How Accurate are Your Word Recognition Scores? | Speech Discrimination Hearing Test
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- Опубліковано 11 лип 2024
- How Accurate is Your Word Recognition Score (WRS)? | Speech Discrimination Hearing Test. Dr. Cliff Olson, Audiologist and founder of Applied Hearing Solutions in Phoenix Arizona, discusses 3 common Mistakes that are often made when performing Word Recognition aka. Speech Discrimination testing during a hearing test. These mistakes can often lead to invalid test scores resulting in improper diagnosis of hearing loss and improper treatment recommendations.
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Another problem with test accuracy that few Audiologists admit is they commonly all use the same word list (in the name of consistency I guess) but those with long-term hearing loss will take the test dozens of times over their life and will consciously (or more typically subconsciously) memorize the word list. So I hear siwawa and I (correctly) reply sidewalk because I have heard the test word so many times previously.
Thanks, Doc! Very interesting and informative! Something I will look out for on my next visit!
Thank you for sharing this important information with us!
Thank You for this very helpful and good information all Your videos are helpful
Great information. This is classic, "I didn't know that". That being said, "Thanks". JimE
Very interesting. Thanks for this information. My testing was done without the recording.
Thanks a lot for all your videos and information, doctor! I've been researching because I'm new and I wasn't satisfied with the hearing aid results of my provider, and all of your videos have been very helpful. That said, one of the things I haven't seen you address yet is the size and shape of rubber domes. My provider fitted me with the largest they had but it still slides out almost all the way, and I don't have hearing loss in all frequencies to justify an ear mold. I was wondering what I should do.
Great video. My audiologist never explained anything to me but just said they recommended hearing aids. 15-20 years earlier I had got a silicone ear plug lost in one ear that led to the ENT visit. After the plug was out one ear still had a significant hearing loss. That was my “bad ear” that had never worked. ENT ordered an MRI and the bones in my middle ear had not totally separated during development. Now I’m waiting to get my HA fitted. My word recognition scores in that ear were 100 percent. Spouse has a cochlear implant and still has a very very hard time understanding people. The hearing loss runs in his family and I was afraid I was going to be like him.
Great video, and a great topic! Thanks.
Glad you enjoyed it!
Thanks Dr. Cliff for this explanation. I'm a veteran with tinnitus (diagnosed in 1988 while in service). I'm just now going through the process of filing for disability compensation. Over the years, my audiograms have showed decreasing in hearing, especially at the higher frequencies. I was prescribed hearing aids last year by an audiologist who works as a contractor for the VA. I had my C&P exam yesterday which included an appointment with a contracted audiologist. I was confused as the word recognition test yesterday was recorded and sounded to be at the same volume level in both ears. However, the word recognition test done when I was prescribed hearing aids was a live speech test and the volume of the spoken words was a different levels. Fortunately, I had a client recently (I'm a photographer) who is an audiologist and she is giving me a free, complete exam today to offer her opinion. It will be interesting to get her perspective as there is no financial incentive for her one way or the other. I have subscribed to your channel and will be watching more of your videos. Thanks again! (I've lived in the Phoenix/Scottsdale area three times but now in Texas for the fourth time.)
The C&P exams require properly calibrated recorded speech to ensure accuracy. Unfortunately, live speech testing can be incredibly variable and should not be trusted.
Thank you for making theses helpful videos as these subjunctive relates to me. 👍. I have a question to ask if you could help answer? I just bought the Costco Rexton Bi Core hearing aids and finding that I cannot hear speech that much better with it on. I was tested with recorded speech words and scored about 50-52% on both ears. I was never tested to see if the tuning done worked with the same recorded speech words to see if I get more correct? Is there a recorded audio speech test to give the user once his/her programmed hearing aids are tuned? It never seems like mines are tunes as the volume for the high pitches are about 4-5x louder than sounds I can normally hear. I can hear perfectly clear to any Bluetooth streaming video using the Aftershokz bone conduction headphones. I wish a company could work on a great true sounding microphone to fit into the bone conduction headphones. I would think large companies like Bose, Sony, Apple would make this a standard No prescription no surgery bone conduction hearing aid head band.
Thanks for the video that is super helpful, as audiologist I went to check my hearing loss was using live speech and not recorded, she called about 10 or 12 words to me wearing face mask (because of covid rules), I completely failed the test calling back correctly about 2-3 words only :(. I am waiting for another NHS audiologist to test my hearing, as the test I had really make me doubt if I do have problem with hearing loss or not.
regarding rule #3, what are your thoughts on recorded vs MLV for SRT?
Hi, another great video. 49 seconds into this video you showed an audio gram sheet. I would love it if you would devote a full video explaining all the sections on that sheet. This video did a great job on the WRS section, but there are other areas I would like to know, i.e., all the info going down the right side, plus my audio gram had other symbols on the chart , like U symbols at the bottom, and lines with [ ] symbols at the top. Thanks
I've had testing using both. The best testing I had done was when I went to see an ENT specialist in 2005 for frequent headaches & sinus infections. He had my hearing tested in his office prior to the exam. That was when my hearing loss was discovered and especially so with background noise. The Audiologist or technician said that based on my scores I had long term hearing loss, probably since childhood & recommended hearing aids. I couldn't afford them & waited 13 years, struggling with hearing loss before seeing another Audiologist. She only did a short list of spoken rather than recorded words. Then just a month ago once I saved enough for a pair of hearing aids combined with a discount from my insurance I saw a Hearing Aid Specialist & although she tested with recorded words there were only about 3 sets of ~5-10 words. In all cases they did recommend hearing aids, but said that my word recognition was poor & indicated a long term hearing loss (atrophy).
Huge red flag to only test 5-10 words. However, are you sure they weren't testing SRTs instead of WRS?
How far ahead are you booking appointments? I will drive down from Wisconsin to see you. It is very hard to find someone who cares enough to help me hear. I do have significant loss of hearing in my left ear, but i don't believe my aids are set up correctly.
regarding rule #2, # of words tested, what about the NU-6 by difficulty list? supposedly according to research if you get the first 10/10 then it's equivalent to testing 25 words, maybe 50 but i'm not sure.
I'm getting my hearing checked for the first time next month. how is the test going to be effected if it is performed in your second language? I have been speaking Danish for twenty years but I am fluent but not perfect.
I have a set of ReSound GN aids from Costco. Locked... Word recognition is my greatest problem , latest test was 45%. The "realear" test was so out of reality that it was not used. The test seemed to have been carefully done. Not at all satisfied with the results. These are my second aids, first were Rexton Cobolt 16, from about 8 years ago. No longer supported , at least at Costco. Is the word test given with a speaker, or with my aids ? Now what do I do to get my hearing and word recognition improved. Goleta, Ca.
Like another commenter said: I practically have the word list memorized at this point (Meniere’s Disease for the past 17 years) and most of the time I can figure out what the word is. How accurate can THAT be?? Quiet sound-proof booth, NO real-life background noise, educated guess on memorized words (yes, I know the word is “death” duh.) and I’m given a pat on the back by the ENT on my “high scores” as if my life isn’t excruciatingly hard every single day. Even WITH hearing aids! I feel invalidated, defeated and even more outcasted than I already do in the real world. I HATE going to my ENT appointments! What can I do to make this better?
I have a moderate cookie bite (50 db right and 55 db left). My last audiogram, which was four years ago, and my current audiogram are nearly identical. Furthermore, my WRS four years ago was 98% right and 100% left. Now it is 100% in both ears, but in the past six months or so, I've begun having noticeable difficulty hearing, especially in situations where there is background noise. Why would this be if my WR scores are so high?
In July of this year I had a VA C&P exam for hearing loss due to Tinnitus. It showed I had moderate hearing loss in both years and was given a 0% rating. They stated that I did have hearing loss but the word Recognition Score was 88% left and 92% right and that just equaled to a 0% rating. The test was a recorded version but the volume was extremely loud. I appealed the decision because of the volume of the test. I do have hearing aids and they work very well. I did find that I was not hearing many things. I do not believe that the test was accurate because of how loud the person was speaking on the recording. Was the test administered correctly? If not, how can I get the VA to understand that the volume of the test was too loud? I do believe that this test does not accurately represent the hearing loss that I have.
I totally agree with the need to use recorded speech for WRS. Unfortunately as a student in a hospital setting we just don't have time for 50 words each. We're constantly being rushed.
As long as you explain to your patients that you'd rather save an extra 3 minutes than give them a proper evaluation. We often self-impose our necessity for speed and justify it by saying you are constantly rushed by the "system". Just remember, if you don't advocate for your patients, who will?
@@DrCliffAuD Oh I'm completely with you. I don't like the way we get rushed at all.
Is there a way for you to do a video going over how to perform a SRT test for hearing professionals? Thank you
But SRTs are so boring😴
Hi Dr Cliff,
Any chance you can add captions to your hearing aid trials video from last week?
I didn't even notice that I was watching with auto-captions last week!
Sorry, forgot to upload the custom captions. They are on there now. Thanks for the heads up! 👍
Sir in very depressed im an Indian 18 on 20 July I had mild tinnitus On both ears on right after an injury But hearing range was 15 DB(both) after 1 year on 2018 the same hearing was 13.6 DB(right) And nearly same for left ear 15 DB(left) on 5 June 2019 I had a burst of sound in my left ear after that I got mild tinnitus stillvno one ever Told me that you are having hearing loss or so but on 19 July I was using headphones and a little loud sound came immediately After that im scared although im able to hear everything I have done many test on net Please tell me should I worry sir im very stressed I will be grateful to you if you reply me plzz plzz sir I beg you
WHERE IS REXTON FOR THE PROFOUND HEARING PROBLEMS , AM I BUYING THE WRONG HEARING AID! HELP!
Your videos are SO articulate and SO well-written that, as a grammarian (yeah, yeah, I know), I want my enhanced ears to hear them at their ABSOLUTE best. So, VERY SMALL NOTE, but a worthwhile one: For a few scripts, have an editor (or obsessive grammarian like me) check for overuse of these words: "that" and "of", and to explain why and where you can drop them; they chronically get overworked in your texts and they're really the only bumps. Another teeny thing: though "based off" seems to have entered mainstream colloq these days, the actual expression, which is literally more accurate as well, is "based on", because you're referencing a foundation (e.g. Screenplay by X, based on the novel by Y; or vice versa).
Lol thanks. Guess there's always room for improvement! 👍
Dr. Cliff is resound hearing aids from Costco the same you would sell?
no
I tested moderaten- mild, wrs 100 (85). Insurance said no! What would you recommend for a patient in that situation?
Find a different insurance company or pay out of pocket.
After having concerns about the quality of my WRS in audiograms by several audiologists, I researched this issue on the web. What I read indicated that the reason (none were mentioned in your video) why these shortcuts are apparently taken, is simply money. Some technicians/audiologists (in my case, all of them) do this in order to shave several minutes off the exam, ostensibly to meet an exam time target, to be able to fit a prescribed number of exams into a day. Is that your view, or do you attribute this mostly to other factors like poor training?
I doubt that saving 1.5 minutes, even if the provider has 4-5 tests in a day, comes down to money. More likely it is just laziness or improper training as you suggest.
@@DrCliffAuD Thanks for the reply. The source I ref'd to (and failed to include above) is www.audiologyonline.com/articles/word-recognition-testing-puzzling-disconnect-11978. "Money" was my interpretation, so that might be my bad. But there seems to be a lot of discussion here about "efficiency" being a driver behind taking the shortcuts.
I guess if you add ALL of the possible diagnostic tests and fitting procedures that either get cut short or eliminated all together, it could result in a significant amount of time savings. This could suggest an effort to save money if the clinic is busy enough to fill the saved time for an additional patient.
You talk about WRS with respect to treatment success. What does WRS say about treatment need? Does a high score, > 90, indicate less of a need?
No, Low or High WRS scores do not indicate the level of need for treatment. It just provides an indication of how well someone should expect to perform with amplification if the need is there.
My provider had my wife read the words as she is the one I listen to most. Thought that was a good idea.
Clever idea, but most definitely not a valid or reliable measure of WRS.
I'd like to get my wife's frequency's filtered out of my hearing aids LOL
Dr Cliff
Could you also inform us why they do not follow the best practice? Everyone might know the recorded version is better than live voice one. But why live voice?
The recorded voice speaks very slowly. Also setup time for the CD (if needbe) is more time-consuming. I would attribute it to the provider's impatience or pressure to keep exams short.
@@jkat9196 but i found the testers can control each one of the word stimuli on the software wuch as interacoustics so that they can retry it or wait for another one when needed
I can’t read my WRS at all. Under WRS it says 9/10% at 95 dB (LV). Now the 9/10%....is that 90% or is that 9 and OR 10%? On my good side it says 100%...so if it’s 90% why couldn’t they just put 90%? Definitely should of asked more questions but my ENT specialist doesn’t give me the feeling like he really cares...every time I’m there, I’m talking to a student and not my doctor. I have asked my family doctors to refer me to another hospital to see if I could be a good candidate for a Bonebridge/soundbridge/BAHA. I also plan to see if they can educate me more on the assessment and my type of hearing loss...but I would also like to go in knowing some information and that portion of the assessment I can’t understand at all (WRS).
Would like to add that your videos are extremely educational and have been binge watching for a while now. Thank you!
Hey Natasha. I'm not sure what they mean by 9/10% either. Would you be willing to send me your audiogram so I could take a look? DrCliff@DrCliffAuD.com
How long should a good hearing test take?
20-30 minutes depending on the complexity of the hearing loss.
Could this test be common when deciding on a hidden hearing loss?
Word Recognition Score is a standard part of a regular audiogram. Technically it could suggest that there is a hidden hearing loss. Essentially, we would expect to see normal thresholds and excellent WRS which would then lead to the question of if there is a hidden hearing loss.
Doctor Cliff, AuD so then what would some common symptoms be of hidden hearing loss?
also important-test should be done in your NATIVE language!!!!
Have you done a test in a different language? I am looking for a test for my wife, however she cant's understand English that well yet.
OK so no test? fun!
How many 20 year old's know the word "Laud"?
my WRS so low as it can be possible because iam deaf haha, because iam deaf I use bilateral Cochlear Implants from
AB (Naida Q90)
What is your post Ci WRS?
Doctor Cliff, AuD I don’t know because I don’t understand my audiogram 😂
Doctor Cliff, AuD it might be around 60-75 but I don’t know but i think It was better some time ago
i'm an audiologist as well and the wrs is just bullshit. it only gives you the results of a sound amplifier, since the speakers can't adjust to your hearing like an hearing aid. it's like rising the volume of your tv, it's not the same thing of correcting the hear loss with a hearing aid. And last and most importantly, in most softwares you can choose between man or women voices and of course the results for a typical high frequencies hearing loss will be much better with a male voice. and i can guarantee you that nobody will do 50 words for each ear first with male and after with female voices. so in my opinion the test is "almost" everytime a fluke, since no matter the result every audiologist will always suggest you to try the hearing aids, we will just add "since the result won't restore 100% of the hearing" like we say to every patients since hearing aids still aren't perfect.
p.s. i'm not english so i probably made some mistakes ;)
Your theory is flawed. We have data to show exactly what we are looking for with WRS testing. Just because you don't like it, doesn't mean that it doesn't do what it is intended to do. Also, not every audiologist will recommend hearing aids no matter the WRS score. I pray you didn't/don't practice audiology this way.
Say the word crap, and so on get it