Hearing loss is a growing public health burden, and aging and occupational noise exposure are two major contributors. This cross-sectional study examined whether phenotypic age acceleration interacts with occupational noise exposure in relation to hearing loss. We included 2,014 adults from the National Health and Nutrition Examination Survey 2005–2010, representing 16,596,487 non-institutionalized U.S. adults after survey weighting. Hearing loss was defined as concordant objective audiometric impairment and self-reported hearing difficulty. Phenotypic age acceleration was derived from the residual of phenotypic age regressed on chronological age. After adjustment for sex, race, body mass index, diabetes, and hypertension, occupational noise exposure was associated with higher odds of hearing loss (OR = 2.35, 95% CI: 1.56–3.43; p < 0.001), as was accelerated phenotypic aging (OR = 2.05, 95% CI: 1.53–2.67; p < 0.001). These associations remained after additional adjustment for chronological age. In the weighted joint analysis, participants with both occupational noise exposure and accelerated phenotypic aging had the highest odds of hearing loss (OR = 5.51, 95% CI: 3.31–9.28). In an unweighted sensitivity analysis, the joint-exposure OR was 12.98 (95% CI: 6.10–27.60), with positive additive interaction indices (RERI = 7.79, AP = 0.60, SI = 2.90). Mediation analysis showed no significant indirect effect through phenotypic age acceleration (mediation proportion = 0.34%; p = 0.19). These findings suggest that occupational noise exposure and accelerated biological aging may jointly increase hearing loss risk.