VISUAL REINFORCEMENT AUDIOMETRY
(VRA)

Watch this short video of a 9.5 month old being tested via ear inserts using VRA, at Sound Steps.

Once six months old, your baby can be conditioned to respond to sound stimuli, by turning his or her head, for which s/he is rewarded, visually, by a light that comes on. This method of testing hearing in infants and babies between the age of six months to thirty-six months, is called Visual Reinforcement Audiometry (VRA). However, children who have had the benefit of early identification and intervention , are ready to transition to Conditioned Play Audiometry (CPA), which requires a more sophisticated response, earlier than this.

VRA requires your baby to participate or co-operate in the testing procedure, seated in your lap or in a high chair. VRA measures your baby’s responses to sound across the speech frequency range of 250Hz (Hertz) upto 8000 Hz (Hertz). The audiologist may choose Narrow Band Noise (NBN) or Warble Tones as the sound stimulus, as these are tones that interest your baby at this age. Each ear is tested individually, at each of these frequencies, to obtain ear specific and frequency specific information, that is reliable. Ear inserts or insert earphones are used to deliver the sound stimulus reliably to your baby’s ears, in order to obtain individual ear information.

Given the short attention span of your baby at this age, VRA takes time to administer and takes several sessions to complete. You and your family learn to observe the responses in your baby during these sessions. Keeping your baby happy and alert during testing is critical to obtaining reliable results; allow your baby to feed or take a break whenever s/he tires of the testing procedure.

Your baby finds speech and songs more interesting to listen to than mere sounds or tones. Your voice in particular or the voice of your partner is by far the most interesting. The audiologist who is testing your baby using VRA may ask you to talk or sing to your baby, while she monitors the intensity levels and observes your baby’s responses while testing.

The responses that your baby gives to both sounds (i.e.tones) and speech over the frequency range, in each ear, are then plotted on an audiogram or graph to obtain your baby’s unaided audiogram. Your baby’s audiogram measues his or her hearing loss. It will help you understand whether your baby has the access to Sound his or her brain needs to understand spoken language and to learn like other babies the same age. These responses will help determine

  1. the presence of hearing loss if any
  2. which model of hearing aid best supports your baby’s hearing loss
  3. the settings for your baby’s hearing aids
  4. whether your infant needs a cochlear implant

Once your baby is using hearing aids during all his or her waking hours for approximately three to four weeks, the audiologist will measure your baby’s responses to sound (i.e. tones) and speech, with hearing aids, one ear at a time, using VRA.The audiologist will then plot these responses, to obtain your baby’s aided audiogram.

Visual Reinforcement Audiology (VRA) provides a reliable method to measure, manage and monitor your toddler’s hearing loss.

Other Tests That Can be Relevant to Your Case

Behavioural Observation Audiometry (BOA)

BOA is the method of testing hearing in newborns from birth to six months, observing their sucking response to sound.

Conditioned Play Audiometry (CPA)

CPA is the method of testing hearing in children who have a cognitive age of atleast 30 months, in which they are expected to do the listen and drop task.

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