“Birthday cake!” Mikail Ozols, 3, of Epping, scurried around a preschool classroom at HEAR in New Hampshire, a school in Hooksett for hearing-impaired children, bearing a Play-Doh blob with candles stuck in the top.

The exercise teaches Ozols, who is one of several children at the school with cochlear implants, to associate clear sounds with objects and improve his diction.

The kids at HEAR are between the ages of 3 and 6. Most of them, like Ozols, have cochlear implants which transmit sound to people who are severely hearing impaired, allowing them the opportunity to hear as normally as possible.

The implant is permanent and is composed of an internal piece which is attached to the side of the head and an earpiece which transmits the sounds. Typically, candidates for the implant receive it between the ages of 2 and 6, but adults can also have implants.

The Food and Drug Administration dropped the eligibility age to 1 year for a particular implant in 2000, according to the National Institute on Deafness and Other Communication Disorders.

More than 20,000 children and 15,000 adults in the United States have been fitted with implants.

One of HEAR’s students, 4-year-old Bella Plourde of Hooksett, has hearing aids which have been sufficient to help her hearing abilities.

HEAR, which opened in 1999 at 1 Kimball Road, is the only school of its kind in the state that works with children that have these devices to get them to a point where they can hear and speak normally. Other schools focus on signing.

“They need to learn strategies, things that will help them have normal access to communication,” said school Director Lynda French, adding that visual communication is a large part of HEAR students’ learning.

The main challenge for these students, French said, is that normal language development has been delayed due to their hearing loss. Children who can hear from birth are able to speak because they can clearly hear the language of others and can form the sounds.

French likened the process to playing a violin, saying that one would not be able to pick it up and play right off the bat, that it would require a lot of practice and repetition.

That is in addition, of course, to the typical challenges children face, including diversity.

“Our children are coming from as many different family situations as hearing kids are coming from,” said Skot Pare, director of development at the school, adding that Ozols was adopted from Russia.

French said the kids at HEAR feel a sense of understanding when they first arrive and see other kids with the same hearing devices as them.

“These kids are just stunned when they walk through the door. Just to have that association is really important,” she said.

Parents are invited to observe the children during class through windows into each classroom. Speakers at each window allow observers to hear everything that goes on in the class.

The goal is to integrate HEAR students into their community schools and equip them with the resources to make a successful transition. HEAR instructors visit the school a particular student is going into to educate the other students about hearing loss and the cochlear implants or hearing aids that student is wearing, things which can seem strange to kids.

During their first year in a regular school, the kids attend HEAR in the morning and a staff member accompanies them to kindergarten in the afternoon, French said, which allows the student to become accustomed to longer days and get the oral and auditory instruction they need from someone they are used to.

The school also provides several support outlets, including a toddler playgroup which any hearing impaired child up to age 3 can attend, a family support group, and a parent resource library filled with materials on hearing loss that any parent with a hearing impaired child can check out.

For more information on HEAR in New Hampshire’s programming, visit www.hearinnh.org.