MedRx Digital VRA vs. Traditional VRA Systems | MEDRX

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VRA (Visual Reinforcement Audiometry) is an essential tool for any clinician testing pediatric patients. Unfortunately, traditional VRA limits functionality and convenience.

Many providers struggle to schedule VRA testing and make it an efficient process for their practice. Yet, researchers at the National Acoustic Laboratories (NAL) and engineers at MedRx have devised solutions to these problems.

Experts in their field at NAL identified shortcomings of traditional VRA and developed a more straightforward approach. By integrating NAL technology with modern MedRx Studio software, we present a product with benefits that go above and beyond industry expectations. With a 2-in-1 audiometer control and reward presentation remote, only one clinician is necessary to complete an exam with the MedRx iVRA system.

Discover how the unique benefits of the MedRx iVRA set us apart from the competition below. 

Comparing Systems

VRA is an audiometric test for children that are not old enough to speak or use push-button responses. These children are usually between 6 months to 2-3 years old.

As its name suggests, Visual Reinforcement Audiometry works by rewarding the child with visual animation when they respond to a sound stimulus. This visual reward varies between video clips or puppets, depending on what type of testing is performed.

The purpose of VRA testing is to determine accurate hearing thresholds for the child. Not all audiologists will approach this with the same technique, making our dynamic software perfect for however you choose to test your pediatric patients.

Whether using transducers or speakers, the visual reinforcement is used to persuade the child to look in the direction the noise is coming from when they hear the sound source. This indicates to the audiologist that the sound level produced is within the child’s hearing threshold. Conditioning is usually required before testing to prepare the child to give these responses. 

All of the following testing methods can produce the valid results; but it is how the tests are conducted that shapes the experience for the child and audiologist. This is why our system stands out.

Traditional VRA

In traditional VRA, the child is placed in between two puppet boxes with an assistant in front of the child, distracting them from looking at the puppet boxes with an engaging toy. This is called centering.

To produce the sound stimulus, the puppet boxes will either contain speakers for free field audiometry or the child will wear transducers. The audiologist is usually in another room or looking through a window, ready to present sound stimuli when the child is distracted by the assistant. The audiologist will then produce the sound and look for a response from the child.

If the child looks in the direction of the sound, the audiologists will present the child with the visual reward (in this case an animated puppet) and record that the patient heard the sound. If they do not respond to the sound, the audiologist does not present the puppet and continues with the exam.

When free field audiometry is conducted, the assistant will usually wear masking headphones to reduce the chance of their bias influencing the child’s response.

Digital VRA

Digital VRA is like traditional VRA, apart from the type of visual reinforcement provided. Instead of using a puppet box as the visual reward, there are 1-3 screens used to present animated video clips. These video clips are engaging, colorful, and contain exciting subject matter, attracting the attention of young children easily.

However, it is still necessary for the audiologist to have an assistant that distracts the child while they conduct the exam and present the reward.

MedRx iVRA

The MedRx iVRA system is an innovative approach to digital VRA.

The unique combination of MedRx’s Studio software and the iOS application (app) on an iPod remote allows hearing care professionals to perform VRA testing on children without help from an assistant. The clinician sits in front of the child and distracts them, then presents the sound stimulus. When the patient responds the clinician plays the reward video clips.

They use a single handheld iPod remote to record these responses and present the animated video reward. One hand will record responses and activate the reward, while the other hand is free to distract the child until they play the next sound stimulus.



Test With One Clinician

With the MedRx VRA system, any audiologist can perform VRA testing, even if you don’t have access to an assistant.

To test a patient, simply open the iVRA app on the VRA’s iPod remote. The iOS app coincides with MedRx Studio software, allowing you to automatically upload and transfer patient data and test results.

Once you’ve begun testing, you can deliver visual rewards and record responses on the iPod remote. Clinicians can adjust frequency, level, presentation ear, presentation, and visual rewarding from the iOS app. If you’re using the remote without a MedRx audiometer, you can still use video-only mode to deliver visual rewards.  

With a single MedRx iVRA remote you can do everything you once had to do behind a window or in another room, right in front of the child without them noticing.

The discreet nature of the device allows you to record responses and present rewards without having to focus your attention on the iPod screen. Simple 4 directional swipes are sufficient to complete both tasks. The familiar touch screen interface makes this system easy to operate with a minimal adjustment period.

Testing with a single clinician removes the need for an assistant, allowing you more scheduling flexibility. You may even find this an overall more efficient testing method. When you manage all aspects of the testing, you have more control over the process and the results observed during the session.

Now, practices with only one clinician can take on new patients they previously didn’t have the resources to support.

4 Testing Modes

The iVRA system has 4 different testing modes. When combined with a MedRx audiometer you have access to all 4 testing modes. If you choose to use a different brand audiometer, or forego one completely, you can still use the Video-Only mode.


Manual testing mode allows the clinician full control of the stimulus being presented to the child. Once you determine the threshold, you can change ears, levels, and frequencies on the app to keep the child engaged or simply monitor each response more intentionally. Even on Manual mode, the interface is easy to read, respond to, and requires minor attention to the screen.



Automatic testing is best used to help a clinician lower bias and focus their attention on the child they are testing. Though the Manual testing mode is simple to use and great for providing full control of the exam, Automatic allows the provider to focus intently on the child’s responses to the stimuli. With catch trials built-in to the iOS software, you can ensure precision in your results.

The audiologist can begin at any desired frequency and sound level. From there, the program automatically adjusts stimulus levels until the child’s thresholds are determined.

In Automatic testing mode, at most, the clinician must indicate when the patient is ready to receive the sound stimulus, record what their responses are, and play the animated reward videos. NAL has developed automatic protocols which will adapt the presentation level of the stimulus and determine hearing threshold, while the clinician only needs to adjust the frequency.

This can also be especially helpful when testing patients who fidget or need more help focusing.



To generate the desired responses from the child when you present the sound stimulus, you must first associate it with the visual reward. Conditioning mode is used for this initial association.

This process also encourages the child to respond to the auditory stimulus by rewarding them with animated video clips before you begin testing.

Therefore, the child is already prepared to look in the direction of the sound stimulus when you start recording responses to the testing.



Video-Only mode gives audiologists who don’t have a MedRx audiometer the option to still use the iVRA as a traditional VRA system. This mode is also convenient for those who have a particularly difficult patient they need to test with multiple clinicians. The iPod remote’s sole function in this mode is as a control for the animated video clips.

With one hand, swipe in 4 directions to present on a left, right, center, or all screens. On the same screen, choose the specific video you want to display for the child’s reward. Pre-uploaded videos are uniquely named and numbered so you can seamlessly cycle through the clips.


Reward Variation

With the MedRx iVRA, it’s no longer necessary to purchase expensive puppet boxes. These limit your reward options in a situation where adaptability is vital to your testing success. Rotating digital animation videos ensure the child does not lose interest in the reward.

Again, the flexibility of our software makes it ideal for use regardless of your testing setup or situation. With 52 animated videos already installed on the device and the capability to add your own custom rewards, this system can accommodate most patients and provider needs. You can even choose from 10 high-contrast videos for visually impaired patients.

They can also be chosen at random to ensure that the child does not become indifferent to the videos. If a child stops responding for lack of interest in the reward, you risk the integrity of your results.

The capability to upload custom videos to the program can help test children who don’t respond to pre-uploaded rewards or are motivated by different visuals.

Combine MedRx Studio Software and the iVRA iOS App

The iVRA app works in conjunction with MedRx’s powerful Studio software. Simply connect your computer and iPod remote to the same Wi-Fi network and enter in the computer’s unique code—easily found in the settings of your iVRA program.

The iOS app also records testing results that can be automatically uploaded to Studio’s software, making them simple to access through your patient database.

Display settings are also customizable for the setup of your unique practice. Use with 1-3 screens depending on how much space you have available to you. During testing, you can activate these screens individually or all at once.



Compatible With MedRx Audiometers

When used with a MedRx AVANT ARC, A2D, or Stealth audiometer, the iVRA system provides you with the 4 testing modes: manual, automatic, conditioning, and video-only. For existing MedRx customers, the most convenient aspect about the iVRA is that you don’t have to purchase an audiometer specifically for the VRA system. However, if you are using the iVRA without a MedRx audiometer, it’s important to note that you will not have the ability to perform conditioning, automatic, or manual testing.

For those who don’t have a MedRx audiometer, we gladly sell and ship you everything you might need for your iVRA. This could include the iPod, a MedRx audiometer, pc, and even new display monitors!

If you are purchasing a new MedRx audiometer with your iVRA system, we recommend you choose the AVANT Stealth. The Stealth audiometer’s most notable feature is that it has two 20-watt built-in amplifiers, necessary to reach higher frequencies and levels. This condenses desktop equipment and gives your audiometer the capability to add high frequency testing up to 20,000 Hz.

AVANT Stealth Clinical Audiometer


Hearing Technology Innovator

In 2020, the MedRx iVRA was entered into the 2020 Hearing Health Innovator awards. Clinicians voted and awarded our unique design and software the Bronze in the Equipment category.

This award demonstrates our dedication to constant progress and our mission to help the world hear better by providing innovative diagnostic technology.


Integrate MedRx Visual Reinforcement Audiometry

Whether you already use a Visual Reinforcement Audiometry system in your practice or are looking to expand the services you offer, the MedRx iVRA can offer flexibility, efficiency, and control.

And, with its straightforward design and layout, the software will make VRA more approachable and accessible for all practices. All products come with free training and support so that even when you’re navigating new technology, you’ll never be left in the dark.

For more information on our VRA system or to purchase one for your practice, contact us at (888)392-1234. Change the way you VRA with MedRx.