Audiology

Percentage Of Hearing Loss | Why Your Word Recogniton Score (WRS) Is Critical

Dr. Cliff Olson
July 13, 2018
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Percentage Of Hearing Loss | Why Your Word Recogniton Score (WRS) Is Critical

What is your Percentage of Hearing Loss? Word Recognition Scores are critical to understanding your ability to hear. Dr. Cliff Olson, Audiologist and Founder of Applied Hearing Solutions in Anthem Arizona, discusses the percentage that you should really be discussing when talking about hearing loss percentage.

Every time someone tells me they have a certain percentage of hearing loss, it drives me crazy. This is because hearing loss has so many factors that are involved in it that you can’t possibly identify it as a single percentage.

I’ll be honest. I can understand why someone would want to classify their hearing loss in a specific percentage. After all, it can be easy to convey that percentage to another individual to let them know how much communication difficulty you’re having.

But, ultimately, it tells us nothing about how much hearing loss you actually have. And this number is typically made up by looking at the X’s and O’s on the graph portion of an audiogram. I think the easiest way to explain this to you is to actually explain how to read an audiogram.

How to read an audiogram

A typical audiogram usually displays a series of X’s and O’s on an XY graph. The X axis shows the different frequencies, and the Y axis shows the degree of hearing loss. Let me explain what the X’s and O’s mean. They are how an audiologist will plot your ability to hear the beeps that are presented during a hearing test. The lower the X’s and O’s on the graph, the louder we need to play the sound before you can hear it. Hence, the lower the X’s and O’s, the poorer your hearing ability.

If you come across an audiogram with marks are halfway down the graph, you may be tempted to interpret this as a 50% hearing loss. But what if the graph shows as normal hearing in the low frequencies and a severe hearing loss in the high frequencies? How is it possible to give a percentage of hearing loss based on the X’s and O’s? The answer is, you can’t.

Your Word Recognition Score

If we want to understand how much hearing loss you actually have, then we have to understand your Word Recognition Score. Your Word Recognition Score is essentially testing your ability to understand speech when that speech is presented at an audible level to you. This will give us much more insight to what your actually hearing ability is.

This is how a word recognition test works. First, we amplify sound to a level that we know you can hear, based on the X’s and O’s based on the results of the Pure Tone Beep test that I mentioned before. Then we play you a list of either 25 or 50 single syllable words and have you repeat those words back to us out-loud. We then score the percentage of those words that you get correct. For instance, if you get 20 out of 25 words correct in your right ear, we would call it an 80% Word Recognition Score. If you get 10 of 25 words correct in your left ear, we would call it a 40% Word Recognition Score.

Your Word Recognition Score is significantly more important than the X’s and O’s that you see on a graph. You could have really bad X’s and O’s and have a really good Word Recognition Score. And, on the other hand, you could have really good X’s and O’s on that graph and have a horrible Word Recognition Score. Essentially, this Word Recognition Score will let us know how much success you should be able to expect with hearing devices. If we’re able to program your hearing devices to your hearing loss prescription, it will let us know if those sounds being presented back to your brain will be clear or not.

Without understanding your Word Recognition Score in addition to the X’s and O’s on the graph of your audiogram, then we really have no idea what your actual hearing loss is.

What Factors influence my Word Recognition Score?

Factor #1: Your inner hair cells.

These cells are located inside of your cochlea, otherwise known as your hearing organ. These are the cells that actually take the vibration of sound and send them up to your brain. If these hair cells are damaged, then there’s no way for them to clearly send the sound up to your brain. So, you might be hearing sound, but you won’t be able to clearly understand it.

Factor #2: Your auditory nerve.

Your auditory nerve is what takes that sound from your inner hair cells and sends it up to your brain. So, if there’s something obstructing the pathway of this transmission of sound, then it won’t actually make it to your brain. And by the time it gets there, it’s distorted. This can be caused by things like a tumor or auditory neuropathy.

Factor #3: Your brain function.

If your brain isn’t capable of correctly interpreting these sounds once they get there, your Word Recognition Score will drop. Now, there’s still a lot of ongoing research on this aspect of hearing, but I can tell you that researchers are constantly learning more about our brain’s involvement with hearing.

It’s important to note that once your Word Recognition Score declines, it’s typically permanent. Unless you get a Cochlear implant to bypass those inner hair cells and stimulate the nerve directly, you won’t be able to get any better speech understanding from amplified sound. On the other hand, you could wait for hair cell regeneration to come out, but that is probably decades away.

There is actually one trick to improve your Word Recognition Score without going through surgery and that trick is actually hearing with both ears. When I say hearing with both ears, I mean if you have a hearing loss in both of your ears, it is extremely important to amplify both of those ears so your brain has more information to work with.

Not only does this significantly improve your Word Recognition Score, this will also help improve your ability to hear in background noise and localize what direction sound is coming from.

Now that you know what a Word Recognition Score is, can you see how much more important it is to know that percentage than it is by coming up with some percentage based off of the X’s and O’s on your audiogram?

As long as your Word Recognition Score is decently high, then your prognosis for success with hearing aids is also high. And do us a favor. The next time that you’re going to tell us what your percentage of hearing loss is, please tell us what your Word Recognition Score is. It will give us a lot more information and be able to determine what treatment option is right for you.

Now, if only there were a score that could tell us how well you would hear in background noise. Well, actually, there is. And I actually already made a video about it here. So, make sure that you check that out.

Video Transcript

When most people talk about hearing loss percentages, they are talking about a made up percentage based on the X's and O's on the graph of an audiogram that indicate what level you hear the "beeps" during a hearing test.  The problem is, this tells us NOTHING about your actual ability to hear.The X's and O's only tell us the sensitivity of your hearing.  They do not tell us what degree you can understand speech.  

Therefore, establishing a percentage of hearing loss on this measurement has relatively no meaning.  If someone has normal hearing in the low frequencies and a severe hearing loss in the low frequencies, how can we create a percentage of hearing loss?  They have 0% loss in the lows and 80% loss in the highs.  You can't average it to 40%, this would make no sense.

Instead, the only percentage you should care about is your word recognition score  (WRS).  The word recognition score is determined based on the accuracy to which you can understand actual speech when sound is amplified appropriately for your hearing loss based on the X's and O's.  An audiologist will say or play a recorded list of single syllable words at an audible level and have you repeat them.  

The percentage of accuracy will be your Word Recognition Score.For instance, if you get 20 out of 25 words correct in your right ear, you would have an 80% Word Recognition Score.  If you get 10 our of 25 words correct, you would have a 40% word recognition score.    Obviously, the higher the percentage, the better hearing ability you have.  WRS is significantly more important than the X's and O's on the graph.  It actually indicates how well your ear and brain can interpret sound, and gives us your prognosis for success with hearing treatment.  You could have Bad X's and O's with Good WRS, or Good X's and O's with Bad WRS.  What factors determine your WRS?

1. Inner Hair Cells - These are the cells inside of your Cochlea (hearing organ) that transmit sound from the ear to the brain.  If these cells die, your WRS score will suffer.

2. Auditory Nerve - If your auditory nerve has a blockage, like a tumor, this sound will not entirely make it to your brain, and if it does, it will be distorted.

3. Brain Function - If your brain loses the capacity to understand speech, this will degrade your Word Recognition Score.

Once your WRS percentage drops it will not recover.  There is one way that you can improve this percentage though.  If you receive hearing treatment in both ears, it can drastically improve your percentage.  This is because your brain has more information to work with.  The 80% right ear score and 40% left ear score could result in a 100% binaural score!

Speech In Noise Video:  https://youtu.be/CaK6UP0W-9o

So the next time someone asks you how much hearing loss you have, give them your Word Recognition Score Percentage instead of the fabricated percentage based on the X's and O's.

Dr. Cliff Olson
Audiologist & YouTuber

Dr. Cliff is an unwavering supporter of Hearing Aid Best Practices and advocate for individuals with hearing loss, which inspired him to develop the Dr. Cliff Approved Provider Network.

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Dr. Cliff Olson

Audiologist & YouTuber