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Hearing loss can be described in terms of when it occurs in the process of the development of speech. A pre-lingual hearing loss occurs where the hearing is lost before a child has completely developed speech and language. A post-lingual hearing impairment is more common and means the hearing loss is acquired after speech and language have developed (usually considered to be after six years of age). Often, the hearing loss develops gradually and may be noticed by family and friends before the person actually notices it. The deaf and hearing impaired community is very diverse, differing greatly in terms of the cause and degree of hearing loss, age of onset, educational background, communication methods, and how people feel about their hearing loss. Audiological – focuses on the cause and severity of the hearing loss, and whether or not hearing can be used for communication purposes.
Cultural – refers to a particular group of deaf people who share a language (for example – New Zealand Sign Language) and a culture.
These people are likely to use sign language as a primary means of communication among themselves, as well as to express a full range of day-to-day, in-depth thoughts, feelings, emotions and needs. Members of this Deaf cultural group hold a set of beliefs about themselves and their connection to wider society, which differs from the beliefs of those who lose their hearing due to illness, trauma or age. However, terms such as “hard-of-hearing” can also be used to describe a person with a mild-to-moderate hearing loss, or a deaf person who doesn't have or want any cultural affiliation with the Deaf community.
It is an invisible condition which impacts on people of all ages and at all levels of society. Pre-lingual hearing loss may be congenital or acquired in the first few years of life, and can affect how well a child learns to speak. Older adults with hearing impairment are likely to hold shorter conversations, use the telephone less, and increasingly ask people to repeat themselves.

Loneliness and depression can arise as a result of isolation from the inability to communicate with friends or work colleagues. Generally, the term “deaf” refers to those who are unable to hear well enough to rely on their hearing and to use it as a means of processing information. Deaf (with a capital 'D') describes people who identify themselves as part of the Deaf community.
Although these people all share the condition of “not hearing”, they do not have access to the same knowledge, beliefs, and practices that make up the culture of deaf people.
How people “label” themselves in terms of their hearing loss is personal and can reflect either identification with the Deaf community or simply how their hearing loss affects their ability to communicate in a “hearing world”.
All congenital (present at birth) hearing loss is pre-lingual, but not all pre-lingual hearing loss is congenital. The term “hard of hearing” refers to people who have some hearing, and are able to use it for communication purposes.
For everyone with a hearing loss, it is a matter of deciding whether to treat it from an audiological perspective or as a cultural and lifestyle issue. Hearing loss that occurs at this stage can have a far-reaching impact on verbal and social skill development. It's all about choices, the person’s comfort level, ways of communicating, and the level of acceptance of the person’s hearing loss. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma.

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