| Primary decider |
Self-identifies as hard of hearing and primarily uses spoken language. |
Self-identifies as Deaf/deaf or primarily uses sign language (e.g., ASL). Assign here even if a device is used. |
| Best-ear PTA |
Typically mild-severe loss (≈ 25-79 dB HL). May have better recognition in quiet than noise. |
Typically profound+ (≥ 80 dB HL) or functionally deaf regardless of PTA (e.g., minimal benefit from amplification). |
| Functional hearing |
Has residual hearing; may follow speech in quiet with amplification but struggles in noise/fast speech. |
Little to no functional hearing; may perceive environmental vibrations/sounds but does not rely on audition for speech. |
| Communication / language |
Primarily spoken language with support (hearing aids, captions, assistive mics). May know some sign. |
Primarily sign language (ASL/other). May use spoken/written language as secondary modes. |
| Devices (not determinative) |
Often uses hearing aids and/or assistive listening devices; may use captions routinely. |
May use no device, hearing aids, or cochlear implants. IF CI IS USED, ASSIGN AS CI |
| Typical challenges |
Speech in noise; fast talkers; high-frequency consonants; multi-talker overlap. |
Auditory-only materials; tasks assuming residual hearing; insufficient sign interpretation. |
| Assignment rule |
Assign HoH if primary language is spoken and participant self-IDs as hard of hearing. |
Assign Deaf if self-ID is Deaf/deaf or primary language is sign—regardless of devices or PTA. |