Tinnitus is a multifactorial condition with limited effective treatment options. Natural compounds have been proposed to modulate molecular pathways potentially involved in its pathophysiology, although clinical evidence remains preliminary. This retrospective observational study, conducted without a control group, evaluated 92 patients receiving a multi-compound nutraceutical (4 capsules/day) containing Auricularia auricula-judae, Curcuma longa, Hericium erinaceus, Ganoderma lucidum, Berberis aristata, and Rosa canina. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI) at baseline (T0), 1.5 months (T1), and 3 months (T2). Concurrently, hearing thresholds were evaluated at T0 and T2. Patients were stratified into secondary (Group A; N = 48) and primary (Group B; N = 44) tinnitus. THI scores decreased significantly in both groups over time (p 7-point THI reduction). Hearing thresholds remained stable in both groups. A modest correlation between THI and dB variation was observed in Group A at T2 (r = 0.346; p