Background: Hearing loss is one of the most common chronic sensory impairments in elderly individuals and significantly affects communication, cognition, emotional well-being, and quality of life. The prevalence of hearing impairment rises sharply with advancing age, with presbycusis being the most common cause. Other causes include chronic noise exposure, cerumen impaction, chronic otitis media, diabetes mellitus, hypertension, ototoxic drug exposure, and hereditary factors. Early diagnosis and management are often delayed because symptoms develop gradually. Aim: To study the pattern of hearing loss and associated etiological factors among elderly patients attending the ENT outpatient department of a tertiary care hospital. Materials and Methods: A prospective observational study was conducted among 300 elderly patients aged ≥60 years attending ENT OPD over 12 months. Detailed clinical history, otoscopic examination, tuning fork tests, pure tone audiometry, and relevant laboratory investigations were performed. Hearing loss was classified as conductive, sensorineural, or mixed. Associated etiological factors were analyzed statistically. Results: Out of 300 patients, 198 (66.0%) had hearing loss. Sensorineural hearing loss was most common (58.1%), followed by conductive (24.2%) and mixed loss (17.7%). Bilateral involvement was seen in 71.2% patients. Mild hearing loss was most frequent (34.8%), followed by moderate (31.3%). Presbycusis (46.4%) was the leading cause, followed by cerumen impaction (18.2%), chronic otitis media (12.1%), noise exposure (10.6%), diabetes mellitus (9.6%), and ototoxic drug use (7.1%). Significant association was observed with increasing age, diabetes, and hypertension (p<0.05). Conclusion: Sensorineural hearing loss due to presbycusis is the predominant hearing disorder among elderly patients. Routine hearing screening, early audiological assessment, and management of reversible causes can improve quality of life.