<p>Tinnitus, defined as the perception of sound without an external acoustic stimulus, has a multifactorial etiology, including metabolic, vascular, and neuro-otological factors. Microvascular dysfunction has been proposed as a possible mechanism in its pathogenesis. This study aimed to investigate whether changes in hematological parameters—specifically mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR)—are associated with tinnitus. In this retrospective case-control study, 100 patients aged 18–59 with tinnitus and 100 age- and sex-matched healthy controls were included. Controls underwent hearing screening during the same period. Subjects with hearing loss, anatomical ear abnormalities, or systemic diseases were excluded. Hematological values including hemoglobin, neutrophil, lymphocyte, platelet counts, MPV, NLR, and PLR were recorded and compared between groups. Neutrophil and lymphocyte counts were significantly higher in the tinnitus group. However, both NLR and PLR values were significantly lower in these patients compared to controls (<i>p</i> &lt; 0.05). The tinnitus group also had a significantly higher mean age and a greater proportion of female participants. Elevated neutrophil and lymphocyte levels may suggest an inflammatory or vascular role in tinnitus. However, the lower NLR and PLR findings complicate this interpretation, implying that other mechanisms may also be involved. Hematological markers such as NLR and PLR may contribute to understanding the underlying pathophysiology of tinnitus and warrant further investigation.</p>