Cochlear immunology and its therapeutic revolution

Over the past five years, cochlear immunology has experienced a paradigm shift, challenging the long-held perception of the inner ear as an "immune-privileged" site. Our review consolidates recent advancements that elucidate the cochlea's intricate local immune system, comprising resident macrophages, Tlymphocytes, and dendritic cells, in conjunction with the regulatory blood-labyrinth barrier. We investigate how immune dysregulation contributes to various auditory disorders, including autoimmune inner ear disease, inflammatory responses to cochlear implantation, noise-induced hearing loss, and age-related hearing loss. The review critically assesses therapeutic strategies, encompassing both traditional immunosuppressants and innovative immunomodulatory approaches, as well as interventions targeting fundamental aging pathways. Significant research gaps are highlighted, including the need for reliable biomarkers, a deeper understanding of immune cell heterogeneity, and the development of enhanced drug delivery systems. These advancements present promising opportunities for the development of targeted treatments for immune-mediated hearing loss, with the potential to revolutionize the clinical management of these conditions.