Early detection of non-organic hearing loss using a simple tone-in-noise test

Early detection of non-organic hearing loss (NOHL) is important in order to ensure appropriate management decisions. One possible audiometric test for achieving this is the tone-in-noise (TIN) test although its current format is not widely applicable and may not optimize accuracy. We sought to investigate a modified TIN test, using narrowband noise, and the influence of different noise levels and alternative approaches to determining the outcome. Seventy-five normal-hearing and 8 hearing-impaired subjects were asked to feign or exaggerate a hearing loss. The shift in genuine or exaggerated/feigned thresholds with the introduction of ipsilateral noise was determined. The TIN test was able to accurately separate between genuine and feigned thresholds when using narrowband noise presented at the effective masking level corresponding to the apparent tone threshold and using a 'fail' criterion of a repeatable threshold shift of ≥ 10 dB at one or more frequencies. It also produced similar shifts in exaggerated thresholds. In conclusion, this modified TIN test is a potentially accurate method to rapidly identify unilateral and bilateral NOHL in a wide range on contexts and could be applied to automated audiometry.