Physical, social and psychological environments have had substantial impact on the hearing efficiency of American youth. During the neonatal, preschool and school years, environmental factors such as injuries, drugs, fractures, noise, viruses and Rh incompatibility have exposed youth to auditory damage. School administrators can plan and should implement acoustical measures in the design of their school buildings and screening programs. Teachers can learn to practice communication techniques that result in more effective education for those students with hearing losses as well as those who hear normally.