 Before selecting an Archived Patient Record

F12 Exit Exit ICS Chartr EP 200 program.
App. 3.12 Review Archived Patient Data

F3 Existing Patient Display Edit Existing Patient dialog box.
F8 Normative Data Display the Normative Data dialog box and review results for selected waveform(s).
F10 Previous Page Go to the waveform page that precedes the current page.
F11 Next Page Go to the waveform page after the current page.

App. 4 Normative Data

This Appendix contains tables of normative data from Michael P. Gorga, Ph.D., and his co-workers123 at Boys Town National
Research Hospital.
Table 1
Boys Town Auditory Brainstem Response Normative Data Measurement Parameters
Stimulus Parameters
Type Click
Duration 100 µsec
Rate 13/sec
Polarity Rarefaction
Intensity 20-80 dB nHL in 20-dB steps
Transducer Beyer DT48
Acquisition Parameters
Amplification 100,000
Electrodes Cz-to-ipsilateral mastoid with forehead ground
Filter settings 100-3000 Hz
Notch filter None
Filter slopes 6 dB/octave
Analysis period 10.24 or 15.36 msec
Number of sweeps 1024; two replications
1Gorga, M.P., Reiland, J.K., Beauchaine, K.A., Worthington, D.S., Jesteadt, W. (1987) Auditory brainstem responses from
graduates of an intensive care nursery: normal patterns of response, Journal of Speech and Hearing Research, 30, 311-
318.
2Gorga, M.P., Kaminiski, J.R., Beauchaine, K.L., Jesteadt, W., Neely, S.T. (1989) Auditory brainstem responses from chil-
dren three months to three years of age: normal patterns of response II. Journal of Speech and Hearing Research, 32,
281-288.
3Gorga, M.P. (1996) Personal communication.

Table 2
Wave I Latency and Interpeak Interval values for an 80 dB nHL click for newborns (GA=Gestational Age in weeks; SD=Stan-
ndard Deviation; N=number of cases)
Latency (msec) Interpeak Interval (msec)
GA I I-III III-V I-V
33-34
Mean 1.78 2.86 2.41 5.27
SD 0.30 0.28 0.26 0.36
N 38 38 38 38
35-36
Mean 1.78 2.84 2.39 5.24
SD 0.26 0.27 0.25 0.36
N 147 144 147 147
37-38
Mean 1.74 2.80 2.34 5.17
SD 0.21 0.31 0.26 0.40
N 150 146 154 150
39-40
Mean 1.72 2.70 2.38 5.09
SD 0.23 0.27 0.25 0.36
N 109 107 109 109
41-42
Mean 1.69 2.74 2.24 5.00
SD 0.19 0.22 0.21 0.30
N 73 73 74 73
43-44
Mean 1.65 2.65 2.21 4.88
SD 0.15 0.26 0.21 0.31
N 35 32 32 35

Table 3
Wave V Latency values as a function of click intensity level for newborns (GA=Gestational Age in weeks; SD=Standard Devi-
ation; N=number of cases)
Wave V Latency (msec)
GA 80 dB nHL 60 dB nHL 40 dB nHL 20 dB nHL
33-34
Mean 7.05 7.62 8.48 9.72
SD 0.39 0.41 0.49 0.56
N 38 37 37 25
35-36
Mean 7.02 7.58 8.42 9.61
SD 0.38 0.43 0.54 0.67
N 150 148 148 106
37-38
Mean 6.94 7.45 8.29 9.57
SD 0.42 0.44 0.51 0.74
N 158 154 157 102
39-40
Mean 6.82 7.30 8.11 9.36
SD 0.38 0.40 0.49 0.57
N 111 107 109 83
41-42
Mean 6.69 7.20 8.08 9.31
SD 0.29 0.29 0.35 0.54
N 74 70 73 52
43-44
Mean 6.53 7.08 7.94 9.16
SD 0.32 0.33 0.51 0.53
N 35 33 34 21

Table 4
Wave I Latency for an 80 dB nHL click and V Latency values as a function of click intensity level for children 3 months to 3
years of age (SD=Standard Deviation; N=number of cases)
Latency (msec)
Wave V
Age in months 80 dB nHL 60 dB nHL 40 dB nHL 20 dB nHL 80 dB nHL
3-6
Mean 6.25 6.73 7.43 8.72 1.59
SD 0.32 0.33 0.36 0.53 0.17
N 79 62 78 79 78
6-9
Mean 6.10 6.56 7.28 8.59 1.59
SD 0.26 0.29 0.38 0.61 0.16
N 67 56 68 68 65
9-12
Mean 5.90 6.31 7.05 8.31 1.59
SD 0.27 0.29 0.37 0.54 0.18
N 91 81 88 91 91
12-15
Mean 5.91 6.30 7.10 8.28 1.59
SD 0.27 0.33 0.45 0.60 0.17
N 48 44 48 48 48
15-18
Mean 5.84 6.24 7.00 8.33 1.58
SD 0.27 0.24 0.38 0.61 0.14
N 73 62 72 74 72
18-21
Mean 5.74 6.19 6.95 8.22 1.55
SD 0.19 0.18 0.36 0.62 0.12
N 28 23 28 28 27
21-24

Latency (msec)
Wave V
Age in months 80 dB nHL 60 dB nHL 40 dB nHL 20 dB nHL 80 dB nHL
Mean 5.71 6.14 6.79 8.05 1.57
SD 0.26 0.29 0.33 0.58 0.17
N 28 23 28 28 28
24-27
Mean 5.71 6.09 6.89 8.30 1.53
SD 0.19 0.22 0.29 0.46 0.14
N 18 15 18 18 17
27-30
Mean 5.60 6.08 6.75 7.98 1.59
SD 0.22 0.28 0.33 0.42 0.19
N 17 13 18 18 58
30-33
Mean 5.68 6.07 6.79 8.12 1.56
SD 0.27 0.31 0.32 0.53 0.16
N 58 45 53 58 58
33-36
Mean 5.68 6.06 6.82 8.10 1.56
SD 0.27 0.31 0.38 0.68 0.15
N 25 21 24 25 25

Table 5
Interpeak Interval values for an 80 dB nHL click for children 3 months to 3 years of age (SD=Standard Deviation; N=number
of cases)
Interpeak Interval (msec)
Age in months I-III III-V I-V
3-6
Mean 2.52 2.13 4.65
SD 0.22 0.22 0.29
N 78 79 78
6-9
Mean 2.42 2.08 4.50
SD 0.23 0.22 0.27
N 65 67 65
9-12
Mean 2.31 1.99 4.31
SD 0.24 0.20 0.29
N 89 89 89
12-15
Mean 2.31 2.01 4.32
SD 0.15 0.22 0.24
N 47 47 48
15-18
Mean 2.26 2.00 4.25
SD 0.16 0.16 0.22
N 70 71 71
18-21
Mean 2.26 1.99 4.18
SD 0.24 0.19 0.23
N 27 28 27
21-24
Mean 2.17 1.96 4.14

Age in months I-III III-V I-V
SD 0.21 0.20 0.25
N 27 27 28
24-27
Mean 2.28 1.91 4.20
SD 0.17 0.18 0.17
N 17 18 17
27-30
Mean 2.10 1.92 4.02
SD 0.14 0.16 0.22
N 17 17 17
30-33
Mean 2.21 1.90 4.12
SD 0.16 0.18 0.23
N 58 58 58
33-36
Mean 2.17 1.94 4.12
SD 0.20 0.17 0.25
N 24 24 25

Table 6
Waves I, III, and V Latency values as a function of click intensity level for ages above three years (SD=Standard Deviation)
Latency (msec)
Wave I Wave III Wave V
80 dB nHL
Mean 1.54 3.69 5.54
SD 0.11 0.10 0.19
70 dB nHL
Mean 1.65 3.85 5.75
SD 0.29 0.12 0.21
60 dB nHL
Mean 1.83 4.09 6.06
SD 0.15 0.12 0.22
50 dB nHL
Mean 4.53 6.39
SD 0.26 0.24
40 dB nHL
Mean 5.00 6.93
SD 0.25 0.24
30 dB nHL
Mean 5.50 7.58
SD 0.33 0.36
20 dB nHL
Mean 8.36
SD 0.54
10 dB nHL
Mean 8.92
SD 0.60

Table 7
Interpeak Interval values as a function of click intensity level for ages above three years (SD=Standard Deviation)
I-III III-V I-V
80 dB nHL
Mean 2.14 1.86 4.00
SD 0.23 0.14 0.20
70 dB nHL
Mean 2.12 1.91 4.03
SD 0.15 0.14 0.25
App. 4.1 Toneburst Normative Data

ICS Chartr EP 200 provides a graphical representation of tone burst normative data for Latency V. The normal data region is
defined as the mean ± 2 SD. To view a tone burst normative data graph, you must select at least one ABR tone burst wave-
form with Wave V marked on a waveform page. Click and tone burst waveforms may not be selected at the same time
when viewing normative data.
Note • Tone burst data normative data was collected by Tom Littman, Ph.D. CCC-A, Virginia Mason Medical
Center, Seattle, Washington.
Data should be collected using the following collection parameters when tone burst normative data graphs will be used:
Stimulus
Ear Right
Mask None
Transducer Insert Phone
Polarity Rarefacting
Stimulus Type Tone Burst
Frequency 500 Hz / 4 kHz / 8 kHz
Envelope Blackman
Ramp 2
Plateau 0
Acquisition
Sweep Time 22 ms

Delay -2 ms
Sweeps 1500
Rate 19.9/s
Channels (Channels 1 and 2)
Gain 100,000
High Pass 50 Hz
Low Pass 1.5 kHz
Notch Off
Artifact On
Table 8
Wave V Latency values as a function of 500 Hz toneburst intensity level for infants age 0 to 2 years old (SD = standard devi-
ation)
Wave V Latency
0 dB nHL 10 dB nHL 20 dB nHL 30 dB nHL 40 dB nHL 50 dB nHL
Male
Mean 14.32 13.75 12.95 12.06 11.02 9.92
SD 9.30 10.60 11.70 14.10 12.10 10.00
Female
Mean 14.32 13.75 12.95 12.06 11.02 9.92
SD 9.30 10.60 11.70 14.10 12.10 10.00
Table 9
Wave V Latency values as a function of 500 Hz toneburst intensity level for infants age 2 years old and older (SD = standard
deviation)
Wave V Latency
Male
Mean 14.14 13.63 12.59 11.62 10.47 9.63
SD 12.60 8.50 10.50 12.20 10.70 9.00
Female
Mean 14.14 13.63 12.59 11.62 10.47 9.63
SD 12.60 8.50 10.50 12.20 10.70 9.00

Table 10
ation)
Wave V Latency
10 dB nHL 20 dB nHL 30 dB nHL 40 dB nHL 50 dB nHL
Male
Mean 8.98 8.75 8.62 8.45 8.33
SD 8.30 7.20 7.80 5.80 3.90
Female
Mean 8.86 8.68 8.60 8.41 8.22
SD 7.80 9.60 6.30 5.10 5.20
Table 11
deviation)
Wave V Latency
Male
Mean 9.16 8.71 8.48 8.30 8.01 7.84
SD 5.20 8.30 9.50 8.30 7.70 6.40
Female
Mean 8.88 8.59 8.44 8.24 7.90 7.65
SD 7.1 5.80 7.80 6.60 8.30 7.10
Table 11
ation)
Wave V Latency
0 dB nHL 10 dB nHL 20 dB nHL 30 dB nHL 40 dB nHL 50 dB nHL 60 dB nHL
Male
Mean 9.29 8.79 8.70 8.57 8.17 7.92 7.57
SD 8.60 6.00 6.00 6.30 4.80 4.30 4.30
Female

Wave V Latency
Mean 9.04 8.73 8.54 8.27 7.86 7.65 7.29
SD 7.60 5.90 6.70 5.70 5.30 4.70 4.90
Table C.12
deviation)
Wave V Latency
Male
Mean 8.99 8.61 8.26 7.98 7.70 7.48 7.16
SD 3.70 5.10 4.60 4.80 5.50 3.70 4.00
Female
Mean 8.72 8.31 8.12 7.84 7.51 7.30 7.07
SD 3.90 4.30 5.60 4.80 6.10 3.90 5.10

App. 5 Customizing the Word Processor Report

App. 5.1 Overview
This appendix explains how to customize the template that is used to produce the word processor portion of a patient
report. Use the procedure in this appendix to create a template that reflects your specific report requirements and
includes unique identifying elements, such as a logo, for your facility.
There are three elements of the word processor portion of the patient report that can be customized:
• Page layout and design including margins, font selection, etc.
• Position of the data elements that extract patient specific information from the database, such as the patient name,
address, etc.
• Font icon.
App. 5.2 Default Page Layout and Design

The text portion of the ICS Chartr EP 200 patient report, is formatted based on the page layout and design defined in a
report template. In addition, the database information in the report is also defined in the template.

Fig. 151 Default Report Page
Using the ICS Chartr EP 200 word processor, the operator may change the font selection and the paragraph appearance of
each individual report. The operator may also add, modify, and delete information in the report. However, the changes
the operator makes only apply to the report the operator is currently working on and will not apply to any other reports
created by the operator.
Note • See Working with Reports ► 114 for information on how to access the report and modify it in the
word processor.
App. 5.3 Database Information

The database fields and access tags defined in the report template for the text portion of a patient report are shown. A
complete list of the database tags and a description of the data each retrieves is at the end of this appendix.

Fig. 152 Default Report Template
The words within the brackets (< >) are the database access tag, and the brackets signal that the enclosed information is
requested from the database. The brackets do not appear in the word-processed version of the report. For example,
<PHYS_LAST> retrieves the last name of the referring physician from the database. If deleted, the section will not be pop-
ulated by the database.
App. 5.4 Customizing the Report Template

Within a patient report, the placement of the information on the page, the font selection and sizes, and the paragraph
styles are all predefined in a Report Template.
The information and format of each report may be changed in the ICS Chartr EP 200 word processor. However, the tem-
plate must be changed in order to implement a global change that will apply to all of the reports produced at a work-
station or at a facility.
Report templates cannot be changed while working in ICS Chartr EP 200.
To access and modify the report template
Note • The file name of the report template is Template. The file extension is .rtf (rich text format).
1. Close ICS Chartr EP 200 and access the Windows Desktop.

2. Click the Windows Explorer icon or select Start > All programs > Accessories > Windows Explorer to open Win-
dows Explorer.
3. Expand the My computer> Local Drive:C > Program Files.
4. Expand the ICS Medical Folder (under Program Files) to display the ICS Chartr EP 200 Folder.
5. Click on ICS Chartr EP 200 to display the contents.

Fig. 153 Template.rtf in Windows Explorer
Warning • Do not change any of the brackets (< >) or the information in the brackets. It must remain exactly as
written in order to retrieve information from the database. You may however, delete these items or change their
placement on the page.
6. Make changes to the font selection and size, as desired. Make changes to the paragraph appearance as desired.
7. Make changes to the placement of data on the page as desired.
8. Save the template as an *.rtf file. The template must saved be in the .rtf format.
App. 5.5 Report Template Database Tags

The following is a list of the ICS Chartr database database access tags and the information each retrieves into a patient
report.
App. 5.5.1 Patient Report Database Access Tags
Access Tag Description

<FAC_HEADER_EP> Facility EP report name
<FAC_NAME> Facility name
<FAC_ADDRESS> Facility address
<FAC_CITY> Facility city
<FAC_STATE> Facility state
<FAC_ZIP> Facility zip code

Access Tag Description

<FAC_COUNTRY> Facility country
<FAC_TELEPHONE> Facility telephone number
<MODALITY> Product modality - ENG, EP, VNG
<PATIENT_ID> Patient identification
<LAST> Patient last name
<FIRST> Patient first name
<BIRTHDATE> Patient birthdate
<GENDER> Patient gender
<ADDRESS1> Patient street address
<ADDRESS2> Patient city, state, zip code
<PHONE> Patient telephone number
<PHYS_LAST> Referring physician last name
<PHYS_FIRST> Referring physician first name
<REF_FACILITY> Referring facility name
<REF_REASON> Referral reason
<OPER_LAST> Operator last name
<OPER_FIRST> Operator first name
<REPORT_DATE> Current date
<COLLECT_OPER> Operator that performed test

App. 6 Error Messages

This appendix contains some commonly encountered error messages. It provides possible causes and suggests actions that
the operator could take to address the problem.
The Error Messages are organized in tables as follows:
App. 6.1 Startup Error Messages ► 203
App. 6.2 Database Error Messages ► 204
App. 6.3 Data Collection / Testing Error Messages ► 205
App. 6.4 Review / Waveforms Error Messages ► 207
App. 6.5 Report, Printing, and Word Processing Error Messages ► 209
App. 6.6 Calibration Error Messages ► 210
App. 6.7 Other Error Messages ► 212
App. 6.1 Startup Error Messages

Message Description / Cause
The serial link between the MCU 90 XP Applies only to MCU 90 XP (tower). This can occur if a sound card is
(tower) and the PA-800 preamplifier installed in the PC.
timed out. Please verify the connections
between the MCU 90 XP (tower) and
the PA-800 preamplifier.
An error occurred while trying to load Applies only to MCU 90 XP (tower). The application could not load the soft-
the VxD. The system will run as a ware that communicates with the audio and data collection hardware. This
review-only system. Please contact GN can occur if a sound card is installed in the PC.
Otometrics using email (hot-
line@gnotometrics.dk) or by calling the
hotline in Denmark (+45 45 755
442).Please contact your local supplier.
Another CHARTR application is already Applies only to MCU 90 XP (tower). Another GN Otometrics application (ICS
using the system hardware. This applic- Chartr ENG or ICS Chartr VNG) was started first and is still running. Only the
ation will run as a review-only system. first ICS Chartr application to start can perform data collection.
Exit the other CHARTR application and
restart this system to run as a collection
system.
The workstation name has been used. The name you entered is already assigned to a different workstation. Select
Choose a new workstation name. a new workstation name.

App. 6.2 Database Error Messages

You cannot delete the active patient. The patient you selected is the same one being reviewed. Close the patient
record, then delete the record.
There are no patients in the database. The selected database does not contain any patient records.
You cannot delete the currently logged You are attempting to delete the currently logged in operator. Log in as a
in operator. different operator, then delete this operator.
You cannot delete the default operator. The default operator is provided by GN Otometrics and cannot be deleted.
The operator record cannot be deleted. At least one test in the database was performed by the operator you are
If you wish to delete the operator attempting to delete. If the database is archived, all tests will be moved to
record, you must archive your database. another database file, then it will be possible to delete the operator.
The referring facility record cannot be At least one test in the database was ordered by the referring facility that
deleted. If you wish to delete the refer- you are attempting to delete. If the database is archived, all tests will be
ring facility record, you must archive moved to another database file, then it will be possible to delete the refer-
your database. ring facility.
No Referring Facility records exist in the No referring facilities have been defined. There is no existing data to edit or
database. to delete.
The referring physician record cannot be At least one test in the database was ordered by the referring physician that
deleted. If you wish to delete the refer- you are trying to delete. If the database is archived, all tests will be moved
ring physician record, you must archive to another database file, then it will be possible to delete the referring phys-
your database. ician.
No Referring Physician records exist in No referring physicians have been defined. There is no existing data to edit
the database. or to delete.
You have less than 5 MB of free disk The hard disk is almost full. Delete unneeded files and/or archive the data-
space available. There might not be base to a different disk to increase the amount of storage space on the hard
enough space to save your test results. drive.
It is recommended that you archive and
start a new database, or delete any
unneeded files from your hard disk.
The selected database contains patient The database was created at a workstation running a more recent version of
record(s) from a newer version of the ICS Chartr EP 200 than the workstation you are using. Your version of the
software. software does not recognize the data format.
This database cannot be opened with
this version of the software.

App. 6.3 Data Collection / Testing Error Messages

The trial cannot be started because the The system cannot start a P300 trial because the trial settings specify a stim-
current trial settings specify an intensity ulus or masking intensity that the audio board cannot generate. The reques-
which is beyond the system capabilities. ted intensity is too loud or too soft.
Please edit the trial settings and correct
the problem.
The system cannot begin collection. The current trial settings call for more channels to be collected than there
There must be one free waveform bank are available waveform slots on the current page. Access a page that has
per channel being tested. available slots.
Do you wish to go to a new page?
The most recent physician order must The patient has multiple physician orders, and the currently selected phys-
be selected to perform this operation. ician order is not the most recent. New tests are added to the most recent
Do you want to switch to the most physician order.
recent physician order?
The current trial settings specify a stim- Changes to calibration or normal threshold values may have caused the stim-
ulus intensity of ## dB nHL. ulus intensity to be too loud or too soft for the audio board to generate.
This is beyond the system capabilities Click OK to continue at the adjusted intensity level. Click Cancel to cancel
and will be adjusted to ## dB nHL. the stimulus.
The current stimulus intensity level of The current trial settings specify an audio intensity level that can cause hear-
## dB nHL (## dB SPL) can be hazardous ing damage if presented for too long. Confirm that you want to use this
if presented for over 15 minutes. intensity level or select a lower intensity level to continue.
The software detected a data acquisition The stimulus interval is almost an exact multiple of the sweep time. The
error. The current test will be discarded application does not have enough time to process the data from one sweep
and the test will end. before the next sweep begins. Use a lower stimulus rate or adjust the
Try running the test again with a lower sweep time to continue.
stimulus rate or after adjusting the
sweep time. If this does not correct the
problem, additional technical assistance
is available.
Please contact GN Otometrics using
email (hotline@gnotometrics.dk) or by
calling the hotline in Denmark (+45 45
755 442).Please contact your local sup-
plier.
Are you sure you want to discard the col- The Continue Trial option is turned on, the trial in progress has completed
lecting waveforms and cancel the test? the requested number of sweeps, and the Cancel function key or menu
item has been selected. Confirm that you did not press Cancel by mistake.

A hardware error occurred while trying The preamplifier is not responding or electrical noise is interfering with the
to run the impedance test. ability to obtain an accurate impedance measurement.
Please contact GN Otometrics using
email (hotline@gnotometrics.dk) or by
calling the hotline in Denmark (+45 45
755 442).Please contact your local sup-
plier.
There have been no waveforms col- There are no test parameters to display. Either no data has been collected
lected for the currently selected phys- for this patient or the collected data is part of a different physician order. To
ician order switch physician orders, select a different order date/time in the Review
Tab drop-down list.
Stimulus intensity is not in the range ## The specified stimulus intensity is beyond the ability of the audio board.
to ## The range of allowable values varies depending on the transducer and fre-
quency. The limits are determined by the capabilities of the audio board,
frequency-specific tone calibration, ANSI threshold value, and the normal
threshold value.
Ramp cycles must be between ## and The specified number of cycles is beyond the ability of the audio board. The
## upper limit varies with tone frequency.
Plateau cycles must be between ## and The specified number of cycles is beyond the ability of the audio board. The
## upper limit varies with tone frequency.
Delay must be between ## and ## The specified rate is beyond the system capabilities. The delay time and
stimulus rates are interdependent; the delay cannot exceed the time
between stimuli.
Sweep time must be greater than or The specified sweep time is beyond the ability of the system. The minimum
equal to ## sweep time varies with the number of channels to be collected (more chan-
nels cause a higher minimum value). For P300 trial settings, the maximum
sweep time is determined by the stimulus rate, since only one stimulus is
allowed per sweep.
The stimulus rate and sweep time over- The stimulus interval is an exact multiple of the sweep time. This is likely to
lap. cause data collection to fail, because the application will not have enough
Do you wish to allow the overlap and time to process the data from one sweep before the next sweep begins.
continue?
Are you sure you want to delete the cur- Confirm that you want to delete the trial setting. If you are editing existing
rently selected trial setting? trial settings and delete one by mistake, press Cancel to exit the Edit Pro-
tocol dialog box. This will prevent the trial setting from being deleted and
will discard any other editing changes you made.

The maximum sweep time is ## ms The specified rate is beyond the system capabilities. For P300 trial settings,
based on the current stimulus rate. the stimulus rate and sweep time are interdependent; only one stimulus is
The maximum stimulus rate is ##/sec allowed per sweep.
based on the current sweep time.
Please adjust either sweep time or stim-
ulus rate accordingly.
Stimulus rate must be between ## and The specified rate is beyond the system capabilities. Select a stimulus rate
##. that is between the specified limits to continue.
You must turn the mode on for at least No channels are turned on. Data cannot be collected unless the channel
one channel. mode is On for at least one channel.
The protocol currently selected on the The protocol selected for deletion in the Delete Protocol dialog box is the
New Test Tab cannot be deleted. same one that is selected in the New Test Tab. To delete this protocol,
select a different protocol in the New Test Tab, then repeat the deletion
request.
You have selected a system defined pro- The protocol selected for deletion in the Delete Protocol window is
tocol for deletion. provided by GN Otometrics and cannot be deleted. However, you may
You cannot delete system defined pro- modify the protocol using the Edit Protocol dialog box.
tocols.
You have selected protocol 'XXX' to be Confirm that you really want to delete the selected protocol. There is no
deleted. Undo for this operation; if a protocol is deleted by mistake, you will have to
The protocol will be deleted for ALL recreate it manually.
operators and cannot be undone.
Do you wish to perform this action?
Are you sure you want to restore the The application is asking you to confirm that you really want to revert to the
default settings for the current protocol? default trial settings. See Working with Trial Setting Options ► 69 in this
manual for a description of this function.
App. 6.4 Review / Waveforms Error Messages

The waveforms being collected may not At least one of the selected waveforms is part of a test in progress.
be (cut/copied/deleted/ added/sub-
tracted/ smoothed/ inverted) until after
the test has ended.

Are you sure you want to delete the Confirm that you really want to delete the waveform(s). If you answer yes,
selected waveform(s) from the page? the selected waveforms and any descriptive text will be deleted. Remem-
ber, test data is never deleted; if you delete a waveform by mistake, double
click on the desired channel in the Review Tab to recreate it.
The waveforms being collected may not At least one of the selected waveforms is part of a test in progress and can-
be deleted until after the test has not be deleted. Confirm that you really want to delete the other selected
ended. waveforms. If you answer yes, the waveforms and all descriptive text will be
Are you sure you want to delete the deleted. Remember, test data is never deleted; if you delete a waveform by
other selected waveform(s) from the mistake, double click on the desired channel in the Review Tab to recreate
page? it.
There is(are) ## waveform(s) to paste There is not enough room on the current page to hold all of the waveforms
and only ## open waveform bank(s). on the clipboard. Go to a new page or delete some waveforms on the cur-
Either delete some waveforms or go to a rent page.
new page.
Are you sure you want to clear the wave- Confirm that you really want to delete all waveforms on the current wave-
form page? form page. If you answer yes, the page will be cleared. Remember, test data
is never deleted; if you clear a waveform page by mistake, double click on
the desired channels in the Review Tab to recreate it.
Are you sure you want to delete the Confirm that you really want to delete the current waveform page. If you
waveform page? answer yes, the page and its comments will be deleted. Remember, test
data is never deleted; if you delete a waveform page by mistake, double
click on the desired channels in the Review Tab to recreate it.
There are no open waveform banks. The current waveform page already contains the maximum number of wave-
Either delete some waveforms or go to a forms. Either delete some of the waveforms or go to a new page.
new page.
You must have at least two waveforms Only one waveform is selected or one of the selected waveforms is part of a
selected that are not being collected to test in progress.
perform a waveform addition operation.
You must have at least one open wave- The current waveform page is full. Either delete some of the waveforms or
form bank to perform a waveform addi- go to a new page.
tion.
Delete a waveform or go to a new page.
The display scale is only precise to hun- A number with three or more decimal places (e.g., 3.006) was entered.
dredths of microvolts. Please enter
fewer than 3 decimal places.

You cannot use the merge function The page contains a mix of P300 and non-P300 waveforms. The system is
when channels from P300 are on the not able to merge the waveforms.
same waveform page with channels from
non-P300.
You must have at least two waveforms Only one waveform is selected. This option requires two or more selected
selected to perform a waveform overlay waveforms.
operation.
There is no normative data available for Normative data is not available for the currently selected waveforms. This
the currently selected waveforms. may be due to one of these reasons:
a) The selected waveforms did not result from an ABR or ECochG test.
b) The selected waveforms do not have the appropriate markers and, there-
fore, no data points will be plotted on the normative data graph.
c) No normative data is available for the current patient's age.
d) The selected waveforms' intensities are outside the range of normative
data (0-100 dB).
You must have at least one open wave- The current waveform page is full. Either delete some of the waveforms or
form bank to perform a waveform sub- go to a new page.
traction.
Delete a waveform or go to a new page.
You must have two waveforms selected Only one waveform is selected.
to perform a waveform subtraction oper-
ation.
You cannot perform a waveform sub- More than two waveforms are selected. This operation requires two selec-
traction operation when more than two ted waveforms.
waveforms are selected.
The result of this subtraction operation Two P300 waveforms are being subtracted; the primary waveform is fre-
will not be the MMN. You must subtract quent and the secondary waveform is rare. To obtain the MMN, the primary
a frequent waveform from a rare wave- waveform must be rare and the secondary must be frequent. The sub-
form. traction will be performed, but the resulting waveform will not represent
the MMN.
App. 6.5 Report, Printing, and Word Processing Error Messages

A macro name is required to save a A name for this macro was not entered in the drop-down box on the Define
macro. Macro dialog box.

This function will overwrite your existing This confirmation message displays when File > New is selected within the
word processor report. word processor. If you select yes, a new template will replace the current
Do you wish to continue? word processor report.
The word processor report is too large The word-processed portion of a patient report must be less than 512 kilo-
to store in the database. bytes. Delete or modify the information in the report to reduce the file
You will need to remove some graphics size.
images and/or text before the report
can be saved.
A macro definition is required to save a No text was provided for this macro. Type text for this macro in the Define
macro. Macro dialog box.
An error occurred loading the word The report template file (template.rtf) is corrupt. Delete the template.rtf
processor report. An invalid RTF format file and reinstall the software.
was found.
The process cannot access the file The report template file (template.rtf) is open for editing in another pro-
because it is being used by another program (e.g., WordPad). Close the template file in the other program.
cess.
The system cannot find the file spe- The report template file (template.rtf) is not in the same directory as the
cified. ICS Chartr EP 200 program. Reinstall the software.
Closing the preview window without You have excluded one or more pages from the printed report. To prevent
printing will discard your excluded page these pages from printing, select Print before closing the preview window.
selections. Do you wish to print now?
App. 6.6 Calibration Error Messages

Intensity levels in existing protocols may One or more frequencies were adjusted. If the adjustment was large, and/or
now be beyond the capability of the there is a protocol that specifies a stimulus intensity close to the limit of the
audio board. audio board, it may no longer be possible to generate that intensity. If this is
the case, a warning message will appear when you attempt to run the pro-
tocol.
The hardware tone calibration was Frequency-specific calibrations apply to a particular hardware calibration. If
changed. You must now run the fre- the hardware calibration changes, recalibrate each frequency to ensure that
quency-specific tone calibrations for all the correct intensity is generated.
applicable transducers.

The frequency-specific tone calibrations Hardware tone calibration assures that the audio board outputs the correct
were never performed for this hardware intensity at a single frequency for a single transducer. A frequency-specific
calibration.Y tone calibration is needed to assure that the audio board outputs the cor-
You must now run the frequency-spe- rect intensity at many frequencies.
cific tone calibrations for all applicable
transducers.
Normal thresholds will be adjusted to One or more of the threshold values has changed. If you save the changes,
compensate for changes to the ANSI the corresponding normal threshold values will be adjusted by an equal and
thresholds. opposite amount. Existing protocols will continue to output the same sound
There will be no net change to intensity intensity as before.
levels in existing protocols.
Are you sure you want to apply these
changes?
The version of the calibration database The calibration database on the floppy disk was created by a later version of
selected is not compatible with this ver- the software than is installed on your PC.
sion of the software.
Threshold value must be between ## One of the threshold values you entered is not in the correct range. ANSI
and ##. threshold values must be between -10 dB and +90 dB SPL.
The range for normal threshold values varies depending on the transducer
and frequency. The limits are determined by the capabilities of the audio
board, frequency-specific tone calibration, and the ANSI threshold.
Any changes you've made to the One or more of the threshold values has changed. If you save the changes,
thresholds will affect output intensity existing protocols may output different sound intensities than before.
levels for subsequent tests. Protocols that specify very loud or very soft sounds may no longer be valid; if
Intensity levels in existing protocols may this is the case, you will be warned when attempting to begin data col-
now be beyond the capability of the lection with such settings.
audio board.
Are you sure you want to apply these
changes?
Are you sure you want to restore the The application is asking you to confirm that you want to reset the
default thresholds for the current trans- threshold values for this transducer to the factory defaults.
ducer?

App. 6.7 Other Error Messages

The display resolution has to be at least An invalid screen resolution is set in the Display Control Panel. The applic-
1024x768 pixels. ation cannot display information at resolutions lower than 1024x768 pixels.
Reset the screen resolution to 1024x768 or greater.
CHARTR EP cannot exit because a dialog You have initiated a Windows shutdown, restart, or logout while the ICS
is active. Chartr EP 200 application is waiting for you to respond to a message box or
Please switch to CHARTR EP and close dialog window. Windows cannot shutdown, restart, or logout until you
the dialog first. respond to the ICS Chartr EP 200 request.

App. 7 Setting up the Hardware

App. 7.1 Setting up the ICS Chartr EP 200 Hardware
The ICS Chartr EP 200 hardware consists of the PC, keyboard, monitor, preamplifier, printer, and interconnecting cables
(connections shown on diagram).
Fig. 154 ICS Chartr EP 200 System Connections
1. VEMP Monitor cable to VEMP port 5. Printer power cord to isolation 9. Isolation transformer cable
2. USB cable between laptop computer and transformer to AC outlet
Chartr EP 200 6. Earphone cable to preamp 10. Printer cable to printer
3. Preamp cable to Preamp 7. Power cable to DC power supply port
4. External trigger cable to Chartr EP 200 8. DC power supply cable to isol- 11. Electrode cables to preamp
ation transformer
When ICS Chartr EP 200 program starts for the first time, a Workstation name dialog box displays. Type a unique name that
will identify the workstation and click OK .
Workstation and Network Considerations

Installation of ICS Chartr EP 200 software on networked workstations requires the following considerations.
• When installing data acquisition workstations on a network, always use fiber optic network connections to preserve
the patient's electrical isolation.
• When installing review-only workstations (no data acquisition hardware) on a network, fiber optic connections are not
required. The insulation precautions are not necessary because there will be no physical contact between the patient
and the workstation.
In addition, remember to provide each network workstation with a unique workstation name.

App. 7.2 Setting up the MCU 90 XP (tower) Hardware

The hardware consists of the main control unit MCU 90 XP (tower) keyboard, monitor, preamplifier, printer, and inter-
connecting cables.
The various components connect as shown.
Fig. 155 Connections to the MCU 90 XP (tower)
Interconnection List
1. Monitor cable to MCU 90 XP 5. Printer power cord to isolation 9. Preamp cable to preamp port on
(tower) monitor port transformer MCU 90 XP (tower)
2. Keyboard cable to MCU 90 XP 6. Earphone cable to audio stim- 10. Mouse cable to MCU 90 XP
(tower) keyboard connector ulator board on MCU 90 XP (tower)
3. Printer cable to MCU 90 XP (tower) 11. MCU 90 XP (tower) power cable
(tower) printer port 7. Monitor power cord to isolation to isolation transformer
4. Electrode cable to patient transformer
8. Isolation transformer cable to hos-
pital grade outlet
App. 7.3 Chartr EP 200 Back Panel

The components on the Chartr EP 200 back panel are shown on the following diagram.

Fig. 156 Chartr EP 200 Back Panel
1. VEMP monitor 5. USB

2. Preamp 6. External trigger
3. USB 7. Power input fuse
4. PC (laptop) 8. DC power input
App. 7.4 Chartr EP 200 Remote Control

The wireless remote control consists of a transmitter and a keypad. The keypad allows the operator to remotely operate
many of the EP data collection activities without using the software function keys.
Description / Function
1. No 10. Collect
2. Yes 11. New Test /
3. Impedance Review
4. Not used 12. Cancel
5. Not used 13. Extend Sweeps
6. Not used 14. Save
7. Pause / Resume 15. Stop
8. Previous Page 16. OK
9. Next Page 17. Reset
Fig. 157 Remote Control Keypad

App. 8 Installing/Reinstalling ICS Chartr EP 200 Software

The ICS Chartr EP 200 software is pre-loaded on the hard drive of all laptop/desktop computers supplied by GN Otometrics
and does not require on-site installation. A workstation name for the system has also been loaded along with a demo data-
base.
The ICS Chartr EP 200 software is provided on a CD-ROM and can be installed if necessary.
App. 8.1 Installing ICS Chartr EP 200 Software

Use the following procedure if you need to reinstall the ICS Chartr EP 200 software.
To install ICS Chartr EP 200 software

1. Access the Windows desktop.
2. Insert the ICS Chartr EP 200 CD-ROM in the CD-ROM drive of the PC. The installation program should start auto-
matically. Go to step 5.
If the installation program does not start in approximately 30 seconds, go to Steps 3 and 4.
3. Click the Start button at the bottom left corner of the screen, and select Run to display the Run dialog box.
Fig. 158 Run Dialog Box for ICS Chartr EP 200 Installation
4. Type D:\Setup (where D = the CD-ROM drive) in the space provided, as shown in Figure 1 and click OK.
5. Follow the on-screen instructions.
– Welcome
Introduces the Install program. Read the instructions and click Next to continue.

Fig. 159 Welcome Dialog Box (Installation Wizard)
– Read Me First
Read the about the enhancements and features available in this version of the software. Click Next to continue.

Fig. 160 Read Me First Dialog Box (Installation Wizard)
– Select Installation Options

Select ICS Chartr EP 200 USB or MCU90 XP (tower) hardware.
Make sure the correct option is selected. Click Next to continue.

Fig. 161 Select Install Dialog Box (Installation Wizard)
– Choose Destination Location

Places the application in the default destination folder (example: C:\...\Chartr EP) unless you select a different des-
tination folder. Click Next to continue.
To make it easier for technical support to assist you if needed, it is best to install the software in the default loc-
ation.

Fig. 162 Choose Destination Location Dialog Box (Installation Wizard)
– Select Setup Type

Click on a setup type (Networked Workstation or Standalone Workstation) to highlight it, then click Next to con-
tinue. Standalone Demo is the default setting.

Fig. 163 Select Setup Type Dialog Box (Installation Wizard)
If you select a Demo setup type, the Demo database becomes the active database, and demo data will be avail-
able for training purposes. Any new patient or collected data will be stored in this database. The demo patient
data can be deleted at a later time, if desired.
– Choose Destination Database Location
Place the database in the default folder (C:\Chartr\DATA) unless you decide to use a different folder. Click Next to
continue.
ation.

Fig. 164 Choose Destination Location Dialog Box (Installation Wizard)
– Select Program Folder

Place the program icons in the default program folder (GN Otometrics) unless you decide to use a different dir-
ectory. Click Next to begin the installation process.
ation.

Fig. 165 Select Program Manager Group Dialog Box (Installation Wizard)
– Start Installation
Click Next to begin installing ICS Chartr EP 200 software.

Fig. 166 Start Installation Dialog Box (Installation Wizard)
– Software Application Installation

The Initializing Wise Installation Wizard notice will display. The current file being loaded on the hard drive along
with the time remaining will display.

Fig. 167 Software Installation (Installation Wizard)
– Hardware Driver Installation

Depending on the application you selected, the Installation Wizard will prompt you to start loading the appro-
priate drivers. Click Next to begin the installation.

Fig. 168 Start Hardware Installation Dialog Box (Installation Wizard)
– Installation Complete
After all of the applications and hardware drivers are installed, click Finish to complete this phase of the install-
ation process.

Fig. 169 Installation Complete Dialog Box (Installation Wizard)
– Start Database Conversion

The system is now ready to start converting the database. The system will locate an previous databases on your sys-
tem, and will first backup the database, and then convert the database for use with this version of the software.
Click Next to continue.

Fig. 170 Start Database Conversion Dialog Box (Installation Wizard)
– Database Conversion in Progress

Once the system locates the existing database, click Convert to continue.

Fig. 171 Database Conversion Dialog Box (Installation Wizard)
– Database Conversion Complete

The progress of each database conversion will display. When the conversion process is complete, click Next to
continue.

Fig. 172 Database Conversion Complete Dialog Box (Installation Wizard)
– Installation Complete
After the software and drivers are installed and the existing databases are converted, click Finish to conclude the
installation process.

Fig. 173 Installation Complete Dialog Box (Installation Wizard)
6. Click OK to restart Windows when prompted. Make sure theChartr EP 200 system hardware is connected and turned
on.Click OK to restart Windows when prompted. Make sure the ICS Chartr EP 200 system hardware is connected and
turned on.
Fig. 174 Restart Windows Prompt
7. Use the Found New Hardware Wizard to install drivers for any new hardware identified when Windows restarted. If
the identified hardware came with an installation CD, insert it. Select an installation option and click Next to con-
tinue.

Fig. 175 Found New Hardware Wizard Dialog Box
8. Click Finish when the hardware installation is complete.

Fig. 176 Hardware Installation Complete
9. Click on the ICS Chartr EP 200 icon to begin a work session.
Fig. 177 ICS Chartr EP 200 Icon
This prompt displays the first time the program starts.

Fig. 178 Workstation Registration Dialog Box
10. Type a descriptive name that identifies the workstation in the Workstation text box and click OK . If the system is run-
ning on a network, the name you supply must be unique. The software is now installed and ready for use.
App. 8.2 Uninstalling ICS Chartr EP 200 Software

Use the following procedure if you need to uninstall the existing ICS Chartr EP 200 software from your hard drive. This pro-
cedure uses the Windows Uninstall Wizard that is located in the Windows Control Panel.
This procedure only removes the ICS Chartr EP 200 software program files. It will not remove the patient database file
(chartr.mdb) or the demo database file (C:\Chartr\Data\Demo) if it is installed. When you reinstall ICS Chartr EP 200, your
patient database will still be available. You must delete the patient database manually if you want to remove it from your
system.
To uninstall the ICS Chartr EP 200 software

1. Click the Start button on the Windows Task bar to display a list of options.
2. Select Settings, Control Panel to display the Control Panel dialog box.
3. Select the Install/Uninstall tab to display that dialog.
4. Double-click on the Add/Remove Programs icon to display the Add/Remove Program Properties dialog box.
5. Scroll through the list of software that can be automatically removed by Windows and select ICS Chartr EP 200.
6. Click the Add/Remove button and the system will prompt with: “Are you sure you want to completely remove ICS
Chartr EP 200 and all of its components?”
7. Click Yes to let windows remove the existing version of ICS Chartr EP 200 from your hard drive. The system may
prompt you to confirm the deletion of files that could be shared by other programs.
8. Click Yes if the file is not shared by other applications. If you are not sure, click No.
9. Repeat the above steps to remove each of the following programs (if they are present):
– ICS Chartr EP 200
– ICS USB EP Driver
– Keyspan Remote
10. Click OK.
Note • This procedure will only remove the ICS Chartr EP 200 program files. It will not remove the patient data-
base.

App. 8.3 Reinstalling ICS Chartr EP 200 Software

If it becomes necessary to reinstall the ICS Chartr EP 200 software, you will need to uninstall the version of the software
that is currently on your hard drive. Uninstalling ICS Chartr EP 200 will remove all of the software programs from the hard
drive. It will not remove the existing patient database!
When you reinstall the software, your patient database will not be replaced. If you want to replace the patient database,
you must remove that database manually before reinstalling ICS Chartr EP 200.
App. 8.4 Demo Database

The demo ICS Chartr database is installed on your system in the Demo folder. This folder is located under the folder that
contains the ICS Chartr database (i.e., C:\Chartr\DATA\DEMO).
Note • The demo Chartr database is used for training purposes. If you need to view the demo patient data, follow
the steps below. See Exporting, Importing, and Archiving Records ► 134 for information on how to import
patient data for analysis.
The demo ICS Chartr database is installed on your system in the Demo subfolder. This subfolder is located under the folder
that contains the ICS Chartr database (i.e., C:\Chartr\Data).
Note • The demo Chartr database will load even if you did not select to install the demo database during rein-
stallation.
To view the demo database

1. Select Database > Open Archived Database or Exported Patient from the Menu bar.
2. Navigate through the list of folders and files and find the Demo folder. The default location is C:\Chartr\Data\Demo.
3. Select the file called Chartrdemo.mdb.
4. Click OK.

App. 9 Troubleshooting Noise

Use the following suggestions to try to locate the possible cause of the noise:
• Start the EEG. Place non-disposable electrodes in a cup of water and see if you still get the noise in the waveform.
Walk around the room and see if it is worse in certain areas or near other equipment to find the source of the noise.
• If only collecting artifact, uncheck the artifact in the trial setting to turn off artifact rejection. Collect the noise and
determine the frequency of the noise to assist with troubleshooting.
• If you suspect 50 or 60 Hz noise, turn on the notch filter to assess the noise. If the notch filter eliminates the noise,
then identify the source. Typically though, noise is usually from another source and at a higher frequency.
• Move the system to another room or different part of the building to determine if something in/near the location is
the source of the noise.
This chart identifies possible causes for noise and suggested solutions:
Possible Cause Solution
Located near a source that produces • Ensure preamp is not be near the isolation transformer, monitor, etc.
electromagnetic interference • Turn off unnecessary computer monitors.
• If patient is in chair that plugs in, unplug it.
• Do not use cellular phones during testing.
• Turn off fluorescent light(s).
• Do not have fluorescent light dimmer switch set in the middle position.
Faulty electrode use/placement • Tape electrodes together (making a sleeve with tape).
• Do not mix electrode types.
• Do not place ground electrode near the heart. Noise can be generated
by large EKG.
• Run all electrode leads toward the top of the patient's head.
Improper setup for transducer box/trans- • Separate the patient cable/electrodes from the transducer cable.
ducer cable • Do not clip the stimulus transducer box to the patient.
• Do not let tubing of the transducer touch the electrode wires.
Faulty connection between device and • Only plug the ICS Chartr EP 200 system into the supplied isolation trans-
mains supply former.
• Connect the isolation transformer directly to the wall outlet. Do not
use power strips or extension cords.
• Use a designated circuit for the ICS Chartr EP 200 system. Verify with an
electrician or Bio-medical department. If not using a designated circuit,
office equipment (such as a copier) can introduce noise.
• Assure that the wall outlet is wired correctly and grounded.

Possible Cause Solution
Miscellaneous problems • Do not place ICS Chartr EP 200 system on a metal cart. Metal cars can
create an electric field and introduce noise into the recordings.
• Try to avoid testing at a site where there are nearby radio transmission
towers and other electrical towers that can introduce noise.
• Try to avoid testing in a location where there are large devices in adja-
cent rooms or floors (e.g., X-ray equipment, MRI (magnetic resonance
imaging) equipment, refrigerator, air conditioning unit, elevator motors,
etc.). These devices can emit electromagnetic interference.

App. 10 Glossary
App. 10 Glossary
ABR electrical activity, evoked (stimulated) by very brief-duration sounds, that
(auditory brain stem response) arises from the VIII cranial nerve and auditory portions of the brain stem.
The ABR usually is recorded from the surface of the scalp and external ear
with disc-type electrodes and processes with a fast signal averaging
computer. ABR wave components are labeled with Roman numerals and
described by the latency after the stimulus (in msec) and the amplitude
from one peak to the following trough (in microvolts).
AER electrical activity evoked (stimulated) by sounds arising from auditory por-
(auditory evoked response) tions of the peripheral or central nervous system and recorded with elec-
trodes. AERs include but are not limited to the electrocochleogram
(ECochG), ABR, auditory middle-latency response (AMLR), 40-Hz response,
auditory late response (ALR), and P300 response.
AMLR electrical activity evoked by sounds, originating from portions of the

(auditory middle latency response) auditory cortex, is measured with electrodes placed on the scalp, and
occurs within a period of 10-80 msec after the sound is presented.
ALR electrical activity evoked by sounds, originating from portions of the

(auditory late response) auditory cortex, is measured with electrodes placed on the scalp, and
occurs within a period of 100-300 msec after the sound is presented.
Analysis in AER measurement, the calculation of specific response parameter values

(e.g., latency or amplitude of wave components). Analysis time is the time
period after a stimulus is presented during which a response is averaged and
analyzed (e.g., 10 msec for the ABR).
ANSI American National Standards Institute
Artifact rejection process during evoked response measurement for eliminating or reducing
the unwanted contamination of the recording by an unwanted feature (arti-
fact). Artifact rejection can be set in the Quick Settings with 100% being full
scale (allowing all electrical activity to be accepted) and by lowering the per-
centage more electrical activity will be rejected. The artifact rejection is set
at +/–5 µV with a default of 99%.
ASSR electrical activity, evoked (stimulated) by amplitude and frequency

(auditory steady state response) modulated pure tones, that arises from the auditory pathway. The ASSR is a
1-channel recording from the surface of the scalp and external ear or nape
of the neck. ASSR allows you to obtain data monaurally or binaurally using
multiple frequencies simultaneously.
Asymmetry Ratio this calculation compares the VEMP amplitude of the left to the right side
and then provides a numerical value that is the percentage difference
between the two sides.

App. 10 Glossary
Average process of summing the response to a repeated stimulus over a specific time
(averaging) period after the stimulus (e.g., 15 msec) and regularly dividing the summed
response by the number of stimuli presented. Random electrical activity
(noise) becomes smaller and electrical brain activity time-locked to the stim-
uli (signal) becomes larger with averaging.
Calibration electroacoustic or psychoacoustic determination that an electrical device

(such as an amplifier) or an acoustic transducer (an earphone) is performing
properly according (to defined characteristics) in terms of its acoustic out-
put, attenuator linearity, frequency accuracy, harmonic distortion, etc.
dB tenth of a Bel, a unit for expressing the ratio between two sound pressures
(decibel) or two sound powers.
dB HL decibel scale referenced to accepted standards for normal hearing (0 dB is

(hearing level) average normal hearing for each audiometric test frequency).
dB nHL decibel scale used in auditory brain stem response measurement ref-
(normalized hearing level) erenced to average behavioral threshold for the click or tone burst stimulus
of a small group of normal hearing subjects.
dB SPL decibel scale referenced to a physical standard for intensity (e.g., 20 mPa or
(sound pressure level) 0.0002 dynes/cm2).
ECochG evoked responses originating from the cochlea and VIIIth (auditory)
(electrocochleography) cranial nerve (i.e., the summating potential [SP], the cochlear microphonic
[CM], and the N1 component). This response occurs in the first few msec
after stimulation.
EEG ongoing electrical activity arising from the brain; background electrical activ-
(electro-encephalography) ity during evoked response measurement.
Electrode metal device (cup, needle, plate) that makes contact with the body and con-
ducts bioelectrical activity from the skin surface via a wire lead to recording
equipment in sensory evoked responses.
Electromyography (EMG) technique for evaluating and recording physiologic properties of muscles at
rest and while contracted. The EMG value is used for the VEMP recording
to assure that equal contraction was performed for both the left and right
sternocleidomastoid.
EMG See Electromyography
Envelope shape of the overall waveform of an acoustic stimulus that follows the rise,
plateau, and fall portions of the stimulus.
EP evoked potential. See AER
Evoked elicited, stimulated, or activated. Sensory evoked responses are elicited,

stimulated, or activated by sensory (auditory, visual, somatosensory) stimuli.

App. 10 Glossary
Frequency number of cycles occurring per unit of time. The frequency is the
reciprocal of the period. The unit is the cycle per second (cps) or Hz.
HL lowest intensity level (in dB hearing level) that a person can hear a sound of
(Hearing Level) a particular frequency; represented as the number of decibels above an
average normal hearing threshold for any given signal. 0 dB HL is
equivalent to normal hearing.
High pass filter filter that passes electrical energy above a specific cutoff frequency and elim-
inates (filters out) energy below that frequency. A typical high-pass filter set-
ting (which is at the lower end of the frequency range being filtered) in ABR
measurement is 50 Hz.
Intensity amount of sound energy per unit area.
Interaural Time Delay for Wave V this calculation compares the ABR Wave V latency difference of the left and
(IT5) right side and provides a numerical.
Invert reverse the polarity of a waveform or turn it upside down. Waveforms can
be inverted by reversing the electrodes in an electrode pair (i.e., the
amplifier inputs) before evoked response recording or, with some evoked
response systems, by a digital manipulation after the averaging process.
Masking process by which the threshold of audibility for one sound is raised by the
presence of another (masking) sound. A masking noise is a constant level of
background noise presented to the non-test ear in an audiometric
procedure or AER measurement. Masking is used in an attempt to prevent a
response from the nontest ear due to possible stimulus crossover from the
test ear.
Myogenic Potential action potential of the muscle. In the ABR test, a myogenic potential can
occur at 10-14 milliseconds and is usually seen as a large rounded peak. This
can be caused due to tension of the head and neck.
nHL normal hearing level.
Noise (acoustic) any undesired sound or disturbance within a useful frequency

band, such as undesired electric waves in a transmission channel or device.
(bioelectric) in evoked response measurement, noise is unwanted activity,
either electrical or muscular, which interferes with detection of the
response.
Normative data statistical information on normal characteristics of data, such as AER latency,
amplitude values, or expected threshold intensity level for the response.
Notch (60 Hz) filter designed to reduce interference from 60-Hz (cycle) electrical activity
(power line noise). Notch filtering introduces filter distortion in responses.

App. 10 Glossary
Ocular Vestibular Evoked Myogenic electrical activity, evoked (stimulated) by very brief-duration, high intensity
Potential (OVEMP) sound, that is thought to arise from the saccule and the inferior vestibular
nerve. The VEMP is usually recorded from the surface of the muscle below
the eye. VEMP wave components are labeled as P1, N1, P2 and described
by the amplitude of P1 (peak) and N1 (trough). See also VEMP
OVEMP See Ocular Vestibular Evoked Myogenic Potential
P300 (in AER) a “cognitive” or “event-related response,” occurring in the 300-

msec region (with positive-voltage, hence “P”) after acoustic stimuli. A P300
is normally recorded when a person listens for rare, “oddball,” stimuli that
is presented along with frequent stimuli.
Peak component of an evoked response waveform, or the extreme amplitude for

the component. In AER, peak often describes a positive-voltage component
and a trough describes a negative-voltage component.
Potential difference in electrical charge measured between two electrodes. In

evoked response measurement, the source of electrical potentials is stim-
ulus-evoked activity in sensory portions of the peripheral or central nervous
system.
Ramp onset or rise portion of a stimulus, usually a tone, is shaped or modified in

some way, rather than immediately rising to maximum (peak)
amplitude within the first portion of a cycle of the stimulus.
Rate number of stimulus repetitions per unit of time. Stimulus rates of 27.7/sec
or 39.1/sec are sometimes used in ABR measurement.
Reference electrode secondary electrode in an electrode pair. In ABR, the reference electrode
measurement is usually on the earlobe or mastoid of the stimulated ear.
Repetitions number of stimuli presented in recording or averaging a single waveform. In

(sweeps) ABR measurement, 1500 repetitions is typical. The terms repetitions and
sweeps are synonymous.
Scale vertical scale displayed in microvolts per division. If the scale is set at
0.2 uV, then there are 0.2 microvolts per division on the vertical access. To
make a waveform smaller, raise the number of microvolts per division. To
make a waveform larger, lower the number of microvolts per division.
Smooth digital manipulation of an evoked response waveform in which voltages for a

(smoothing) sequence of three or more data points are added together. Smoothing may
reduce the noisy appearance of waveforms containing excessive high-fre-
quency electrical activity and may facilitate identification of major wave
components.
Sound Level Meter device for measuring the intensity level of sound waves in air; the unit of
measurement is in decibels sound pressure level (SPL dB).

App. 10 Glossary
SPL amount (intensity) of a sound, such as an acoustic stimulus for evoked

(sound pressure level) responses, expressed in decibels (dB). 0 dB SPL is the smallest amount of dis-
placement of air molecules caused by a sound that can just be detected by
the human ear at a given frequency. Normal hearing SPL dB reference is
0.0002 dyne/cm2 or 20 mPa.
Sweeps See Repetitions.
Test Fixture Box small black box with 5 or 9 prongs; fits into the auditory stimulus slot on the
MCU and is used to troubleshoot hardware. The patient cable plugs into the
prongs.
Threshold of Audibility least audible SPL for a given stimulus; the level at which stimulus can be
heard by an individual 50% of the time.
Time Delay time interval between the presentation of a stimulus for an evoked
response and the initiation of response averaging.
Tone sinusoid or steady-state (ongoing) sound of a single-frequency (vs. noise with

many frequencies or a click).
Transducer electro-acoustic device for converting energy from one form to another. An
earphone is a transducer that converts electrical energy to acoustic energy.
Vestibular Evoked Myogenic Potential electrical activity, evoked (stimulated) by very brief-duration, high
(VEMP) intensity sound that is thought to arise from the saccule and the inferior ves-
tibular nerve. The VEMP is usually recorded from the surface of the neck on
the sternocleidomastoid muscle. VEMP wave components are labeled as P1,
N1, P2 and described by the amplitude of P1 (peak) and N1 (trough).
VEMP See Vestibular Evoked Myogenic Potential

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Auditory Evoked Potential

2 Otometrics - ICS Chartr EP 200

2 Getting Started in ICS Chartr EP 200ICS Chartr EP 200 10

3 Establishing and Maintaining Records 39

Otometrics - ICS Chartr EP 200 3

4 Otometrics - ICS Chartr EP 200

6 Working with Reports 114

Otometrics - ICS Chartr EP 200 5

8 Calibration and External Trigger 140

11 Technical Specifications 150

App. 1 Data Collection Reference 160

App. 2 Keyboard Shortcuts 179

6 Otometrics - ICS Chartr EP 200

App. 4 Normative Data 186

App. 5 Customizing the Word Processor Report 198

App. 6 Error Messages 203

App. 7 Setting up the Hardware 213

App. 8 Installing/Reinstalling ICS Chartr EP 200 Software 216

App. 9 Troubleshooting Noise 236

App. 10 Glossary 238

Otometrics - ICS Chartr EP 200 7

1.1 Intended Use

1.2 Intended User

1.3 About this manual

Access to digital version

• Click the button available in many dialog boxes

8 Otometrics - ICS Chartr EP 200

1.4 Typographical conventions

Note • Indicates that you should take special notice.

1.4.1 Navigating this manual

Otometrics - ICS Chartr EP 200 9

2 Getting Started in ICS Chartr EP 200ICS Chartr EP 200

2.1 ICS Chartr EP 200 Work Session

2.1.1 Starting an ICS Chartr EP 200 Work Session

To start a ICS Chartr EP 200 work session

Fig. 1 ICS Chartr EP 200 Icon

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Fig. 2 Operator Login Dialog Box

2.1.2 Ending an ICS Chartr EP 200 Work Session

To end an ICS Chartr EP 200 session

Otometrics - ICS Chartr EP 200 11

Fig. 3 End ICS Chartr EP 200 Session Dialog Box

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2.2 ICS Chartr EP 200 Main Window

Fig. 4 ICS Chartr EP 200 Main Window

Areas displayed with or without Function/Purpose

A Title bar View patient and operator names

B Menu bar Select program options

C Toolbar Quick access and labeling waveforms

D Function/Operation keys Select program options

E Status bar View program information

F Maximize/Minimize Close buttons Toggle between testing and review modes

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Additional areas displayed with Function/Purpose

G Ongoing EEG box Display EEG waveforms during data collection

J Calculation box View waveform calculations

L Waveform work area View collected waveforms

N Waveform bank numbers Select waveform by number

O Waveform page comments box Type comments to be saved with waveforms

2.2.1 New Test Tab