Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 0 0 2025 10 11 1474 1474 Arun Kumar M Assistant professor Department of BASLP, SRBS, Vinayaka mission medical college and hospital, Karaikal, Puducherry India. Arun Banik Dean & Director, Professor (Speech and Hearing) School of Rehabilitation and Behavioural Sciences Vinayaka Mission Research Foundation (Deemed to be University) Aarupadai Veedu Medical College, Puducherry, India 2025 07 18 2025 10 08 Background and Aim: Tinnitus often occurs in individuals with normal audiograms and may reflect hidden hearing loss (HHL). Conventional audiometry fails to detect these suprathreshold deficits. This study evaluated the clinical utility of a validated Tamil Speech-in-Noise (SIN) test, supported by otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs), in detecting HHL in tinnitus patients. Methods: Thirty native Tamil-speaking adults were recruited: 15 with chronic bilateral tinnitus and 15 matched controls. All had normal hearing thresholds. Participants underwent the Tamil SIN test, transient evoked OAEs, distortion product OAEs, and click-evoked ABRs. Group differences were analyzed using independent-sample t-tests. Results: The tinnitus group showed significantly higher SNR-50 thresholds and SNR loss compared to controls, indicating impaired SIN perception. Both DPOAEs and TEOAEs were significantly reduced across frequencies, confirming cochlear dysfunction despite normal audiograms. ABR analysis revealed delayed Wave I and Wave III latencies, with marginal prolongation of Wave V, indicating early auditory nerve involvement. Conclusion: Tinnitus patients with normal audiograms demonstrate measurable auditory deficits, reflecting HHL. The Tamil SIN test, complemented by OAE and ABR, provides a culturally appropriate and sensitive protocol for early detection. These findings highlight the limitations of pure-tone audiometry and support integrating multimodal assessments into tinnitus evaluations. https://avr.tums.ac.ir/index.php/avr/article/view/1474