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There are a number of things to consider when conducting OAE testing in order to ensure valid and reliable results. Consideration of the factors below will ensure an optimal OAE test.

1. Probe and cable configurations
   Ensure that the protocol that you select or create is valid for the test population and for the expected clinical outcome. Protocols generally differ between those used for Newborn Hearing Screening where a clinical outcome is based on a single test versus those used in a diagnostic follow up situation where the OAE result forms part of an overall test battery approach where many tests are analyzed to form a conclusion.

   Refer to the Titan Additional Information manual for more details about test parameter considerations when creating an OAE protocol. This document also highlights parameters to consider when creating a screening
   TEOAE protocol: Neonatal Hearing Screening and Assessment (2002). Transient Evoked Oto-Acoustic Emission (TEOAE) Testing in Babies. 

   
   
2. Probe and cable configurations
   When performing OAE testing with Titan, it is important to use either the Long Clinical Extension cable with the shoulder box or the Preamplifier cable. As described in the manual, testing must not be conducted while the probe is directly connected to the Titan or directly connected to the Preamplifier cable. OAE tests should not be performed while holding the probe in the patient’s ear as this increases noise levels and the chance of incorrect delivery of the stimulus.
   
   
   
3. Daily Probe Test
   Probe performance is crucial to OAE test results. It is common practice to conduct a probe test at the beginning of each day before starting to test on patients to ensure that the probe is functioning correctly.
   • Before conducting the probe test, ensure that the probe tip is clean and free of wax and/or debris.
   • Always conduct the probe test in a quiet test environment.
   • Only use the recommend cavity for testing. Using a different type of cavity may not detect probe faults.

   Refer to the TEOAE Probe Test Quick Guide for more information.

4. Cleaning the probe tip
   It is important that the probe tip is clean and free of wax or other debris before conducting a test. Wax or debris in the probe tip can cause incorrect presentation of the stimulus or recording of the OAE. Refer to the manual or the Cleaning the Titan Probe Tip Quick Guide for more information.
   
   
   
5. Probe placement
   A good probe placement will ensure a good test. Ensure that the correct size ear tip is selected so that the probe does not fall out of the ear during testing. Refer to the Selecting the Correct Ear Tip for Titan Quick Guide for more information.
   
   
   
6. Test environment
   Ambient and physiological (patient) noise can affect the recording of an OAE response significantly. It is very important to conduct testing in a quiet environment and instruct the patient to be still and quiet during the entire test.
   
   
   
7. Analyzing the result
   Depending on the type of test, screening vs diagnostic, the test analysis will differ. In screening, the protocol usually provides pass/refer labels for ease of understanding. In diagnostics, the stimulus, probe check, response waveform and OAE response graph along with SNR values are usually analyzed to form a conclusion of the test result.

1. Turn on Titan by pressing the R or L button.

2. Select a tympanometry protocol (e.g., Tymp 226Hz) and record tympanometry measurements on the left and right ear.

3. Save the tympanometry measurements to the handheld unit. Note: Tympanometry results do not need to be saved in order for the handheld unit to use the last recorded MEP data for pressurized OAE testing.

4. Select a pressurized DPOAE protocol.

5. Ensure the correct test ear is selected, so that the correct MEP is used from the tympanometry test.

6. Press the start button and record the OAE. Change ears and repeat.

7. Save results on the handheld unit.

Select a tymp protocol	Record tympanograms	Select a Pressurized DPOAE protocol	Record & save DPOAE results

Note: Ensure that the Titan handheld unit is turned off between patients. The Titan handheld unit will always use the last recorded MEP measurements (right and left ear) for the pressurized OAE test.

Prepare the equipment 

1. Turn on Titan by pressing the R or L button.
2. Open the OtoAccess or Noah database and enter new patient details.
3. Double click on the Titan Suite icon to launch the software and click on the DPOAE module tab.
4. Select the desired test protocol from the dropdown list.
5. Select the ear for testing.

Test environment
The ideal test environment is a quiet room. High ambient background noise adversely affects OAE measurements.

Prepare the baby
The baby should be sleeping or in quiet relaxed state. Sucking, blinking, crying or movement may affect testing.

Place transducer
Place the probe in the ear –  the light will turn green when a good seal is obtained.

Run test
Click on START in the software, press the spacebar or press the shoulder box button.

Results

PASS result

REFER result

PASS –  when the criteria for a pass are reached, PASS is displayed in green above the measurement.
REFER –  when the criteria for a pass are not reached within the measurement time, REFER is displayed in amber above the measurement.
INCOMPLETE –  if the test is stopped before a PASS or REFER is generated by the system, INCOMPLETE is displayed above the measurement indicating that the full test was not completed.

Prepare the equipment

1. Turn on Titan by pressing the R or L button.
2. Choose the test protocol from the list using the up & down arrow keys and then press Select .
3. To use a different protocol than the one selected, press Protocol  and then repeat step 2 above.
4. Select the ear for testing.

Test environment
The ideal test environment is a quiet room. High ambient background noise adversely affects OAE measurements.

Prepare the baby
The baby should be sleeping or in quiet relaxed state. Sucking, blinking, crying or movement may affect testing.

Place transducer
Place the probe in the ear –  the light will turn green when a good seal is obtained.

Run test
Press the START button on the Titan or press the shoulder box button.

Results

PASS result

REFER result

PASS –  when the criteria for a pass are reached, PASS is displayed in green above the measurement.
REFER –  when the criteria for a pass are not reached within the measurement time, REFER is displayed in amber above the measurement.
INCOMPLETE –  if the test is stopped before a PASS or REFER is generated by the system, INCOMPLETE is displayed above the measurement indicating that the full test was not completed.

1. Turn on Titan by pressing the R or L button.

2. Select a tympanometry protocol (e.g., Tymp 226Hz) and record tympanometry measurements on the left and right ear.

3. Save the tympanometry measurements to the handheld unit. Note: Tympanometry results do not need to be saved in order for the handheld unit to use the last recorded MEP data for pressurized OAE testing.

4. Select a pressurized TEOAE protocol.

5. Ensure the correct test ear is selected so that the correct MEP is used from the tympanometry test.

6. Press the start button and record the OAE. Change ears and repeat.

7. Save results on the handheld unit. 

Select a tymp protocol	Record tympanograms	Select a Pressurized TEOAE protocol	Record & save TEOAE results

Note: Ensure that the Titan handheld unit is turned off between patients. The Titan handheld unit will always use the last recorded MEP measurements (right and left ear) for the pressurized OAE test.

Prepare the equipment 

1. Turn on Titan by pressing the R or L button.
2. Open the OtoAccess or Noah database and enter new patient details.
3. Double click on the Titan Suite icon to launch the software and click on the TEOAE module tab.
4. Select the desired test protocol from the dropdown list.
5. Select the ear for testing.

Test environment
The ideal test environment is a quiet room. High ambient background noise adversely affects OAE measurements.

Prepare the baby
The baby should be sleeping or in quiet relaxed state. Sucking, blinking, crying or movement may affect testing.

Place transducer 
Place the probe in the ear –  the light will turn green when a good seal is obtained.

Run test
Click on START in the software, press the spacebar or press the shoulder box button.

Results

PASS result

REFER result

PASS –  when the criteria for a pass are reached, PASS is displayed in green above the measurement.
REFER –  when the criteria for a pass are not reached within the measurement time, REFER is displayed in amber above the measurement.
INCOMPLETE –  if the test is stopped before a PASS or REFER is generated by the system, INCOMPLETE is displayed above the measurement indicating that the full test was not completed.

Prepare the equipment 

1. Turn on Titan by pressing the R or L button.
2. Choose the test protocol from the list using the up & down arrow keys and then press Select .
3. To use a different protocol than the one selected, press Protocol  and then repeat step 2 above.
4. Select the ear for testing

Test environment 
The ideal test environment is a quiet room. High ambient background noise adversely affects OAE measurements.

Prepare the baby
The baby should be sleeping or in quiet relaxed state. Sucking, blinking, crying or movement may affect testing.

Place transducer
Place the probe in the ear –  the light will turn green when a good seal is obtained.

Run test
Press the START button on the Titan or press the shoulder box button.

Results

PASS result

REFER result

PASS –  when the criteria for a pass are reached, PASS is displayed in green above the measurement.
REFER –  when the criteria for a pass are not reached within the measurement time, REFER is displayed in amber above the measurement.
INCOMPLETE –  if the test is stopped before a PASS or REFER is generated by the system, INCOMPLETE is displayed above the measurement indicating that the full test was not completed.