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The SGN output is directly modulated by inhibitory cholinergic axodendritic synapses from the efferent fibers originating in the superior olivary complex. When the adult cochlea is subjected to noxious stimuli or aging, the efferent system undergoes major rewiring, such that it reestablishes direct axosomatic contacts with the inner hair cells (IHCs), which occur only transiently during prehearing stages of development. The trigger, origin, and degree of efferent plasticity in the cochlea remains largely unknown. Using functional and morphological approaches, we demonstrate that efferent plasticity in the adult cochlea occurs as a direct consequence of mechanoelectrical transducer current dysfunction. We also show that, different from prehearing stages of development, the lateral olivocochlear \u2014 but not the medial olivocochlear \u2014 efferent fibers are those that form the axosomatic synapses with the IHCs. The study also demonstrates that in vivo restoration of IHC function using AAV-\n                    <jats:italic>Myo7a<\/jats:italic>\n                    rescue reestablishes the synaptic profile of adult IHCs and improves hearing, highlighting the potential of using gene-replacement therapy for progressive hearing loss.\n                  <\/jats:p>","DOI":"10.1172\/jci.insight.182138","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T14:00:34Z","timestamp":1733407234000},"source":"Crossref","is-referenced-by-count":7,"title":["In vivo AAV9-Myo7a gene rescue restores hearing and cholinergic efferent innervation in inner hair cells"],"prefix":"10.1172","volume":"9","author":[{"given":"Andrew P.","family":"O\u2019Connor","sequence":"first","affiliation":[{"name":"School of Biosciences, University of Sheffield, Sheffield, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana 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