Background: This study aimed to investigate the association between early-onset cataract and tinnitus using a population-based database. Methods: Retrospective claims data from the Taiwan National Health Insurance Research Database were analysed. Study subjects comprised patients with early-onset cataract, aged 20-55 years and diagnosed between 2000 and 2010 (n = 2084) and a comparison cohort without the disease (n = 8336). Both cohorts were followed until 2010 to estimate the incidence of tinnitus. To calculate the risk of tinnitus in the case and control groups, Cox proportional hazards models were used and presented as hazard ratios (HRs), adjusted HRs (aHRs) and 95% confidence intervals (CIs). Results: Patients with early-onset cataract had 1.53-fold increased risk (HR = 1.53, 95% CI = 1.17-2.01, p < 0.01) of developing tinnitus than controls. The number of patients with vertigo (p < 0.0001), insomnia (p < 0.0001), anxiety (p < 0.0001) and hearing loss (p < 0.0001) as comorbidities was also significantly higher in the case group. After adjusting for age, sex and all listed comorbidities, patients with increasing age (aHR = 1.04, 95% CI = 1.02-1.07), early-onset cataract (aHR = 1.32, 95% CI = 1.01-1.74), vertigo (aHR = 1.75, 95% CI = 1.15-2.67), insomnia (aHR = 1.48, 95% CI = 1.14-1.93) and hearing loss (aHR = 6.20, 95% CI = 3.58-10.70) had significantly higher risk of tinnitus. Conclusions: Patients with early-onset cataract are at an increased risk of developing tinnitus in subsequent years and should receive further evaluation for early diagnosis and management if any signs of tinnitus occur.