I think in Canada we are probably, as ever, somewhere between mother England and big brother America. I run WRS all the time, but mostly I am interested in max WRS in each ear as a flag for possible retrocochlear issues, although it also gives me some very gross information about expected functional outcomes with hearing aids. To get max WRS you technically need to run a bunch of different levels and get a curve, although you can typically get close to it just under the uncomfortable loudness level where clinical time is short and you have to make decisions about its best use.
I see clinicians American colleagues running WRS in all sorts of ways that make me feel that they are either using it for marketting or they misunderstand significant differences and variability (as recall, and to underscore Um Bongo’s point about it being a weak test, on a one-time 25-word list 50% and 35% are not statistically different scores). For example: Present it at real-word conversational levels (~45 dB HL) to see just how badly the patient does. But you can use the audiogram to get the patients unaided speech intelligibility index to predict what their score will be given their hearing loss, which is roughly as accurate a measure. So the process of actually doing it seems to me to just be an opportunity to let the patient experience failure in the clinic. It doesn’t give me any extra information, but I suppose it’s arguably useful for the patient to experience to move them ahead with purchasing hearing aids? Then you can do aided WRS at a conversational level and the clinician could say, “look, you improved X%” which again they could do with predicted aided SII but it won’t feel the same to the patient. I’ve tended to think that patient day-to-day trial experience is more relevant (and doesn’t drive up clinical time and therefore hearing aid expense), but maybe not. I don’t know, you guys tell me.
Clinicians who run live-voice WRS. . . I don’t even know what they are doing. WRS for fun, since it dramatically increases the variability and makes test-retest completely uninterprettable. 10 words live-voice is just them jumping through a hoop half-way for no functional reason–I see it all the time on ENT audiograms where the poor clinician only has 10 minutes to do the test anyway, and it is unclear to me why they haven’t just dropped it at that point. The only place I see live-voice WRS being useful is to demonstrate to the patient how much they get with and without lip-reading.
In terms of CI candidacy: <60% max WRS and >60dB HL PTA is a possible candidate. The actual candidacy assessment is interested in limits of functionality with well-fit hearing aids as well as individual motivation and support, and here is typically assessed with aided sentence tests in quiet and in noise and patient interview. I think patients are generally under-referred. CI implantation is a scary big step, but every single patient I have who has gotten one has had good outcomes and basically reports back, “wish I had done this 10 years ago.” If in doubt, I tend to refer as I trust our very good CI teams to turn them away if they are not a good candidate. I might be less confident about that if the system weren’t publicly funded.
