ABR/DPOAE publications

Objective Cisplatin, a life-saving chemotherapeutic drug, causes ototoxicity. Although sodium thiosulfate is used to prevent ototoxicity in pediatric patients, no other intervention has been approved for clinical use against cisplatin-induced hearing loss. Hence, there is an urgent need to identify drugs that prevent cisplatin ototoxicity. Methods CBA/J mice were treated with cisplatin (3 mg/kg, i.p., daily for 5 days), and MnTBAP (10 mg/kg, i.p., daily for 8 days) was used to inhibit cisplatin-induced ototoxicity. Auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) were recorded before and after treatment to assess hearing loss, while immunohistochemistry with anti-Myosin-VIIa was conducted to examine hair cell loss, with phalloidin to examine spiral ganglion neuron (SGN) loss, and with anti-nitrotyrosine to assess nitrotyrosine levels. Results Cisplatin treatment elevated the nitrotyrosine levels in hair cells and SGNs and increased the loss of these cells in the middle and basal cochlear regions. A negative correlation was observed between cisplatin-induced changes in the hair cell count or SGN density and nitrotyrosine levels. Cisplatin treatment elevated the hearing thresholds, as indicated by the ABRs, and lowered the DPOAE amplitudes, suggesting cisplatin-induced hearing loss. However, MnTBAP cotreatment prevented the cisplatin-induced changes in hearing sensitivity and reversed the morphological changes. Conclusion The otoprotection observed with MnTBAP cotreatment along with the attenuation of cisplatin-induced increase in nitrotyrosine levels in the cochlea indicates its potential as an inhibitor of cochlear nitrative stress and its utility in mitigating cisplatin-induced ototoxicity.

The transcription factor ATOH1 is a master regulator of mechanosensory hair-cell (HC) development in the ear. Here, we report that its target gene Casz1 regulates the maturation of outer HCs (OHCs). Genetic deletion of Casz1 during (but not after) cochlear development in the mouse caused: hearing loss; disorganization of mechanosensory stereocilia bundles in OHCs; reduced F-actin density in OHC cuticular plates; progressive OHC loss; and mild morphological alterations in inner HCs. This deletion also altered gene expression, delaying downregulation of genes expressed in immature OHCs, including the actin regulator-encoding gene Coro2a, and accelerating upregulation of genes expressed in mature OHCs. Deleting Coro2a in Casz1 mutant mice restored F-actin density in cuticular plates but increased stereocilia bundle disorganization and hearing thresholds, revealing that CORO2A provides an overall beneficial effect. Our data indicate that CASZ1 regulates transcriptional and morphological maturation of OHCs, and that CASZ1 in maturing HCs is necessary for hearing.

Mammalian cochlear hair cells convert acoustic stimuli into electrical signals, which are relayed to the central auditory pathway via auditory neurons. Progressive loss of hair cells and their synapses is a characteristic of age‐related hearing loss (ARHL), but the underlying mechanisms remain poorly understood. In this study, we tested the hypothesis that hair cell physiological properties change with age in CBA/CaJ mice, a strain known for its slow ARHL progression. We found that hair cell size began to decrease from 10 months of age, well before detectable increase in hearing thresholds from auditory brainstem responses. This structural change was associated with a significant decrease in the size of the basolateral membrane current, in particular that carried by the large conductance calcium‐activated potassium (BK) channel currents ( I K,f ) in the apical inner hair cells (IHCs). However, the size of the mechanoelectrical transducer (MET) current measured in the IHCs remained unaffected at least up to 22 months of age. Our results provide clear evidence of an early change in the physiological properties of apical IHCs with age, which precedes measurable hearing loss, suggesting that these cellular deficits might define a distinct pathological route in the CBA/CaJ mice.

Understanding the molecular basis of hair cell function is essential for elucidating inner ear physiology and developing therapies for auditory–vestibular disorders. Here, we identify acyl-CoA binding domain-containing 7 ( Acbd7 ) as a hair cell-specific gene critical for sensory maintenance. Single-cell transcriptomics of mouse cochlear organoids revealed Acbd7 as a top hair cell-enriched transcript, with its spatiotemporal expression confirmed from embryonic development through adulthood in both auditory and vestibular hair cells. Acbd7 ‑deficient mice exhibited pronounced hair cell degeneration, characterized by synaptic defects and diminished calcium currents in inner hair cells and loss of outer hair cells. Transcriptomic and proteomic analyses linked Acbd7 to the regulation of Ca 2+ signaling and fatty acid metabolism pathways. Our findings establish Acbd7 as a critical regulator of Ca 2+ homeostasis and functional integrity in hair cells, thereby elucidating a key mechanism by which a fatty acid metabolism factor sustains hair cell function and providing potential therapeutic targets for inner ear disorders.

The detection of unexpected sounds, or auditory deviance detection, is thought to be achieved by comparing prediction signals and sensory inputs in the auditory cortex. This process is markedly impaired in patients with schizophrenia. However, the local circuit properties underlying deviance detection, together with their dysfunction in schizophrenia-related conditions, remain poorly understood. We used two-photon calcium imaging to monitor the population activity of cortical neurons during auditory deviance detection. The deviance-detecting component was predominant in layer 2/3 neurons of the higher-order auditory cortex. The deviance-detecting cells were spatially clustered, exhibited robust synchronization, and constitutively expressed immediate-early genes. In the Del(1.5 megabase)/+ mouse model of 22q11.2 deletion syndrome, a model of schizophrenia, deviance-detecting activity in the upper-layer network was disrupted, accompanied by dysregulated gene expression and selective loss of dendritic spines in immediate-early gene–positive neurons. Our findings support the hypothesis that ensemble activation of this neuronal subpopulation amplifies unexpected inputs, driving error signals that propagate to higher-order cortical areas.

Cochlear damage triggers compensatory primary auditory cortex (A1) plasticity that amplifies responses to residual sensory inputs, thereby contributing to the restoration of both cortical responsiveness to sound and perceptual sound detection threshold. However, this adaptation can become maladaptive, producing neuronal hyperactivity that contributes to tinnitus and hyperacusis. The neuromodulatory mechanisms governing these adaptive and maladaptive changes remain unknown. Here, we demonstrate that noise-induced cochlear injury triggers bidirectional synaptic zinc signaling plasticity that potentiates activity in excitatory principal neurons and parvalbumin-expressing interneurons, while suppressing activity in somatostatin-expressing interneurons. These cell-type-specific effects of synaptic zinc plasticity contribute to restoring A1 responsiveness to sound and perceptual detection thresholds, while being necessary for neural hyperactivity. Together, our findings establish synaptic zinc as a pivotal neuromodulator that shapes both adaptive and maladaptive cortical plasticity and identify a promising therapeutic target for improving perceptual recovery after cochlear damage and mitigating tinnitus and hyperacusis.

The auditory nerve (AN) glial transition zone (GTZ), where myelination shifts from Schwann cells in the peripheral AN to oligodendrocytes in the central AN, is a unique biological niche housed within the cochlear modiolus. Although age-related hearing loss (ARHL) is associated with AN degeneration, the neuroimmune mechanisms contributing to age-related myelin pathology and altered immune cell function remain poorly defined. We hypothesized that the AN GTZ is especially vulnerable to age-related immune activity which may contribute to AN degeneration and myelin pathology. Using an ARHL mouse model, we combined large-field light sheet microscopy of tissue-cleared mouse temporal bones, three-dimensional high-resolution imaging, and quantitative immunohistochemistry to evaluate the AN GTZ. RNA-sequencing was used to evaluate age-related changes in gene expression of the whole AN. Human temporal bones were also examined to evaluate the AN and its macrophages/microglia. RNA-sequencing revealed age-associated enrichment of neuroinflammation and myelin degeneration-related pathways. Aging was associated with an increase in Iba1 + macrophages/microglia throughout the AN, with prominent accumulation at the AN GTZ. The aged AN GTZ contained Iba1 + subpopulations expressing CD206, Gal3, CD163, and Lamp1, suggesting enhanced phagocytic activity and altered activation state at the AN GTZ. CD68 + cells were also increased at the AN GTZ, as well as the central AN, with aging. Macrophages/microglia contained significantly more internalized myelin debris across all regions of the AN with aging, including myelin localized within Lamp1 + lysosomes of Iba1 + cells. More importantly, normal-appearing myelin was frequently observed within macrophages/microglia at the AN GTZ, but not in the peripheral or central regions of the AN. Myelin debris within Iba1 + cells was also found in the human AN, consistent with our findings in mouse. Together, these findings identify the AN GTZ as a unique microenvironment with age-related alterations in phagocytic activity and immune activation. The immune cell heterogeneity and enhanced myelin phagocytosis observed in the aging AN emphasize the importance of defining how distinct macrophage/microglia populations contribute to AN degeneration and ARHL.

Tinnitus involves peripheral auditory damage and aberrant central plasticity, with dysregulated BDNF signaling linking injury to compensation. Yet, direct evidence connecting BDNF/AKT/mTOR pathway activation to behavioral phenotypes is limited. This study examined BDNF/AKT/mTOR expression in the inferior colliculus (IC) of sodium salicylate (SS)-induced tinnitus rats and assessed therapeutic inhibition. Rats received intraperitoneal SS, showing decreased GPIAS ratios, elevated ABR thresholds, and upregulated BDNF/TrkB/AKT/mTOR phosphorylation in the IC-changes associated with tinnitus-like behavior. Bilateral IC microinjection of BDNF siRNA or systemic rapamycin revealed that siRNA suppressed BDNF/TrkB and ameliorated tinnitus without improving hearing, while rapamycin reduced mTOR phosphorylation and partially alleviated behavior. These results first demonstrate that BDNF/AKT/mTOR upregulation in the IC contributes to tinnitus in SS rats, and its inhibition improves behavioral manifestations without reversing peripheral hearing loss.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in otitis media (OM), including acute otitis media (AOM) and chronic suppurative otitis media (CSOM), presenting considerable therapeutic challenges due to its biofilm formation, host immune evasion, and promotion of persistent inflammation. This study evaluated the therapeutic potential of Schisandrin C (Sch C), a natural lignan derived from Schisandra chinensis , in mitigating MRSA-induced OM. In rat models of MRSA-induced AOM and CSOM, Sch C significantly reduced bacterial load and inflammatory responses by decreasing pro-inflammatory cytokine levels. By upregulating tight junction protein ZO-1 and downregulating mucin MUC5B, it also restored epithelial barrier integrity. In addition, Sch C treatment improved auditory function. Mechanistic studies revealed that Sch C directly inhibited sortase A (SrtA), a key enzyme responsible for anchoring surface virulence factors in MRSA, by binding to its active site and inhibiting its transpeptidase activity (fluorescence resonance energy transfer IC₅₀ = 38.68 µM). Through inhibiting SrtA, Sch C disrupted MRSA adhesion, invasion, and biofilm formation without exerting direct bactericidal effects. Furthermore, Sch C synergized with ofloxacin, enhancing its efficacy against MRSA otitis by reducing bacterial load, inflammation, and tissue damage. Collectively, these findings establish Sch C as a potent S. aureus SrtA inhibitor, highlighting its promise as a therapeutic strategy for MRSA-induced OM.

Age‐related vestibular dysfunction (ARVD) is a prevalent and debilitating condition among the elderly, yet its etiology and underlying molecular mechanisms remain poorly understood. We focused on mechanosensitive hair cells (HCs), which are widely recognized as susceptible to aging. Using single‐cell RNA‐seq transcriptomic analysis of young and old mice, we show that old vestibular HCs exhibit conserved transcriptomic hallmarks of cellular aging, including cellular senescence, mitochondrial dysfunction, and impaired proteostasis, along with prominent cell type‐specific changes linked to hair bundle architecture and the mechanotransduction machinery. Consistent with these transcriptomic findings, imaging and electrophysiological recordings from old vestibular sensory epithelia reveal hair bundle degeneration and reduced mechanotransduction activity. Importantly, this structural and functional deterioration precedes HC loss, underscoring impaired hair bundle function as a key driver of ARVD. Furthermore, our comparative analysis identifies both shared and distinct aging signatures in vestibular and cochlear HCs, providing broader insight into the mechanisms that may underlie their different rates of age‐related degeneration.

Kanamycin (KM), a widely used aminoglycoside antibiotic, is limited by its ototoxic side effects, primarily targeting cochlear outer hair cells (OHCs) and leading to irreversible sensorineural hearing loss. Our previous work showed that silencing AMP‐activated protein kinase alpha 1 (AMPKα1) prevents noise‐induced hearing loss through a redox‐sensitive regulatory mechanism. Given that both noise‐induced and aminoglycoside‐induced hearing loss share oxidative stress as a key pathological feature, we tested whether AMPKα1 silencing could mitigate KM‐induced damage using an acute ototoxic model combining KM with furosemide (KM + FU). KM + FU exposure markedly increased AMPKα phosphorylation at Thr172. Targeted siRNA‐mediated silencing via posterior semicircular canal delivery in CBA/J mice significantly reduced AMPKα1 expression in OHCs and effectively prevented KM + FU‐induced OHC loss and hearing impairment. This preventive effect was independent of stria vascularis permeability or cochlear KM uptake. These findings identify AMPKα as a contributor to KM + FU‐induced acute ototoxicity and suggest that its inhibition may be a promising strategy for hearing preservation.

Background Stem cell therapy offers promise for the neurodegenerative diseases and has been explored for sensorineural hearing loss (SNHL). However, effective cell delivery strategies remain a critical challenge for SNHL treatment. Methods To address this need, we established an ouabain‐induced SGN injured hearing loss model in rat and evaluated a novel transplantation strategy targeting the cochlear nerve surface via posterior occipital approach, designed to minimize cochlear structural damage and facilitate targeted cell delivery to Rosenthal's canal (RC). The temporal changes in glial cell densities within RC revealed a progressively deteriorating neural microenvironment, supporting early‐stage intervention. Accordingly, hair follicle‐derived neural crest stem cell (HFNCSC) transplantation was performed 3 or 4 days after modeling via two approaches: cochlear nerve surface transplantation (CNT) and round window transplantation (RWT). Results CNT resulted in significant improvements in auditory function, as evidenced by reduced auditory brainstem response (ABR) thresholds, shortened wave I latencies, and preserved wave I amplitudes post‐transplantation. Transplanted cells were distributed along the nerve trunk and within RC. In contrast, RWT failed to improve auditory function and caused cochlear structural damage, with widespread cell dispersion in cochlear fluids. Notably, the CNT group exhibited significantly higher densities of TUJ1‐positive neuron‐like cells and glial cells in the RC, accompanied by enhanced myelin basic protein expression suggestive of remyelination. No such improvements were observed in the RWT group. Conclusions These findings suggest that cochlear nerve surface transplantation enhances stem cell survival and auditory function recovery, and represents a promising delivery approach for stem cell‐based therapy of SGN‐related hearing loss.

The neural response of the brainstem to brief sounds, known as the auditory brainstem response (ABR), is widely employed in the laboratory and the clinic to diagnose hearing loss. Current ABR approaches are limited to analyzing the average ABR to hundreds of stimulus trials. Historically, trial-by-trial ABR analysis has not been possible owing to each trial's small signal-to-noise ratio. Here we overcome this limitation and show how to score individual ABR trials. We use the distribution of individual-trial ABR scores to define thresholds, which we call auditory brainstem detection (ABD) thresholds, and to assess suprathreshold hearing. Scores based on individual-trial amplitude and similarity produce lower ABD thresholds than scores based on individual-trial amplitude alone. Our method enables us to rank the suprathreshold hearing of individual subjects. Despite having normal ABR thresholds, some subjects appear to have suprathreshold hearing deficits.

Hereditary hearing loss, the most prevalent genetic sensory disorder, lacks approved pharmacological therapies and represents a compelling target for gene correction. Pathogenic variants in KCNQ4 account for ~9.5% of autosomal dominant nonsyndromic cases. Prior gene-editing strategies disrupting mutant alleles have failed to achieve durable auditory rescue. Here we employed a knock-in mouse model harboring the human KCNQ4 c.961 G > A (p.G321S) mutation to evaluate precise base editing. Dual-AAV delivery of the adenine base editor ABE8e achieved 21.4–28.9% correction in the organ of Corti—the highest efficiency reported for genetic hearing loss. A dose-dependent therapeutic window emerged: higher doses promoted rapid recovery, whereas optimized lower doses minimized long-term toxicity and sustained functional benefit for at least 32 weeks. Treatment reduced auditory brainstem response thresholds by up to 49.09 dB SPL at optimal frequencies, mitigated degeneration of hair cells, spiral ganglion neurons, and auditory nerve fibers, and partially restored outer hair cell electrophysiology. These findings demonstrate the durability of precise mutation correction over allele-disruptive approaches and support clinical translation for KCNQ4 -associated hearing loss.

Hearing is the largest modifiable mid-life risk factor for Alzheimer's disease (AD), yet its link to dementia remains unclear. We identified a neurophysiological biomarker of AD risk using the non-invasive, rapidly acquired, and clinically translatable auditory brainstem response (ABR) in normal hearing knock-in rats (Swedish familial AD risk variant to Amyloid precursor protein, AppS; male and female). Human ABRs have been proposed as a biomarker for AD and related dementias. The novel metric reported here is derived from multidimensional parametric feature extraction on the distribution statistics of repeated single-trial ABR traces. We report accurate prediction of genetic risk for AD risk in young and aged rats: AppS separate clearly from healthy humanized (AppH) in sex- and age-dependent manners. Notably, auditory learning during young adulthood shifted the AppS ABR signature towards a healthy AppH-like state that maintained over time into older age. Altogether the findings support the utility of the ABR to track disease state, progression, and effects of intervention, and point to a central neural generator of auditory dysfunction related to AD risk. ABRs could provide a very early biomarker for detection of AD risk and used to test the synergy of auditory and cognitive functions in human dementia.

SLC26A4 is a major causative gene for hereditary hearing loss, its mutation spectrum shows pronounced population specificity. In Chinese populations, patients predominantly carry biallelic mutations, and compound heterozygous genotypes are prevalent, which results in a wide spectrum of auditory phenotypes. However, how different alleles interact within these contexts to shape phenotypic variability remains poorly understood. We employed cellular and mouse models to explore the allele-specific mechanisms associated with two novel mutations, a frameshift mutation and a missense mutation, in compound heterozygous that share the same splice-site pathogenic allele. In vitro, wild-type (WT) and mutant (c.574delC, c.1211C>A) SLC26A4 constructs were expressed in HeLa cells to assess pendrin localization. Both mutations reduced membrane enrichment and increased intracellular retention. In vivo, compound heterozygous knock-in mouse models (Slc26a4c.574delC/c.919-2A>G and Slc26a4c.1211C>A/c.919-2A>G) were generated using CRISPR/Cas9. The auditory function and cochlear pathology were investigated. Both compound mutants exhibited elevated ABR thresholds, with more severe hearing loss in Slc26a4c.574delC/c.919-2A>G mice. Correspondingly, these mice showed marked hair cell disruption, stereociliary loss, and cochlear structural abnormalities, whereas the Slc26a4c.1211C>A/c.919-2A>G mice displayed milder changes. Transcriptomic profiling examined by bulk RNA-sequencing revealed broader differential expression in Slc26a4c.574delC/c.919-2A>G mice, enriched in structural and developmental pathways, while the missense model showed predominantly immune-related signatures. Our findings demonstrate that allele-specific functional divergence in compound heterozygous SLC26A4 mutations leads to distinct auditory dysfunction, cochlear pathology, and transcriptional programs. These findings provide mechanistic insight into the phenotypic heterogeneity of hearing loss and may indicate future allele-specific interventions or therapeutic strategies.

Oncomodulin (OCM) is the most abundant Ca2+ buffering protein found in mature outer hair cells (OHCs). Cadherin 23 (CDH23) is a crucial component of the tip-links in hair cell stereocilia. The absence or dysfunction of these two proteins contributes to the early onset of age-related hearing loss (AHL). In this study, we investigated the effects of the Cdh23753G→A mutation on OHC function using new Ocm-knockout (KO) mouse models (Ocmtm1a/tm1a) with or without the Cdh23753G→A mutation. Despite having the same genetic background, Ocm-KO mice carrying the Cdh23753G→A mutation displayed a notable decline in OHC function across all measured frequencies as early as three months of age. In contrast, Ocm-KO mice without the Cdh23753G→A mutation did not exhibit comparable hearing loss until they reached twelve months of age. Additionally, we examined the role of OCM in preserving OHC function under ototoxic stress induced by HPβCD (2-hydroxypropyl-β-cyclodextrin). The distortion product otoacoustic emission data show that the administration of HPβCD resulted in a more pronounced decline in OHC function in Ocm-KO mice compared to wild-type (WT) mice. Time-lapse recording also shows that HPβCD treatment led to greater structural deterioration and more rapid rupture events in OHCs from Ocm-KO mice than in those from WT mice. These findings suggest that the Cdh23753G→A mutation, rather than other potential strain-specific genetic factors associated with AHL, significantly exacerbates the early onset of AHL phenotypes in Ocm-KO mice. Furthermore, our data indicates that the OCM protein in OHCs enhances their ability to withstand ototoxic stimuli.

The CUGBP Elav-like family 4 (CELF4), an RNA-binding protein, is dynamically expressed in spiral ganglion neurons (SGNs) in the cochlea over development, but how Celf4 is involved in regulating hearing functions is poorly understood. In this study, we generated a Celf4 ± mouse line and examined changes in the first two synapses along the auditory pathways. Firstly, we found that hearing functions were largely intact in Celf4 ± mice, with exception of reduced amplitude for Wave II of auditory brainstem responses (ABRs) and increased delays for Wave II and IV, both in case of 4 kHz only. Secondly, we found that counts of inner and outer hair cells (IHCs and OHCs) and SGNs remained unchanged in Celf4 ± mice, and that the number and function of ribbon synapses between IHCs and SGNs were comparable between WT and Celf4 ± mice. Lastly, function of the endbulb of Held synapse, formed between auditory nerve fibers (ANFs) of SGNs and bushy cells in the cochlear nucleus, was significantly altered in Celf4 ± mice. Specifically, synaptic vesicle release was subtly reduced, and excitability of bushy cells was significantly dampened, likely due to a hyperpolarized resting membrane potential. Furthermore, we found that spike kinetics was significantly faster in Celf4 ± bushy cells, likely caused by a larger fast-inactivating A-type potassium current (I A ) found in these cells. In conclusion, we found that Celf4 haploinsufficiency altered transmission at the endbulb of Held synapses in the cochlear nucleus in a significant and multifaceted manner, revealing the roles of Celf4 in regulating hearing functions. Graphical Abstract Title: Schematic representation of the experimental approach and major findings. Legend: In mice with Celf4 haploinsufficiency, we found that while function at hair cell ribbon synapses was largely preserved, transmission at the endbulb of Held synapse was significantly altered, including subtly reduced release of synaptic vesicles from the endbulb, dampened excitability in bushy cells, and accelerated spike kinetics caused by enhanced voltage-gated K + current.

Activity-dependent modulation of presynaptic voltage-gated Ca 2+ channels (Ca V 2) regulates Ca 2+ influx to control neuronal circuit output. Although Ca V 2.1 can undergo robust Ca 2+ dependent facilitation (CDF), whether it occurs in native central nervous system neuronal circuits is disputed. Accurate auditory information processing requires precise and reliable synaptic transmission at high activity rates in the auditory brainstem. To determine if Ca V 2.1 CDF is a key regulator of high-fidelity synaptic transmission, we expressed Ca V 2.1 splice variants capable (Ca V 2.1 37a) or incapable (Ca V 2.1 37b) of CDF at the calyx of Held presynaptic terminal in the auditory brainstem. We found no difference in basal Ca V 2.1 currents or synaptic transmission. However, Ca V 2.1 37b terminals lacked CDF, synaptic facilitation and had a decreased reliability and precision of postsynaptic action-potential firing. Additionally, the Wave III amplitude of the auditory brainstem responses was reduced. We propose that Ca V 2.1 CDF is essential for accurate auditory information processing.

Sensorineural hearing loss (SNHL) induced by noise or aminoglycoside antibiotics is a significant public health concern without any FDA‐approved pharmaceutical therapies. Dysregulation of iron homeostasis and its subsequently induced ferroptosis has increasingly been identified as a key mechanism underlying cochlear hair cell (HC) damage. Nevertheless, the therapeutic targets for restoring iron balance for hearing protection remain poorly investigated. In this study, we uncover a previously unrecognized role of the SMO pathway in regulating iron homeostasis. SMO expression was rapidly upregulated and activated in HCs following injury. Both genetic ablation of Smo and pharmacological inhibition of SMO reduced iron accumulation and lipid peroxidation, promoting HC survival and preserving auditory function in mouse models of ototoxic‐ and noise‐induced hearing loss. Mechanistically, SMO inhibition suppressed ATF2 phosphorylation, resulting in downregulation of IRP1, which decreased iron accumulation via downregulation of Tfrc and upregulation of Fpn , ultimately protecting HCs from ferroptosis. Notably, treatment with the SMO inhibitor SANT‐1 nearly restored auditory thresholds to baseline levels in mice subjected to ototoxic injury. Our findings identify the SMO–ATF2–IRP1–FPN/TFRC axis as a central regulator of cochlear iron homeostasis and propose SMO inhibition as a promising therapeutic strategy for SNHL through precise modulation of iron metabolism.