Background and ObjectivesTo investigate the association between metabolic syndrome (MetS) and hearing impairment (HI) in elderly Korean adults using a large-scale cohort data. Subjects and Method Data was collected on 729664 adults who underwent at least one health screening between 2009 and 2012 from the Korea National Health Insurance Service-Senior Cohort. The study utilized a Cox proportional hazards regression model to assess the relationship between MetS and the risk of developing HI. The results were presented as an adjusted hazard ratio (aHR) with 95% confidence intervals (CI). All subjects were monitored until the occurrence of HI, death, or December 31, 2019. Results A total of 10102 cases of HI were identified during the follow-up period of 4920397 person-years. In the crude model, MetS was linked to an increased risk of developing HI (HR, 1.14; 95% CI,. No significant association was found after adjusting for potential confounding factors (aHR, 1.03; 95% CI, 0.99-1.08). Abnormal triglyceride (TG) levels were associated with a higher risk of HI compared to normal TG levels (aHR, 1.07; 95% CI, 1.03-1.12). In addition, the risk of HI increased as TG levels increased (>150 mg/dL). Conclusion Abnormalities in TG levels were independently associated with an increased risk of HI among elderly adults. Management of TG levels may protect against the risk of incident HI.