K Number
K971399
Device Name
AURIS AE, AURIS TL, AURIS HS, AURIS AC, AURIS MM, AURIS COE, AURIS CIC
Date Cleared
1997-06-13

(59 days)

Product Code
Regulation Number
874.3300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Mild to severe conductive, mixed or sensoryneural hearing loss Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are of some concern Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern, but the ear can not accommodate a complete in the canal style Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern. Mild to severe conductive, mixed or sensoryneural hearing loss when a more cosmetic AE is desired. Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are a major concern but the ear prevents use of a CIC or MM. Normal low and middle frequency hearing with a sloping mild to moderate high frequency sensory neural or mixed loss.
Device Description
To amplify and transmit sound to the ear. DSD K-amp or Intrigue programmable circuitry Assembled from standard components that are widely used by other hearing aid manufacturers. "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by individual audiogram Volume control similar to other devices. Standard size 13 battery Standard size 312 battery Standard size 10A battery Standard size 10a or 5a battery
More Information

Not Found

Not Found

No
The summary describes a standard hearing aid with programmable circuitry and standard components, with no mention of AI or ML terms, image processing, or data sets for training/testing.

Yes
The device is intended to treat hearing loss, which is a medical condition, by amplifying and transmitting sound to the ear. This falls under the definition of a therapeutic device.

No

The "Intended Use" section describes the device addressing "hearing loss" and the "Device Description" states its purpose "To amplify and transmit sound to the ear." These indicate the device is a hearing aid, which is a therapeutic device designed to assist hearing, not a diagnostic tool for identifying or characterizing a medical condition.

No

The device description explicitly mentions physical components like batteries and circuitry, indicating it is a hardware device, not software-only.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are tests performed on samples taken from the human body (like blood, urine, or tissue) to detect diseases, conditions, or infections.
  • Device Function: The description clearly states the device's function is to "amplify and transmit sound to the ear" to address hearing loss. This is a device that interacts with the body externally to improve a physical function, not a test performed on a sample.
  • Intended Use: The intended uses all relate to different types and severities of hearing loss, which is a physical condition affecting the ear.
  • Device Description: The components and specifications described are consistent with a hearing aid, not an in vitro diagnostic test.

Therefore, based on the provided information, this device is a hearing aid, which is a medical device but not an IVD.

N/A

Intended Use / Indications for Use

Mild to severe conductive, mixed or sensoryneural hearing loss
Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are of some concern
Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern, but the ear can not accommodate a complete in the canal style
Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern.
Mild to severe conductive, mixed or sensoryneural hearing loss when a more cosmetic AE is desired.
Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are a major concern but the ear prevents use of a CIC or MM.
Normal low and middle frequency hearing with a sloping mild to moderate high frequency sensory neural or mixed loss.

Product codes

77 ESD

Device Description

NAME OF DEVICE: Auris AE
TYPE OF DEVICE: All-in-the-Ear
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER : Standard size 13 battery

NAME OF DEVICE: Auris TL
TYPE OF DEVICE: All-in-the-Ear
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 312 battery

NAME OF DEVICE: Auris HS
TYPE OF DEVICE: Half-shell-in-the-Canal
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 312 battery

NAME OF DEVICE: Auris AC
TYPE OF DEVICE: All-in-the-Canal
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 312 battery

NAME OF DEVICE: Auris MM
TYPE OF DEVICE: Micro-Mini (All-in-the-Canal)
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 10A battery

NAME OF DEVICE: Auris COE
TYPE OF DEVICE: Canal-Open-Ear (All-in-the-Canal)
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 10A battery

NAME OF DEVICE: Auris CIC
TYPE OF DEVICE: Completely-in-the-Canal
FEATURES : DSD K-amp or Intrigue programmable circuitry
ASSEMBLY : Assembled from standard components that are widely used by other hearing aid manufacturers.
TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards"
FIT: Frequency response dictated by individual audiogram
CONTROLS : Volume control similar to other devices.
POWER: Standard size 10a or 5a battery

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

ear

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 874.3300 Air-conduction hearing aid.

(a)
Identification. An air-conduction hearing aid is a wearable sound-amplifying device intended to compensate for impaired hearing that conducts sound to the ear through the air. An air-conduction hearing aid is subject to the requirements in § 800.30 or § 801.422 of this chapter, as applicable. The air-conduction hearing aid generic type excludes the group hearing aid or group auditory trainer, master hearing aid, and the tinnitus masker, regulated under §§ 874.3320, 874.3330, and 874.3400, respectively.(b)
Classification. Class I (general controls). This device is exempt from premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 874.9.

0

K971399

  • TUN I 3 Nagt
    NAME OF DEVICE: Auris AE

TYPE OF DEVICE: All-in-the-Ear

To amplify and transmit sound to the INTENDED USE : ear.

DSD K-amp or Intrigue programmable FEATURES : circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by FIT:

individual audiogram

Volume control similar to other devices. CONTROLS : Standard size 13 battery POWER :

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

1

NAME OF DEVICE: Auris TL

TYPE OF DEVICE: All-in-the-Ear

To amplify and transmit sound to the INTENDED USE : ear.

DSD K-amp or Intrigue programmable FEATURES : ي تي پي په پ circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by FIT: individual audiogram Volume control similar to other devices. CONTROLS :

Standard size 312 battery POWER:

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

2

NAME OF DEVICE: Auris HS

TYPE OF DEVICE: Half-shell-in-the-Canal

To amplify and transmit sound to the INTENDED USE : ear.

DSD K-amp or Intrigue programmable FEATURES : ﺔ ﺗﻮﻓﻴﺮ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤ circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by FIT: individual audiogram

Volume control similar to other devices. CONTROLS :

POWER: Standard size 312 battery

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

3

NAME OF DEVICE: Auris AC

TYPE OF DEVICE: All-in-the-Canal

To amplify and transmit sound to the ear. INTENDED USE : DSD K-amp or Intrigue programmable FEATURES :

circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid ته ته ته ته ته ا manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications

comply with S3.2-1987 ANSI Standards"

Frequency response dictated by individual FIT: audiogram

Volume control similar to other devices. CONTROLS :

Standard size 312 battery POWER:

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

4

NAME OF DEVICE: Auris MM

FIT:

TYPE OF DEVICE: Micro-Mini (All-in-the-Canal)

To amplify and transmit sound to the ear. INTENDED USE : DSD K-amp or Intrigue programmable FEATURES : circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications

comply with S3.2-1987 ANSI Standards"

Frequency response dictated by

individual audiogram

Volume control similar to other devices. CONTROLS :

Standard size 10A battery POWER:

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

5

NAME OF DEVICE: Auris COE

TYPE OF DEVICE: Canal-Open-Ear (All-in-the-Canal)

To amplify and transmit sound to the INTENDED USE : ear.

DSD K-amp or Intrigue programmable FEATURES : نيو سي پيتي جي تي circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by FIT: individual audiogram

Volume control similar to other devices. CONTROLS : Standard size 10A battery POWER:

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

6

NAME OF DEVICE: Auris CIC

TYPE OF DEVICE: Completely-in-the-Canal

To amplify and transmit sound to the ear. INTENDED USE :

DSD K-amp or Intrigue programmable FEATURES : ﻨﻲ circuitry

Assembled from standard components that ASSEMBLY : are widely used by other hearing aid manufacturers.

TECHNICAL CHARACTERISTICS: "Technical specifications comply with S3.2-1987 ANSI Standards" Frequency response dictated by individual FIT: audiogram

CONTROLS : Volume control similar to other devices.

POWER: Standard size 10a or 5a battery

A USERS' MANUAL AND OTHER INFORMATION

IS SUPPLIED WITH EACH HEARING AID.

7

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/7/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three lines representing its wings. The eagle is positioned within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged around the circle's perimeter.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

1661 8 1 NUTT

Roger P. Juneau President General Hearing Instruments, Inc. -P.O. Box 61010 New Orleans, LA 70161-1010

Re: K971399

Programmable Option for Auris AE, Auris TL, Auris HS, Auris AC, Auris MM, Auris COE and CIC Air Conduction Hearing Aids Dated: April 25, 1997 Received: April 28, 1997 Regulatory Class: I 21 CFR 874.3300/Procode: 77 ESD

Dear Mr. Juneau:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to devices marketed in interstate commerce prior to May 28, 1976, the exactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent . determination assumes compliance with the Good Manufacturing Practice for Medical Devices: General (GMP) regulation (21 CFR Part 820) and that, through periodic GMP inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device in a classification for your device and thus, permits your device to proceed to the market.

While your device has been deemed substantially equivalent to other legally marketed hearing ands, please be advised that electromagnetic interference from digital cellular telephones, as well as from other sources, is increasingly becoming a concern. Typically, this interference takes the form of a buzzing sound that can range from annoying to very loud and may render a hearing aid temporarily ineffective for the wearer. Because electromagnetic interference may affect your device, you may be asked to test for electromagnetic compatibility in the future. In this interim period, we encourage you to modify your device labeling to inform practitioners and users of the potential for electromagnetic interference. Please be aware that a 510(k) submission is required for any claims that infer that your device is compatible with potential sources of electromagnetic interference, such as "compatible with digital cellular telephones", and that data supporting such claims is necessary.

8

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or at (301) 443-6597 or at its Internet address ----------------------------------------------------"http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

.

Lillian Yin, Ph.D.

Director, Division of Reproductive, Abdominal, Ear, Nose and Throat, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

..............................................................................................................................................................................

9

510(k) Number (if known): _K971399

Device Name: Auris AE-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to severe conductive, mixed or sensoryneural hearing loss

发:大

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Drive

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

Harriet M. Bergman

ivision Sign-Off) · vision of Reproductive, Abdominal, ENT, d Radiological Devices 0(k) Number _

10

Page 2_of_7

510(k) Number (if known): K971399

Device Name: Auris HS-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are of some concern

乐 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Seine

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

Schmidt Ch. Sejrem
(Division Sign-Off)

( - Choice Of Reproductive, Abdominal, ENT,
and Radiological Devices and Radiological Device

510(k) Number K971344

11

Page 3 of 7

510(k) Number (if known): _K971399

Device Name: Auris MM-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern, but the ear can not accommodate a complete in the canal style

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Service

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

Clifford W. Kellison

(Division Sign-Off) Division of Reproductive, Abdominal, ENT and Radiological Devices

510(k) Number K9711394

12

Page 4 of 7

510(k) Number (if known): K971399

Device Name: Auris CIC-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to moderate conductive, mixed or sensoryneural hearing loss when cosmetics are of major concern.

乐心--

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

OR

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Service

Prescription Use (Per 21 CFR 801.109) Over-The-Counter Use (Optional Format 1-2-96)

Varick A. Wynen

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Device 510(k) Number _

13

Page 5_of _

510(k) Number (if known):_K971399

Device Name: Auris TL-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to severe conductive, mixed or sensoryneural hearing loss when a more cosmetic AE is desired.

ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Sample. $\checkmark$

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

Daniel C. Segerson

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Device 510(k) Number

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14

510(k) Number (if known): _K971399

Device Name: Auris AC- (DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Mild to severe conductive, mixed or sensoryneural hearing loss when cosmetics are a major concern but the ear prevents use of a CIC or MM.

ﺮ ﺍﻟﻤﻮﺍﻗﻊ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤ

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Device

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

David A. Siyonn

(Division Sign-Off) Division of Reproductive, Abdominal, ENT and Radiological Devi 510(k) Number

15

510(k) Number (if known):_K971399

Device Name: Auris COE-(DSD K-amp) or (Intrigue-Pro) Option

Indications For Use:

Normal low and middle frequency hearing with a sloping mild to moderate high frequency sensory neural or mixed loss.

4

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Restricted Device ✓

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use (Optional Format 1-2-96)

Daniel A. Lippman

(Division Sign-Off) Division of Reproductive, Abdominal, ENT and Radiological Devi 510(k) Number