This cross-sectional study analyzed NHANES data (2012–2018) from 4,950 U.S. adults to examine the relationship between blood levels of five heavy metals (lead, cadmium, mercury, selenium, and manganese) and tinnitus. The findings showed that higher levels of lead and cadmium were significantly associated with increased odds of tinnitus, particularly at higher exposure levels, while mercury and selenium demonstrated more complex, nonlinear relationships. No significant association was found for manganese. These relationships remained robust after adjusting for demographic and health factors, though effect strength varied by sex and ethnicity. Overall, the study suggests that environmental exposure to certain heavy metals may contribute to tinnitus risk and could serve as indicators for prevention and management strategies.