Visual reinforcement audiometry (VRA) is a test that allows an audiologist to assess hearing in infants and toddlers too young for normal tests. VRA relies on behavioral conditioning to train very young kids to respond to sounds. It is designed for children aged 6 months to around 2 to 3 years old.

VRA uses a machine called an audiometer to test a child’s hearing threshold levels. Standard pure tone audiometers use headphones and a feedback button, so they are not practical for young kids. VRA replaces the headphones with earphones (usually with foam tips) or sound field speakers. Visual reinforcers such as video animations or lighted toys are placed 90-degrees to each side of the patient to “train” the child to look toward the direction of the sound.

During the test, the child sits on parent’s lap in a sound booth (booth with a window that is insulated to outside noise), where speech sounds and tones are presented through two speakers in corners of the booth. The typical response is a head turn in the direction of the speaker, reinforced by lighting an animated toy above the speaker. Once the child is conditioned to respond to the sound, intensity of the signal is decreased to determine his or her child’s hearing sensitivity.