assess the child's residual hearing, look at the hearing aid's performance and fit the child with an appropriate instrument. Equally important is the ear mold, which has to be custom made to suit the shape of the child's ear. If a child has profound deafness, the benefits of hearing aids are limited. Cochlear implants may be used instead of hearing aids. They can be surgically inserted in the inner ear of children as young as 12 months of age to stimulate hearing. The surgery requires a hospital stay of one to several days. With additional language and speech therapy, children with cochlear implants may learn to understand speech and speak reasonably well, but the amount of improvement is variable. Assistive devices can be used alone or paired with a hearing aid or cochlear implant to aid listening in difficult or noisy environments. In the United States of America, the type preferred by most deaf adults is American Sign Language (ASL), which has rules and grammar that is distinct from English. There are also several variations of sign language that can be used along with spoken English which are standard in English-speaking countries outside the United States. There is also a visual model of spoken language called cued speech. Learning to lip read is very difficult because many sounds look the same on the lips. Cued speech enables young children with hearing loss to clearly see what is being said, and learn spoken languages with normal grammar and vocabulary. It clarifies lip reading using 8 hand shapes in 4 positions and usually takes less than 20 hours to learn the entire system. Famous cases Princess Alice of Battenberg Deaf white cats References American Speech-Language-Hearing Association. Hearing Treatment and Rehabilitation, Rockville, MD, February 12, 2002. Boys Town National Research Hospital. Information on Hearing Loss, Omaha, NE, February 12, 2002. Centers for Disease Control and Prevention. The Early Hearing Detection and Intervention Program, Atlanta, GA, February 7, 2002. The Decibels Foundation. Helping children with hearing loss and their families live happier lives. National Center for Hearing Assessment and Management. Early Hearing Detection and Intervention Programs, Utah State University, Logan, UT, February 7, 2002. Parchment Hill Causes of Congenital Hearing Loss Texas Newborn Hearing Screening Program Alaska Universal Newborn Hearing Screening Michigan Hearing Screening Program NHS Newborn Hearing Screening Programme Hearing loss