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The sensorineural cells required for human hearing\u2014located within the cochlea\u2014are just 10\u201350\u00a0\u00b5m, placing them outside the resolution of magnetic resonance imaging, computed tomography, and positron emission tomography. These cells are highly mechano\u2010 and chemo\u2010sensitive, and their death or dysfunction underlie the vast majority of hearing loss. Further, the cochlea is only 4\u20137\u00a0mm in diameter, has complex anatomy, and is deeply embedded in bone. Cochlear blood flow is partially separated by a blood barrier, limiting access to radiotracers or fluorophores. These and other features have left the human cochlea as a \u201cblack box\u201d that cannot be assessed with high precision in vivo, limiting the development of novel hearing loss therapies. The benefits and drawbacks of existing medical imaging techniques used to diagnose disorders of the human inner ear are discussed, as well as those of emerging technologies that may help overcome challenges to access, resolution, and functional detail. A comprehensive and up\u2010to\u2010date discussion is provided on research efforts to improve and adapt current clinical imaging methods and introduce recent innovations that have shown exciting promise for deriving both structural and metabolic information from cochlear cells.<\/jats:p>","DOI":"10.1002\/advs.202500556","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T06:05:35Z","timestamp":1749103535000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The State of High\u2010Resolution Imaging of the Human Inner Ear: A Look Into the Black Box"],"prefix":"10.1002","volume":"12","author":[{"given":"Shelley","family":"Batts","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Stanford University School of Medicine  801 Welch Rd Stanford CA 94304 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University School of Medicine  1201 Welch Rd Stanford CA 94304 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Tearney","sequence":"additional","affiliation":[{"name":"Department of Pathology Harvard Medical School  25 Shattuck Street Boston MA 02115 USA"},{"name":"Wellman Center for Photomedicine Massachusetts General Hospital  55 Fruit St Boston MA 02114 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-279X","authenticated-orcid":false,"given":"Konstantina M.","family":"Stankovic","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Stanford University School of Medicine  801 Welch Rd Stanford CA 94304 USA"},{"name":"Department of Neurosurgery Stanford University School of Medicine  300 Pasteur Dr Stanford CA 94304 USA"},{"name":"Wu Tsai Neurosciences Institute Stanford University  288 Campus Drive Stanford CA 94305 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"e_1_2_8_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nima.2005.03.127"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/51\/13\/R02"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12194-021-00642-2"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.JBO.26.1.010901"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2016.04.023"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000960"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2005.19.6.4"},{"key":"e_1_2_8_5_3","doi-asserted-by":"publisher","DOI":"10.1002\/jemt.20445"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/joa.12308"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ar.a.10096"},{"key":"e_1_2_8_7_1","first-page":"1","volume":"19","author":"Erixon E.","year":"2011","journal-title":"Natl. 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