Abstract: Over-the-counter (OTC) hearing aids aim to lower barriers to amplification for individuals with mild to moderate hearing loss. This study evaluated the electroacoustic performance of Apple’s new OTC hearing aid feature using standardized hearing loss profiles. Results showed that system-programmed gain levels often underfit NAL-NL2 targets for both mild and moderate losses. Gain limitations could be partially bypassed to reach targets for mild losses but remained insufficient for moderate losses. These findings suggest that Airpods Pro 2 provides adequate amplification for mild hearing loss. Combined with additional electroacoustic performance data, this study informs professionals about Apple’s highly anticipated OTC device.
Summary: Rationale Mild to moderate hearing loss affects approximately 1.4 billion people worldwide. To lower barriers to amplification devices, the FDA established a new category of over-the-counter (OTC) hearing aids for adults 18 years of age and older with perceived mild to moderate hearing loss in 2022. In response, Apple released an OTC hearing aid feature in its Airpods Pro 2 in fall 2024. With Apple’s leadership in global true wireless stereo market (22%), a surge of interest in using Airpods Pro 2 as an amplification device is anticipated among patients. This study aimed to support clinical professionals in counseling patients interested in OTC devices by evaluating the electroacoustic performance of this technology, specifically addressing the following questions:
1) Does the auto-programmed output provide sufficient gain for varying severities and configurations of hearing loss?
2) How much fine-tuning could be done by the user to increase or decrease frequency-specific gains?
3) When used with an iPhone as a remote microphone, what is the quality of signal transparency?
4) How much does the directional technology improve the signal-to-noise ratio across different noise configurations?
Methods Very mild, mild, and moderate flat and sloping hearing loss profiles were used to program an Apple Airpods Pro 2. These hearing loss profiles were from a published set of standard audiograms that reflect typical configurations for sensorineural hearing loss in adults. Various electroacoustic measures were made, including evaluations of match to prescriptive target and directional microphone verification. For test box measures, Airpods Pro 2 was coupled to Verifit 2 as an in-the-ear (ITE) device. Gain adjustment and frequency shaping were made by either adjusting Airpod gain settings on the iPhone and/or by entering a different hearing loss to bypass gain limits set for a given hearing loss. An iPhone 8 Plus was used to adjust Airpod settings and function as a remote microphone when appropriate. Two commercially-available medical grade hearing aids served as comparison devices.
Results Preliminary testing revealed that Apple Airpods Pro2’s self-programmed gain levels were lower than NAL-NL2 targets for audiograms with mild and moderate losses. The under-fit problem for the moderate hearing loss could not be resolved by either using maximum gain settings on the phone, or by entering a more severe hearing loss as a workaround. For the mild hearing loss, while maximum gain settings still resulted in an underfit, using a more severe hearing loss as the user’s hearing profile could bypass some limitations and approximate NAL-NL2 targets. Verification of using iPhone as a remote microphone revealed that the Airpods were able to output sounds at NL2 targets after adjusting the iPhone volume control.
Conclusions: Combined, these results imply a programmed gain ‘ceiling’ for amplification that limits the output of Airpods from reaching NL2 targets for moderate hearing losses. The matches to prescriptive targets demonstrate that Apple Airpods would provide appropriate amplification only for people who have mild hearing loss. These findings will aid clinicians in counselling patients who are interested in OTC products or specifically Apple products due to brand recognition.
Learning Objectives:
After this presentation, participants will be able to describe Apple Airpods Pro 2’s OTC hearing aid feature, in terms of sufficiency of gain, transparency of remote microphone signal, and directional microphone effectiveness.
2. After this presentation, participants will be able to describe situations where they might recommend the hearing aid feature of Apple Airpods 2 in their patient counseling.
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