“…The physiological and anatomical changes that co-occur with hearing loss present at multiple levels of the auditory system. This stretches from the middle ear and tympanum ( Etholm and Belal, 1974 ; Ruah et al., 1991 ; Rolvien et al., 2018 ), to the inner ear supporting cells ( Thorne and Gavin, 1985 ; Shi and Nuttall, 2003 ) and auditory receptors ( Keithley and Feldman, 1982 ; Liberman and Beil, 1978 ; Bohne and Harding, 2000 ; Wu et al., 2019 ; Jeng et al., 2020 ; Boyd-Gibbins et al., 2021 ) including their synapses to the auditory nerve ( Kujawa and Liberman, 2009 , 2015 ; Wu et al., 2019 ) and the central nervous system where sound is processed ( Fetoni et al., 2013 ). The most profound and best quantified change in the auditory system is loss of hair cells ( Coleman, 1976 ; Keithley and Feldman, 1982 ; Bhattacharyya and Dayal, 1985 ; Dayal and Bhattacharyya, 1986 ; Li and Hultcranz, 1994 ; Dixon and Arndt, 1971 ; Pinheiro et al., 1973 ; Clark et al., 1974 ; Moody et al., 1978 ).…”