ImportanceTinnitus is a prevalent condition among noise-exposed workers, with significant implications for hearing health and quality of life. Identifying associated factors can inform prevention and management strategies.ObjectivesTo identify factors associated with tinnitus prevalence among noise-exposed workers and assess the effectiveness of hearing protection in mitigating tinnitus.DesignCross-sectional study.SettingData from the National Health and Nutrition Examination Surveys database.ParticipantsThis study included 4931 noise-exposed workers (mean age 48.9 ± 0.3 years). Participants were categorized into speech-frequency hearing loss (SFHL; n = 1032, mean age 67.2 ± 0.4 years) and high-frequency hearing loss (HFHL; n = 1634, mean age 62.9 ± 0.3 years) groups based on hearing threshold levels.Intervention or ExposuresNoise exposure duration, hearing loss severity, demographics, and medical history. Hearing protection usage was assessed for its effectiveness in preventing tinnitus.Main Outcome MeasuresPrimary outcome: tinnitus prevalence. Associations were analyzed using logistic regression, with factors including self-reported noise exposure, hearing loss severity, demographics, and medical history.ResultTinnitus prevalence was 32.85% in the group with SFHL and 29.99% in the group with HFHL. Prolonged noise exposure and greater hearing loss severity were associated with tinnitus in both groups. Hearing protection usage was potentially linked to a lower tinnitus prevalence in HFHL but not in SFHL. For SFHL, univariate analysis showed lower tinnitus prevalence in older age and females, while Caucasian ethnicity and higher income were associated with higher prevalence. Multivariate analysis indicated that older age was positively associated with tinnitus ( < .05). In HFHL, factors such as higher BMI, higher educational level, and elevated Patient Health Questionnaire-9 (PHQ9) scores were significantly associated with tinnitus prevalence.ConclusionsProlonged noise exposure and hearing loss severity among noise-exposed workers were associated with tinnitus prevalence in SFHL and HFHL. Hearing protection showed tendency to reduce tinnitus prevalence in HFHL but had a limited effect in SFHL. Higher BMI, higher education levels, and elevated PHQ9 scores were significantly associated with tinnitus in HFHL, warranting further research into protective strategies.RelevanceFuture studies should explore alternative protective strategies for SFHL patients and refine tinnitus prevention approaches in noise-exposed workers.