Elderly Hearing Aid Research Articles

Description of tinnitus and its relation to discomfort level in a group of elderly hearing aid wearers.

Evaluating quality of life for tinnitus patients has been an interest of several specialties that have seen the negative impact that the disorder has on people. To assess and qualify tinnitus in a group of elderly hearing aid wearers. A descriptive cross-sectional study involving 53 elderly patients with tinnitus without remission after wearing hearing aids. All subjects were submitted to: a medical evaluation, an audiological evaluation, acuphenometry, an investigation of tinnitus annoyance level and quality of life. There were 20 men and 33 women. The mean age was 72.5 years. The sample was mostly characterized by having sensorineural hearing loss (84%), moderate to moderately severe (86%) and downward sloping (82%). With respect to the description of the tinnitus sound, the most common were a hissing sound (93%) of average pitch (84%). Regarding the subjects' perception of tinnitus, it was found that subjects had varying levels of annoyance: mild (25%), moderate (33%), severe (22%), most severe (20%). Men are more bothered by tinnitus than women. Most of the sample reported being satisfied or very satisfied with their quality of life. It was possible to evaluate and qualify tinnitus in the sample. Although tinnitus is a frequent audiological symptom that interferes in the life of the elderly, in the sample it did not weigh heavily in terms of quality of life.

Speech perception enhancement in elderly hearing aid users using an auditory training program for mobile devices.

The goal of the present study was to develop an auditory training program using a mobile device and to test its efficacy by applying it to older adults suffering from moderate-to-severe sensorineural hearing loss. Among the 20 elderly hearing-impaired listeners who participated, 10 were randomly assigned to a training group (TG) and 10 were assigned to a non-training group (NTG) as a control. As a baseline, all participants were measured by vowel, consonant and sentence tests. In the experiment, the TG had been trained for 4 weeks using a mobile program, which had four levels and consisted of 10 Korean nonsense syllables, with each level completed in 1 week. In contrast, traditional auditory training had been provided for the NTG during the same period. To evaluate whether a training effect was achieved, the two groups also carried out the same tests as the baseline after completing the experiment. The results showed that performance on the consonant and sentence tests in the TG was significantly increased compared with that of the NTG. Also, improved scores of speech perception were retained at 2 weeks after the training was completed. However, vowel scores were not changed after the 4-week training in both the TG and the NTG. This result pattern suggests that a moderate amount of auditory training using the mobile device with cost-effective and minimal supervision is useful when it is used to improve the speech understanding of older adults with hearing loss. Geriatr Gerontol Int 2017; 17: 61-68.

Hearing loss in the aged: Status and interventions in China

Hearing loss is now one of the chronic diseases with the most impact on quality of life of aged Chinese people. According to the second China National Sample Survey on Disability there are 15,400,000 people over 60 years of age suffering from a hearing disorder. Among these, 2,788,600 have more than a severe hearing loss. The main causes of hearing loss in Chinese elderly people are presbycusis, long-term exposure to noise, otitis media and systematic diseases. Hearing thresholds increase approximately 10dB per decade for subjects aged 60 years and above, and remain stable from 50 to 70 years of age. A dramatic increase occurs after 70 years of age. Speech recognition showed a poor correlation with pure tone thresholds in patients older than 80 years, suggesting that the age factor should be taken into account when considering hearing amplification. The auditory brainstem response (ABR) and mismatch negativity (MMN) response have demonstrated both peripheral and central deterioration of hearing pathways in elderly people. Use of a hearing aid is the main approach for helping elderly people overcome difficulties in communication. In the past 10 years, digital hearing aids have gradually replaced analogue ones in China and have been shown to have a better effect. However, compared with the proportion of aged people with hearing loss in China, the number of those who use hearing aids is very small. This may be related to the following factors: 1) a traditional attitude towards hearing loss in the elderly; 2) financial reasons; 3) some worries due to the unfamiliarity of hearing aids; and 4) inability to manipulate hearing aids. The main complaints in elderly hearing aid users include self-hearing being too loud, a muffled feeling, excessive gain in the higher frequencies and poor speech recognition. Cochlear implants have also been used in pre-elderly and elderly patients in China. At present there is a long way to go in developing hearing healthcare services for elderly people in China. It is necessary to provide more hearing training and rehabilitation for elderly people with hearing loss using various means.

Desempenho de idosos com adaptação binaural x monoaural em testes de fala no silêncio e no ruído

OBJETIVO:avaliar o reconhecimento de sentenças no silêncio e no ruído de indivíduos idosos com perdas auditivas simétricas, usuários de próteses auditivas com adaptação mono e binaural; investigar em qual das duas situações pode ser verificado o melhor desempenho em condições que simulam situações de comunicação do dia a dia.MÉTODOS:foram avaliados 27 indivíduos, 20 do gênero masculino e sete do feminino, com idades entre 60 e 80 anos, com perda auditiva neurossensorial de grau leve a moderadamente severo e configuração simétrica. Utilizando o teste Listas de Sentenças em Português, realizou-se a pesquisa dos Limiares de Reconhecimento de Sentenças no Silêncio e no Ruído e Índice Percentual de Reconhecimento de Sentenças no Silêncio e no Ruído, em diferentes situações de escuta, com adaptação binaural e monoaural.RESULTADOS:os valores médios obtidos para os índices no silêncio foram de 80,89% com adaptação binaural, 76,33% com aparelho somente na orelha direita e 71,16% com aparelho somente na orelha esquerda. Já as médias obtidas nos índices no ruído foram 62,05 % com adaptação binaural, 60,52% com aparelho somente na orelha direita e 60,33% com aparelho somente na orelha esquerda. Ao comparar as diferentes condições de escuta, não foi encontrada diferença estatisticamente significante.CONCLUSÃO:não foi encontrada diferença estatisticamente significante entre os idosos usuários de próteses auditivas com adaptação mono e binaural, tanto no silêncio como no ruído.

Relating hearing loss and executive functions to hearing aid users' preference for, and speech recognition with, different combinations of binaural noise reduction and microphone directionality.

Knowledge of how executive functions relate to preferred hearing aid (HA) processing is sparse and seemingly inconsistent with related knowledge for speech recognition outcomes. This study thus aimed to find out if (1) performance on a measure of reading span (RS) is related to preferred binaural noise reduction (NR) strength, (2) similar relations exist for two different, non-verbal measures of executive function, (3) pure-tone average hearing loss (PTA), signal-to-noise ratio (SNR), and microphone directionality (DIR) also influence preferred NR strength, and (4) preference and speech recognition outcomes are similar. Sixty elderly HA users took part. Six HA conditions consisting of omnidirectional or cardioid microphones followed by inactive, moderate, or strong binaural NR as well as linear amplification were tested. Outcome was assessed at fixed SNRs using headphone simulations of a frontal target talker in a busy cafeteria. Analyses showed positive effects of active NR and DIR on preference, and negative and positive effects of, respectively, strong NR and DIR on speech recognition. Also, while moderate NR was the most preferred NR setting overall, preference for strong NR increased with SNR. No relation between RS and preference was found. However, larger PTA was related to weaker preference for inactive NR and stronger preference for strong NR for both microphone modes. Equivalent (but weaker) relations between worse performance on one non-verbal measure of executive function and the HA conditions without DIR were found. For speech recognition, there were relations between HA condition, PTA, and RS, but their pattern differed from that for preference. Altogether, these results indicate that, while moderate NR works well in general, a notable proportion of HA users prefer stronger NR. Furthermore, PTA and executive functions can account for some of the variability in preference for, and speech recognition with, different binaural NR and DIR settings.

Comparative Analysis of the Effectiveness of Two Strategies for Adaptation of Hearing Aids in Elderly through Perceived Impact on Quality of Life

Comparative Analysis of the Effectiveness of Two Strategies for Adaptation of Hearing Aids in Elderly through Perceived Impact on Quality of Life

Dichotic Hearing in Elderly Hearing Aid Users Who Choose to Use a Single-Ear Device

Introduction Elderly individuals with bilateral hearing loss often do not use hearing aids in both ears. Because of this, dichotic tests to assess hearing in this group may help identify peculiar degenerative processes of aging and hearing aid selection. Objective To evaluate dichotic hearing for a group of elderly hearing aid users who did not adapt to using binaural devices and to verify the correlation between ear dominance and the side chosen to use the device. Methods A cross-sectional descriptive study involving 30 subjects from 60 to 81 years old, of both genders, with an indication for bilateral hearing aids for over 6 months, but using only a single device. Medical history, pure tone audiometry, and dichotic listening tests were all completed. Results All subjects (100%) of the sample failed the dichotic digit test; 94% of the sample preferred to use the device in one ear because bilateral use bothered them and affected speech understanding. In 6%, the concern was aesthetics. In the dichotic digit test, there was significant predominance of the right ear over the left, and there was a significant correlation between the dominant side with the ear chosen by the participant for use of the hearing aid. Conclusion In elderly subjects with bilateral hearing loss who have chosen to use only one hearing aid, there is dominance of the right ear over the left in dichotic listening tasks. There is a correlation between the dominant ear and the ear chosen for hearing aid fitting.

Screening of cognitive function and hearing impairment in older adults: a preliminary study.

Background. Previous research has found that hearing loss is associated with poorer cognitive function. The question is that when a hearing impairment is being compensated for by appropriately fitted monaural hearing aids, special precautions are still needed when screening cognitive function in older adults. Objective. This research examined cognitive function in elderly hearing aid users who used monaural hearing aids and whether the presence of a hearing impairment should be accounted for when screening cognitive function in these individuals. Methods. Auditory thresholds, sentence reception thresholds, and self-reported outcomes with hearing aids were measured in 34 older hearing aid users to ensure hearing aids were appropriately fitted. Mini-Mental State Examination (MMSE) results obtained in these participants were then compared to normative data obtained in a general older population exhibiting similar demographic characteristics. Stepwise multiple regression analyses were used to examine the effects of demographic and auditory variables on MMSE scores. Conclusions. Results showed that, even with appropriately fitted hearing aids, cognitive decline was significant. Besides the factors commonly measured in the literature, we believed that auditory deprivation was not being fully compensated for by hearing aids. Most importantly, screening of cognitive function should take into account the effects of hearing impairment, even when hearing devices have been appropriately fitted.

Case Study of Auditory Training for an Elderly Hearing Aid User

소음 속에서 의사소통을 하거나 빠른 말하기 등 언어적 단서가 저하된 환경에서의 의사소통은 난청인들에게 의사소통하기 어려운 상황 중 하나이다(Paytonet al., 1994). 특히 노인의 경우는 중추신경계의 언어처리 능력의 저하로 인하여 이러한 어려움은 더 커질수 있다(Pichora-Fuller & Souza, 2003). 난청인들은 보청기 혹은 인공와우 등의 보장구를 통하여 가창력은 향상시킬 수 있으나, 언어를 이해하는 능력은 보장구의 착용만으로는 향상시킬 수 없다. 이러한 이유로 소음 속에서의 의사소통 등 어려운 의사소통 환경에서 난청인들은 보장구에 대한 높은 만족도를 보이지 않는다(Kricos, 2006). Sweetow & Sabes(2006)은 청능훈련이 의사소통 능력을 향상시키는데 매우 효과적이며 절대로 시간 혹은 비용의 면에서 비효율적인 것이 아님을 강조한 바 있다. 1970년대부터 최근까지 성인 혹은 노인을 대상으로 다양한 청능훈련 혹은 재활에 대한 연구가 진행되었고, 서로 다른 청능훈련 방법에도 불구하고 훈련으로 인해 향상된 능력을 확인하였다(Burk & Humes, 2008; Kricos & Holmes, 1996;Stecker et al., 2006; Sweetow & Palmer, 2005;Walden et al., 1981). 여러가지 청능훈련 프로그램 중 Sweetow & Sabes(2006)이 개발한 LACE (Listening and Communication Enhancement)는 시간 압축한 문장, 소음 속 문장 등을 사용하는 청능훈련 소프트웨어로 실험 연구실 외 집에서도 사용 가능하다. 난청노인에게 최소 8주 이상의 청능훈련을 실시한 연구(Burk et al., 2006; Burk & Humes, 2008; Stecker et al.,2006; 이예슬, 2012) 모두에서 소음 속에서 목표어음을 인지하는 청능훈련을 받은 후 소음 하 어음인지능력이 향상되었다.

Semi-Structured Listening Experience (Listening Training) in Hearing Aid Fitting: Influence on Dichotic Listening

In this study, the authors tested whether training with amplified, clear speech in regular room acoustics would result in larger perceptual gains of auditory processing in elderly hearing aid users. Elderly participants with hearing impairment (N = 36, ages 64–88) were fitted with bilateral hearing aids and were randomly assigned to 2 unequal groups. Study group participants were provided with 7 sessions (1 month) of individual listening training during which a free conversation was conducted, with the aim of stimulating the amplified ears with verbal auditory input. The control group participants were fitted with hearing aids without training. Auditory processing changes were assessed through the use of dichotic listening tasks. During hearing aid use, dichotic listening scores—tested without the hearing aids—improved in both groups, mainly in the non-dominant ears. The overall dichotic performance was significantly higher in the study group, and the main effect of auditory training was manifested in the scores of the dominant ear. Hearing aid use may improve auditory processing performance as tested in unaided conditions. Listening training has an additional beneficial effect on the dominant ear—that is, the ear with the lesser potential for improvement. Listening training in elderly adults presumably enhanced the acclimatization process by better recruiting the potential for auditory plasticity and improving attention recruitment.

Degree of satisfaction among hearing aid users.

Summary Introduction: Hearing loss (HL) is defined as the complete or partial loss of hearing ability. Aims: To characterize (1) the degree of satisfaction among adult and elderly hearing aid (HA) users who were treated by a public hearing health service and (2) the relationship between satisfaction and the variables of gender, age, degree of HL, and type of HA. Method: The clinical and experimental study included the administration of the Satisfaction with Amplification in Daily Life (SADL) questionnaire to 110 patients who had used HAs for more than 3 months and were 18 years of age or older. Results: Test patients were sex-balanced (48% were women) and had a mean age of 67 years. A relatively high incidence of sensorineural moderate HL was detected in the study patients (66%) and device B was the most commonly used HA type (48%). No significant differences were evident between HA satisfaction and sex. The importance placed on services/costs and personal image varied between age groups. Correlation was evident at all levels between user satisfaction and amplification. Decreased satisfaction was observed in individuals with severe and/or profound HL. The type of HA used yielded statistically significant differences in the positive effects referring. Conclusion: No correlations were evident between the different factors proposed. HA users exhibited high levels of satisfaction in all SADL areas.

Desempenho de idosos com presbiacusia em tarefas de controle inibitório

OBJETIVO: Avaliar o desempenho de idosos em tarefa não verbal ligada a funções executivas, a fim de verificar a hipótese de que idosos usuários de próteses auditivas obteriam escores mais altos do que idosos não usuários de próteses na tarefa proposta. MÉTODOS: A tarefa Simon, administrada individualmente em um laptop com o software e-prime, foi utilizada para mensurar aspectos ligados a funções executivas por meio de uma condição controle e duas condições de teste. Na condição controle, os estímulos - quadrados coloridos - eram apresentados no centro da tela. As condições de teste subdividiam-se em condições laterais congruentes - estímulos posicionados no mesmo lado da tela em que a tecla do computador a ser selecionada para a resposta - e laterais incongruentes - em que os estímulos aparecem no lado da tela oposto ao da tecla a ser selecionada. A diferença de tempo de reação entre as condições congruente e incongruente é chamada de efeito Simon. Os idosos foram agrupados em três grupos: um grupo controle de indivíduos com audição normal; indivíduos com presbiacusia, usuários de próteses auditivas; e indivíduos com presbiacusia não usuários de próteses auditivas. RESULTADOS: A análise estatística apontou diferença entre o grupo sem perda auditiva (controle) e o grupo de não usuários de prótese auditiva somente no tempo de reação (TR) na condição controle. Nas demais comparações não foram encontradas diferenças. CONCLUSÃO: A hipótese levantada não foi corroborada, o que aponta a necessidade de utilização de novos métodos exploratórios de observação dos fenômenos estudados.

Are Two Ears Not Better Than One?

The decision to fit one or two hearing aids in individuals with binaural hearing loss has been debated for years. Although some 78% of U.S. hearing aid fittings are binaural (Kochkin , 2010), Walden and Walden (2005) presented data showing that 82% (23 of 28 patients) of their sample obtained significantly better speech recognition in noise scores when wearing one hearing aid as opposed to two. To conduct two new experiments to fuel the monaural/binaural debate. The first experiment was a replication of Walden and Walden (2005), whereas the second experiment examined the use of binaural cues to improve speech recognition in noise. A repeated measures experimental design. Twenty veterans (aged 59-85 yr), with mild to moderately severe binaurally symmetrical hearing loss who wore binaural hearing aids were recruited from the Audiology Department at the Bay Pines VA Healthcare System. Experiment 1 followed the procedures of the Walden and Walden study, where signal-to-noise ratio (SNR) loss was measured using the Quick Speech-in-Noise (QuickSIN) test on participants who were aided with their current hearing aids. Signal and noise were presented in the sound booth at 0° azimuth under five test conditions: (1) right ear aided, (2) left ear aided, (3) both ears aided, (4) right ear aided, left ear plugged, and (5) unaided. The opposite ear in (1) and (2) was left open. In Experiment 2, binaural Knowles Electronics Manikin for Acoustic Research (KEMAR) manikin recordings made in Lou Malnati's pizza restaurant during a busy period provided a typical real-world noise, while prerecorded target sentences were presented through a small loudspeaker located in front of the KEMAR manikin. Subjects listened to the resulting binaural recordings through insert earphones under the following four conditions: (1) binaural, (2) diotic, (3) monaural left, and (4) monaural right. Results of repeated measures ANOVAs demonstrated that the best speech recognition in noise performance was obtained by most participants with both ears aided in Experiment 1 and in the binaural condition in Experiment 2. In both experiments, only 20% of our subjects did better in noise with a single ear, roughly similar to the earlier Jerger et al (1993) finding that 8-10% of elderly hearing aid users preferred one hearing aid.

Efeitos da reabilitação auditiva na habilidade de ordenação temporal em idosos usuários de próteses auditivas

To analyze the effects of an auditory rehabilitation program for the temporal ordering ability, of duration and pitch patterns of sounds, in elderly hearing aids users. Participants were 17 elderly people, with ages between 60 and 84 years, divided into Control Group (CG), which only used hearing aids, and Study Group (SG), which were submitted to an auditory rehabilitation program that included auditory counseling and training. All subjects were assessed at the beginning and at the end of the study, through the Duration Pattern Sequence and Pitch Pattern Sequence tests. The period between assessments was seven weeks. In the Duration Pattern Sequence test, CG subjects showed mean values of accuracy in the murmured condition of 48.64 and 54.43%, for initial and final assessments, respectively; SG subjects, presented 60.39 and 76.28%. In the named condition, CG presented 51.93 and 52.43%, and SG, 63.94 and 77.44% for initial and final assessments, respectively. In the Pitch Pattern Sequence test, CG subjects showed mean values of accuracy in the murmured condition of 80.62 and 79.94%, and SG subjects, of 79.78 and 90.39%, for initial and final assessments, respectively. In the named the condition, CG presented 82.64 and 84.21%, and SG, 82.94 and 85.89%, for initial and final assessments. There was a difference only for SG subjects in the murmured and named conditions of the Duration Pattern Sequence test, in the named condition of the Pitch Pattern Sequence test, indicating higher mean values in the final assessment. The auditory rehabilitation program to elderly hearing aid users provide satisfactory improvement in recognition, temporal ordering, and naming of duration and pitch patterns of sounds.

Effects of Word Recognition Score as a Function of Auditory Training Terms for Elderly Hearing Impaired with Hearing Aid

Although a use of hearing aids improves speech audibility, it is known that elderly hearing-impaired listeners often exhibit difficulty understanding speech in background noise. The purpose of this study was to examine a short-term (8-week) auditory training in word-recognition performance of 24 old hearing aid users. Twelve aged listeners (M=76.2 yrs) participated as auditory training group (ATG), and other twelve old listeners (M=74.0 yrs) served as non-training group (NTG). The ATG received forty-minute auditory training twice a week across the entire 8 weeks of training. During the training, the target monosyllabic words (Korean monosyllabic words) were presented in both open-set and closed-set aided conditions. All the words were presented at the most comfortable level of each participant with four different signal-to-noise ratios (SNRs of -5, 0, +5, +10 dB). To check the training benefit, word-recognition performance of ATG was tested after 1-, 4-, 8-week trainings. Results showed that word recognition performance of NTG did not improve as expected. Word recognition score of ATG was, however, significantly increased after 8-week training. Even though 4-week training results revealed a tendency of increment in word-recognition performance, a positive change after 4-week training was not significant. The amount of improvement after 8-week auditory training was the greatest at +10 dB SNR and the least at -5 dB SNR. The results indicate that the short-term (8-week) auditory training would be beneficial for old listeners to recognize speech in the background noise yet the training effect would depend on the SNRs. Therefore, at least 8 weeks of training in various listening conditions should be considered for elderly hearing aid users who want training benefit in daily listening and communication. KEY WORDS：Auditory training·Elderly hearing impaired·Hearing aid·Signal-to-noise (SNR)·Word recognition score.

Hearing Aid Use by Infants: More Than Meets the Ear?

Hearing Aid Use by Infants: More Than Meets the Ear?

Formal auditory training in elderly hearing aid users

SummaryIt is of paramount importance to install hearing rehabilitation programs for the elderly. Aim: to check the efficacy of a forma auditory training program for elderly patients fitted with hearing aids for at least three months, by means of speech recognition tests and self-assessment questionnaires. Methods: longitudinal contemporary cohort study. We selected 13 elderly hearing aid users, using intra-canal hearing aids in both ears, from both genders, with average age of 65.3 years. This group was randomly divided in Experiment Group and Control Group. The Experiment Group underwent seven formal auditory training sessions, aiming at stimulating their hearing skills for hearing closing, memory, attention, background figure and binaural integration. The participants were assessed by three behavioral tests and one self assessment questionnaire. Results: The elderly from the Experiment Group had significantly better performance in the assessments after auditory training in comparison to the Control Group. Conclusion: the formal auditory training program in a soundproof booth, associated with the use of hearing aids, improves speech recognition performance and reduces the perception of auditory handicap for the elderly who use intra-canal hearing aids.

Cost-Effectiveness of Hearing Aids in the Hearing-Impaired Elderly

Hearing aids are the principal tool for rehabilitation of hearing loss, one of the most prevalent impairments among elderly adults, but cost-utility ratings for hearing aid use are limited. Cost-effectiveness analysis. A multistate Markov model was constructed to model 50- to 80-year-old patients moving between states, including normal hearing, mild, moderate, or severe hearing loss. Parameters assigned in the model are partly derived from the Medline source (1966-2005) and partly from data on hearing-impaired elders (n = 96) in a tertiary care center in Taiwan. To address uncertainty, most of the parameters were specified by distributions, rather than base-case values. A probabilistic approach with Monte Carlo simulations was performed to produce an acceptability curve, showing the probabilities of being cost-effective given threshold values of willingness to pay (WTP). Hearing-related quality-adjusted life-years and cost in US dollars and Euros. The incremental costs for gaining an additional hearing-related quality-adjusted life-years in women and men were US $13,615 (Euro 10,826) and 9,702 (Euro 7,715), respectively. The probability of being cost-effective increased to 53% in women and 65% in men given a WTP of US $12,000 (Euro 9,542). The probabilities of being cost-effective to reach plateau were 67% for women and 78% for men given a WTP of US $20,000 (Euro 15,904). By modeling different degrees of hearing loss with a multistate model, hearing aid use was demonstrated to be a cost-effective strategy to rehabilitate the hearing-impaired elderly. These results can assist policy makers in allocating health resources appropriately and effectively.

Enjoyment of Music by Elderly Hearing-Impaired Listeners

Anecdotal evidence suggests that hearing loss interferes with the enjoyment of music, although it is not known how widespread this problem currently is. To estimate the prevalence of music-listening difficulties among a group of elderly hearing aid wearers. Interview. Telephone interviews were conducted with patients who wore hearing aids. Questions regarding several aspects of music listening were included. Sixty-eight hearing-impaired people served as subjects. They had all been seen in the audiology clinic for hearing aid evaluation during the previous year. Subjects were asked questions concerning their use of hearing aids, the importance of listening to music in their lives, their habits and practices concerning music, and difficulties they experienced in listening to music. Almost 30% of the respondents reported that their hearing losses affected their enjoyment of music. About half of the respondents indicated that music was either too loud or too soft, although only about one-third reported difficulties with level contrasts within musical pieces. In contrast to a similar survey carried out 20 years ago, there were many fewer complaints about listening to music. This result may be due in large part to improvements in hearing aids, especially with regard to nonlinear compression. Although new hearing aid technologies have somewhat reduced problems of music enjoyment experienced by hearing-impaired people, audiologists should be aware that some 25-30% of patients may have difficulties with listening to music and may require extra attention to minimize those problems.

Clinical Interpretation of the CPHI

Clinical Interpretation of the CPHI