Visual reinforcement audiometry and its association with neonatal hearing screening and the offer of speech therapists, services and equipment

Dutra, Monique Ramos Paschoal; Fonsêca, Rodrigo Oliveira da; Nunes-Araújo, Aryelly Dayane da Silva; Balen, Sheila Andreoli

doi:10.1590/2317-1782/e20240237pt

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Original Article • CoDAS 38 (1) • 2026 • https://doi.org/10.1590/2317-1782/e20240237en linkcopy

Visual reinforcement audiometry and its association with neonatal hearing screening and the offer of speech therapists, services and equipment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To analyze the outpatient production of the visual reinforcement audiometry (VRA) in the Unified Health System (SUS), in the Federation Units (UFs) of Brazil, between 2004 and 2021, and its association with Neonatal Hearing Screening (NHS) and offering audiologists, hearing health services and VRA equipment.

Methods Ecological mixed study, which used data from the SUS Outpatient Information System, of the National Registry of Health Establishments and of the Brazilian Institute of Geography and Statistics. The dependent variable was the rate of performance of the “visual reinforcement audiometry (air/bone route)” procedure, per 10 thousand inhabitants, while the independent variables were the rates of NHS, speech therapists, hearing health services and VRA equipment. Descriptive and inferential statistics and spatial analysis were performed.

Results The VRA rate in Brazil was 11.8/10 thousand inhabitants between 2004 and 2021. In the UFs, VRA rates varied from 0 to 125.1/10 thousand inhabitants in the periods studied. The lowest rate for this exam was recorded in the 2004-2006 triennium, while the highest was seen in the 2007-2009 triennium. It was found that there was no significant correlation between the VRA performance rate for the 2016-2018 three-year period with the rates of NHS, speech therapists, hearing health services and VRA equipment.

Conclusion The realization of the VRA is restricted and discrepant among Brazilian states and does not show any association with the variables investigated, indicating the need for measures to improve access to this exam in the SUS.

Keywords:
Hearing; Hearing Loss; Public Health Policy; Unified Health System; Health Information Systems

Variable	Formula
Visual Reinforcement Audiometry completion rate	Average number of Visual Reinforcement Audiometry procedures in the three years/population aged 0 to 4 years in the second year of the three years per 10,000 inhabitants.
Neonatal Hearing Screening Implementation Rate	Average number of “Evoked Otoacoustic Emissions for Hearing Screening” procedures in the three years/population aged 0 to 4 years in the second year of the three years per 10,000 inhabitants.
Speech therapists' rate	Average number of speech therapists working in the Unified Health System in the three years/population, aged 0 to 4 years, in the second year of the three years, per 10,000 inhabitants.
Hearing health services rate	Average number of hearing health services and specialized rehabilitation centers in the Unified Health System in the three years/population, aged 0 to 4 years, in the second year of the three years, per 10,000 inhabitants.
Visual Reinforcement Audiometry Equipment Rate	Average number of visual reinforcement audiometry devices available in the Brazilian National Health System in the three years/population aged 0 to 4 years, in the second year of the three years, per 10,000 inhabitants.

FU	TXVRA	TXTAN	TXFONO	TXSS	TXEQUIP
Rondônia	26.80	891.40	9.40	0.4	0.00
Acre	0.00	2,018.60	5.00	0.4	0.00
Amazonas	0.20	1,216.30	4.40	0.2	0.10
Roraima	0.00	2,746.80	7.50	0.2	0.10
Pará	16.20	1,089.70	5.60	0.3	0.10
Amapá	0.00	3,324.80	8.80	0.5	0.00
Tocantins	0.30	1,451.90	9.40	0.8	0.00
Maranhão	39.90	786.50	6.50	0.3	0.00
Piauí	0.10	2,530.90	12.90	0.2	0.20
Ceará	9.30	1,217.70	9.70	0.2	0.10
Rio Grande do Norte	22.80	1,611.30	13.10	0.6	0.40
Paraíba	106.90	2,558.60	13.30	0.3	0.10
Pernambuco	0.70	827.20	10.70	0.4	0.10
Alagoas	4.10	1,263.10	9.30	0.1	0.10
Sergipe	0.00	1,630.00	9.50	0.3	0.00
Bahia	17.80	1,003.90	8.20	0.3	0.10
Minas Gerais	4.00	1,261.30	18.90	0.3	0.10
Espírito Santo	8.30	1,417.00	13.00	0.3	0.20
Rio de Janeiro	5.60	1,036.30	17.20	0.4	0.10
São Paulo	21.50	1,167.90	18.70	0.5	0.20
Paraná	12.70	3,306.90	16.90	1.2	0.20
Santa Catarina	1.90	2,010.30	17.20	0.6	0.20
Rio Grande do Sul	6.50	3,259.50	15.20	0.6	0.10
Mato Grosso do Sul	12.50	3,055.60	13.30	0.5	0.30
Mato Grosso	2.80	581.30	8.80	0.2	0.20
Goiás	23.20	963.80	12.10	0.5	0.60
Distrito Federal	30.70	2,471.70	12.20	0.3	0.00
Total	14.70	1,483.20	13.70	0.4	0.13

Variables	TX VRA	TX TAN	TX FONO	TX EQUIP	TX SS
TX VRA	1.000
TX TAN	-0.269	1.000
TX FONO	0.241	0.257	1.000
TX EQUIP	0.191	0.015	0.486*	1.000
TX SS	0.138	0.274	0.464*	0.369	1.000

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[1] Caption: FU = Federal Unit; TXVRA= VRA completion rate; TXTAN = Neonatal Hearing Screening rate; TXFONO = speech therapist rate; TXSS = Hearing health services rate; TXEQUIP = VRA equipment rate