<p>Hypothyroidism is associated with many otologic symptoms, Such as hearing loss, tinnitus, vertigo and etc. Therefore, it was considered to investigate the ontological manifestations in people with hypothyroidism and its response to thyroid hormone therapy. To assess relation between hypothyroidism and otologic manifestations and compare them with control group and effect of treatment on them. A case–control study was conducted on people aged 20–67 years. At the beginning of the study, there were 110 people who were divided into 2 groups. The case group included hypothyroid patients (n = 55) and the control group included healthy people (n = 55) who entered the study with informed consent. For all patients, ear examination including examination under the microscope, examination with tuning fork and audiometry was performed. A total of 46 people in the case group and 49 people in the control group were examined. In the hypothyroid group, 45.7% of the patients were male and in the control group, 49.0%. In general, hearing complications in hypothyroid patients (71.7%) were more than the control group (30.6%). In hypothyroid patients, 16 (34.8%) had evidence of hearing loss in audiogram and 11 (23.9%) complained of vertigo (<i>p</i> &lt; 0.05). After treatment with levothyroxine, otology complications decreased from 77.1 to 26.1%. Hypothyroid patients had significant degrees of hearing damage. Improvement in hearing parameters occurred after levothyroxine replacement therapy over a 6-month period.</p>