To determine the prevalence, severity, and audiometric characteristics of age-related hearing loss (ARHL) in older Chinese adults attending a tertiary otolaryngology clinic, with emphasis on age- and sex-specific patterns based on the updated World Health Organization (WHO 2020) criteria.

In this cross-sectional study, 1,000 adults aged ≥60 years underwent otologic examination, tympanometry, and pure-tone audiometry at a tertiary medical center between March 2022 and January 2023. Individuals with abnormal tympanograms or evidence of middle ear disease were excluded. Pure-tone averages (0.5, 1, 2, and 4 kHz) from the better ear were used to define and grade ARHL. Age- and sex-related differences in hearing thresholds were assessed using chi-square tests, t-tests, and two-way ANOVA.

Within this tertiary-care outpatient cohort, the prevalence of hearing loss according to WHO 2020 criteria was 84.1%, rising from 78.3% in the 60s to 100% in those aged over 90 years. Hearing thresholds showed a consistent high-frequency–sloping configuration, with high-frequency (8,000 Hz) thresholds declining at nearly double the rate of low-to-mid frequencies (11.7 dB vs. 4.5–6.3 dB per decade). The steepest decadal deterioration occurred between the 70s and 80s, characterized by a transition from high-frequency sensory loss to generalized cochlear decline. A sex-dependent "crossover" was observed: females exhibited superior hearing in their 60s and 70s but experienced more rapid deterioration in late life, resulting in comparable or poorer thresholds than males by their 80s and 90s.

In this tertiary-care outpatient cohort of older Chinese adults, ARHL demonstrated distinct age- and sex-specific trajectories,including disproportionate high-frequency vulnerability and a late-life sex crossover effect. Adoption of WHO 2020 criteria substantially increased hearing-loss identification, particularly among adults in their 60s and 70s.