We aimed to assess associations between dietary intake of fats (saturated and monounsaturated fats and cholesterol) and certain food groups (butter, margarine, and nuts) with the prevalence, incidence, and progression of age-related hearing loss. We also aimed to investigate the link between serum lipids and cholesterol-lowering medication (statins) and hearing loss. The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss. Hearing loss was measured in 2956 participants (aged ≥50 y) and was defined as the pure-tone average (PTA) of frequencies 0.5, 1.0, 2.0, and 4.0 kHz > 25 dB hearing level (PTA0.5–4kHz). Dietary data were collected using a semiquantitative FFQ. After multivariable adjustment, the likelihood of prevalent hearing loss increased from the lowest (reference) to the highest quartile of dietary cholesterol intake (P-trend = 0.04). Among persons self-reporting statin use (n = 274), a 48% reduced odds of prevalent hearing loss was observed after multivariable adjustment [OR = 0.52 (95% CI = 0.29–0.93)]. Participants in the second and 3rd quartiles of dietary monounsaturated fat intake compared with those in the first quartile (reference) had a significantly reduced risk of hearing loss progression 5 y later [multivariable-adjusted OR = 0.39 (95% CI = 0.21–0.71)] and [OR = 0.51 (95% CI = 0.29–0.91)], respectively. Our results suggest that a diet high in cholesterol could have adverse influences on hearing, whereas treatment with statins and consumption of monounsaturated fats may have a beneficial influence.