The rising use of earphones among young adults has raised concerns over early-onset noise-induced hearing loss (NIHL). To assess the prevalence and severity of hearing loss in young adult earphone users and its association with listening volume, duration, and years of usage. An analytical cross-sectional study was conducted with 350 participants aged 18–25 years at a tertiary care hospital. Data were gathered via structured questionnaires and pure tone audiometry. Overall, 17.6% of participants had bilateral mild sensorineural hearing loss, and 32% showed a 4 kHz dip—an early indicator of NIHL. Hearing loss was more prevalent among in-ear device users and those with 4–7 years of earphone usage. No significant associations were found between gender or preferred volume and hearing loss severity. Prolonged earphone use, especially with in-ear devices and over several years, is significantly associated with early NIHL. Public awareness, safe listening practices, and regular audiometric screening are vital preventive measures. © 2025 Elsevier B.V., All rights reserved.