Hearing impairment includes any degree of hearing loss that results in a diagnosis of hard of hearing. Hearing loss for the hard of hearing can be either permanent or fluctuating. Hearing loss must be confirmed by a certified audiologist and the school district must complete an evaluation to determine how the loss affects the child in school. A child with a hearing loss often has problems learning and using language which can affect many or all areas of performance, including academic subjects as well as social development. Children with identical hearing levels can function differently.