The Word Recognition Score (WRS) is a foundational measurement in audiology, providing insight into a person’s ability to understand spoken language. Unlike tests that measure the softest sound a person can hear, the WRS assesses the clarity of hearing when speech is presented at a comfortable volume. It is a specific type of speech audiometry test that helps determine how effectively the auditory system processes complex speech signals. This measurement is a percentage score used by audiologists to diagnose the nature of hearing loss and plan effective intervention strategies.
Defining Word Recognition Score and Its Purpose
The Word Recognition Score quantifies the ability to correctly identify single-syllable words when they are made loud enough to be heard easily. This test is performed at a supra-threshold level, meaning the words are presented well above the softest sound the patient can detect. The resulting percentage indicates the maximum clarity of speech understanding the individual can achieve under optimal listening conditions.
The WRS differs significantly from Pure Tone Audiometry (PTA), which measures hearing sensitivity for beeps, and the Speech Recognition Threshold (SRT), which finds the softest level at which a person can repeat two-syllable words. The WRS specifically assesses the integrity of the auditory nerve and the cochlea, which process the fine details of speech sounds. A reduced WRS suggests a problem with the inner ear or the pathway to the brain, even if sounds are loud enough to hear.
The Measurement Process
The WRS test is typically conducted in a sound-treated booth to eliminate outside noise. The audiologist presents standardized lists of monosyllabic words through headphones or an insert earphone. These lists, such as the Northwestern University Auditory Test No. 6 (NU-6) or the Central Institute for the Deaf (CID) W-22 lists, are designed to be phonetically balanced, meaning they contain speech sounds that occur with the same frequency as in everyday spoken English.
The words are presented at a single, consistent volume level, usually set at the patient’s most comfortable loudness level, or about 30 to 40 decibels above their SRT. The patient is instructed to repeat each word they hear. The audiologist calculates the score by dividing the number of words correctly repeated by the total number of words presented, yielding a percentage.
Interpreting Word Recognition Scores
The percentage obtained from the WRS test is categorized to provide a clinical interpretation of speech processing ability.
- 90% to 100%: Excellent, generally considered within the range of normal hearing.
- 80% to 89%: Good recognition ability.
- 70% to 79%: Fair recognition ability.
- Below 70%: Poor recognition ability.
A low WRS, particularly one below 70%, is a strong indicator of sensorineural hearing loss (damage to the inner ear or auditory nerve). This damage impairs the ability to resolve acoustic details necessary to distinguish between similar words, even when the sound is loud. The WRS is highly useful in differentiating between types of hearing loss.
In conductive hearing loss (problems in the outer or middle ear), the WRS is typically high (80% to 100%) when words are made loud enough to overcome the blockage. Conversely, a disproportionately low WRS compared to the degree of hearing loss may suggest a retrocochlear pathology, a disorder affecting the auditory nerve or brainstem. For example, a person with an auditory nerve tumor may exhibit a significantly reduced WRS, often below 70%, even with mild hearing loss, a phenomenon known as rollover.
WRS and Clinical Recommendations
The WRS is a significant factor when determining the best course of action for managing hearing loss. A high WRS suggests that standard hearing aids will be beneficial because the auditory system is capable of processing clear speech once the sound is amplified. Amplification alone is likely to restore functional communication in these cases.
Conversely, a very poor WRS indicates that making sounds louder will not restore clarity, as the underlying problem lies in the auditory nerve’s ability to transmit a clear signal. For these individuals, a low WRS limits the expected benefit from standard hearing aids and serves as a primary marker for considering more advanced interventions.
A low WRS is a major criterion for referral for a cochlear implant evaluation. The “60/60 Guideline” suggests referral if the patient’s pure tone average is 60 dB hearing level or greater and their WRS is 60% or lower in the better ear. This score helps identify patients who will receive limited benefit from conventional amplification and may be candidates for a cochlear implant, which bypasses the damaged inner ear structures.