This study aimed to explore clinical characteristics and prognosis of elderly cases with sudden sensorineural hearing loss. Fifty-five elderly cases with sudden sensorineural hearing loss and 55 younger cases with sudden sensorineural hearing loss were enrolled in the study. Recovery rates of hearing between elderly group and younger group were compared. In elderly group, the recovery rate of hearing in the patients with normal hearing of the contralateral ear was compared to those with hearing loss of the contralateral ear. The overall recovery rate in the elderly group was 50.9%, significantly lower than 74.5% in the younger group ( < .01). Among the elderly group, the patients with normal hearing of the contralateral ear recovered better than those with hearing loss of the contralateral ear (recovery rates, 76.7% versus 20.0%). Among the elderly group, the recovery rate of cases with treatment onset ≤14 days was 64.7%, while the recovery rate of those with treatment onset longer than 14 days was only 28.6%, with significant difference ( < .01). Elderly cases with sudden sensorineural hearing loss had poor prognosis. Prognosis of elderly cases with sudden sensorineural hearing loss was associated with hearing of the contralateral ear and treatment onset.