Objectives <p>Although the link between hearing loss and tinnitus is well established, the relationship between tinnitus-related distress and the degree of hearing impairment remains insufficiently explored. This study aimed to investigate the association between tinnitus severity and hearing thresholds using a large-scale population-based dataset.</p> Methods <p>From the 8th and 9th Korea National Health and Nutrition Examination Surveys during 2020–2022, 10,028 participants with complete information on demographics, hearing thresholds, tinnitus status, and normal tympanic membranes were included. Participants were classified into three groups according to the visual analogue scales (VAS) for tinnitus distress: non-tinnitus (no tinnitus within the past year), non-bothersome tinnitus (VAS score 0–4), and bothersome tinnitus (VAS score ≥ 5). Their hearing thresholds was analyzed according to the sex and chronicity.</p> Results <p>Hearing thresholds worsened with increasing severity of tinnitus-related distress (<i>p</i> &lt; 0.001). The bothersome tinnitus group showed the highest proportion of moderate (17.25%), moderately severe (12.45%), and severe-to-profound (6.37%) hearing loss and the lowest proportion of normal hearing (34.77%). This pattern was observed in both males and females overall and in those with chronic tinnitus, whereas in acute tinnitus, it was observed only in males, although not statistically significant. Males showed worse hearing thresholds and greater severity in the non-bothersome and bothersome tinnitus than females.</p> Conclusion <p>Tinnitus was significantly associated with hearing loss, even when distress was mild, and greater distress corresponded to more severe impairment. These findings highlight the importance of considering tinnitus severity when estimating hearing levels and providing appropriate counseling for hearing evaluation.</p>