Recommended Procedure: Visual Reinforcement Audiometry
British Society of Audiology. (2014).
Berkshire (United Kingdom): British Society of Audiology, 2-27.
This guideline provides recommendations for the use of visual reinforcement audiometry (VRA) to assess hearing in infants with a minimum developmental age of 5-7 months. The document includes detailed technical procedures for conducting VRA and covers equipment/environment considerations, interpretation of the results, and patient-handling procedures. Select recommendations are included below.
British Society of Audiology
<p>Recommendations for test interpretation include:</p><ul> <li>adjusting soundfield thresholds down by 10 dB and</li> <li>using normative values as correction factors for testing with insert earphones (pp. 18-20).</li></ul>
<p>Recommendations for the stimuli include:</p><ul> <li>frequency-modulated tones and/or narrow-band noise,</li> <li>introduction of stimuli through earphones, when possible, and</li> <li>calibration of the stimuli presented (pp. 9-10).</li></ul>
<p>Recommendations for the test procedure include:</p><ul> <li>explanation of the procedure to the caregiver in the room,</li> <li>have only one caregiver in the test situation with the child,</li> <li>condition the child to the stimulus/reward,</li> <li>obtain minimum response levels at one frequency at a time,</li> <li>prioritize clinical information in anticipation of the child fatiguing, and</li> <li>adjust testing for children with vision disorders or other disabilities (pp. 11-17).</li></ul>
<p>Recommendations for the test environment include:</p><ul> <li>competent staff for supporting or leading the assessment;</li> <li>minimum floor dimensions of 6 meters x 4 meters;</li> <li>loudspeakers at a 90 degree azimuth at least 1 meter from the test position;</li> <li>illuminated reinforcers, positioned as close to the azimuth as possible;</li> <li>positioning of the child, parent, and support staff so that the lead clinician has a clear view and there is communication between the staff and clinician; and</li> <li>hearing protection available at stimuli 80 dB (pp. 5-9).</li></ul>
