The recent FDA approval of OTOF gene therapy is a major milestone for the field of hearing loss.1 However, auditory gene therapy still lags behind other fields in terms of clinical trials and approvals. A myriad of promising preclinical studies have been published for pediatric and juvenile-onset hearing loss, but far fewer have demonstrated similar promise for adult-onset hearing disorders. One thing is clear: effective gene delivery to adult hair cells and spiral ganglion neurons remains a key challenge for translating gene therapies for sensorineural hearing loss.