Objective To explore the application value of distortion product otoacoustic emission (DPOAE) and speech in noise(SIN) testing in occupational health surveillance of noise-exposed workers. Methods A total of 220 noise-exposed workers was selected as the study subjects using the convenient sampling method. The study subjects participated questionnaire survey, personal noise exposure assessment, acoustic immittance testing, pure tone audiometry (PTA), DPOAE and SIN testing. According to PTA results, workers were enrolled into a high-frequency hearing loss (HFHL) group and a non-HFHL group. Results The detection rate of HFHL among the study subjects was 41.4%, and the detection rate of speech-frequency hearing loss was 15.9%. Workers′ bilateral DPOAE response amplitudes and signal-to-noise ratios at frequencies of 2.0-8.0 kHz in the HFHL group were lower than those in the non-HFHL group (all P<0.05). The DPOAE amplitudes at frequencies of 1.0-8.0 kHz in both ears of the study subjects were negatively correlated with the PTA threshold (all P<0.01), and were negatively correlated with age (all P<0.01). The signal-to-noise ratio loss score was higher among worker in the HFHL group than in the non-HFHL group (P<0.01) and was positively correlated with PTA thresholds (P<0.05). Conclusion DPOAE and SIN testing can detect early cochlear outer hair cell impairment and reduction of noise-related speech recognition ability in noise-exposed workers and may serve as an effective supplementary tool to routine PTA in occupational hearing surveillance.