The FDA approval of Otarmeni, an AAV-based gene therapy for biallelic OTOF-associated sensorineural hearing loss, represents a conceptual shift in otology: from bypassing defective auditory physiology to restoring it. Unlike cochlear implantation, which circumvents damaged sensory structures, OTOF gene replacement targets a synaptic deficit in a structurally intact cochlea. Early clinical trial data are encouraging, with 75% of evaluable participants-children with molecularly confirmed biallelic OTOF variants enrolled in early-phase trials-achieving the primary hearing endpoint at 24 weeks. However, critical questions remain regarding long-term durability, the feasibility of redosing, and the surgical and logistical infrastructure required for intracochlear delivery. This commentary argues that otoferlin gene therapy initiates a new treatment hierarchy rather than rendering cochlear implantation obsolete: restore when biology permits, bypass when it does not. Realizing this potential will require advances in newborn genetic screening, workforce training, and equitable access to gene delivery.

Much confusion surrounds the terminology used to describe minor laryngeal clefts in pediatric otolaryngology. The widely accepted Benjamin-Inglis classification defined type 1 clefts as those where the interarytenoid mucosal is at the level of the vocal folds. However, many children with aspiration and intact supraglottic mucosa respond favorably to interarytenoid augmentation. This finding has prompted the use of terms to suggest a deficient, and clinically significant, anatomic anomaly including "deep interarytenoid notch," "deep interarytenoid groove," "low interarytenoid height," and "type 1a cleft." These ambiguous terms are inconsistently applied, lack validated anatomic correlates, and hinder reproducible diagnosis and outcome comparison. We propose the term "interarytenoid dysfunction" (IAD) to replace these ambiguous descriptors, emphasizing the functional contribution of the interarytenoid region to airway protection rather than its often-indeterminate anatomic contour.