Purpose: 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.

Method: A cross-sectional evaluation was conducted at a university audiology clinic. Digitally literate iPhone users (n = 25; age 20-72) independently used AirPods Pro 2 to complete the Apple Hearing Test Feature (HTF) and activate the OTC-HAF. The sample size aligns with usability model recommendations for moderately complex systems. Outcomes were assessed immediately after setup.

Results: Usability was high, with a mean mHealth App Usability Questionnaire (MAUQ) score of 6.7/7 (0.3 SD) and mean Hearing Aid Skills and Knowledge Inventory-Clinical (HASKI-clin) score of 93.4% (9.0% SD). 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 non-significant speech-in-noise benefit (QuickSIN mean benefit 0.1 dB SNR, 1.9 SD), and real-ear measurements showed gain levels generally below NAL-NL2 targets.

Conclusions: The Apple OTC-HAF showed high usability and satisfaction among digitally literate iPhone users, but non-significant 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.