Thank you Stephen, for that information. I have never had a WRS, neither from the NHS or the Private sector, so I am assuming that it is not common practice in the UK? I do not recall any of my HOH friends ever mentioning WRS, or indeed clients, when I worked with the HOH as a support worker. Just over a year ago, I was in all truth astounded that the NHS now do REM, when fitting my Naida M70 BTE SP’s aids, that was a first time for me, I have never encountered REM in the Private sector… Cheers Kev 
1 Like
In the USA it’s both audiogram and word understanding scores.
My ski slope audiogram was borderline for Medicare but my word understanding was dramatically lower than the requirements.
1 Like
Using a hearing aid dryer with the UV light every day proved to almost eliminate itchy ears for me. Every once in a while I would clean out my ears with isopropyl alcohol. Cleaning the forms /molds with alcohol every once in a while helped too.
1 Like
Hi @MDB, according to NICE, these are the criteria… But, the truth is more obscure, in order to get a CI assessment at a centre, you have to be referred by your local Audiology department. Cheers Kev
1 Like
I can actually see where you wouldn’t meet those criteria because you hear better than 80dB in all but one of the frequencies they listed. My take of the criteria is that they do a phoneme test IF your audiogram qualifies. Thanks for the reference.
3 Likes
WRS here lately is done with headphones and a standard prerecorded voice. The sound level used is also logged for reproducibility. My last test was at the maximum level I could tolerate.
1 Like
Here in Australia the WRS isn’t a big factor for people with hearing aids either… As @Um_bongo said some do most don’t.
When it comes to a CI evaluation the 50 word WRS, SRT & both again with white noise, is the major part of the evaluation.
2 Likes
That’s why it has no reproducible function in fitting HA. You can use it as a measure of where you’re at, but comparing a word list delivered through Headphones and one through HA via Freefield speakers is entirely meaningless.
1 Like
My “understanding” of it’s use is an indicator of how much hearing aids might help and if the WRS score is low, it at least suggests that Cochlear Implant might be worthwhile.
3 Likes
I can absolutely see that 40% 65dB is an objectively poor score vs 95% at X.
That wasn’t my point. I don’t deal with CI in any form. I tend to deal with ‘normal’ presbyacusis cases (within reason) - we have fairly tight criteria for onward referral to ENT/Audiology. One of those criteria is ‘unusual’ losses; mixed cases, asymmetry or poor auditory resolution.
If there’s any doubt we forward them to their GP to refer onwards to the correct NHS pathway, or more usually they’ve already tried the NHS route, had a go with the Free offering and weren’t satisfied.
The other occasion you’d possibly find it useful is where they’re in a degenerative condition in operation or a potential for TIA. However, in my book you’d get better objective data on the decline with repeated audiograms as the sensitivity of the response will diminish accordingly.
3 Likes
One of the reasons I sought expert medical care myself was looking at the word recognition asymmetry. I saw online that one of the audiology professional organizations strongly recommends that over 15% word recognition asymmetry be referred medically. I was greater than 20% difference 4 years ago and was not referred. I was really noticing word recognition affecting my professional and personal life.
The ENT specialist required a new hearing test. After reviewing their new test that had much higher recognition scores and his examination, he thought properly adjusted aids would be my best option. I have exhausted all local hearing professionals so I am paying extra money to them for my More 1 aids that I will get in a couple of weeks.
1 Like
Which is fair enough.
Serious question; why were his WRS that much better than the previous result?
I’d imagine test consistency is very important if it’s being used as CI referral criteria.
1 Like
I actually talked afterward with the HIS who performed the old test. She checked her records and said the newer test used a higher sound level. If I recall correctly, by best ear went from 55% up to 83%. The more recent degrees audiologist works for a major research university but is a recent (within the last 2 years) graduate.
1 Like
Which kinda illustrates what I was saying above, even before considering testing variability, you’ve got to be consistent on test parameters if that ‘standard’ is the basis for future treatment.
Otherwise the lot is inherently pointless.
3 Likes
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.
6 Likes
I don’t think there is a test out there that can’t be screwed up by incompetence or malfeasance. Even something well studied like a potassium blood test can be invalid if the specimen is drawn above flowing IV fluid. The situation that makes sense to me to really want to know what WRS are is fairly common on the forum. People coming here with severe to profound losses and wanting to know what the latest and greatest hearing aid is because they’re having problems with their current Ultra BTE hearing aid. If their WRS is low (when done with adequate gain), no hearing aid in the world is going to help that much.
4 Likes
Here is an older article I found interesting on the difference between what is taught vs best practice.
2 Likes
Asking a person to repeat words that he can’t hear but is lip-reading? That is not a hearing test at all! It’s a lip-reading test! 
Using that sort of measurement, a completely deaf person could pass a “hearing” test!
2 Likes
I have never had a word understanding test done face to face.
Every one of them was from a pre-recorded device. There was no way for me to read lips.
Lots of good information coming out in this thread.
Thanks
4 Likes
Have you been checked by an ENT specialist for otomycosis? It’s a fungal infection that causes itching, fluid discharge etc and your symptoms sound similar to mine when I suffered from it, particularly the occlusion.
In my experience an audiologist might not detect either, even when fitting your aids.
1 Like