Apple headphones can work as hearing aids. Minnesota-based Starkey says it welcomes competition.

Ross Graham loves loud bands like Nine Inch Nails, and in his younger days he used to frequent ear-numbing concerts and crank up the volume on his headphones. He thinks it was a 2013 concert by the Reverend Peyton's Big Damn Band in Indianapolis that probably wrecked his hearing.

"I left and thought, 'Wow, my hearing is not going to be the same," Graham said. To fix the ringing in his ears, Graham, 52, has dished out roughly $7,490 for Starkey hearing aids through his audiologist. The hearing aids come with annual checkups and adjustments, free replacement parts and hearing tests.

His Apple AirPods 2, which he uses as hearing aids on rainy days, cost $249.

Launched in September, the Silicon Valley tech giant's hearing aid technology is disrupting a hearing-aid market that has long endured the gaze of officials critical of high prices. The Food and Drug Administration recently authorized Apple's "Hearing Aid Feature" as the first over-the-counter hearing aid software device.

The chief executive of Minnesota-based Starkey, the United States' largest hearing aid manufacturer, said Apple's technology is no cause for worry.

"I like competition because that makes you better and the patient wins," CEO Brandon Sawalich said. "You push for better technology."

Sawalich and AirPod users say that Apple's technology increases awareness for hearing health and peels back the stigma of wearing hearing aids. In the United States, researchers have estimated that 1 in 5 people has hearing loss in at least one ear. But Sawalich said the technology doesn't compare to Starkey's hearing aids, which can translate languages and prevent falls; a pair of $6,000 hearing aids are a health care product, not a commodity.

"If I need a knee replacement, I'm not going to go ask, 'Who makes that knee? Can I get it cheaper?'" Sawalich, who wears hearing aids, said. "I want to know I'm going to do the best because I have to hear every day for my job."

Apple declined a request for comment.

Silicon Valley meets Medical Alley

The FDA in August 2022 allowed companies to start selling hearing aids over the counter, and the devices became available in stores such as Costco and Walmart. In September, the FDA authorized Apple's Hearing Aid Feature, which amplifies sounds for people with perceived mild to moderate hearing problems.

After taking a hearing test, Apple guides AirPods Pro 2 users to its hearing aid feature that "boosts frequencies so sounds are clearer and more vibrant to your ears. It also uses machine learning to make real-time adjustments as you go about your day," the company says on its website. The stock of European hearing aid companies like Sonova dropped following Apple's product unveil in September, according to Reuters.

A Sonova spokesperson said in a statement that while the company is still examining the Apple software's full functionality and capabilities, Sonova has always been supportive of "new, innovative ways of creating awareness for the important topic of hearing health."

"However, we strongly believe that hearing care professionals will remain central to the hearing care market and most people with hearing loss will ultimately seek their expertise and support," Sonova's statement continued.

AirPod users said the devices are low-cost alternatives.

For Graham, of Indianapolis, the AirPods don't compare to his Starkey Evolv AI 2400 hearing aids. He said the Apple AirPods' feature makes his voice sound microphonic. But they serve as a convenient alternative when he heads to events where he worries about misplacing his Starkey pair.

Joe McMahon's hearing loss also dates back to the days of loud bands.

The 67-year-old San Jose, Calif., software engineer put off purchasing hearing aids for years after encountering the type of salesman "that you just really can't wait to get away from," he said.

After setting up the Apple feature on his AirPods, he said he sat down and chatted with his wife and thought, "Good heavens, I could have a conversation with her and she didn't have to repeat anything."

The AirPods' limited four to six hours of battery life prompted McMahon to upgrade to hearing aids: He purchased the Philips HearLink 40 miniRITE T pair at Costco, which cost $1,549.99. "Things are a little bit sharper," he said of the hearing aids' quality compared with Apple's feature.

Prabu Venkatraman, a Leesburg, Va., resident, said he struggles to hear sounds like the high-frequency beep of a microwave. He has opted for the AirPods instead of hearing aids. Apple's hearing test felt similar to a professional one he received, he said, encouraging others to test it out.

"There are many people who do not know that they have a hearing loss," said Venkatraman, 54.

One vision: 'To be the best'

Catherine Palmer, a former president of the American Academy of Audiology, said the Apple technology is useful for people who don't have access to an audiologist. "Anything that calls attention to the negative result of untreated hearing loss … and provides accurate information is a win," Palmer said in an email to the Minnesota Star Tribune.

Sawalich, the Starkey CEO, agrees. Sitting at a conference table at the company's Eden Prairie headquarters on Thursday, he clapped when asked for his thoughts on the technology. It prompted people to address their hearing problems and ask for help, he said.

European companies dominate the hearing aid market, with four of the "Big Five" industry leaders based there. Starkey, which has 5,000 employees and 29 facilities around the world, is the only one based in the United States — it was founded in Hopkins and headquartered in Eden Prairie today.

"Prices for traditional hearing aids are out of reach for a lot of people, and they don't understand why it costs several thousands of dollars to buy a traditional hearing aid," said Brent Lucas, CEO of Envoy Medical, a Minnesota-based company that makes fully implantable hearing systems. "Now, you'll be able to buy [AirPods Pro] for a couple of hundred dollars, program it on your phone and really get a benefit."

Competitors sacrifice quality for price, Sawalich said. "Not Starkey," he added.

"I have one vision for Starkey, and I share this with all the employees for the last two years: to be the best," Sawalich said.

Starkey's hearing aids typically cost in the thousands, while over-the-counter aids can cost in the hundreds. The latter typically just amplify sound, Sawalich said, while Starkey's adapt to unique environments and are customizable. They also often come with audiologist appointments. The company has found tumors during hearing tests at the headquarters, Sawalich said.

The company's hearing aids also run for days, track health and incorporate AI. Unlike Apple's AirPods, users don't feel the hearing aid, he said.

Sawalich said there's no plans to sell an ultra-low-cost hearing aid. He suggested that could hurt the company's reputation.

Starkey is a private company, and Sawalich says it generates more than $1 billion in annual revenue. It saw record sales in October, he said, up 7% over the previous record month of March 2023. In five years, he said, he wants to be "10 years ahead of our competition."

"I don't want to be like everybody else," Sawalich said. "Our priority is simple: What's best for the patient is best for our customer is best for Starkey."