Purpose <p>This study explores the relationship between noise acceptance levels and tinnitus distress, focusing on individuals with chronic non-pulsatile tinnitus and normal hearing. Given the neurological overlap between tinnitus perception and noise suppression mechanisms, we hypothesized that increased tinnitus distress correlates with reduced noise acceptance.</p> Methods <p>28 individuals with tinnitus and 17 normal-hearing controls participated. The tinnitus group was categorized into bothersome and non-bothersome tinnitus based on Tinnitus Handicap Inventory (THI) scores. Psychoacoustic assessments, psychometric evaluations, and the Acceptable Noise Level (ANL) test were conducted. ANL, Background Noise Level (BNL), and Most Comfortable Listening Level (MCL) were compared across groups, and correlations between ANL scores and tinnitus distress measures were analyzed.</p> Results <p>Individuals with bothersome tinnitus exhibited significantly higher ANL scores than non-bothersome tinnitus and normal-hearing controls (<i>p</i> &lt; 0.001). BNL was significantly lower in the bothersome tinnitus group than in the control group (<i>p</i> = 0.001), whereas MCL did not differ significantly across groups. A positive correlation was found between ANL and THI scores (<i>r</i> = 0.51, <i>p</i> = 0.005), suggesting that greater tinnitus distress is associated with lower noise acceptance. No significant correlation was observed between ANL and psychoacoustic characteristics of tinnitus.</p> Conclusion <p>The findings indicate that individuals with bothersome tinnitus have reduced noise acceptance, likely due to deficits in central inhibitory mechanisms. The relationship between ANL and tinnitus distress supports the hypothesis that top-down noise suppression deficits contribute to tinnitus perception and its bothersomeness. These results underscore the importance of considering noise acceptance in tinnitus rehabilitation strategies.</p>