The Word Recognition Score (WRS) is a measurement audiologists use to determine the clarity of a person’s hearing, distinct from the loudness of hearing. This score assesses the auditory system’s ability to process speech sounds accurately once they have been made loud enough to be heard. The WRS establishes how well an individual can understand words and sentences in a quiet environment when the volume is adequately increased. This test moves beyond simple sound detection and evaluates the functional integrity of the inner ear and the central auditory pathways.
The Procedure for Determining Your Score
The process for calculating the WRS involves presenting a standardized list of single-syllable words to the patient, who is seated in a sound-treated room, typically wearing headphones. These words are phonetically balanced, meaning they contain speech sounds that occur with the same frequency as in everyday conversation. Common examples of these materials include the Northwestern University Auditory Test No. 6 (NU-6) or the Central Institute for the Deaf (CID) W-22 word lists.
The words are presented at a comfortable listening volume, known as a suprathreshold level, rather than a barely audible level. This presentation level is usually set 30 to 40 decibels above the individual’s Speech Reception Threshold (SRT) to ensure the sounds are easily heard. The patient’s task is simply to repeat each word they hear back to the audiologist.
The audiologist records the response as either correct or incorrect. The final Word Recognition Score is calculated as a percentage of the total words repeated accurately. For instance, if a list of 50 words is used and the patient correctly identifies 40 of them, the resulting WRS is 80%. This percentage provides a snapshot of the auditory system’s ability to interpret speech when the factor of volume has been minimized.
Interpreting the Word Recognition Score
The resulting WRS percentage offers a direct measure of speech intelligibility, which is the ability to distinguish between different speech sounds. A score in the 90% to 100% range is considered excellent, suggesting the person can understand nearly all speech presented at a comfortable level. This range indicates a very clear auditory signal is being sent to the brain.
Scores between 80% and 89% are classified as good, meaning communication is generally effective, though there may be occasional difficulty with fast speech or similar-sounding words. A score in the 70% to 79% range is considered fair, and listeners often report noticeable difficulty understanding conversations, particularly in noisy environments.
When the WRS drops into the 50% to 69% range, speech understanding is considered poor, and the individual will likely experience significant communication problems. Any score below 50% is classified as very poor, indicating that speech sounds are highly distorted and extremely difficult to comprehend, even when amplified. A lower score implies that the inner ear or auditory nerve is not transmitting a clear signal, meaning simply making the sound louder will not necessarily improve understanding.
Why the Word Recognition Score Matters in Hearing Diagnosis
The WRS provides a functional measure of communicative ability that is distinct from the pure-tone audiogram, which only measures the softest sounds a person can hear. While the pure-tone test tells the audiologist how loud a sound needs to be, the WRS reveals how clearly that sound is processed once it is audible. This distinction is significant for accurate hearing diagnosis.
The score helps differentiate between the two primary types of hearing loss: conductive and sensorineural. Individuals with conductive hearing loss (problems in the outer or middle ear) often have a WRS near 100% because the inner ear and auditory nerve are typically healthy. In contrast, a reduced WRS is a defining characteristic of sensorineural hearing loss, which involves damage to the cochlea’s hair cells or the auditory nerve.
The WRS is also a predictive tool used in treatment planning, particularly for amplification devices. A person with a high WRS, even with significant hearing loss, is expected to have a good prognosis for success with hearing aids because their auditory system can process a clear signal once it is loud enough. Conversely, a very low WRS suggests that even the best hearing aid may not restore full clarity, leading the audiologist to set more realistic expectations.
For those with severe to profound hearing loss and a very poor WRS, the score can indicate the necessity for more advanced interventions. A WRS below a certain threshold is a factor used in determining candidacy for a cochlear implant. This device bypasses the damaged parts of the inner ear to stimulate the auditory nerve directly. This single percentage score is a powerful indicator of the overall health of the auditory system and a guide for personalized rehabilitation strategies.