Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that may cause multiorgan inflammation and tissue damage, including auditory involvement. This study evaluated the association between SLE disease activity and hearing loss at Adam Malik Hospital. This analytic observational study used a cross-sectional design and was conducted at the Otorhinolaryngology and Internal Medicine outpatient clinics of Adam Malik Hospital from May to December 2025. The study population comprised patients with SLE diagnosed by an internal medicine rheumatology consultant. Forty-two patients who fulfilled the inclusion and exclusion criteria were enrolled in the study using a non-probability consecutive sampling technique. Data were analyzed using univariate and bivariate analyses, and receiver operating characteristic (ROC) analysis was performed to assess disease duration as a predictor of hearing loss. The study population was predominantly female (97.6%) and consisted of young adults. Mean disease duration was 5.21 ± 3.96 months, with a median of 5.5 months. Moderate disease activity based on the SLE Disease Activity Index (SLEDAI) was the most frequent category (38.1%). Mean hearing thresholds tended to increase with increasing frequency, indicating predominant high-frequency involvement. ROC analysis showed that disease duration had acceptable discriminative ability for hearing loss (AUC = 0.704), with an optimal cut-off of 6 months. Disease duration and SLE disease activity level were significantly associated with sensorineural hearing loss and hearing-loss severity. Higher SLE disease activity was associated with more severe hearing loss.