Abstract: Objective To understand the difficulty during the diagnosis of occupational noise-induced deafness. Methods The data of 164 cases who applied for diagnosis of occupational disease in 2015 was analyzed. Results All the cases were suspected as victims by regular occupational health examinations and among them 149 cases were already diagnosed as the suspected patients with occupational noise-induced deafness (90.9%) by other occupational health service agencies. After these patients received a series of examination during hospitalization period, 60 cases were finally diagnosed as the occupational noise-induced deafness (36.6%),including 55 cases from 149 suspected patients. One hundred and four undiagnosed cases were found that the weighted value of hearing threshold of either ear was under 26 dB(37/104); or the time of occupational exposure to noise was less than 3 years(29/104); or there was inconsistency between the subjective and objective hearing tests(27/104); or the binaural high-frequency hearing threshold was under 40 dB (7/104) and the noise intensity at workplaces was under 85 dB(A)(4/104). The retrospective analysis showed that there was no difference of diagnosis accuracy among different health service agencies(P>0.05). Conclusion The objective hearing tests are effective means of identification of the exaggerated deaf and pseudo deaf. Proper training should be provided for the workers to reduce exaggerated deafness cases during occupational health examination.