Sensorineural hearing loss affects hundreds of millions of adults globally, yet no approved pharmacological treatment exists — a gap this comprehensive scoping review begins to close by systematically mapping the entire emerging drug landscape. For the roughly 1.5 billion people living with some degree of hearing loss, this research signals that medicine may finally be moving beyond hearing aids and cochlear implants toward disease-modifying therapies.
The review, registered on the Open Science Framework and conducted according to PRISMA-ScR guidelines, screened five major databases covering 2004–2024 and identified 66 qualifying records: 48 published human studies and 18 active or recently completed clinical trials. Six mechanistic categories emerged — antioxidant therapy, steroid-based combination therapy, hematologic agents, pathway modulators, regenerative therapy, and gene therapy. Antioxidants, corticosteroids, and hematologic agents showed the broadest evidence base for prevention or treatment, while regenerative and gene-therapy approaches represent earlier-stage but potentially transformative pipelines.
What makes this review particularly valuable is its breadth as a scoping rather than systematic review — it maps the terrain rather than adjudicates efficacy, which is appropriate given how fragmented the evidence base still is. Corticosteroids, especially intratympanic dexamethasone, have the longest clinical history here and remain the de facto emergency intervention for sudden sensorineural hearing loss, though response rates remain inconsistent. The antioxidant findings are intriguing — compounds targeting oxidative cochlear damage align well with noise-induced and age-related mechanistic models, and several trials are underway. Gene therapy, while still nascent in this space, parallels breakthroughs seen in inherited retinal dystrophies, raising cautious optimism.
Key limitations: most included studies are small, heterogeneous in outcome measures, and span very different SNHL etiologies. The scoping methodology intentionally avoids pooled effect estimates, so clinical magnitude remains uncertain. This is best read as a research-priority map rather than a treatment guide — but for a condition long considered pharmacologically intractable, even a map represents genuine progress.