© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objectives To evaluate whether gout is associated with a higher risk of hearing loss in older adults. Design Retrospective cohort study. Setting USA. Participants 5% random sample of US Medicare claims 2006-2012, representative of US adults aged 65 years or older. Primary and secondary outcomes Incident (new) hearing loss identified by the presence of at least two claims at least 4 weeks apart with an International Classification of Diseases, Ninth Revision, 389.xx, with no respective claim in the baseline 1-year observation period. Results Among the 1.71 million eligible people, 89 409 developed incident hearing impairment. The crude incidence rates of incident hearing impairment in people with versus without gout were 16.9 vs. 8.7 per 1000 person-years. Using Cox regression analyses adjusted for demographics, medical comorbidity and common cardiovascular and gout medications, we found that gout was associated with a significantly higher HR of incident hearing impairment, HR was 1.44 (95% CI 1.40 to 1.49, p<0.0001). Findings were confirmed in sensitivity analyses that substituted continuous Charlson-Romano Index with categorical variable or all comorbidities and additionally cardiovascular risk factors, with minimal attenuation of HR. Conclusions Gout is associated with a higher risk of development of hearing loss in older adults. Future studies need to assess the underlying mechanisms of this association.