One use-case I had was connecting an Android app over 4g to a backend service running on my development machine, for some ad-hoc debugging. Using a tool like this was more straightforward than setting something more permanent up manually (spinning up a server, certificates, DNS, etc). Especially for someone not super familiar with how to configure the tools involved.
The value is in getting public URLs for sharing your localhost instantly without any infrastructure or software setup.
I have never heard of ngrok, and have used ssh tunnels for over a decade.
I must be missing something.
So, for example, if you are hosting a web server locally on port 8080, you could ssh to a service like this, and then it would give you back a link such as h59dke4.example.com.
All traffic that goes to h59dke4.example.com:80 will actually be routed to your 127.0.0.1:8080