Behavioral testing comprises the majority of hearing testing procedures utilized in clinics and hospitals to ascertain hearing levels and resultant predictions of hearing performance.  The vast majority of patients can understand and participate in the associative response of pressing a button or raising one’s hand to a sound stimulus presented to each ear.  But in many cases where the patient is a young toddler, autistic, cognitively impaired or has vision loss or dementia, they may not be reliable participants in the process.

Visual Reinforcement Audiometry may offer an alternative method to obtain useful behavioral information for non-traditional populations to establish a clinical impression of their hearing capabilities along with other objective tests to make an overall assessment.  VRA testing can be viewed as a game process where there moments of stimulation followed by rewarding displays of lights, sounds and toy movements creating an air of anticipation awaiting the next round. If presented properly, VRA testing could be a fun activity for both the client and clinician while bracketing their hearing range and localization capabilities.

VRA testing can be accomplished using bone conduction, earphones and most typically sound field sound delivery systems.  The willingness and cooperation of the child will limit which methods to be used and the trade offs  between obtaining maximum information before loosing the child’s attention and or cooperation during the duration of the test.  VRA testing techniques can be a stepping stone to using play audiometry with those children that have had more experience in conditioned testing protocols or have lost interest in the “VRA game” as they have grown older.

VRA systems can be used in cochlear implant testing for young children utilizing many of the same approaches as used for bilateral testing.

Secondarily, these VRA systems can serve as a distraction tool when performing a related procedure such as making ear molds or wax removal from a child’s ear canal.  Many systems have been designed to permit the operator to activate the system in an all-on, stay-on mode to create an entertaining show of sounds, lights and movement monopolizing their attention while other sensitive procedures are completed during the show.

Incorporating a VRA system into the testing regime can be accomplished for under $1,500 and is easily installed in most sound booths or screening rooms.  A video VRA system can be acquired for around $3,000 for a wireless system but may require installing mounting brackets for the monitors inside the sound room.  All in all, the barrier to entry is very low with an ROI on this investment of only 6-9 months depending upon how many tests you need to perform using CPT Code 92579.

The Video VRA could be used for purposes other than testing a child’s hearing levels, to display valuable and informative images on these video screens to other patients, adults, or parents in the sound room receiving other services?  Many Video VRA systems have been designed to display uploaded images or movies for marketing, educational, or language translation purposes when they are not employed in their primary task of conditioning young children’s listening behaviors.  Some examples come to mind that would include: an animated SRT board for picture pointing tests, relaxing background images displayed during adult hearing testing to comfort or relax the patient especially during longer time taking tests.  Or it could be as simple as advertising the clinic’s name and services they provide to all that enter the sound room?  These audio/visual monitors could lend themselves to many creative purposes to support or accent the services provided with a memorable image or unique selling proposition (USP)