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 HiBrow Multi-Monitor - Visual Reinforcement Audiometry (VRA)
Visual Reinforcement Audiometry (VRA) has long been recognised as a valuable tool in the assessment of young children for hearing loss and is widely used by hearing care professionals worldwide. Until now the VRA devices available have usually consisted of two black boxes with smoked perspex fronts, containing a dancing doll/animal, which moves up and down and is illuminated by light either constant or pulsed.

The HiBrow Multi Monitor VRA has been designed in conjunction with the Paediatric Audiology Services at Guys Hospital (part of the Southwark Primary Care NHS Trust). The system displays animations on computer monitors to provide the visual reinforcement following the sound produced from an audiometer. There are many animations available and for ease of use they are split into categories. The system has three modes for displaying the animations:

  1. Automatic - The system will cycle through all animations available.
  2. By Category – The system will cycle through all animations in a category.
  3. Fixed – Where a child associates with a particular animation, the system will retain that animation for as long as required.
VRA - Layout

The HiBrow Multi Monitor VRA also has the option of a third monitor for the conditioning of a child prior to undertaking the controlled tests.

The sound is switched from one of the channels of the audiometer when using the conditioning set of speaker and monitor.


VRA - Screen Shot



Shown opposite is the software module of the HiBrow Multi Monitor VRA. This is being used in conjunction with the Siemens Unity Audiometer or you may use any PC based or standalone audiometer.

The picture shows the device being used in the three-monitor mode.

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Case Study

The Newcomen centre in conjunction with the physics department of Guys Hospital developed a monitor based VRA system a number of years ago but this systems was DOS based with mechanical switching and used proprietary software made by a company that no longer exists. Our brief to HiBrow was provide a replacement system that uses modern Windows based technology and was simple to use. Our basic specification was:

  • Animation to appear instantly on demand.
  • Two monitors, with an option for a third
  • The animations should be moving
  • Choice of animations for different ages.
  • Mouse/Keyboard control
  • The controlling computer should be multi functional.

Our requirements have been met in all aspects and in use the HiBrow Multi Monitor VRA has surpassed all our expectations. With this software we can operate our PC based audiometers and our VRA system seamlessly and can therefore concentrate more time on the patient.

We have found that with the multitude of animations available we can either provide a different animation at each test or a specific animation that suits that particular child. With this facility the attention span of the child is longer and therefore we are able to carry out more detailed testing.

Philip Evans
Consultant Audiological Scientist
Head of the Paediatric Audiology Service
Newcomen Centre, Guy’s Hospital

HiBrow Multi-Monitor - Visual Reinforcement Audiometry

System Requirements

Pentium 4
256MB Memory
100 MB free disk space
1 free USB 2.0 port
Windows 2000 or Windows XP

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