AbstractObjectiveTo understand the effect of age on health‐related quality of life (HRQoL) in patients with hearing loss and determine how primary language mediates this relationship.Study DesignCross‐sectional study.SettingGeneral otolaryngology clinic in Los Angeles.MethodsDemographics, medical records, and HRQoL data of adult patients presenting with otology symptoms were reviewed. HRQoL was measured using the Short‐Form 6‐Dimension utility index. All patients underwent audiological testing. A path analysis was performed to generate a moderated path analysis with HRQoL as the primary outcome.ResultsThis study included 255 patients (mean age = 54 years; 55% female; 27.8% did not speak English as a primary language). Age had a positive direct association with HRQoL (p< .001). However, the direction of this association was reversed by hearing loss. Older patients exhibited significantly worse hearing (p< .001), which was negatively associated with HRQoL (p< .05). Primary language moderated the relationship between age and hearing loss. Specifically, patients who did not speak English as a primary language had significantly worse hearing (p< .001) and therefore worse HRQoL (p< .01) than patients who spoke English as a primary language with hearing loss. Increasing age was associated with bilateral hearing loss compared to unilateral hearing loss (p< .001) and subsequently lower HRQoL (p< .001). Polypharmacy (p< .01) and female gender (p< .01) were significantly associated with lower HRQoL.ConclusionAmong otolaryngology patients with otology symptoms, older age and not speaking English as a primary language were associated with worse hearing and subsequently lower HRQoL.