Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.