OTOF and auditory neuropathy: In summary, the main pathological mechanisms of hearing loss may focus on the following: (1) Electrolyte cycling, including imbalance and impaired uptake of K+, Na+, and Cl+, etc.(2) Changes in ATP release and Ca+ signaling, which may lead to impaired development of the columnar cytoskeleton as well as cochlea development (Bobbin and Thompson, 1978; Kujawa et al., 1994; Munoz et al., 1995) (3) Auditory neuropathy (mainly caused by mutations in the OTOF gene).