Used, but in very good condition. The first image is a stock image; the tips are not (and never were) as white as that; they're more of an ivory color. They work perfectly. They do not include the original case or additional "flange" tips, but those are very easy (and cheap) to buy online.
From Etymotic's website:
Transparent, reference-quality sound | For audiophiles, performing musicians and recording engineers | For mixing, monitoring and critical listening | Accurate real-ear response | Unsurpassed isolation from outside sound
The ER4 MicroPro earphones are the next best thing to live music, with noise isolation far surpassing that of active noise-canceling earphones. The ER4s require NO batteries, and can be plugged into any audio source. Their external noise exclusion -- 35 dB with 3-flange eartips... allows you to hear the full dynamic range of recordings without having to play them at unnaturally high and unsafe levels.