Deafness can be a medical, legal or cultural term. In medical or legal terms deafness is typically understood to mean that the individual does not perceive sounds at all, or perceives only certain loud sounds with their ears. Some individuals may identify as culturally deaf and use sign-language, even though they have some hearing in one or both ears. Individuals who are deaf may or may not use assistive technology such as hearing aids or cochlear implants. Many individuals who are deaf use American Sign Language as their primary means of communication and consider it to be their first language and a key part of their cultural identity. Others may prefer to use other forms of manual, oral, or written communication or may prefer to use different methods of communication depending on the situation.