The purpose of this study was to gain a descriptive understanding of the teachers’ perceptions and application of multimodal communication in the instruction of learners with hearing impairment, in inclusive classrooms. In particular it was aimed at finding out how teachers perceive multimodal communication and the practice in a classroom milieu where learners with hearing impairment are instructed together with their hearing counterparts.The study followed a qualitative case study design. The reason for choosing this design was to study the phenomena in depth. Three cases were studied. To gain a deeper understanding therefore, a non- participant observation strategy was used to observe the cases in their respective classrooms. Methods of data collection used were observation as the main and interview. The study adapted some of the aspects in the ‘Total Communication Checklist and Assessment’ developed by (Waldo, et.al. 1981) in the structuring of both the observation and interview guides. A video material entitled ‘Teachers for All’ was used to find out the influence it had on the teacher’s prior instruction.Numerous findings emerged from the study. Regarding perceptions, teachers were aware of the importance of multimodal communication in the instruction of learners with hearing impairment. However, two of the cases studied perceived it to be very difficult and time consuming in situations where content was abstract and taught in the area language other than English. Further said it was easier to forget one category of learners in the process. Despite that, one of the cases perceived it to be ease in terms of application.Regarding teachers application of multimodal communication, findings revealed that teachers used varied communication modalities in the instruction of learners with hearing impairment speech, signs, a combination of speech and signs and total communication. Speech was the pre-dominantly used communication modality. Other supplementary communication modalities used included the non-verbal, the facial expression, gestures, finger spelling, mouthing and body movement. Manual/visual modalities were used when in specific instruction was geared towards a learner with hearing impairment. Only one case balanced the use of the manual/visual and auditory modalities.The underlying theory that guided the study was Vygotsky’s social/cultural frame work for the most comprehensive inclusive practices. Argued for a learning environment that supplies learners with alternative means of communication that compensates for their disability. Based on the overall findings, conclusions were made among others, that Teachers’ perceptions and application of multimodal communication in the instruction of learners with hearing impairment differed from teacher to teacher and was dependant on one’s background training and subject taught. Effective instruction called for teacher skillfulness in the use of the two main communication modalities, the visual and the manual modalities. Conclusively, communication and instruction of learners with hearing impairment in inclusive classrooms is a subject that needed further research.