This study aimed to explore the risk of dementia in a middle- and older-aged population with severe or profound hearing impairments. Data were collected for the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013. Participants aged 40 or older were selected. The 4,432 severely hearing-impaired participants were matched 1:4 with 17,728 controls, and the 958 profoundly hearing-impaired participants were matched 1:4 with 3,832 controls who had not reported any hearing impairment. Age, sex, income, region of residence, hypertension, diabetes mellitus, and dyslipidemia histories were matched between hearing-impaired and control groups. The crude (simple) and adjusted (age, sex, income, region of residence, dementia, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, cerebrovascular disease, and depression) hazard ratios (HRs) of hearing impairment on dementia were analyzed using Cox-proportional hazard models. The severe hearing impairment group showed an increased risk of dementia (adjusted HR = 1.17, 95% confidence interval [CI] = 1.04-1.31, P = 0.010). The profound hearing impairment group also showed an increased risk of dementia (adjusted HR = 1.51, 95% CI = 1.14-2.00, P = 0.004). Both severe and profound hearing impairments were associated with elevated the risk of dementia in middle- and older-aged individuals.