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Visual Reinforcement Audiometry (VRA) and Conditioned Play Audiometry (CPA) are two essential behavioral hearing tests used in pediatric audiology. While both help assess hearing in children, they differ in age range, response type, and developmental demands. Understanding when to use VRA versus CPA allows audiologists to obtain more reliable thresholds, reduce testing challenges, and create a better experience for young patients and their families.

Visual Reinforcement Audiometry (VRA) has transformed how audiologists assess hearing in infants and young children. Explore the history of VRA—from its early beginnings to modern innovations like Flex VRA—and discover how evolving technology has improved engagement, accuracy, and reliability in pediatric hearing assessments.

Visual Reinforcement Audiometry (VRA) is a proven hearing test used to evaluate infants and toddlers during critical stages of development. Learn how VRA works, why early hearing detection matters, and how modern systems like Flex VRA are improving accuracy, engagement, and outcomes in pediatric audiology.

Disclaimer This content is provided for general educational purposes only and does not constitute billing, coding, or legal advice. CPT coding requirements, reimbursement policies, and payer guidelines may change and can vary by insurer and jurisdiction. Clinicians and practices should consult payer-specific policies, professional guidance, or qualified billing specialists to ensure accurate coding and compliance. Visual Reinforcement Audiometry is a commonly used behavioral

To say we’re happy with the results of this redesign would be an understatement. Dare I say it...I’m genuinely excited about traditional toy VRA now.

A modern VRA system should adapt to the patient—not the other way around. While standard visual reinforcement works for most children, some patients only engage with very specific content. Flex VRA’s Targeted Content allows clinicians to customize stimuli in advance, ensuring even difficult-to-test children stay engaged. This approach improves testing accuracy, reduces fatigue, and helps pediatric audiologists focus on what matters most: the child and their family.

Flex VRA introduces House Rules, a feature designed to control the center monitor during visual reinforcement audiometry. By reducing distractions and keeping children focused on left and right reinforcers, clinicians can improve head-turn responses, maintain accurate localization, and streamline testing for better pediatric hearing assessments. Available on all new systems starting January 2026, with upgrade options for existing clinics.

Preparing your child for a Visual Reinforcement Audiometry (VRA) test can make the experience calmer and more successful for everyone involved. Designed for infants and toddlers, VRA uses engaging visual rewards to measure hearing in a child-friendly way. With a little preparation—like practicing listening games, choosing the right appointment time, and bringing comfort items—parents can help ensure accurate results and a positive testing experience.

New audiology research highlights how evidence-based visual reinforcers can improve Visual Reinforcement Audiometry (VRA) outcomes—especially for children with developmental disabilities. A recent study by Bonino et al. shows that tailored, interest-based visual content may increase engagement, reduce habituation, and improve data reliability. Modern VRA systems that support customizable, research-backed reinforcers are better equipped to meet real-world pediatric testing cha

Pediatric hearing tests offer only a short window of focus, and every second matters. Flex PC was designed to help audiologists stay fully engaged with the child by eliminating the need to reach for a separate VRA remote. This lightweight, wireless tool integrates directly with computerized audiometers, allowing fast, intuitive control of Flex VRA from the testing computer—reducing friction, saving time, and helping clinicians capture reliable data before attention fades.

Pediatric audiology relies on visual cues to engage infants and toddlers during hearing tests. Visual Reinforcement Audiometry (VRA) pairs sounds with entertaining visual stimuli, encouraging head-turn responses that help audiologists measure hearing accurately. By leveraging children’s natural attraction to movement, color, and light, VRA improves focus, reduces testing time, and creates a positive, stress-free experience for young patients and their families.

Hey Bear Sensory Toys, integrated with Flex VRA, revolutionize Visual Reinforcement Audiometry by keeping children engaged with vibrant, rhythmic, and sensory-friendly animations. Perfect for infants, toddlers, and children with sensory sensitivities, these videos increase attention, cooperation, and test accuracy. By combining captivating content with flexible VRA technology, audiologists can collect reliable data faster while creating a fun, stress-free experience for young

Flex VRA’s Touchscreen Lock keeps pediatric hearing tests distraction-free by preventing accidental taps during Visual Reinforcement Audiometry. With a simple long-press unlock for staff only, clinics maintain control of settings while children stay focused on the visual stimuli. This feature improves test accuracy, ensures smooth sessions, and helps young patients remain engaged—making VRA testing more reliable and stress-free for both audiologists and children.

Hey Bear Sensory videos, integrated with Flex VRA, transform pediatric hearing tests by keeping children engaged with vibrant, rhythmic, and visually stimulating content. By capturing attention and encouraging active participation, these sensory-rich videos improve cooperation, shorten testing time, and yield more reliable results. This combination of fun visuals and advanced VRA technology creates a positive, stress-free experience for both children and audiologists.

Early hearing tests are critical for a child’s speech, language, and social development. Newborn screenings, follow-up tests by 3 months, and age-appropriate assessments like VRA or Conditioned Play Audiometry help detect issues early. Monitoring for signs like speech delays, frequent ear infections, or poor response to sounds ensures timely intervention. Early detection and testing give children the best chance to thrive and communicate effectively.

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