Multi-grade instruction is utilized as a strategy to compensate for climatic limitations, shortages of human resources, and financial constraints in certain regions—particularly at the elementary level—where students of varying ages, skill levels, and academic grades are taught in a single classroom by one teacher. Despite differing perspectives on the efficiency of this model, its implementation in the education of students with hearing impairment faces compounded challenges, as hearing impairment is a hidden disability that, in cases of delayed diagnosis and intervention, leaves irreversible consequences on communication, social, emotional, and academic skills. Although advancements in diagnosis and rehabilitation have enhanced language skills and increased families' willingness to place children in mainstream schools, the group of students with hearing impairment is heterogeneous; differences in impairment severity, age of diagnosis, assistive listening devices, and the extent of benefiting from rehabilitation services create significant educational gaps. Furthermore, the prevalence of comorbid disorders, such as cognitive and neurodevelopmental problems, intensifies the need for special education, threatening educational quality and equity in multi-grade classrooms characterized by a high volume of material, diverse needs, and insufficient teacher expertise. Proposed strategies include accurate identification of the current status and influencing factors, designing appropriate instructional methods, utilizing modern technologies, and updating curriculum content based on the actual needs of students.