This study explores the perspectives of experienced mainstream primary school teachers in Malaysia regarding the inclusion of students who are Deaf or Hard of Hearing (DHH) within the context of the nation’s shift toward inclusive education (IE). While most teachers expressed positive attitudes and aligned IE with their teaching philosophies, significant challenges were identified, including a lack of training, limited understanding of hearing loss, and minimal collaboration with audiologists or speech-language pathologists (SLPs). Teachers’ experiences were shaped by personal encounters with individual DHH students, often resulting in varied and inconsistent expectations for inclusion. Many set prerequisites for enrolment, such as prior placement in special education (SE), spoken language ability, and support from resource teachers—highlighting a gap in awareness of Ministry of Education (MOE) guidelines. Findings also showed that verbal DHH students were generally perceived as socially and academically competent, especially when supported by peer buddies or SE teachers. However, students with no speech or those exhibiting behavioural issues were more difficult to include effectively, often due to teachers’ lack of training in sign language and behavioural management. Teachers reported minimal classroom adaptations and limited use of assistive listening technology despite evidence supporting its effectiveness. Collaboration with healthcare professionals and families was inconsistent, with varying expectations about parental involvement. Overall, the study highlights a critical need for targeted professional development, interprofessional collaboration, and systemic support to facilitate effective IE for students with DHH. Without these, efforts to balance inclusivity and appropriate educational support remain constrained.