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Dysfunctions of the inner ear such as hearing impairment due to noise exposure or presbycusis and vertigo are often caused by loss of hair cells in the sensory epithelium. There is still no specific therapy, just technical aids. Options for protecting and regenerating hair cells are explained here. The inhibition of apoptosis via caspases is presently the main target of research. They are involved in damage caused by aminoglycosides, cisplatin, or noise exposure. Bcl-2, growth factors, and oxidative stress are discussed. In regeneration the transdifferentiation of supporting cells to hair cells is explained. This can be achieved with local gene therapy using math1. Approach and media for the application are discussed, while viral vectors such as the adenovector seem the most promising in research.