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Newborn Hearing Assessment: Behavioral Observation and Visual Reinforcement Audiometry

This guide outlines two key methods used to assess newborn hearing: Behavioral Observation Audiometry (BOA), suitable for infants younger than 5 months, and Visual Reinforcement Audiometry (VRA), designed for children aged 6 to 24 months. BOA relies on reflexive responses to sound stimuli like speech and music in a quiet environment, although its reliability is limited. In contrast, VRA uses animated toys to elicit head-turning responses to sounds presented in a sound field, showing good reliability for assessing hearing ability in older infants.

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Newborn Hearing Assessment: Behavioral Observation and Visual Reinforcement Audiometry

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  1. Examinations to Assess Newborn Hearing Behavioral Observation Audiometry • Younger than 5 mo; done in a quiet room • Limited to unconditioned, reflexive responses to complex (not frequency-specific) test sounds • Stimulus: speech, tones, rattles or music • Response: startle • Poor to fair reliability Response levels can vary widely within and among infants.

  2. Examinations to Assess Newborn Hearing Visual Reinforcement Audiometry • Between ages 6-24 mos. • Child is observed for a head-turning response upon activation of an animated (mechanical) toy reinforcer • Sounds are presented by loudspeakers in a sound field • Simulus: speech, tones, warble • Response: head turning • Reliability is good

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