DESCRIPTION
Visual reinforcement audiometry (VRA) is part of a battery of tests used in the determination of infant and toddler hearing loss. The premise of the test is that the rate of individual response is increased by the use of reinforcement. Assessment of hearing in an infant or toddler is done to rule out hearing loss, which could adversely affect the development of speech and language skills.
Developing infants normally make head turns toward sound sources during the first few months of life. This response provides an opportunity for auditory behavior evaluation. When VRA is used, a head turn response following an auditory stimulus is rewarded with an interesting visual event or reinforcer, such as an animated toy. This test appears to be well suited for normally developing infants and toddlers. This response seems to decrease for children between the ages of 2 and 3 years of age because they tend to quickly become adjusted to the reinforcers.
POLICY
Visual reinforcement audiometry, when used in the testing for hearing impairment, is considered medically necessary if the medical appropriateness criterion is met. (See Medical Appropriateness below.)
See also:
MEDICAL APPROPRIATENESS
Visual reinforcement audiometry for children who are functioning at 7 months to 3 years developmental age is considered medically appropriate.
ADDITIONAL INFORMATION
Visual reinforcement audiometry is not preferred when testing adults. Age listings are intended as a guideline for members who have no other developmental or physical impairment. Conditioning play audiometry may be attempted as children mature beyond their second birthday (see associated policy).
Examples of conditions when audiometric studies may be used include:
Bacterial meningitis
Cochlear otosclerosis
Congenital anomalies
Exposure to intense noise
Facial nerve paralysis (Bell's Palsy)
Fractures of the temporal bone or trauma affecting the central auditory pathways
Hearing loss
Labyrinthitis
Ménière's disease
Neoplasms of the auditory or central nervous system
Otitis media
Ototoxic drugs
Surgery involving the auditory and/or central nervous system (e.g. skull-based tumors such as acoustic neuroma and meningioma)
Tinnitus
Vertigo (dizziness)
SOURCES
American Academy of Pediatrics. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Retrieved June 3, 2008 from http://pediatrics.aappublications.org/cgi/content/full/120/4/898?ijkey=oj9BAleq21OlA&keytype=ref&siteid=aapjournals. (141 articles and/or guidelines reviewed)
American Academy of Pediatrics. (2000, June). Year 2000 position statement: principles and guidelines for early hearing detection. Pediatrics, 106 (4), 798-817.
American Speech and Language Association. (1997). Guidelines for audiologic screening. Retrieved November 8, 2001 from http://professional.asha.org/resources/deskref/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=4280.
American Speech-Language Hearing Association. (1997-2002). Hearing assessment. Retrieved November 8, 2001 from http://www.asha.org/hearing/testing/assess.cfm.
American Speech-Language Hearing Association. (1997-2002). Hearing screening. Retrieved November 8, 2001 from http://www.asha.org/hearing/testing/index.cfm.
Behrman, R. E., Kliegman, R., Jenson, H. G. (2000). In Behrman: Nelson Textbook of Pediatrics, (16th ed., p. 1942-1946). Philadelphia: W.B. Saunders Company.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment. (9.01.02). Retrieved June 3, 2008 from BlueWeb. (6 articles and/or guidelines reviewed)
Folsom, R. C. & Diefendorf, A. O. (1999). Hearing loss in children: physiologic and behavioral approaches to pediatric hearing assessment. Pediatric Clinics of North America, 46 (1), 107-120.
Hayes. Medical Technology Directory. (2005, July). Neonatal hearing screening. Retrieved June 3, 2008 from www.Hayesinc.com/subscribers. (61 articles and/or guidelines reviewed)
Joint Committee on Infant Hearing. (2000). Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics, 106 (4), 798-817.
National Center for Hearing Assessment Management. (2001). Diagnostic audiology for early hearing detection and intervention. Retrieved October 16, 2001 from http://www.infanthearing.org/audiology/index.html.
U.S. Preventive Services Task Force (2007, September) Guide to Clinical Preventive Services, 2007: Newborn Hearing Screening. Retrieved June 4, 2008 from http://www.ahrq.gov/clinic/pocketgd07/.
Winter, M. & Eisenberg, L. (1999). Early identification and intervention of hearing-impaired infants. Otolaryngologic Clinics of North America, 32 (6), 1051-1065.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 7/24/2008
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.