From Physical Replacement to Biological Symbiosis: Evolutionary Paradigms and Future Prospects of Auditory...

Auditory Brain-Computer Interfaces (BCIs) constitute the vital intervention for profound sensorineural hearing loss where the auditory nerve is compromised, yet their clinical efficacy remains restricted by substantial biological bottlenecks and limited spectral resolution. This review critically examines the evolutionary paradigm of auditory restoration, tracing the transition from static physical replacement to dynamic biological symbiosis. We systematically analyze physiological barriers across cochlear, brainstem, and cortical levels, elucidating how rigid interfaces provoke chronic tissue responses and why linear encoding protocols fail in distorted central tonotopy. The article synthesizes emerging methodologies in material science, demonstrating how soft, bio-integrated electronics and biomimetic topologies effectively address mechanical impedance mismatches. Furthermore, the trajectory of neural encoding is evaluated, highlighting the paradigm shift from traditional envelope extraction to deep learning-driven non-linear mapping and adaptive closed-loop neuromodulation. Finally, the potential of high-resolution modulation techniques, including optogenetics and sonogenetics, alongside AI-facilitated intent perception for active listening, is assessed. It is concluded that future neuroprostheses must evolve into symbiotic systems capable of seamlessly integrating with neural plasticity to enable high-fidelity cognitive reconstruction.