Tone-in-notched-noise testing for screening high-frequency sensorineural hearing loss

High-frequency sensorineural hearing loss (HF-SNHL) is typically permanent and progressive, making early detection important. This study evaluated masked tone thresholds in narrowband noise (TNB), notched noise (TNN), and their derived difference (TFS) for HF-SNHL screening at 4 and 8 kHz. Eighty-eight participants (18–79 years) with normal hearing or varying degrees of HF-SNHL completed testing using a self-administered Frequency Selectivity Screener application on consumer-grade devices. TNN demonstrated equivalent or better within-session test–retest reliability than TNB and TFS, with Bland–Altman limits of agreement of ±3.11 dB at 4 kHz and ±4.07 dB at 8 kHz. TNN also showed stronger associations with pure-tone audiometric thresholds (Spearman's ρ = 0.84–0.87). Diagnostic accuracy, evaluated using receiver operating characteristic curves, was excellent for TNN (area under the curve 0.90 at both frequencies), outperforming TNB and matching the performance of TFS. Despite its assumed advantage for isolating peripheral dysfunction, TFS provided no diagnostic advantage over TNN alone. These findings support TNN testing as a reliable suprathreshold, frequency-specific measure for HF-SNHL screening that could complement conventional audiological assessments. Further studies are warranted to validate its utility across diverse populations and for longitudinal monitoring.