Objective To investigate the characteristics of extended high frequency distortion product otoacoustic emission (EHF DPOAE) in idiopathic tinnitus patients with normal pure-tone average (PTA), and investigate the clinical values for finding early hidden hearing loss with EHF DPOAE in these patients. Methods In this study, 68 tinnitus patients (104 ears) with normal PTA (experimental group) and 40 normal PTA volunteers (40 ears) without tinnitus (control group) were enrolled. All subjects were tested with distortion product otoacoustic emission (DPOAE) of routine frequencies ranged from 1 to 6 kHz and EHF DPOAE of 8 to 12 kHz by using Neuro-Audio otoacoustic emission analyzer. Results The detectable rates of the routine DPOAE and EHF DPOAE for the control group were 97.2% and 88.7%, while those for the experimental group were 72.2% and 51.2%. The detectable rate of EHF DPOAE for the experimental group was significantly lower than that of the control group (P<0.001). The average DP amplitudes of the experimental group were significantly lower than those of the control group (P<0.001). The average SNRs of the experimental group were also significantly lower than those of the control group (P<0.001). Conclusion The detectable rate of EHF DPOAE is significantly lower than that of the routine DPOAE in tinnitus subjects with normal PTA and the DP amplitude of EHF DPOAE at each frequency decreases significantly, which indicates that the EHF DPOAE has higher sensitivity in diagnosing the hidden hearing loss for the idiopathic tinnitus patient with "normal hearing" than the routine DPOAE, and can reflect the early functional status of cochlear outer hair cell.