For adults audiometric evaluation is relatively easy because the majority accepts to wear a headphone and is able to respond correctly if a sound is audible.
Also evaluation of hearing instrument benefit can be done by using speech material presented by loudspeakers.
For children, and especially very young ones audiometric and hearing instrument benefit evaluation is much more demanding.
Some children do not accept that a headphone is put on their head or insert earphones are inserted in their ear. The only way to conduct an audiometric evaluation is to present sounds by means of loudspeakers. In order to achieve correct results the test environment must be calibrated prior to the actual test.
One more difficulty is to make the child respond to a sound which is audible to the child. This is achieved by connecting sounds with visual signals like funny, colorful pictures what children are interested to look at. The procedure is called "Visual Reinforcement Audiometry (VRA)".
Every time after a sound is presented a picture follows some seconds later. After a couple of times the child realizes "If there is a sound afterwards there is a picture". Actually the child is not interested in the sound but in the picture.
An audible sound makes the child looking for the picture. Therefore, every search reaction following a sound suggests that the previous sound was audible.
For hearing instrument benefit evaluation VRA is done twice: first without and then with hearing instrument. The difference between these two results is the improvement provided by the hearing instrument.
VRA is one part of a whole test battery for children which includes also Tympanometry, OAE and ABR.
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