Hearing Health Guide
Definition
Word recognition score (WRS) is a clinical measure of speech understanding obtained by presenting a standardized list of monosyllabic words at a suprathreshold level (typically 40 dBSL above the speech reception threshold or at the most comfortable level) and recording the percentage repeated correctly. It is functionally equivalent to speech discrimination score and is sometimes used interchangeably.
Word recognition score is one of the strongest predictors of hearing aid success. People with high word recognition scores (90%+) who receive appropriate amplification tend to have excellent outcomes. Once the sounds are audible, their auditory system decodes them accurately.
People with low word recognition scores (below 60–70%) often find that hearing aids improve audibility but not clarity. They hear more, but still struggle to understand. This is important counseling information: setting realistic expectations before fitting prevents dissatisfaction.
In most listeners, word recognition scores improve as presentation level increases up to the most comfortable level, then plateau. In some individuals, scores decline when volume is increased beyond a certain point. This is called rollover.
Significant rollover (a decrease of more than 20–45% from peak score as level increases) is a warning sign for retrocochlear pathology, such as an acoustic neuroma or auditory neuropathy. It is one of the reasons audiologists present words at multiple levels rather than just one.
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