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Hearing loss in midlife is an important and potentially modifiable risk factor for the development of dementia. Research examining the association between dementia and hearing loss has expanded rapidly; however, evidence for the mechanisms linking the two conditions is inconclusive, limiting the development of targeted interventions. This review provides a critical overview of current evidence on dementia risk in relation to hearing loss, proposed mechanisms underpinning this association, and emerging evidence on the effectiveness of hearing interventions in modifying trajectories of cognitive decline, dementia risk, and disease progression. Alongside its role as a risk factor, hearing loss commonly co-occurs with dementia, highlighting the need for integrated approaches to care that address the considerable impact of these co-morbid conditions on individuals and communities. Finally, we emphasise the importance of including diverse populations in future research to improve generalisability of findings and help advance equity in dementia prevention and care.