Approximately 40-80% of children with Down syndrome have hearing impairment in addition to speech and language impairment. The commonest cause of hearing impairment in young children is otitis media with effusion. This paper investigated the impact of early hearing loss on language outcomes in children with Down syndrome. They found that early hearing loss has a significant impact on the speech and language development of children with Down syndrome. The authors suggest that speech and language therapy should be provided when children are found to have ongoing hearing difficulties. In addition, joint audiology and speech and language therapy clinics could be considered for preschool children.