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Communication Options

There are many different types of communication options for those with hearing loss.  

Auditory Therapy 

After a child is diagnosed with hearing loss and fit with hearing technology, the family may decide to pursue therapy services to promote the development of oral communication. Hearing loss may be present prior to (pre-lingual) or after (post-lingual) speech and language development, and depending on the communication option the family decides, services are available to facilitate positive communication outcomes. As more than 90 percent of children with hearing loss are born to hearing families1, many families choose a listening and spoken language option. 

Listening and Spoken Language (LSL) 

Listening and spoken language (LSL) focuses on the development of listening and talking without the use of sign language. Early identification of the hearing loss, appropriate hearing technology [e.g. hearing aid(s), cochlear implant(s), and/or bone-anchored implant technology], and the use of specific intervention strategies are important for children with pre-lingual hearing loss to develop positive listening and talking abilities. The anticipated outcome is for the child to be successfully mainstreamed in school with language skills comparable to his or her peers.

Families interested in a listening and spoken language outcome for their young child should seek auditory-verbal therapy (AVT) through a LSL Specialist, who is a teacher of the deaf, speech-language pathologist, or audiologist with specialized knowledge in hearing and auditory functioning, spoken language development, child development, and emergent literacy. Parents and caregivers play a primary role and must commit to following LSL intervention strategies in the child’s natural environment as well as ensuring full-time use of hearing device(s) to facilitate the development of listening for spoken language.    

Though auditory-verbal therapy is reserved for children who are developing listening and spoken language, older hearing-impaired children and even adults with hearing loss can seek auditory-based therapy after appropriate hearing technology is fit. 

Manual Communication 

Some families decide on a manual communication approach for their child, such as American Sign Language (ASL), Cued Speech, and Total Communication. These approaches all rely on some degree of visual information, and the development of spoken language through listening is not the primary goal. Families who use a manual approach should be or become fluent users to serve as a positive communication model for the child. Manual communication can be used in coordination with oral communication with no detrimental effect to a child’s oral language use.2

Role of Audiologists 

Audiologists provide families with evidence-based and non-biased information on communication options as well as resources for available therapies. Audiologists may provide direct therapy services or direct families to appropriate professionals.   

To locate an LSL Specialist, click here and select “Find Services” 

For more information: 


1 Mitchell RE, Karchmer MA. Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies. 2004;4(2):138-163. (As cited in

2 Yoshinaga-Itano C, & Sedey A. Speech development of deaf and hard-of-hearing children in early childhood: interrelationships with language and hearing, The Volta Review, 10092, 181-212. 

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