Precision Diagnostics in Age-Related Hearing Loss: Emerging Molecular Biomarkers for Early Detection and Targeted Prevention.

Age-related hearing loss (ARHL) is a prevalent neurosensory impairment. Traditional audiometry is post-symptomatic, fundamentally failing to capture the molecular deterioration that precedes clinical hearing decline by years. To address this gap, the clinical paradigm is urgently shifting toward precision medicine. This review summarizes emerging molecular biomarkers enabling the early detection, patient stratification, and targeted prevention of ARHL. We systematically evaluate the clinical measurability and diagnostic value of biomarkers across core pathological axes: cellular senescence, inner ear apoptosis, chronic inflammaging, oxidative stress, and genetic variants. Crucially, we highlight how these molecular signatures show preclinical promise as future actionable targets for personalized interventions, including novel anti-inflammatory, antioxidant, and gene therapies. Finally, we explore the future potential of integrating these preliminary indicators into comprehensive biomarker panels. We conceptualize a theoretical precision diagnostics framework that synthesizes genomic, inflammatory, and oxidative profiles. While acknowledging that current evidence is predominantly based on mechanistic and preclinical studies requiring extensive human clinical validation, this proposed framework aims to guide future translational research. Ultimately, this conceptual approach lays the groundwork for discovering early interventions that could delay disease progression and improve long-term auditory prognosis.