As this type of therapy requires topical administration of stem cells or progenitor cells, developing efficient and safe modes of administration is clinically important. This review focuses on the latter, specifically the approach of using gene therapy to induce proliferation of inner ear cells. There are two main approaches to inducing regeneration of damaged cochlear hair cells: the injection of stem cells to replace dead cells and therapies that induce damaged sensory cells to regenerate. While cochlear implants are the intervention of choice, in recent years, the possibility of inner ear cell regeneration has received much attention as an alternative therapy for hearing loss. As a result, researchers have focused on ways to mitigate or even reverse hearing loss. Damage to the inner ear can have profound, long-lasting consequences, affecting not only hearing but also balance. The inner ear comprises three main structures: the cochlea (hearing organ), the vestibule, and the semicircular canals (balance organ). In this regard, we also discuss our development of an inner ear endoscope to facilitate topical administration. Developing efficient and safe modes of administration is clinically important. The therapies mentioned above require topical administration of transgenes or drug onto progenitors of sensory cells. We discuss the future road map for clinical application. In this paper, we discuss recent approaches to hair cell proliferation and differentiation for inner ear regeneration. Inducing differentiation of endogenous stem cells or inner ear stem cell transplantation is expected. Factors necessary for regeneration have also been elucidated from the mechanism of hair cell generation. Inner ear cell progenitors or stem cells have been identified. Recently, the mechanisms underlying inner ear regeneration have been gradually clarified. For these disorders, inner ear regeneration therapy is expected to be a feasible alternative to cochlear implants for hearing recovery. Others occur due to acoustic trauma, exposure to ototoxic drugs, viral infections, immune responses, or endolymphatic hydrops (Meniere’s disease). Some are related to aging or are idiopathic, as in sudden deafness. Inner ear disorders have various etiologies. If these cells are damaged, they do not regenerate. The inner ear contains many types of cell, including sensory hair cells and neurons.
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