A newborn hearing screen tells you whether a baby was born with significant permanent hearing loss. It does not tell you what happens after that. Ears change. Fluid collects behind the eardrum after colds and infections. Some hearing loss is progressive and only shows up months or years down the track. A baby who passed the screen in hospital can still develop a hearing problem that affects how they learn to talk.
You cannot ask a seven-month-old to raise their hand when they hear a beep. That is the gap Visual Reinforcement Orientation Audiometry fills.
What the test is
Visual Reinforcement Orientation Audiometry, usually shortened to VROA or VRA, is a behavioural hearing test built for babies and toddlers. It suits children from a developmental age of about six to seven months up to around two and a half or three years. It measures how softly a child can hear across the range of pitches that carry speech.
Developmental age matters more than the birthday. A baby born prematurely, or a child with a developmental delay, is assessed on where they sit developmentally rather than the date on the birth certificate.
How it works
The child sits on a parent’s lap in a quiet, sound-treated room, facing forward, with a speaker or a small toy display set to each side. The audiologist plays a sound. When the child turns their head towards it, a reward appears on that side: a puppet that lights up and moves, or a short animation on a screen.
Children work this out quickly. Within a few goes, most babies grasp that a sound means something interesting is about to happen over there, and they turn to look for it. Once that link is set, the audiologist brings the sounds down, quieter at each pitch, watching for a reliable head turn. The softest level that still earns a consistent response marks the child’s threshold at that frequency.
The reward is what keeps a baby in the game. A toy that only lights up when they turn the right way holds a child’s attention far longer than any instruction could. Testing a baby is as much about reading their engagement as reading the audiometer.
Sounds can come through the room speakers or through soft foam tips placed just inside the ear canals. Speakers tell you about the better-hearing ear. Foam tips let the audiologist test each ear on its own, which matters when a problem sits in one ear only.
Why the head turn works
Somewhere around six to seven months, a baby develops the ability to work out where a sound is coming from and turn towards it. VROA is built on that reflex. Below that age the response is not steady enough to trust, so younger babies are assessed a different way, usually with tests done while they sleep that measure the ear and hearing nerve directly.
What it helps detect
VROA picks up hearing loss that a newborn screen was never designed to catch, and it maps out how much and which pitches are affected:
- Glue ear, the fluid that builds up behind the eardrum after ear infections. It is the most common cause of hearing loss in young children, it comes and goes, and it can dull a child’s hearing during the exact months they are learning to talk.
- Permanent inner-ear hearing loss that was missed at birth or has worsened since.
- Hearing loss in one ear only, which is easy to overlook because the child seems to respond normally.
- The degree and shape of a loss across frequencies, so a plan can be built around what the child actually hears.
Run alongside tympanometry, which checks how the eardrum and middle ear are moving, VROA shows both how well a child hears and why.
Why finding it early matters
Children learn to talk by listening. By their first birthday, a baby has spent roughly a year soaking up the speech around them. A hearing problem during that window, even a mild or fluctuating one from repeated ear infections, can slow speech and language. Picking it up early means it can be sorted early, while the timing still counts.
How we test at The Audiology Place
Testing a baby well takes time and a clinician who has done it many times over. Dr Signe Steers has more than twenty years in paediatric audiology and lectures on it at the University of Sydney. Appointments run long enough for a child to settle in, take a break, and give their best responses, rather than being pushed through a short slot. We test children from six months of age.
Independence sits behind every recommendation. The Audiology Place is owned by its audiologists, not a hearing aid manufacturer. What we suggest for your child follows from what the testing shows, and nothing else.
If you have concerns about your baby or toddler’s hearing, or your child was flagged for follow-up after their newborn screen, book an assessment at our Forestville or Epping clinic. Call (02) 9315 8327 or visit theaudiologyplace.com.au.
