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

## TL;DR

This study examines the use of visual reinforcement audiometry in Brazil's public health system from 2004 to 2021 and finds it is unevenly distributed and not linked to neonatal hearing screening or available services.

## Contribution

The study provides the first national analysis of VRA performance rates and their lack of association with key health variables in Brazil.

## Key findings

- The VRA rate in Brazil was 11.8 per 10,000 inhabitants between 2004 and 2021.
- VRA rates varied widely among Brazilian states, from 0 to 125.1 per 10,000 inhabitants.
- No significant correlation was found between VRA performance and neonatal hearing screening or available services.

## Abstract

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.

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.

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.

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.

Analisar a produção ambulatorial do visual reinforcement audiometry (VRA) no Sistema Único de Saúde (SUS), nas Unidades da Federação (UFs) do Brasil, entre 2004 e 2021, e sua associação com a Triagem Auditiva Neonatal (TAN) e a oferta de fonoaudiólogos, serviços de saúde auditiva e equipamentos de VRA.

Estudo ecológico misto, que utilizou dados do Sistema de Informações Ambulatoriais do SUS, do Cadastro Nacional de Estabelecimentos de Saúde e do Instituto Brasileiro de Geografia e Estatística. A variável dependente foi a taxa da realização do procedimento “audiometria de reforço visual (via aérea/óssea)”, por 10 mil habitantes, enquanto as variáveis independentes foram as taxas de TAN, fonoaudiólogos, serviços de saúde auditiva e equipamentos de VRA. Foi realizada estatística descritiva e inferencial e análise espacial.

A taxa de realização de VRA no Brasil foi de 11,8/10 mil habitantes entre 2004 e 2021. Nas UFs, as taxas de VRA variaram de 0 a 125,1/10 mil habitantes nos períodos estudados. A menor taxa deste exame foi registrada no triênio 2004-2006, ao passo que a maior foi visualizada no triênio 2007-2009. Constatou-se que não houve correlação significativa entre a taxa de realização de VRA do triênio 2016-2018 com as taxas de TAN, fonoaudiólogos, serviços de saúde auditiva e equipamentos de VRA.

A realização do VRA é restrita e discrepante entre as UFs brasileiras e não apresenta associação com as variáveis investigadas, apontando a necessidade de medidas para melhorar o acesso a este exame no SUS.