University of Edinburgh

Audiology Refresher 3

Presented in February, 2004

Visual Reinforcement Audiometry VRA

The essence of VRA is to reward an observable behavioural response (usually a head turn) to a frequency specific sound with a visual reward; that is the child hears the sound and turns to see the visual reward.

VRA aims to obtain accurate frequency-specific thresholds across the frequency range 250Hz to 4000Hz. It is applicable to children aged from 5 months through to about 3 years of age but can also be used to test older children who are unable to take part in conventional pure tone audiometry.

Test procedure

Please note that in free field testing the sound stimuli used are warble tones or narrow band noise.

  1. The tester presents a 1kHz signal at a level thought to be well above the child’s threshold of hearing at the same time as the visual reinforcer. If the child does not turn to locate the sound and look at the reinforcer, the child’s attention should be drawn to the reinforcer when it is on.
  2. Conditioning trials are repeated as often as required to secure conditioning, that is, the child turns in response to the sound alone.
  3. After the child has been successfully conditioned it is then possible to lower the stimulus and establish thresholds.

Insert VRA

Use inserts or child’s earmoulds.
Gives ear specific information.

Bone conduction VRA
In the Field VRA