Abstract: Over the past three decades, inclusive education has become a contagious topic in the education systems of various countries around the globe. This has prompted the current study to explore the use of sign language in the teaching and learning of the students with hearing impairments in Patandi Maalum inclusive secondary schools in Tanzania. This qualitative study used in depth interviews as data collection tool with a total of 10 secondary school teachers and 8 students with hearing impairment. The translation used to interpret conversations with students with hearing impairments. Thematic analysis were used to analyze the collected data. Findings reveal that students with hearing impairments are given special care while teaching and learning in an inclusive environment, especially when it comes to use sign language. However, students struggle much with medium of instruction, teachers’ competence, the kind of assistance obtained from their fellow normal students, which could be caused by the teacher’s competence and the availability of resources. Also, students’ perspectives on the difficulties and the entire process of teaching and learning sign language, curriculum, and the amount of time needed to complete each school level differed widely. The study recommends the increase of time from four to six years and two to three years in advanced secondary education levels. It suffices also to suggest a friendlier learning environment with adequate relevant resources for students with hearing impairments. This should be accompanied with professional development for special needs teachers.