In this video, I'm talking about your word recognition score and three reasons why your score may not be as accurate as you think. Coming up! Hi guys, Cliff Olson, Doctor of Audiology and founder of Applied Hearing Solutions in Phoenix, Arizona. And on this channel, I cover a bunch of hearing-related information to help make you a better informed consumer. So if you're into that, make sure you hit that subscribe button.
And don't forget to click the bell to receive a notification every time I post a new video. Speech understanding and background noise is usually the first thing that everybody's looking for when deciding to treat their hearing loss with hearing aids. However, your word recognition score in quiet is perhaps even more important when trying to determine if hearing aids will successfully treat your hearing loss. On your audiogram, your word recognition score is usually located inside the speech testing section. and either listed as word recognition or WRS.
You will see a percentage correct score and the volume of the presentation level in decibels for your right ear and the left ear. Sometimes it will also indicate whether or not this test was performed with live speech or recorded speech. Your word recognition score is measured by presenting you with a list of single syllable words at a fully audible level, taking into account your hearing loss thresholds and calculating the percentage of these words that you repeat back correctly.
The test would go something like this. Say the word cat or say the word dog, whatever that last word is, that's the word that you have to repeat back correctly. After repeating back a number of these words, your hearing care professional would calculate a percentage of those words that you got correct, which would indicate to us how well you should expect to understand speech in a quiet situation when you don't have any visual cues and you don't have any context. If you repeat these words back with a high level of accuracy, then your prognosis for treatment success is relatively high. However, if you repeat these words back with a low level of accuracy, your prognosis for treatment success is usually on the lower side.
This is why having an accurate measurement of your word recognition score is so important at this initial diagnosis phase of your hearing loss. The problem is not all word recognition scores are measured correctly. There are three very significant factors that will impact the accuracy of your scores, and the first factor is the presentation level of the words.
If you have a hearing loss, the words must be presented at a fully audible level, taking into account your hearing loss in order to get an accurate score. If you repeat these words back with a high level of accuracy, then your prognosis for treatment success with hearing aids is on the higher side, because when those hearing aids amplify those sounds for you, you have the ability to understand what they are. However, if you score low on your word recognition score, that means that your prognosis for success with hearing treatment with hearing aids is on the lower side because even when those sounds are amplified appropriately for you, you still can't understand what they are. For instance, if you have hearing loss thresholds like you see on this screen, you would need to make sure that the presentation level of the word lists are around 75 decibels to ensure that the high frequency speech components are loud enough for you to actually hear them.
If the volume level is too low, then your word recognition score will look worse than it really is, potentially leading your hearing care professional to question your candidacy for hearing aids. The second thing that could negatively impact the accuracy of your word recognition score is the number of words used to perform the test. Most testing protocols use multiple lists of words with 50 words on each list, to reduce the potential variability of your score.
Here's an extreme example of how many words presented can impact your score. If I give you two words and you miss the second word, then you scored 50% of those words correctly. However, if I present you with 50 words and you still miss the same word, but that's the only word that you missed, then you ultimately score 98% on that test. The fewer words that you're presented with, the more variability that you can get in your score and the less accurate that it is.
And this is why your hearing care professional should not be reducing the amount of words that they're using during this testing because it can lead to an inaccurate score at the end. The third and arguably most important factor when measuring your word recognition score is that your hearing care provider must use recorded words. Way too many hearing care providers are still using live speech, which means that they're actually reading words to you. usually through their headset microphone, when they should be using recorded words.
This is yet another factor that leads to an immense amount of variability in your word recognition score. Way back in 1983, this is the year after I was born, Dr. Fred Best actually took a look at several different presentations of the NU6 which is a very common list that is still used today in word recognition testing, and found that through these different recordings, there were variabilities up to 60%. So I'm talking about one time on one test, you would score like 20%, and the next time you would score 80% on that same test.
That's the kind of difference that we're talking about here. Now the difference between 20% and 80%, again, is a huge difference. So what makes you think when someone who's actually doing this, actually giving you live speech that's not recorded, it's not calibrated, it's not ensured to come out at a very specific level, what makes you think that that would be reliable and accurate?
Well, it is not reliable, nor is it accurate. And I'm gonna quote the authors of the Essentials of Modern Hearing Aids textbook, where they said that the words are not the test. The recorded version of the words is the test.
So if you're being tested with live speech, meaning that your hearing care provider is actually saying the words to you, instead of playing a recording of those words, then there is a high probability that your score is not accurate and there should be no clinical decisions made about your hearing treatment based off of that score. Now, I say it all the time. There are best practices when it comes to audiologic testing. And if you choose to ignore best practices during the testing, then it can ultimately lead to improper diagnoses, it can lead to unrealistic expectations, and it can even lead to improper treatment.
So the next time that you get your hearing tested, hopefully your hearing care professional does not make these three common mistakes so you can get an accurate understanding of what your word recognition score is. That's it for this video. If you have any questions, leave them in the comment section below. If you liked the video, please share it.
And if you wanna see other videos just like this one, go ahead and hit that subscribe button. Also feel free to check out my website, drcliffaud.com.