- In this video, I'm talkin' about
your word recognition score and three reasons
why your score may not be as accurate as you think.
Comin' up.
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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
and how to make you a better-informed consumer.
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make sure you hit that subscribe button.
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Speech understanding in 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 this 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 score 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 miss,
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 Bess actually took a look
at several different presentations of the NU-6,
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 talkin' about one time on one test,
you would score 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 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 comments section below.
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Also feel free to check out my website, DrCliffAuD.com.
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