Cochlear Homeostasis in Sensorineural Hearing Loss: Mechanisms, Implications, and Therapeutic Prospects - open access narrative review

Sep 30, 2026

Cochlear homeostasis preserves hearing sensitivity by maintaining optimal cochlear fluid composition, sustaining electrochemical gradients, and supporting the function of cochlear sensory and supporting cells. Sensorineural hearing loss arises from damage or loss of hair cells, auditory neurons, and other cochlear structures, and is closely tied to failures in the homeostatic environment. This narrative review analyzes cellular and molecular pathways underlying cochlear homeostasis in health and disease, and explains how disrupted homeostasis drives SNHL. It also outlines current research directions and emerging therapeutic strategies aimed at restoring or compensating for lost balance, supporting the prospect of regenerative repair and functional recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages24

Reading Time1 h 0 min

AccessFree to download

Abstract

Keywords

1. Introduction

Cochlear homeostasis and auditory function

Sensorineural hearing loss and disrupted homeostasis

Inner ear structure and ion gradients

Review Cochlear Homeostasis in Sensorineural Hearing Loss: Mechanisms, Implications, and Therapeutic Prospects Srdjan M. Vlajkovic 1,2, *, Haruna Suzuki-Kerr 1,2 and Bryony A. Nayagam 3 Academic Editor: Joachim Neumann Received: 3 November 2025 Revised: 17 December 2025 Accepted: 19 December 2025 Published: 22 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand; [h.suzuki-kerr@auckland.ac.nz](h.suzuki-kerr@auckland.ac.nz) 2 Eisdell Moore Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand 3 Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, VIC 3010, Australia; [b.nayagam@unimelb.edu.au](b.nayagam@unimelb.edu.au) * Correspondence: [s.vlajkovic@auckland.ac.nz](s.vlajkovic@auckland.ac.nz); Tel.: +64-9-923-9782 Abstract Cochlear homeostasis is critical for the preservation of hearing sensitivity by maintaining optimal cochlear fluid composition, sustaining electrochemical gradients, and supporting the function of sensory and supporting cells in the cochlea. Sensorineural hearing loss, resulting from the damage or loss of sensory hair cells, auditory neurons and other cochlear cells and structures, is intimately linked to disruptions in the homeostatic environment. In this narrative review, we explore the cellular and molecular pathways underpinning cochlear homeostasis in health and disease and examine the mechanisms by which failed homeostasis leads to sensorineural hearing loss. We further discuss current research avenues and emerging therapeutic strategies to restore or compensate for the loss of homeostatic balance. These interventions suggest a future where regenerative healing is possible, ultimately leading to permanent repair and functional recovery. Keywords: cochlea; homeostasis; stria vascularis; sensorineural hearing loss; gene therapy; regenerative medicine 1. Introduction The human ear is a biological and evolutionary masterpiece, responsible for converting sound vibrations into electrical signals that the brain interprets as sound. The central structure of the auditory system is the cochlea of the inner ear (Figure 1A), a spiral-shaped organ designed for exquisite sensitivity to sound intensity and frequency discrimination [1] . Maintaining the delicate balance of the cochlear environment, known as cochlear homeostasis, is critical for optimal auditory function. Yet, disruptions in this equilibrium are key to sensorineural hearing loss, affecting millions worldwide. Sensorineural hearing loss (SNHL) encompasses a range of pathologies in which the cochlear sensory hair cells, supporting structures, and synaptic connections to the auditory nerve are compromised [2] . Unlike conductive hearing loss, which impedes sound transmission through the outer or middle ear, SNHL is caused by cellular and molecular alterations in the cochlea due to altered homeostasis. Figure 1. The structure of the mammalian inner ear. (A) MRI of the human inner ear. The inner ear contains two sensory organs, the hearing organ (cochlea) and the vestibular organ, which includes semicircular canals and two otolith organs (utricle and saccule) . (B) The cochlea comprises three fluid-filled compartments: Scala vestibuli (SV) and scala tympani (ST) filled with perilymph, a typical extracellular fluid with high Na+ concentration, and scala media (SM) filled with K+-rich endolymph. The organ of Corti is the sensory organ of the cochlea. It contains two types of sensory cells, inner hair cells and outer hair cells, upheld by supporting cells, such as Deiters’, Hensen’s, pillar, inner border, inner phalangeal and inner sulcus cells. (C) Stria vascu

FAQs

What is cochlear homeostasis and why is it important?

Cochlear homeostasis maintains optimal cochlear fluid composition, sustains electrochemical gradients, and supports sensory and supporting cells. This balance is essential for normal auditory function.

How does failed homeostasis contribute to sensorineural hearing loss?

Disruptions in the homeostatic environment alter cellular and molecular conditions in the cochlea, leading to cellular damage, apoptosis, and permanent SNHL.

What therapeutic directions are discussed for restoring hearing?

The review discusses emerging therapeutic strategies and research avenues aimed at restoring or compensating for homeostatic imbalance, with a focus on regenerative healing and functional recovery.

Sep 30, 2026

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