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Background: Effective management of hearing loss in adults is fundamental for communication, relationships, employment, and learning. This study examined the rates and management of self-reported hearing loss in urban Aboriginal and Torres Strait Islander adults. Methods: A retrospective, observational study of Aboriginal and Torres Strait Islander people aged ≥15 years who had annual health checks at an urban Aboriginal and Torres Strait Islander primary healthcare clinic in Inala, Queensland, was conducted to determine self-reported hearing loss rates by age and ethnic groups stratified by sex. A medical record audit of patients who self-reported hearing loss from January to June 2021 was performed to identify current management approaches, and the proportion of patients that were appropriately managed. Results: Of the 1735 patients (average age 40.7 years, range 15.0–88.5 years, 900 [52.0%] women) who completed 3090 health checks between July 2018 and September 2021, 18.8% self-reported hearing loss. Rates did not differ between men and women. However, significant effects were noted for age, with rates increasing from 10.7% for patients aged 15–24 years to 38.7% for those aged ≥65 years. An audit of 73 patient medical records revealed that 39.7% of patients with self-reported hearing loss were referred to Ear, Nose and Throat/audiology or received other management. A total of 17.8% of patients owned hearing aids. Conclusions: Only 40% of Aboriginal and Torres Strait Islander adults who self-reported hearing loss were referred for management. Significant changes to clinical management and government-funded referral options for hearing services are required to improve the management of self-reported hearing loss in this population. Limited evidence on hearing loss in Aboriginal and Torres Strait Islander adults exists. In this primary care adult population, the rate of self-reported hearing loss was 18.8%. Only two in five adults received further action to manage their hearing loss with successful hearing outcomes evident. Hearing loss in Aboriginal and Torres Strait Islander adults is underreported, undermanaged, and requires urgent attention from health professionals and government policymakers to enhance its clinical management leading to improved quality of life. [ABSTRACT FROM AUTHOR]