Many children with hearing loss (CHL) show a delay in mathematical achievement compared to children with normal hearing (CNH). This study examined whether there are differences in acuity of the approximate number system (ANS) between CHL and CNH, and whether ANS acuity is related to math achievement. Working memory (WM), short-term memory (STM), and inhibition were considered as mediators of any relationship between ANS acuity and math achievement. Seventy-five CHL were compared with 75 age-and gender-matched CNH. ANS acuity, mathematical reasoning, WM, and STM of CHL were significantly poorer compared to CNH. Group differences in math ability were no longer significant when ANS acuity, WM, or STM was controlled. For CNH, WM and STM fully mediated the relationship of ANS acuity to math ability; for CHL, WM and STM only partially mediated this relationship. ANS acuity, WM, and STM are significant contributors to hearing status differences in math achievement, and to individual differences within the group of CHL.