Minimal response levels for visual reinforcement audiometry in infants.

The aim of this study was to determine normative values for minimal response levels (MRLs) for normal-hearing young infants using insert earphone visual reinforcement audiometry (VRA). The subjects were 46 normally developing infants aged between 33 and 50 weeks who had hearing sensitivity assumed to be within normal limits and no evidence of middle ear dysfunction. VRA was carried out using insert earphones with warble tone stimuli, generated from an AC33 audiometer and calibrated to ISO 389-2 for insert earphones in adults. The frequencies assessed were 500 Hz, 1 kHz, 2 kHz and 4 kHz. In total, 102 MRLs were obtained, with an approximately equal number of MRLs per frequency. Mean MRLs for 500 Hz, 1 kHz, 2 kHz and 4kHz were 16 dB HL, 13 dB HL, 7 dB HL and 6 dB HL, respectively. Standard deviations were close to 6 dB for all frequencies. Mean MRLs at the lower frequencies were significantly greater than MRLs at the two higher frequencies. MRLs did not vary significantly with age. The results obtained from this study suggest significant infant adult differences when testing hearing using VRA with insert earphones, particularly at lower frequencies. Possible reasons for this and the clinical use of these normative values are discussed.