A coach stands on the side-lines, providing messages of strategy and tactics to an athlete. A referee blows the whistle to signal the stoppage of play. A teammate yells encouraging words on the field. The fans roar with applause after an athlete scores a goal.

Athletes rely on hearing for direction, encouragement, teamwork, and safety. "The prevalence of hearing loss for adults with intellectual disabilities is higher than for persons in the general population," said Dr. Beth Lannon, Special Olympics Global Clinical Advisor for Healthy Hearing. Any type of hearing problem can negatively impact communication ability, quality of life, social interactions, and health. "Off the field, hearing loss can interfere with cognitive development, limit social interactions, and limit vocational opportunities" explains Dr. Lannon. Special Olympics Healthy Hearing changes lives around the world by providing free hearing examinations, ear wax removal, swim molds, minor hearing aid repair, and other services for people with intellectual disabilities (ID).

Since 2007, Special Olympics Healthy Hearing has performed close to 85,000 hearing screenings in 65 countries around the world. The results of these screenings showed 40% of Special Olympics athletes have blocked or partially blocked ear canals with ear wax and over 25% failed hearing examinations. In addition to screenings, Healthy Hearing trains audiology professionals and students to be able to identify the specific needs of individuals with intellectual disabilities, provide screening services in a non-threatening environment, and provide follow up recommendations for each individual. Healthy Hearing is one of eight Special Olympics Health disciplines that provides screenings, trains professionals, and creates links to follow-up care providers so people with ID can get such care in their own communities.

"Volunteerism is a precious gift to the person who is volunteering, and each of those individuals who volunteers to help with the Special Olympics Healthy Athletes program is rewarded a thousand fold by the positive outcomes in better health for athletes identified with health problems," explains Dr. Gil Herer, founder of Special Olympics Healthy Hearing.

Healthy Hearing screenings have a strict protocol that is used worldwide. Upon entering a Healthy Hearing event, all athletes go through registration where they provide basic information and answer questions related to how they perceive their current hearing status. At the first station, the volunteers complete an external ear canal inspection and then the athletes proceed to the second station to have their inner ear tested. Depending on the results of the first two stations, the athlete may need to move onto the third, fourth, and fifth stations to investigate potential middle ear problems, which can include middle ear infection, confirm hearing loss, as well as determine the degree of hearing loss. At certain events, hearing aids, swim ear plugs, noise protection, hearing aid maintenance and repair, or other services may be available for athletes demonstrating need. Prior to leaving the Healthy Hearing screening, athletes will stop at the check-out station to review their results, receive education on hearing loss prevention, and receive any referral information, if necessary. Each athlete spends about 10 to 30 minutes at the Healthy Hearing screening and is encouraged to return annually.

Ricki is a Special Olympics Southern California athlete. His mother, Eva, recognizes the tremendous gift that volunteers provide to these athletes. "We are just so grateful for the people who donate their time to provide these free screenings," she proclaims. Her son, Ricki, agrees. "They don't even get paid. They are doing this out of their own kindness."

Ricki attended a Healthy Hearing event in 2013, at the age of 36. For over 30 years, Ricki suffered from hearing loss in one ear which impacted him on the tennis and bocce courts and in his is job as a D.J. His mother, Eva, reported that "Ricki tended to speak much louder and people would get annoyed. Constantly, he would need to ask people to repeat themselves." Eva was told by doctors that Ricki had a hearing problem, but his condition could not be treated. This changed when Ricki attended a Healthy Hearing event. The volunteers at the event recommended Ricki see a local audiologist who referred him to a specialist for surgery. The surgery involved the removal of a benign tumor, inserting a prosthetic device, and reconstructing the middle ear.

Ricki describes the results of his surgery as a tremendous success: "I can hear much louder and hear more things now. I can understand people better now." Ricki loves country music and enjoys listening to Friends in Low Places by Garth Brooks with his improved hearing. His love of music translates to his job as a D.J. at weddings, birthday parties, outdoor events, and other private or public events, which he's been doing since the age of 12. "As a D.J., I can understand the customers coming up to me to request things and I can make sure the speakers are set up right. I can also check the volume and balance levels." Ricki has also seen a positive effect on his sports per formance on the tennis and bocce courts, now more able to more clearly hear his coaches, teammates and, most important, the fans.

Individuals with intellectual disabilities and their families should be aware of the signs of hearing loss, including: difficulty following conversation, especially in noisy environments, asking people to repeat themselves, not responding to noise at a young age, and pain or ringing in the ears. It is critical to protect your hearing to prevent hearing loss by wearing ear protection around loud noises, turn down the volume on personal listening devices, and walk away from noise when possible. The Global Clinical Advisors for Special Olympics Healthy Hearing encourage individuals with intellectual disabilities to have their ears checked by a medical doctor for ear wax, once or twice a year and have a hearing evaluation by an audiologist/ENT specialist every one to five years. Additionally, all individuals with intellectual disabilities are welcome to attend a screening at a local Special Olympics event.

Ricki encourages all Special Olympics athletes to go to a healthy hearing event and get a referral if needed. Ricki's mom, Eva, also advises "if doctors in the past have expressed concern with your child's ears when they were younger, it's always good to get a regular screenings as things can change over time." •

For more information about Special Olympics, Healthy Athletes and Healthy Hearing at specialolympics.org/health.

ABOUT THE AUTHOR: Jamie Valis, PhD, is Manager of Healthy Hearing, Fit Feet, and Strong Minds, Special Olympics International.