<p>Presbycusis, or age-related hearing loss, is a common progressive sensorineural hearing impairment typically seen in the elderly. However, its early onset in younger age groups, especially in urban environments, is becoming a growing concern due to lifestyle and environmental changes. To determine the prevalence and risk factors associated with early-onset presbycusis among adults aged 30–50 years in an urban population attending a tertiary care hospital. A descriptive cross-sectional study was conducted among 219 patients aged 30–50 years attending the ENT outpatient department of Maulana Azad Medical College, New Delhi, India from January to Dec 2024. Patients with ear complaints or histories suggestive of otological pathology were excluded. Detailed clinical histories were obtained, and otoscopic examination was performed. Pure tone audiometry was done to assess hearing thresholds across 500–8000&#xa0;Hz frequencies. Patients showing bilateral symmetrical high-frequency sensorineural hearing loss were diagnosed with early-onset presbycusis. Of 219 participants, 30 (13.7%) were diagnosed with early-onset presbycusis. A statistically significant association was found with increasing age (<i>p</i> = 0.04), male sex, smoking (<i>p</i> = 0.034), occupational chemical exposure (<i>p</i> = 0.006) and chronic noise exposure(p-value of 0.054). High-risk occupations included tailors, factory workers, security guards, and maids. Comorbidities such as diabetes, hypertension, cardiovascular disease, and alcohol consumption did not show significant associations in our study. The study reveals a noteworthy prevalence of early-onset presbycusis in urban adults, highlighting the influence of modifiable risk factors like occupational exposure, smoking, and noise pollution. Preventive strategies, early screening, and health education programs are essential to mitigate the rising burden of early hearing loss in urban settings.</p>