How does visual reinforcement audiometry test hearing in toddlers?

Visual reinforcement audiometry (VRA) is the primary method used to test the hearing of children between the ages of six months and three years.1

The procedure relies on the following steps:

• Conditioning: The audiologist pairs a sound stimulus with an interesting visual reward, such as an animated toy or a flashing light. This establishes a link where the child learns that a sound is followed by a visual event.1
• Operant Conditioning: Once the child understands this association, the test proceeds by presenting a sound and waiting for the child to turn their head toward the source. If the child turns their head in response to the sound, the visual reward is presented as reinforcement.1
• Threshold Determination: The goal of the test is to identify the minimum sound intensity level that consistently elicits a head-turn response from the child.1

In some instances, children may not tolerate wearing earphones, in which case the sound is presented through a loudspeaker; this variation is known as sound field audiometry.1