X0206 3 2020-06-25 0 0001722271 Akouos, Inc. AKUS 0001606826 Preston Heather C/O AKOUOS, INC. 645 SUMMER STREET SUITE 200 BOSTON MA 02210 1 0 1 0 Series B Preferred Stock Common Stock 1499971 I See Footnote The Series B Preferred Stock is convertible into Common Stock on a 21.073-for-1 basis into the number of shares of Common Stock as shown in Column 3 without payment of further consideration at the holder's election or upon closing of the initial public offering of the Issuer's common stock. The shares have no expiration date. The reportable securities are owned directly by Pivotal bioVenture Partners Fund I, L.P. ("Pivotal"). The Reporting Person is a managing partner of Pivotal bioVenture Partners Management Ltd. ("Investment Advisor"), which is the investment advisor to Pivotal, and is managing partner of Pivotal bioVenture Partners Investment Advisor, LLC, which is the U.S. sub-advisor to the Investment Advisor. Therefore, the Reporting Person may be deemed to beneficially own the shares held by Pivotal. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of the Reporting Person's pecuniary interest therein, if any. Exhibit Index: 24.1 Power of Attorney /s/ Karoline K. Shair, as attorney-in-fact for Heather Preston 2020-06-25