Pediatric hearing testing is challenging at best when you are attempting to seek cooperation from a little person in a sound room listening to strange sounds!  Efficiency and flow are essential elements of the testing process to avoid loosing their attention or suddenly decide not to play the game any longer.

To conduct VRA testing requires a well coordinated testing process controlling the presentation of sounds while monitoring the child’s attention with timely reinforcement to establish conditioning of their responses. Many of the variables are unique to the specific testing situation such as the willingness of the participants, discomfort they might be experiencing with an ear problem such as fluid in the ear and general awareness during the test.

The ease of use and controllability of the equipment can play a big roll in providing a fundamental basis from which to optimize the best test outcomes!  Ergonomics is the study of designing equipment and devices that accommodate the human body and its cognitive abilities to optimize their interaction.  Special attention should be given to the operation and control of the equipment used in the hearing testing process as their integration into the process is vital in achieving quantifying test results in a timely manner.

The wireless remote controls used on most modern VRA testing equipment should be designed to be implemented quickly and easily during the testing process-sometimes in a dimly lit control room while moving around to gain the best view of the child through the sound room window.  The number of buttons displayed should be limited to those only necessary during the testing process and should be laid out logistically and color coded to quickly identify and actuate them during the testing process.  Spacing between buttons can be used to segregate those that are used frequently from others used only to set up the system parameters as to eliminate hunting for the correct button.  LED lighting can be used to identify which functions have been activated at a glance-even in the dark.  Tactile feel is important in the ergonomics of remote control design giving the user sensory feedback on its actuation.  Confirmation that the action was taken without any further verification needed.

Another step in this process is the additional task of recording the results of each test frequency following its presentation and possible reinforcement.  Some automatic, computer-based audiometers will track results from the last presentation and resultant reinforcement -but often lack accuracy and do not allow for retesting situations.  Integrating the recording of these responses into the test process with some degree of animation will go a long way on reducing the time to shift from one task to another by tracking the actions of the presenter via the equipment.

VRA reinforcement depends upon the the tester’s ability to view the child’s head turns and make a determination that he/she was attentive towards the sound source during the test.  A full 90 degree head turn is desirable but often difficult to assume when viewing the testing set up from anther room positioned behind the child often times sitting on the mother’s lap during the test.  The viewing angle and lighting play a key role in providing the tester adequate information to make a judgement.  Careful planning of the test environment is critical to assure that the equipment is positioned properly for a full head turn and that the tester can view this behavior easily and confidently throughout the test.

Future directions for the VRA industry will definitely include designs that further ease-of-use and testing efficiency by coordinating functions between the sound generator (audiometer/computer) and the reinforcement VRA system by reducing the steps or time involved in moving between these devices to conduct the testing process.