A comparison of some clinical features of visual reinforcement audiometry and the distraction test

The aim of this study was to compare aspects of visual reinforcement audiometry (VRA) and the distraction test (DT), the two most commonly used behavioural tests of hearing for young children. The number of assessments completed, time taken, parental opinion and levels of minimum responses were compared in a group of 20 infants (mean age 17.7 months; SD 4.7 months; range 12-25 months) who had been selected from those referred from a local second-tier community audiology service. Each infant was assessed with each test following set protocols and a balanced design on two occasions separated by one week. Parental opinion was determined by application of two questionnaires, one after each session. There was no difference in the number of minimum response levels (MRLs) measured by the two tests. However, if a VRA protocol using three MRLs was assumed then the assessment was completed successfully in a significantly greater number of subjects with VRA. VRA took, on average, two minutes less than the DT to measure six MRLs. Most of the subject sample had normal hearing as defined by both tests. However, where MRLs were >30 dB HL for at least one of the tests, the DT elicited responses at significantly higher levels than VRA, suggesting that in these subjects the DT under-estimated hearing sensitivity. Seventy per cent of parents selected VRA when asked to choose between the tests.