DO I HAVE TINNITUS?

Have you ever heard a ringing in your ears? If so, you have experienced tinnitus. Tinnitus can be annoying, inconvenient, or even painful for the many people who suffer from it. Interestingly, some people never really notice symptoms of tinnitus, even though they are experiencing it. Recent research indicates that people have varying experiences of tinnitus, and these symptoms originate in the brain, not the ears.

A study done at the University of Illinois found that the brains of people with tinnitus hear sounds differently than those who don’t have tinnitus. Even among tinnitus sufferers, there are differences the way peoples’ brains process sound.

What Exactly is Tinnitus?

Tinnitus is actually just a symptom (not a disorder or disease). There are a lot of different causes of tinnitus, like noise exposure or use of ototoxic medications (medications that cause hearing loss). Approximately 25 million people across America are affected by tinnitus. There is no cure for tinnitus, and it is often temporary. It’s important to understand how to manage it and lessen its effects, or if possible, prevent it entirely.

Tinnitus Can be Affected by Your Feelings

Recent studies have found that the brain’s blood oxygen levels can change when exposed to different types of noise. Researchers discovered differences in the way tinnitus sufferer’s brains processed sound compared with non-tinnitus sufferers. “Good” sounds, like laughter, were presented, along with “neutral” and “unpleasant” sounds.

The Brain and Emotions

People with tinnitus engage with sounds differently in their brains, which can trigger emotion. Not so with people without tinnitus. The study also found that tinnitus sufferers who complain the most process emotional noise in different parts of the brain than the people who did not think the symptoms were bothersome.

This can explain why some people are very bothered by tinnitus, and others are not. This shows that the symptoms distress some people more than others.

Insomnia. irritability, depression, mood swings, anxiety, and even suicidal thoughts have been reportedly caused by tinnitus. Some people merely report it as a minor irritant or even say it doesn’t trouble them at all. The people who are less bothered by tinnitus generally process emotion in the brain’s frontal lobe, while others process emotions in the brain’s amygdala.

Treatment Options for Tinnitus

This study helps explain why tinnitus is more bothersome to some people and not others. It may also help scientists to come up with more effective treatments that can target the cause of this suffering.

Hearing loss and tinnitus are often connected, but even people with normal hearing can have tinnitus. If you begin to experience tinnitus symptoms a trip to your audiologist is a good idea, and may help to prevent hearing loss. Hearing technology with sound therapy tools are shown to help ease the symptoms of tinnitus and hearing aids can also be an option for those who suffer from hearing loss and tinnitus.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening. We can discuss hearing aid options with you and work with you to find one that fits your needs and budget.

HEARING RESOLUTIONS FOR 2019

With a new year comes a time to reflect on our old patterns and how to update our habits and improve ourselves. Do you typically make New Year’s Resolutions, and what is your track record at sticking to them?

Personally, I don’t make New Year’s Resolutions. I educate myself throughout the year and when I see changes that need to be made, I don’t wait for a new year to make them. Even so, I have been reflective on my habits and patterns this new year, thinking about things that I might like to change.

We all value our hearing. From conversing with friends and family to watching TV or listening to music, we use hearing almost continuously. Hearing health is something we take for granted, but when we begin to experience hearing loss we realize what a gift our hearing health has always been.

Fortunately, there are ways we can protect our hearing. Here are a few easy things you can do right now to ensure your hearing health lasts as long as possible.

1.    Yearly hearing screenings are key. One of the easiest things you can do to protect your hearing is to get annual hearing evaluations at your audiologist. Since hearing damage is irreversible, it’s important to catch it early: even before you notice it. Hearing screenings are quick, easy, and often covered by insurance.

2.    Wear protective gear. Since the most common type of hearing damage is noise-induced hearing loss, it is important to protect your ears whenever you are in a noisy environment. Whether you are at work in a factory, at a firework show, or at a concert, be sure to protect your ears from loud noises. It’s a good idea to always carry earplugs. You never know when you will be in a noisy environment, so it’s good to be prepared.

3.    Keep the volume low. When we listen to music or watch TV on mobile devices using ear buds, it’s easy to have the volume at a level above 80 decibels, which is the threshold for hearing damage. It’s best to keep the volume at less than 60% of the maximum, and if you can use over-the-ear earphones with noise-canceling technology, that can prevent you from needing to turn the volume up as loud to hear your device.  

4.    Get custom-made. If you listen to a lot of music or if music is your business, it’s a good idea to get custom-made earplugs or earphone molds. They are relatively inexpensive and a great way to protect your hearing from noise-induced hearing loss. They are customized to fit your ear canal exactly. Not only do they deliver superior sound, they allow for better quality listening, so you can listen at a lower volume and prevent hearing damage.

The first step to halting hearing loss and preventing further damage is to recognize your situation. Come in today for a hearing screening and formulate a strategy to train your brain to listen actively and effectively.

DISCREET HEARING AID TECHNOLOGY COULD GIVE YOU YOUR LIFE BACK!

Anyone with substantial hearing loss knows that it can lead to a considerable decrease in quality of life, especially while in the presence of others. Hearing is a critical part of participating in public activities. Luckily, hearing aids can help people to live a normal life even with hearing loss.

Technology You Don’t Notice

The hearing aid technology of today offers the most seamless hearing experience ever. Even if your hearing loss is severe, hearing aids can help you to communicate and understand the world around you normally. The newest wireless technology allows users to control all of the settings via smart phone or other device, acting as a kind of remote control. Hearing devices are now smaller than ever–so discreet that people you encounter may not know you are wearing them!

The functional technology of modern hearing aids like feedback cancellation, background noise reduction and speech recognition can make the use of hearing devices easier than ever. Hearing aids are now “smart” and can learn your needs and automatically adjust to your preferences.

In addition to their basic functions of restoring your hearing, today’s hearing aids can also allow you to stream sound from telephones, TVs and other devices—like having earbuds available whenever you wear them.  Without any additional devices you can listen to TV, movies or music wirelessly.

New Capability for New Technology

In the past, hearing aids were merely amplifiers of sound, doing nothing to assist the brain in processing sound. We now realize that hearing loss is much more than not hearing sounds—it can involve the inability of the brain to interpret the sound coming in. it therefore becomes necessary to find a way to assist that communication between the brain and the ears.

Hearing aids today are truly smart devices, complete with computer chips that can predict your hearing needs and provide a solution. They have learning capabilities, for example, that can help you control background noise and volume—almost as well as your natural ears!

The Tech is Available. Why Not Use it?

With the technology available and the wide variety of devices for every need, there is no reason not to use hearing aids. Check with your audiologist for a recommendation of hearing aids that can best fit your style and comfort preferences, as well as your budget.  Schedule an appointment today and find out the options that are available to you. Don’t let hearing loss steal your quality of life!

If you think you could have hearing loss, no matter what the cause, be sure to visit your audiologist immediately to take action. You may find a resolution that can inhibit or stop the development of hearing damage.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

IS TWO ALWAYS BETTER THAN ONE?

When you were diagnosed with hearing loss, was one ear affected more than the other? This can often be the case, and because hearing aids can be expensive, it can be tempting to use just one hearing aid instead of two. But is that a good idea?

The Ears Work Together

Because they are all we can see, we may think that our hearing is done mainly by our two ears, but that isn’t true. Our brains are even more important to hearing and understanding the world around us, and our brains are connected to our ears through auditory nerves. Our brains are the heavyweights, translating noises we hear into sound that means something. Who knew our hearing was so complex? Or that a problem with any one component in the auditory system can cause hearing as a whole to break down.

Even if they are not equally damaged, hearing loss in one ear is quite often accompanied by damage in the other ear as well. Wearing a hearing device on only one side can backfire, because it will support one ear and not the other. The ear that is being helped will probably not decline any further, but the unassisted one might.

Hearing Exercises

Our bodies need regular exercise—without it, our muscles will atrophy and wither away. Regular exercise is important—and this is also true for our brains and our ears. With the progression of hearing loss, sounds can sometimes be heard but not understood. This can be very frustrating and may be the result of a “bad connection” along the auditory nerve between the ears and the brain. Doing “hearing exercises” can slow this progression and help your brain to “re-learn” how to interpret sounds meaningfully.

Your audiologist can give you exercises and other options that could help.

Hearing Well

One way to support good listening comprehension is to make sure your ears are hearing equally. Auditory stimulation is increased, and your brain can work less to understand the noises your ears bring in. Therefore, for any hearing damage and you want the most seamless, effortless listening experience possible, you should wear two hearing aids instead of just one.

Wearing two hearing aids can also save on battery life over wearing just one, on top of being more effective overall. It may also give you the opportunity to wear more discreet (smaller) hearing devices because of the lower power requirements of each hearing aid.

Triangulation

Our ears are fine-tuned to help us not only hear and understand the world around us, but to determine from which direction sound is coming. This can come in handy when we are in danger: we don’t want to run towards something that will hurt us, so we need to know where it is coming from! When both ears hear equally, you can better pinpoint the source of the noise around you. This ability, called “localization” is practical in everyday life, and also necessary for protection. Lopsided hearing makes localization much more difficult.

Wearing hearing aids instead of one are generally happier and more content with their hearing experience, because two hearing aids can reestablish hearing much more efficiently than one. Hearing, listening and understanding depend on more than just our ears, so the more help they have the better.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

PROTECT YOUR HEARING AND STILL ENJOY CONCERTS!

With summertime comes fun in the sun and outdoors at concerts and picnics.  It’s the time for beach visits and laying out by the pool, park outings, and outdoor concerts when the day cools into evening. Festivals and concerts are a great change meet new friends, hear great music and hang out outside.

One thing that all concerts are is loud, however: often the noise levels are in more than 100 decibels! We know that hearing loss can happen at noise levels that are higher than 80 dB, it’s vital that we take precautions to guard our hearing. But that doesn’t mean you can’t enjoy summer festivities!

Noise-Induced Hearing Loss and Youth

An estimated 1.1 billion youth world-wide have been affected by noise-induced hearing damage. Energetic and adventurous, young people often gather in loud environments such as night clubs, sporting events and concerts, which often have very loud music or noise from crowds.

Even a short period of exposure to loud music can cause hearing damage, so it is important to find ways to protect your ears before going to these venues.

In one Amsterdam study in 2015, the effects on hearing of wearing earplugs or not wearing them was measured for outdoor concert-goers. 25 people wore earplugs to the concert and 26 people went without them. Of those, In the 4.5-hours concert, temporary hearing loss was measured in 22 of the 26 unprotected participants.

In contrast, only 4 people of the 25 wearing earplugs showed any hearing damage at all. Since repeated occurrences of temporary hearing loss can lead to permanent hearing loss, preventing even temporary hearing damage is crucial to long-term hearing health.

What Should I Do?

When worn during exposure to loud noises, earplugs can help to prevent noise-induced hearing loss. So next time you attend a sporting event, concert, or night club consider grabbing a pair of earplugs first.

Though this type of hearing loss is often temporary, remember that repeated exposure can have long-term effects and eventually become permanent damage. Sounds being muffled or difficulty hearing quiet sounds are some symptoms of hearing loss. If you experience any of these symptoms, please see your audiologist for a hearing screening to check on the level of damage and if anything can be done to prevent further hearing loss.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

COULD THE SEVERITY OF TINNITUS ORIGINATE IN THE BRAIN?

Ringing in the ears, also called tinnitus, can be a debilitating problem for the millions of people who suffer in the U.S. Some who are affected by tinnitus, however, do not suffer any major symptoms. Recent studies show that a person’s experience with tinnitus originates with the brain, not the ears.

One study from the University of Illinois found that sounds are processed differently in the brains of those with tinnitus than those without it. Even among people who have tinnitus, however, there are differences between how sound is processed in the brain.

Tinnitus is more a symptom than a disease in and of itself. Another trauma or condition may be the source of the symptom, which could stem from ototoxic medications or exposure to loud noise. It is important to understand more about the causes of tinnitus, because across America it is estimated that 25 million people are affected by it. Since there is no cure but only treatments that manage symptoms, understanding how to avoid or lessen its effects will prove useful for sufferers of tinnitus.

How Emotional Sounds Affect Tinnitus

Researchers have pinpointed changes in blood oxygen levels in the brain when exposed to different types of sounds. First they looked at the differences in sound processing between people with tinnitus compared to those without it. Sounds were introduced that were considered “pleasant” (children giggling), “unpleasant” (a baby crying) or “neutral” (a bottle being opened).

Areas of the Brain and Emotions

The study found brain engagement in different areas of the brain for emotion-triggering sounds for people with tinnitus than those without. They then took the study a step further and found that people who experience worse symptoms of tinnitus processed emotional sounds in different parts of the brain than those that described their symptoms as less severe.

This helps explain why some sufferers of tinnitus describe their symptoms as very severe and others say it doesn’t bother them at all. It shows that the severity of tinnitus can vary greatly from one person to the next because the level of distress caused by the symptoms varies.

Some people say tinnitus doesn’t affect their lives, and others report consequences such as irritability, mood swings, insomnia, anxiety, depression and even suicidal thoughts. The study showed that people who report less severe symptoms processed emotions primarily through the frontal lobe of the brain, while others processed emotions primarily in the amygdala portion of the brain.

Creating Treatment Options for Tinnitus

This research can help us to better understand why tinnitus causes more distress in some people than in others, and may lead to more effective treatment and therapy that can target the source of the distress.

Since hearing loss and tinnitus are often connected, visiting your audiologist when you begin to experience tinnitus symptoms may also help you to delay or prevent hearing damage. Sufferers of both tinnitus and hearing loss often find that hearing aids can also alleviate both issues. 

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

PROTECT YOUR HEART AND PRESERVE HEARING

Many things come to mind when you think of your heart: emotions, desires and dreams, the soul.You may also think of the physical organ that pumps blood through your body and sustains your life.

Heart health is an important part of overall health. The Center of Disease Control (CDC) reported that 600,000 people die from heart disease yearly in the U.S. The leading cause of death for both men and women, heart disease is a major health concern, and coronary heart disease is the most common type.

The media tells us these facts regularly, but did you know that hearing health is related to heart health? It then follows that protecting heart health also serves to protect hearing health!

Heart and Hearing Health

 Smoking

Everyone knows that smoking is bad for health. The chemicals in cigarette smoke damage blood cells and every organ in the body. One in five deaths results from in some way from smoking in the US. Smoking also causes plaque to develop in arteries. The arteries then harden and the blood pathways become narrow, causing stress to the heart.

Hearing is also affected by the chemicals present in cigarettes. The auditory nerve’s neurotransmitters can become blocked, which confuses your brain when it hears sound. As a result vertigo, tinnitus and dizziness may occur.

Hypertension

High blood pressure of 140/90 or higher can stretch your arteries, resulting in vascular weakness and scarring. Plaque and blood clots that clogs arteries may follow.

Constant blood flow is vital to the inner ear hair cells that help our brains to translate sounds into meaning. Blood pressure medications may also cause hearing damage. Some people develop ringing in the ears (tinnitus) from these medications.

Diabetes

Millions of Americans are affected by high blood sugar, and adult onset (type 2) diabetes is the most common. Hyperglycemia (high blood sugar) can burden the heart and other organs by affecting blood flow.

Diabetes can also restrict the blood flow to the inner ear as a result of this decreased blood flow. The delicate hair cells of the inner ear can then die, and they can’t grow back. This makes hearing damage irreversible. Studies have shown that people with diabetes are twice as likely to suffer from hearing damage as those without it.

Sedentary Lifestyle

Modern Americans live sedentary lifestyles: many people sit in front of a computer at work during the day and then go home and sit in front of the TV before bedtime.

Exercise and eating real, unprocessed foods is the ideal method for heart disease prevention, as well as to prevent obesity.

If changing your diet and routine seems overwhelming, consider that even small tweaks can bring results. Swapping out your morning pastry for a protein-rich option like eggs, and your afternoon chicps for an apple, peanuts or a piece of cheese can cut down on carbs and keep your blood sugar levels in check. Take a walk around the block on your lunch break. Not only will you get some movement into your day, you’ll benefit from a change of scenery and fresh air.

Obesity

A majority of Americans are overweight. Obesity can stress your heart and increas the risk of heart disease, which in turn will increases the likelihood of heart failure in the future. Obesity are also often correlated with diabetes and high blood pressure, which bring more risk.

Alcoholism

If you drink one serving of alcohol with dinner, studies have shown that to be beneficial, alcohol consumption in excess can increase the risk of high blood pressure and can weaken your heart.

Drinking heavily produces free radicals that also affect the inner ear. Balance issues like vertigo, tinnitus and noise-induced hearing damage may result.

Remember these tips to protect your heart and your hearing:

  • Cut out processed foods and buy only fresh meats, fruits and vegetables
  • Get some exercise every day
  • Don’t smoke (or quit smoking)
  • Keep your weight at healthy levels
  • Drink no more than one serving of alcohol daily
  • Always get regular hearing screenings

Love your heart AND your hearing all year long!

Heart Healthy is Hearing Healthy!

Heart health and hearing health are connected, so we have to be aware of our overall health. Exercise at least a little every day (just a walk around the block will do!) and eat whole, unprocessed foods–these steps can make a big difference in overall health and also protect your hearing.

FREE Hearing Screening Celebrating Better Hearing Month

California Hearing Center invites you to come in for your Free Hearing Screening. When it comes to your hearing health, prevention is still the best medicine! No-obligation. Every Friday during the month for May 4, 11, 18 & 25 from 9:00 am – 3:00 pmAll ages welcome – No appointment necessary

Drop by at 88 N. San Mateo Dr. San Mateo, CA 94401  (650) 342-9449 www.calhearing.com

HOW DO MEDICATIONS AFFECT HEARING HEALTH?

Have you heard of ototoxicity?
Ototoxicity is a term used by health professionals for medications that can cause hearing loss. Both prescription and over-the-counter medications can be ototoxic.

Though these drugs may be effective for treating specific conditions and illnesses, they can also cause damage to delicate inner-ear hair cells and may affect balance and hearing.

Ototoxicity can affect people temporarily or permanently–so it is important to know how it is caused and how to prevent it or stop it.

Because drugs can accumulate in the body, the effects can be cumulative over time and get worse as the chemicals build up in the cells.

The American Speech-Language-Hearing Association has found that there are currently more than two hundred medications and chemicals that can cause both balance disorders and hearing loss. If you are taking any of these types of drugs, speak with your physician about the implications for your hearing.

Pain Relievers

NSAID (non-steroidal anti-inflammatory drugs) such as acetaminophen, aspirin and other over-the-counter medicines can be effective to reduce inflammation and ease pain. Studies have shown, however, that regular use of these drugs can cause hearing loss. Even a daily aspirin recommended by your doctor may have hearing loss effects.

Diuretics

Diuretics are prescribed to alleviate many conditions, such as high blood pressure, glaucoma, edema and other issues. These medicines can also cause temporary tinnitus and hearing loss, however, though we don’t fully understand why.

Antibiotics

Antibiotics can be used as life-saving medicines, and are important for serious bacterial infections. One classification of antibiotics, aminogycosides, have hearing loss as a side effect. This type of antibiotic is often treated as a last-resort medication when other antibiotics do not work for serious infections.

Chemotherapy Drugs

A platinum-based chemotherapy called Cisplatin is frequently used to treat metastatic testicular, ovarian and bladder cancers. Side effects reported for this drug range from vertigo to tinnitus as well as permanent or temporary hearing loss. A strong correlation has been found between platinum-based chemotherapy treatments and hearing loss, and researchers are looking for ways to alleviate this side effect.

What Can You Do?

You may need to take one of these medications for a serious issue, so the risks and benefits must be weighed. It is important to understand the risks and side effects of medications (even over-the-counter medications) however, so you can recognize these risks if they appear.

Medications affect different people differently, so stay attuned to your hearing and if the medications you are taking are affecting you, and approach your physician with any concerns.

Often if a medication begins to cause issues with hearing or balance, stopping those symptoms can be as simple as not taking that medication. If pro-active steps are taken, permanent damage can often be avoided.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

WELCOME SPRING – PREPARE YOUR EARS!

Spring is in the air! The weather is changing and we are already starting to enjoy blooming flowers and warmer! With the changing of seasons, we also get rainy weather, seasonal allergies, and erratic temperatures. Along with hearing aids, these changes can affect us, but we can downplay those effects.

The Weather is Changing

With changing weather, some people have a feeling of fullness in their ears. Barometric pressure changes with changes in the weather and causes this sensation of fullness, and makes the fluid in the inner ear sensitive to the weather. Seasonal allergy sufferers can experience this even more intensely.

Meniere’s disease can make the irritating symptoms even worse in the Springtime. The chambers of the inner ear can bulge and the fluid may back up. Difficulty hearing and discomfort as well as vertigo or tinnitus may sometimes result from this build-up.

Seasonal Allergies

Sinus pressure and sneezing can also result from seasonal allergies and add pressure to the inner ear. Seasonal allergies affect 40 percent of children and between 10 and 30 percent of adults. Up to 60 million Americans experience sneezing, ear pressure, sinus pressure, and itchy, watery eyes. Each of these symptoms can affect hearing temporarily.

Ear pressure can be temporarily relieved with non-prescription medications such as antihistamines and decongestants. Moderate exercise and a sensible diet of whole foods often improve these symptoms. Vegetables and fruits, like bell peppers, grapes, asparagus, watermelon, and celery serve as diuretics and promote fluid drainage.

Spring-time and Hearing Aids

Warmer, wetter weather may also affect the functionality of your hearing aids. Your hearing aids’ maintenance and care of during this time of year may also require more attention. The microphone ports can sometimes get obstructed by matter such as bee pollen. Proper cleaning of your hearing aids is important, and be sure to replace the mic port covers when needed.

Moisture from the heat, rain and humidity of spring and summer can also be introduced to your hearing aids, building up in the tubing and causing static in the receiver or microphone. Ensuring your hearing aids stay dry when going out in wet or humid weather can prevent issues.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.

WHAT ARE THE LINKS BETWEEN SMOKING AND HEARING LOSS?

If you smoke, you are well aware at this point of the dangers and risks associated with that habit. The media has no shortage of news stories about how smoking can increase the risk of respiratory problems, heart disease and cancer.

These risks are widely known to the 40 million American adults who smoke cigarettes, but did you know that smoking can also affect your hearing health?

Experts in the field of hearing health have long suspected that smoking can contribute to hearing damage, but on-going studies the past few decades has confirmed it. These same studies also show that second-hand smoke exposure also doubles your risk to develop hearing loss.

How does smoking affect hearing health?

It turns out there are several ways. An abundance of chemicals are found in cigarettes, from arsenic, formaldehyde, and nicotine to hydrogen cyanide.

The combination of carbon monoxide and nicotine work to deplete oxygen levels and tighten blood vessels throughout the body. The inner ear is very sensitive and dependent on the small blood vessels that circulate in them for maintaining hair cell health and hearing overall.

Chemicals that Affect Hearing.

Nicotine, the main addictive component of cigarettes, also has a number of harmful effects, including dizziness, vertigo and tinnitus and interfering with neurotransmitters in the auditory nerve, which regulate how your brain interprets sound.

Smoking in general causes damage to every cell in the body with free radicals that cause disease and damage DNA. Smoking can also irritate the lining of the middle ear and make you more sensitive to loud noise. This can in turn increase your risk of developing noise-induced hearing loss.

Studies have shown that the longer you smoke, the worse for your hearing health, but the good news is that as soon as you stop smoking you can start to see the benefits of quitting. As soon as 20 minutes after your last smoke, circulation improves and blood pressure is decreased. Eight hours later, oxygen and carbon monoxide levels normalize and in 48 hours your senses of taste and smell return to more normal levels.

Quitting smoking has numerous benefits for your whole body, including lowering your risk of heard disease, vascular disease and stroke as well as several types of cancer. Not smoking can also increase fertility and reduce risk of many other diseases.

Stop the damage now.

Since you can’t reverse hearing damage that has already happened, it is beneficial to quit smoking before the damage occurs, or gets worse. If you are ready to quit smoking, visit smokefree.gov for tips and ways to get through your first few days without cigarettes.

No matter what the cause, if you suspect you have hearing loss it is best to visit your audiologist right away to take the best course of action. Your audiologist may offer a solution that can slow or halt the progression of hearing loss.

Here at California Hearing Center we are committed to your hearing health. Call us today to set up an appointment for a hearing screening.