Clinical Utility of a Tamil SIN Test in Tinnitus with Normal Audiograms: Insights from Behavioral and Electrophysiological Measures

Clinical Utility of a Tamil SIN Test in Tinnitus with Normal Audiograms: Insights from Behavioral and Electrophysiological Measures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Utility of a Tamil SIN Test in Tinnitus with Normal Audiograms: Insights from Behavioral and Electrophysiological Measures ARUNKUMAR M This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7146156/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Introduction Tinnitus, the perception of sound without an external source, is a common auditory disorder that may occur even in individuals with normal hearing. Such cases are often associated with Hidden Hearing Loss (HHL), involving suprathreshold deficits linked to cochlear synaptopathy and neural dysfunction, undetectable by standard audiometry. Speech-in-noise (SIN) testing, particularly in the listener’s native language, along with objective measures like otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs), can help uncover these deficits. This study evaluated the clinical utility of a validated Tamil SIN test in detecting hidden auditory deficits in individuals with tinnitus and normal hearing, supported by electrophysiological measures including OAE fine structure and ABR. Materials and Methods Fifteen adults with chronic bilateral tinnitus and 15 age- and gender-matched controls with normal hearing participated. SIN performance was assessed using a validated Tamil sentence-in-noise test. The electrophysiological assessment included transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem responses (ABRs). Group comparisons were made using independent-sample t-tests. Results Compared to controls, the tinnitus group demonstrated significantly higher SNR-50 thresholds and greater SNR loss in the Tamil SIN test, indicating impaired speech-in-noise recognition. DPOAE amplitudes were markedly reduced across mid- to high-frequency ranges, suggesting subclinical cochlear dysfunction. ABR results revealed prolonged absolute latencies of Waves I and III and elevated interaural latency differences of Wave V, consistent with early neural conduction abnormalities. All key differences were statistically significant (p < 0.05), supporting the presence of suprathreshold auditory deficits in tinnitus patients with clinically normal hearing. Conclusion This study confirms that individuals with tinnitus and normal audiograms exhibit both behavioral and electrophysiological signs of hidden hearing loss. The Tamil SIN test, when used alongside DPOAE and ABR, offers a sensitive and language-appropriate tool for detecting subclinical auditory dysfunction. These findings underscore the need to incorporate suprathreshold testing in routine audiological evaluations of tinnitus, even when standard thresholds are within normal limits. Tinnitus Hidden Hearing Loss Tamil Speech-in-Noise Test Auditory Brainstem Response Distortion Product Otoacoustic Emissions Normal Audiogram Suprathreshold Deficit Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7146156","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513130357,"identity":"881001fe-8e49-11f0-907b-06cc9d20a69f","order_by":0,"name":"ARUNKUMAR M","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYJACxgYwdSDB4OM/GxC/8QBxWhgPPCicwZYG5hOphfngg888bIchFuJTzj/7jNnDmW3b5M3bDidu4OE5b7e2/TDQlhqbaFxaJM7lmBtubLttOOfMsWQDCYnbydvOJAK1HEvLbcCl5wyPmeTDttuMMyTOpBkYGNxONjsA1MLYcBinFnmoFvsZ8u+//0hIOJdsdv4hfi0GIC1AhyXOAAXygQMH7MxuELDF8AxbmeSMc7eTQVoMGxuSE8xuAG1JwOMXuTPM2yR7ym7bgrQY/22wszc7n/7wwYcaG9zeRweJYJUJxCoHAXtSFI+CUTAKRsHIAADnamzLrKGYIwAAAABJRU5ErkJggg==","orcid":"","institution":"Vinayaka Missions Medical College and Hospitals","correspondingAuthor":true,"prefix":"","firstName":"ARUNKUMAR","middleName":"","lastName":"M","suffix":""}],"badges":[],"createdAt":"2025-07-17 07:38:36","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-7146156/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-7146156/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103989481,"identity":"e7190810-f3f3-41c2-a874-1c0b7e627b60","added_by":"auto","created_at":"2026-03-05 11:12:01","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":451845,"visible":true,"origin":"","legend":"","description":"","filename":"MANUSCRIPTREVISEDTSPIN.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7146156/v2_covered_1435c3db-f6a4-4c99-92be-f04449ee7633.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Utility of a Tamil SIN Test in Tinnitus with Normal Audiograms: Insights from Behavioral and Electrophysiological Measures","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tinnitus, Hidden Hearing Loss, Tamil Speech-in-Noise Test, Auditory Brainstem Response, Distortion Product Otoacoustic Emissions, Normal Audiogram, Suprathreshold Deficit","lastPublishedDoi":"10.21203/rs.3.rs-7146156/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7146156/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\u003cp\u003eTinnitus, the perception of sound without an external source, is a common auditory disorder that may occur even in individuals with normal hearing. Such cases are often associated with Hidden Hearing Loss (HHL), involving suprathreshold deficits linked to cochlear synaptopathy and neural dysfunction, undetectable by standard audiometry. Speech-in-noise (SIN) testing, particularly in the listener\u0026rsquo;s native language, along with objective measures like otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs), can help uncover these deficits.\u003c/p\u003e\u003cp\u003eThis study evaluated the clinical utility of a validated Tamil SIN test in detecting hidden auditory deficits in individuals with tinnitus and normal hearing, supported by electrophysiological measures including OAE fine structure and ABR.\u003c/p\u003e\u003cp\u003eMaterials and Methods\u003c/p\u003e\u003cp\u003eFifteen adults with chronic bilateral tinnitus and 15 age- and gender-matched controls with normal hearing participated. SIN performance was assessed using a validated Tamil sentence-in-noise test. The electrophysiological assessment included transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem responses (ABRs). Group comparisons were made using independent-sample t-tests.\u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003eCompared to controls, the tinnitus group demonstrated significantly higher SNR-50 thresholds and greater SNR loss in the Tamil SIN test, indicating impaired speech-in-noise recognition. DPOAE amplitudes were markedly reduced across mid- to high-frequency ranges, suggesting subclinical cochlear dysfunction. ABR results revealed prolonged absolute latencies of Waves I and III and elevated interaural latency differences of Wave V, consistent with early neural conduction abnormalities. All key differences were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), supporting the presence of suprathreshold auditory deficits in tinnitus patients with clinically normal hearing.\u003c/p\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003cp\u003eThis study confirms that individuals with tinnitus and normal audiograms exhibit both behavioral and electrophysiological signs of hidden hearing loss. The Tamil SIN test, when used alongside DPOAE and ABR, offers a sensitive and language-appropriate tool for detecting subclinical auditory dysfunction. These findings underscore the need to incorporate suprathreshold testing in routine audiological evaluations of tinnitus, even when standard thresholds are within normal limits.\u003c/p\u003e","manuscriptTitle":"Clinical Utility of a Tamil SIN Test in Tinnitus with Normal Audiograms: Insights from Behavioral and Electrophysiological Measures","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-09-10 13:29:42","doi":"10.21203/rs.3.rs-7146156/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2025-08-25 19:36:14","doi":"10.21203/rs.3.rs-7146156/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8d877e8-f03a-4152-88bd-f50086d9948f","owner":[],"postedDate":"September 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T11:11:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-10 13:29:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-7146156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7146156","identity":"rs-7146156","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}