The recent U.S. Food and Drug Administration authorization of AirPods Pro as over-the-counter hearing aids (HAs) has increased interest in consumer devices as potential alternatives to traditional amplification; however, their electroacoustic performance relative to clinically fitted HAs remains unclear. The purpose of this study was to compare the electroacoustic characteristics and real-ear measures of AirPods Pro 2nd generation (APP2), AirPods Pro 3rd generation (APP3), and a traditional receiver-in-the-canal HA across mild flat, mild-to-moderate sloping, and moderate flat hearing loss configurations. Outcome measures included 2cc coupler output curves, saturation sound pressure level for a 90 dB input (SSPL90), real-ear speech mapping, maximum power output (MPO), and real-ear-to-coupler differences. Coupler-based electroacoustic measures showed that APP2 and APP3 produced output comparable to the traditional HA (within 7 dB). SSPL90 outputs were similar for APP2 and APP3, whereas the HA demonstrated profile-dependent increases. In contrast, real-ear measurements demonstrated that both APP2 and APP3 consistently produced less output relative to the HA that was fitted to NAL-NL2 targets, with the largest deviations observed for moderate hearing loss and at higher frequencies (up to 14 dB). Across all configurations, MPO was consistently highest for the HA, with both AirPods devices exhibiting reduced maximum output, especially in speech-critical frequency regions. Real-ear-to-coupler difference findings indicated reduced acoustic coupling for APP3 relative to APP2 and the HA, contributing to reduced in-ear amplification despite comparable coupler outputs. While AirPods Pro may offer benefit for mild hearing loss or moderate high-frequency hearing loss, they do not provide output comparable to prescriptively fitted HAs. These findings underscore the continued importance of clinical verification and prescription-based fitting of hearing assistive technology for achieving appropriate audibility across hearing loss configurations.
AirPods Pro 3 incorporate an in-ear optical heart-rate sensor, but independent validation during exercise is limited. We evaluated agreement between AirPods Pro 3 heart rate and an ECG-derived chest-strap reference (Polar H10) during graded treadmill exercise in a controlled laboratory setting. Forty adults (mean age 23·8 years; 37·5% female) completed a protocol comprising rest and progressive exercise stages targeting ~40-85% of age-predicted maximal heart rate, including rapid workload transitions. Heart-rate time series from both devices were synchronised by timestamp and aggregated into non-overlapping 5-s epochs. Agreement was assessed using a repeated-measures Bland-Altman approach implemented via a linear mixed-effects model with participant-level random effects; absolute error metrics were calculated at the participant level and summarised overall and by intensity category. Across 16,735 paired epochs, mean bias was -0·03 beats·min ⁻ ¹ (AirPods Pro 3 minus Polar H10; 95% CI -0·22 to 0·17), indicating negligible systematic error. The total standard deviation of differences was 5·23 beats·min ⁻ ¹, yielding 95% limits of agreement from -10·27 to 10·22 beats·min ⁻ ¹, with greater dispersion at higher heart rates. Overall mean absolute error was 2·08 beats·min ⁻ ¹ and mean absolute percentage error was 2·02%, with mean absolute error ranging from 1·31 to 2·4 beats·min ⁻ ¹ across intensity categories. AirPods Pro 3 therefore provided heart-rate estimates closely aligned with a validated chest-worn reference during graded treadmill exercise in healthy adults, with minimal bias and low average error but wider epoch-to-epoch variability at higher intensities.
This study aimed to assess the feasibility of the Apple AirPods Pro with the headphone accommodation feature as a hearing assistive device for patients with mild to moderate hearing loss (HL). The study included a total of 35 participants with mild to moderate HL. To determine the degree of HL in the participants, a screening test using pure-tone audiometry was conducted prior to the main tests of functional gain, word recognition score (WRS), and sentence recognition in noisy environments. The study employed two hearing devices: the Bean (a personal sound amplification product, PSAP) and the AirPods Pro. Regarding functional gain, there were no significant differences between the Bean and the AirPods Pro at all frequencies, except 8 kHz. In terms of WRS, both the Bean and the AirPods Pro had higher scores than the unaided condition. In sentence recognition, both the Bean and the AirPods Pro had higher scores than the unaided condition. During real-ear measurement, the Bean demonstrated consistent frequency responses, while the AirPods had a deviation exceeding 10 dB SPL at 6 kHz in the left ear. This deviation was absent for all other frequencies. This study shows that the Apple AirPods Pro, with its headphone accommodation feature, performed similarly to a validated PSAP and improved hearing compared to unaided conditions.
The purpose of this study was to evaluate the benefit of the Apple AirPods Pro 2 Live Listen feature on speech recognition and recall in noise among older adults in a controlled laboratory setting. Twenty adults aged 60-90+ years completed a modified speech-in-noise task with and without AirPods using the Live Listen feature. A Quick Speech-in-Noise Test-derived task measured recognition and recall under both conditions. Participants also completed audiometric screening, working memory assessment, and signal-to-noise ratio (SNR) loss estimation. Paired t tests and multiple regression analyses were used to assess performance differences and predictors. Participants demonstrated significantly higher speech recognition (p < .00001) and recall (p = .00023) when using Live Listen. Recognition improvements were predicted by age, SNR loss, and sex, while recall improvements showed no significant predictors. The Live Listen feature of the Apple AirPods Pro 2 significantly improved speech-in-noise performance in older adults. These preliminary findings support its potential as an affordable assistive tool in noisy environments, such as hospitals, where traditional hearing aids may be unavailable.
To investigate the extent to which Headphone Accommodations in Apple AirPods Pro attend to the hearing needs of individuals with normal audiograms who experience hearing difficulties in noisy environments. Single-arm interventional study using acoustic measures, speech-in-noise laboratory testing, and real-world measures via questionnaires and ecological momentary assessment. Seventeen normal-hearing individuals (9 female, 21-59 years) with self-reported hearing-in-noise difficulties. Acoustic measures showed that, relative to unaided, AirPods Pro provided a SNR advantage of +5.4 dB. Speech intelligibility performance in laboratory testing increased 11.8% with AirPods Pro, relative to unaided. On average, participants trialling AirPods Pro in real-world noisy venues reported that their overall hearing experience was a bit better than without them. Five participants (29%) reported that they would continue using AirPods Pro in the future. The most relevant barriers that would discourage their future use were limited hearing benefit, discomfort, and stigma. Occasional use of AirPods Pro may help some individuals with normal audiograms ameliorate their speech-in-noise hearing difficulties. The identified barriers may inspire the development of new technological solutions aimed at providing an optimal management strategy for the hearing difficulties of this segment of the population.
We aimed to record deviation of Apple AirPods Pro 2 Hearing Aid Feature (HAF) output from prescriptive targets (i.e., NAL-NL2) using two manually entered, standardized audiograms. We also aimed to record the acoustic effects of the HAF tuning controls and their utility for fine tuning HAF outputs. HAF output was quantified by real-ear aided responses measured bilaterally in an acoustic manikin using 55, 65, and 75 dB SPL recorded speech inputs. Repeated measurements were made for left and right earbuds, from two sets of AirPods Pro 2 devices. Two manually entered, standardized audiograms (mild- and moderate-sloping hearing losses) were used to generate prescriptive targets. Fine tuning by a researcher towards validated prescriptive targets was explored using "Amplification" and "Tone" sliders on an iPhone. For both manually-entered audiograms, under-amplification relative to targets was observed at HAF's default setting; however, match to targets could be achieved after fine tuning. The "amplification" slider gives ∼10 dB of broadband level changes, while "Tone" slider gives ∼5-10 dB of spectral tilt. We provide preliminary data supporting the potential of HAF for fitting patients with manually-entered mild- and moderate-sloping audiograms. HAF tuning controls could be used to meet prescriptive targets.
To evaluate the accuracy, test-retest reliability, and time-efficiency of Apple's Hearing Test Feature (HTF) compared to reference standard pure-tone audiometry (PTA). Cross-sectional validation study. Single-center study at a university clinic. PTA was performed in a sound-treated booth. HTF testing occurred in a quiet room. A sample of 25 adults (mean age 50.1 years [SD 14.2]; 68% female) with self-reported mild-to-moderate hearing loss participated. Each contributed 16 thresholds, yielding 400 comparisons. Participants underwent PTA by an audiologist, followed by two independent HTF assessments (start and end of session) using Apple AirPods Pro 2 paired with an iPhone 13. Outcomes included threshold accuracy versus PTA, test-retest reliability, and test duration. Across 400 comparisons, 86.5% of HTF thresholds were within 10 dB HL of PTA. Root mean square deviation (RMSD) values ranged from 3.3 to 7.9 dB HL (left ear) and 5.8 to 9.7 dB HL (right ear), meeting minimally acceptable accuracy (≤10 dB HL). Test-retest was reliable, 84.1% of thresholds within 5 dB HL and 96.6% within 10 dB HL. Desired reliability (≤6 dB HL) was met at all frequencies except 250 Hz (left ear), which met minimum acceptable level. HTF was significantly faster (median 5.5 minutes) than PTA (10.0 minutes; P < .001). Apple's HTF demonstrated clinically acceptable accuracy and reliability, with improved time-efficiency compared to PTA. Findings support its potential for consumer-led hearing monitoring and OTC hearing aid self-fitting. Further research should assess inter-device reliability and integration with Apple's Hearing Aid Feature.
Apple AirPods Pro 2 recently received approval from the US Food and Drug Administration for use as an over-the-counter hearing aid device, the first approval of an over-the-counter hearing aid software by the Agency.
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Apple's new hearing health experience with AirPods Pro 2 was released this Fall of 2024, allowing any user with a compatible iPhone and AirPods Pro 2 to perform hearing tests and use the device as a hearing aid for perceived mild to moderate hearing loss. This innovation may increase accessibility to hearing testing and hearing augmentation for the public but there are many potential drawbacks that will impact hearing loss care. The advent of AirPods Pro 2 and the inevitable arrival of similar devices to the market will alter the clinical practice. It is crucial for our field to learn about this technology and prepare for changes in practice.
This study provides the first independent evaluation of the Apple Over-the-Counter Hearing Aid Feature (OTC-HAF), examining its usability and laboratory performance among adults with self-perceived mild-to-moderate hearing loss. A cross-sectional evaluation was conducted at a university audiology clinic. Digitally literate iPhone users (n = 25, ages 20-72 years) independently used AirPods Pro 2 to complete the Apple Hearing Test Feature and activate the OTC-HAF. The sample size aligns with usability model recommendations for moderately complex systems. Outcomes were assessed immediately after setup. Usability was high, with a mean mHealth App Usability Questionnaire score of 6.7/7 (SD = 0.3) and a mean Hearing Aid Skills and Knowledge Inventory-Clinical score of 93.4% (SD = 9.0%). Study-specific questionnaire responses showed high satisfaction, good sound quality, and ease of use. Qualitative feedback highlighted affordability, convenience, and dual-purpose design, with some noting occlusion and difficulty locating settings. Some participants reported they would only use the device situationally. The audiogram import feature showed limited accuracy: 71% of thresholds were within 5 dB of the reference when both ears were scanned together and 73% when each ear was scanned separately, with 12% and 8% of thresholds missing for these methods, respectively. Objective performance measures showed nonsignificant speech-in-noise benefit (Quick Speech-in-Noise Test mean benefit of 0.1 dB SNR, SD = 1.9), and real-ear measurements showed gain levels generally below National Acoustic Laboratories-Non-Linear 2 targets. The Apple OTC-HAF showed high usability and satisfaction among digitally literate iPhone users, but nonsignificant speech-in-noise benefit and gain levels generally lower than prescriptive targets. Further research should explore broader applicability, long-term outcomes, and strategies to support uptake and consistent use. https://doi.org/10.23641/asha.31366123.
The use of inertial measurement unit (IMU) sensors for gait analysis has become more prevalent. More options are being offered under the development of wearable smart devices and smartphones. These techniques provide a cost-effective way to collect motion data from everyday activities, addressing the limitations of controlled laboratory environments. Despite the potential of these technologies, there are still many challenges in analyzing gait data from everyday life. Experiments involved 16 participants (7 women, 9 men; mean age: 27.69 years) who performed walking, jogging, and going up and down stairs under three smartphone-carrying conditions: pocket, backpack, and shoulder bag. Data were collected using iPhone 14, Apple Watch Series 10, and AirPods Pro, supplemented with Xsens motion capture for ground truth. IMU data from accelerometers and gyroscopes were preprocessed and standardized before applying Principal Component Analysis (PCA). A novel sliding window-based algorithm was developed for gait segmentation and grouping, featuring a Continuity-Matching Score (CMS) for evaluating both continuity and match quality. The proposed algorithm achieved an overall segmentation accuracy of 89.25%, with the highest performance (90.38%) observed when the smartphone was carried in a pocket. Rand Index values confirmed reliable gait grouping, with minor accuracy reductions under more dynamic carrying conditions, such as backpacks. For walk-only dataset, segmentation accuracy improved to 95.67%, while for run-only dataset, the accuracy reached 96.21%. This study introduced a system for daily-life gait analysis using consumer-grade IMU-equipped devices. The algorithm is capable of handling data containing multiple gait types, achieving reliable segmentation and grouping of synchronous gaits. Future work will focus on enhancing algorithm adaptability to dynamic environments and expanding its applicability to larger and more diverse datasets.
Difficulty understanding speech in noisy environments is a primary challenge of hearing impairment, inadequately addressed by hearing aids alone. While auditory training can enhance selective attention and speech perception, current digital programs face poor user adherence and lack realistic 3D spatial audio. This pilot study evaluated the feasibility, usability, and preliminary efficacy of ARIA (Augmented Reality Immersive Auditory training), a handheld mobile intervention that provides gamified at-home auditory training to middle-aged adults via earbud-delivered spatial audio. In this single-arm, pre-post-follow-up pilot study, 11 adults (mean age 53.0, SD 3.0 y) with functional hearing not requiring amplification completed a 4-week at-home training program using ARIA on provided devices (iPhone 14 Pro, AirPods Pro 2). Speech-in-noise perception was assessed via the Korean Matrix Sentence Test at baseline, 4 weeks, and 8 weeks at 3 signal-to-noise ratios (SNRs; 0 dB, -6 dB, and -9 dB, respectively). Feasibility, usability (System Usability Scale), user experience (Player Experience of Need Satisfaction), in-game performance, and qualitative feedback were collected. Protocol completion was 100% (11/11), demonstrating technical feasibility. Exploratory efficacy analyses revealed statistically significant speech-in-noise improvements posttraining across all conditions (0 dB: t10=3.43, P=.02; -6 dB: t10=5.34, P<.001; -9 dB: t10=4.34, P=.004). Gains were maintained at the 8-week follow-up. In-game localization improvements correlated significantly with speech perception gains at -6 dB SNR (ρ=0.639; P=.03) and -9 dB SNR (ρ=0.612; P=.045). User experience showed mixed results: the mean System Usability Scale score was 70.2 (SD 19.6; range 47.5-92.5), reflecting substantial individual differences in usability perception. While 72% (n=8) reported difficulties with the augmented reality (AR) environmental setup, 63% reported genuine mastery-driven engagement with core gameplay. Thematic analysis revealed a dissociation between peripheral usability challenges (setup friction, "homework" characterization due to protocol structure) and successful engagement with the training paradigm itself. This pilot demonstrated the feasibility of AR-based audio-motor training for at-home delivery and revealed encouraging preliminary efficacy signals, warranting progression to controlled efficacy trials. Formative findings identified specific usability refinements needed for broader implementation, particularly streamlining AR setup while preserving the core gameplay elements that successfully fostered competence and engagement. These insights provide clear guidance for platform optimization and randomized controlled trial design.
CSF diversion through ventricular shunt placement is a mainstay of hydrocephalus treatment, and the advent of programmable shunt valves in the last 40 years has continued to improve treatment options. Programmable shunt valves allow noninvasive setting adjustment with magnetic programming devices. However, since there are objects in everyday life that emit magnetic fields, the shunt valve setting may be unintentionally changed. The authors aimed to summarize the current literature on handheld, wearable, and earpiece devices and their impact on programmable shunts, as well as explore the effect of the magnetic field of handheld and wearable electronics when actively in use in common positions on programmable shunt valve settings. The following reprogrammable shunt valves were tested: Medtronic Strata II, Codman Hakim, and Codman Certas. The electronic devices used were Apple AirPods Pro 2, Bose QC 45, Oculus Meta Quest 3, Apple iPad 6, and Apple iPhone 15. A shunt valve with a predetermined setting was attached to the skull model in the right parieto-occipital and right frontal locations. The devices in their active mode were placed on or around the ear for a minimum of 5 minutes. The shunt valve setting was then rechecked. As rotary motion may impact magnetic fields, secondary testing with various motions was performed and the shunt setting was rechecked. The programmable shunt valves were set as follows: Medtronic Strata II at 1.5, Codman Hakim at 70 mm H2O, and Codman Certas at 4. After a minimum of 5 minutes of realistic interaction with the aforementioned electronics, the shunt setting was rechecked. The shunt setting remained the same in each case tested. It is safe for children and adults with hydrocephalus and programmable shunt valves to use common handheld and wearable electronics without concern for their shunt valve setting being affected unknowingly.
Some tobacco companies have announced support for transitioning people who smoke to non-combustible tobacco products. However, tobacco manufacturers continue to spend billions of US$ annually promoting combustible products. This study examined the prevalence and characteristics of three types of promotions offered by leading US combustible brands. We identified leading US cigarette and cigar brands by market share and conducted online searches to determine which of these brands had brand-specific websites. A total of 11 cigarette and 8 cigar brand websites were included, representing 85.6% and 90.3% of cigarette and cigar sales, respectively. Each brand website was dual-coded for content related to coupons, rewards programmes and sweepstakes. All cigarette brand websites offered coupons, while 27.3% promoted rewards programmes. Examples of prizes offered through rewards programmes included Apple AirPods, Ray-Ban sunglasses, GoPro cameras, cigarette coupons and a variety of gift cards (eg, Uber Eats). Moreover, 45.5% of cigarette brand websites promoted sweepstakes, offering prizes, including instant cash, a motorcycle and a vacation. Among leading cigar brands, 12.5% offered coupons and 37.5% promoted rewards programmes, with prizes including cigar coupons, cigar branded clothing and ashtrays. None of the cigar brands offered sweepstakes. Many leading US combustible tobacco product brands incentivise continued combustible product use through offerings of free prizes and reduced prices, including some brands made by manufacturers that claim to be committed to tobacco harm reduction. Marketing restrictions may be needed to address combustible tobacco product use.
Background: Transparency mode in hearables aims to maintain environmental awareness by transmitting external sounds through built-in microphones and speakers. While technical assessments have documented acoustic alterations in these devices, their impact on spatial hearing abilities under realistic listening conditions remains unclear. This study aimed to evaluate how transparency mode affects sound localization performance with and without background noise. Methods: Ten normal-hearing adults completed sound localization tasks across azimuth (±90°) and elevation (±30°) with and without background noise. Performance was assessed with and without AirPods Pro in transparency mode. Sound localization performance was evaluated through linear regression analysis and mean absolute errors. Head-Related Transfer Function measurements quantified changes in binaural and spectral cues. Results: While interaural time differences were largely preserved, transparency mode introduced systematic alterations in level differences (up to 8 dB) and eliminated spectral cues above 5 kHz. These modifications resulted in increased localization errors, particularly for elevation perception and in noise. Mean absolute errors increased from 6.81° to 19.6° in azimuth and from 6.79° to 19.4° in elevation without background noise, with further degradation at lower SNRs (p < 0.05). Response times were affected by background noise (p < 0.001) but not by device use. Conclusions: Current transparency mode implementation significantly compromises spatial hearing abilities, particularly in noisy environments typical of everyday listening situations. These findings highlight the need for technological improvements in maintaining natural spatial cues through transparency mode, as current limitations may impact user safety and communication in real-world environments.
Given the low prevalence of hearing aid use among individuals with hearing loss due to their high costs and social stigma, personal sound amplification products (PSAPs) may serve as alternatives with adequate hearing compensation and greater accessibility. This study examined the electroacoustic features of hearing aids and selected smartphone-bundled earphones, specifically AirPods, as PSAPs, and compared hearing performances among adults with mild-to-moderate hearing loss when aided with each hearing assistive device. Our results indicated that AirPods Pro met four out of five PSAP standards. No significant differences were found regarding speech perception between AirPods Pro and hearing aids in quiet but not with the presence of background noises. AirPods Pro may have the potential to be a hearing assistive device for adults with mild-to-moderate hearing loss. More research is needed to investigate the safety and feasibility of using earphones bundled with other smartphones as PSAPs.
Electronic products, including the iPhone 12, Apple Watch Series 6, and 2nd Generation AirPods, contain magnets to facilitate wireless charging. Permanent magnets may affect CIED magnet mode features by causing pacemakers to pace asynchronously and defibrillators to suspend arrhythmia detection. This study determined if CIEDs are affected by static magnetic fields from commonly used portable electronics (PE) at any distance and intends to reinforce FDA recommendations concerning consumer PE which contain permanent magnets. The maximum magnet field measurement was evaluated by a Gauss meter. The interaction between PE and CIEDs from Boston Scientific and Medtronic were tested ex vivo using a body torso model. The CIED was placed in physiologic saline, and the PE was placed at the surface and at increasing distances of 0.5, 1.0, and 1.5 cm. Interactions were recorded by assessment of magnet mode status. The iPhone 12 had almost three times the static magnetic field measured at the surface as the iPhone XR, but magnetic field strength decreased dramatically with increasing distance. At the surface of the model, PE triggered magnet mode in all CIEDs. The maximum interaction distance for all combinations of CIEDs and Apple products was 1.5 cm. The iPhone 12 produces a stronger static magnetic field than previous iPhone models. Magnets in PE tested will not interact with CIEDs when they are 15 cm from the implanted device. Since no interaction was observed beyond 1.5 cm, it is unlikely that magnet mode activation will occur during most daily activities.