Advances in pathogenesis, novel therapeutic strategies and interventions for age-related hearing loss

Age-related hearing loss (ARHL), or presbycusis, represents one of the most prevalent sensory dysfunctions in the elderly people. It is characterized by progressive hearing deterioration that significantly impairs quality of life and increases the risk of comorbidities including cognitive impairment, depression, and social isolation. The pathogenesis of ARHL involves complex structural alterations such as degeneration of cochlear hair cells, loss of spiral ganglion neurons, and stria vascularis atrophy, coupled with molecular and cellular dysregulations including oxidative stress, inflammation, autophagy dysfunction, and cellular senescence. Meanwhile, genetic predisposition and environmental factors contribute to its development. Current conventional management primarily relies on hearing aids, which fail to reverse disease progression, while effective pharmacological interventions remain unavailable. Recent years have witnessed promising developments in innovative approaches such as gene therapy, stem cell-based regenerative medicine, nanotechnology-based delivery systems, and early biomarker screening, offering new directions for precise ARHL intervention. The purpose of this review is to provide a comprehensive overview of the current state of research in ARHL, with the goal of advancing our understanding, treatment and interventions of presbycusis.