OBJECTIVE: To assess relations between tinnitus and suicidality, measured by suicidal ideation and suicide attempts. DATA SOURCES: CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS databases were searched from inception through June 14, 2024. REVIEW METHODS: Observational studies related to suicidality in tinnitus patients at least 18 years old were included. Case reports and studies on objective or pulsatile tinnitus were excluded. Two authors extracted data, and disagreements were resolved with a third party if needed. The risk of bias was assessed according to the Risk Of Bias In Non-randomized Studies of Exposure for cohort studies and the Joanna Briggs Institute critical appraisal checklist for cross-sectional studies. Random effects meta-analyses (single means, proportions, and relative risks (RR)) were used for primary analysis. RESULTS: Nine studies (n = 912,013) pertaining to suicidality and tinnitus in an adult population were included. The tinnitus group experienced a significantly higher prevalence of suicidal ideation (19.5% [95% CI: 12.9%-27.1%] versus 9.9% [95% CI: 7.1%-13.2%]) and suicide attempts (1.9% [95% CI: 0.1%-5.7%] versus 0.9% [95% CI: 0.0%-3.9%]) than the control population (p <
0.0001). The tinnitus group had a significantly (p <
0.001) higher risk of suicidal ideation (RR = 2.1, 95% CI: 1.6-2.8) and suicide attempts (RR = 1.8, 95% CI: 1.3-2.4) than the control group. CONCLUSION: Nearly one in five people with tinnitus will experience suicidal ideation, and nearly 2% will attempt suicide. Thus, otolaryngologists should be mindful of the increased risk of suicidality in patients with tinnitus.