A study published on November 15 in the journal iScience found that some AirPods were able to help people with mild to moderate hearing loss. Audiology experts and bioengineers in Taiwan tested Apple’s AirPods 2 and AirPods Pro alongside premium and basic hearing aids sold in the region. Among the two wireless headphone models, the AirPods Pro stood out, meeting four out of five technology standards for hearing aids, the researchers note. “We want to try to break the barrier and popularize the use of hearing devices for our patients,” says Yen-Fu Cheng, an author on the study and an otolaryngologist at Taipei Veterans General Hospital. In the US, nearly 50 percent of people 75 and older develop disabling hearing loss. Yet, one 2012 study estimates that 75 percent of individuals with the condition don’t use hearing aids. There are a number of potential reasons for this, Cheng says, including discomfort, ease of use, age stigma, accessibility, and cost. In their paper, his team mentions that Taiwanese market prices for premium hearing aids are around $10,000, while the basic type are $1,500. Hearing aids in the states, meanwhile, can cost between $900 to $6,000. (The Food and Drug Administration (FDA) approved over-the-counter hearing aid devices to alleviate some of the accessibility and cost issues.) Hearing aids must go through very careful inspection and tests by otolaryngologists and audiologists, and meet specific technology standards, Cheng says. “But many patients don’t want to use it even after they own it because they often say it makes them look old, or handicapped. We started to think about what could be some alternatives.” An array of assistive hearing devices, many of which don’t require a prescription, have been exploding on the market—but they come with different benefits. For instance, personal sound amplification products (PSAPs) aren’t intentionally designed as a hearing tool, but happen to amplify audio in ways that might help certain patients. Cheng and his collaborators wanted to see if Apple AirPods 2 and AirPods Pro, which cost $129 and $249, respectively, could be a more affordable and stylish option for individuals with mild to moderate hearing loss, who’d be served by situational boosts in hearing quality. “These people are like patients who are nearsighted and don’t think they need to use eyeglasses, but whenever they use it all the words are so clear,” he says. For their study, the researchers worked with a pool of 21 patients in Taiwan—whose average age was 41—with mild to moderate hearing loss. They tested Apple’s Live Listen feature, which utilizes the iPhone’s microphone to transmit audio directly to Bluetooth-paired AirPods in real time. The feature has been used to listen in on hard-to-hear sounds like bird calls or quiet speakers in a big lecture hall (and sometimes for eavesdropping). But it could also double as an assistive hearing device by amplifying sounds in noisy environments. “It’s actually pretty fun,” says Cheng. “You can use this function in a very noisy cocktail party to talk to your friends, but you can actually use it as a very good assistive device if you want to get a better signal out of the noise.” When used with the noise-canceling AirPods Pro, Live Listen can boost conversation volumes while maintaining safe-listening levels, filter in some outside noises to heighten awareness through “transparent mode,” and play calming sounds that can relieve tinnitus (a constant ringing in one’s ear). It just so happens that these accessibility features also benefit those with hearing loss. The study authors had the subjects perform a Hearing in Noise Test, commonly known as HINT, where patients were read various sentences in Mandarin like “the electricity bills went up recently” and were asked to repeat them verbatim. They completed these tests either wearing the different headphones and hearing aids, both in quiet settings and environments with background noise. Unsurprisingly, the premium hearing aid provided the best assistance. The AirPods 2 weren’t able to provide the same quality as the other devices, but the researchers found that the earbuds were better than wearing no hearing device at all. The AirPods Pro, however, performed just as well as the basic hearing aids in a quiet environment. Interestingly, the direction of background noise impacted participants’ ability to hear with the AirPods Pro in the more buzzy settings: Participants could still hear well when the sound came from the sides, but struggled when it came from the front. Ying-Hui Lai, a collaborator on the paper and a bioengineer at National Yang Ming Chiao Tung University in Taipei, thinks the difference may be due to the signal processing algorithm in the chip of the AirPods Pro. “I hope that [Apple] can improve the algorithm and the internal [buzz] in future AirPod generations so that they will be a better fit,” he says. He also notes that other companies like Sony, Bose, and Jabra are working on these kinds of assisted hearing devices. “I think that in the future there will be more products that can be selected for hearing loss patients.” More enhanced headphones and earbuds could provide solid sound amplification, but it’s worth noting that they still aren’t a full replacement for hearing aids, says Lindsey Jorgensen, a practicing audiologist and chair of communications disorders at the University of South Dakota. In the study, the AirPods Pro met “kind of your minimum standards,” she explains. “So if you think about car emission standards, my car meets the emission standards, but it’s not a fully electric vehicle, right? Electric vehicle emission outputs would be significantly less than my gasoline-powered vehicle’s.” She stresses that patients need to understand that PSAPs and wearables like AirPods aren’t going to alleviate or assist hearing loss in the same way as medical-grade hearing aids. While the results from the Taiwanese research are promising, Jorgensen also points out the small sample size and that the phrases used in HINT assessments can be somewhat predictable for patients. In fact, the test is not generally used in the US for this reason. This is even more important now that the FDA has cleared OTC hearing aids for adults with mild to moderate hearing loss, which could potentially help patients save up to $3,000. Devices from select companies that fit this category have been available since mid-October, but even so, Jorgensen advises going to your medical audiologist and getting a hearing test to know where your levels are before making a purchase. “Some audiologists are very nervous about over-the-counter hearing aids, but we do recommend them to some people,” like “on-the-edge patients,” she says. “We’ll start with an over-the counter-hearing aid, and then if that doesn’t work, we could go up to another option.” The AirPods Pro aren’t approved in the OTC category in the US—and Cheng agrees that they shouldn’t be confused for or called hearing aids. That said, he hopes the results of the study demonstrate that they can still be a nifty option in certain scenarios. “I think it’s great for patients with hearing loss that they have more choices. If they want to have a professional hearing aid for their work they can choose the very high-end one, but if they just want to have one to improve their conversation with their family members at home or a quiet environment, I think the AirPod Pro might work as well.”
