Background <p>Hearing loss is one of the most prevalent challenges of aging, often leading to diminished quality of life (QOL) and heightened psychological distress. This study aims to explore the relationship between psychological distress and QOL in older adults with hearing loss attending outpatient clinics in Tehran, in 2024.</p> Methods <p>This cross-sectional descriptive-analytical study included adults aged 60 years and above with hearing impairment who sought care in outpatient clinics. Hearing loss was assessed using the whisper test, while data on psychological distress and QOL were gathered using the Kessler Psychological Distress Scale (K10) and the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S). Demographic data were also collected using a structured questionnaire.</p> Results <p>The study included participants with a mean age of 72 ± 5.9 years, comprising 53.3% males. Age demonstrated a moderately strong positive correlation with both QOL (<i>r</i> = 0.550, <i>p</i> &lt; 0.001) and psychological distress (<i>r</i> = 0.383, <i>p</i> &lt; 0.001). In contrast, educational attainment was inversely associated with QOL (<i>r</i> = − 0.351, <i>p</i> &lt; 0.001), though no significant relationship was found between education and psychological distress (<i>r</i> = − 0.008, <i>p</i> = 0.594). Neither QOL nor psychological distress exhibited statistically significant associations with gender or cohabitation status (<i>p</i> &gt; 0.05). Notably, a robust positive correlation emerged between psychological distress and QOL (<i>r</i> = 0.606, <i>p</i> &lt; 0.001), suggesting a nuanced interdependence between these factors in older adults with hearing loss.</p> Conclusion <p>The findings underscore the need for targeted interventions to mitigate the effects of hearing loss on psychological well-being and QOL among older adults. Future research and comprehensive programs focusing on hearing health could significantly enhance this vulnerable population’s mental and emotional well-being.</p>