Autosomal Recessive Nonsyndromic Hearing Loss 9 (ARNSHL9)

Other names
Types
Causes
Symptoms and day-to-day signs
Diagnostic tests
Treatment Overview
Drug treatments
Dietary molecular supplements
Immunity-booster / regenerative / stem-cell drug concepts
Surgeries
Practical preventions
When to see a doctor
What to eat and what to avoid
FAQs

Autosomal Recessive Nonsyndromic Hearing Loss 9 (ARNSHL9) is a genetic type of hearing loss caused by changes (variants) in a gene called OTOF. This gene makes a protein named otoferlin, which helps inner hair cells in the cochlea pass sound signals to the hearing nerve. In ARNSHL9, the hair cells themselves often work, but the “signal hand-off” at the synapse is broken. This pattern is called auditory synaptopathy or auditory neuropathy. Children usually have normal otoacoustic emissions (OAEs) but absent or abnormal auditory brainstem responses (ABR). Speech understanding is usually poor without the right treatment. NCBI+2PMC+2

Autosomal recessive nonsyndromic hearing loss 9 (often shortened to DFNB9) is a genetic form of hearing loss caused by harmful changes (variants) in a single gene called OTOF. The OTOF gene gives instructions to make a protein named otoferlin. Otoferlin helps the inner hair cells of the cochlea pass sound signals to the hearing nerve. When otoferlin does not work well, the hair cells can still detect sound, but they cannot pass the signal properly to the nerve. This creates a problem at the synapse (the connection between hair cell and nerve). Doctors call this pattern an auditory synaptopathy or a type of auditory neuropathy spectrum disorder (ANSD). People with DFNB9 usually have hearing loss from birth or early infancy, without other medical problems (“nonsyndromic”). NCBI+2Frontiers+2

Most babies with DFNB9 have profound sensorineural hearing loss in both ears. Some have a milder loss, and a few have temperature-sensitive hearing problems where hearing gets worse during fever and improves after fever resolves. Because the outer hair cells may still function early on, a newborn may pass an otoacoustic emission (OAE) screen but fail an auditory brainstem response (ABR) test. This “present OAE + absent ABR” pattern is a classic clue to DFNB9. NCBI+2PMC+2

Other names

DFNB9 (DeaFNess, autosomal recessive, locus 9)
OTOF-related hearing loss
Otoferlin-related auditory neuropathy / auditory synaptopathy
Nonsyndromic auditory neuropathy due to OTOF
Autosomal recessive nonsyndromic deafness 9 (NRSD9) NCBI+1

Types

By age at onset
Most cases are prelingual (present at birth or within the first year). Rarely, onset can be later in childhood. NCBI
By severity
Hearing loss is often profound, but some families show moderate-to-severe or even progressive loss. PMC
By physiologic pattern
Classic auditory synaptopathy / neuropathy: absent or abnormal ABR, often present OAEs early on, and poor speech understanding that does not match pure-tone thresholds. NCBI+1
Temperature-sensitive DFNB9
Hearing gets worse with fever and improves when temperature normalizes; linked to specific OTOF variants that are heat-sensitive. PreventionGenetics
By genotype (what the variants do)
Truncating variants (nonsense/frameshift) usually cause severe loss; missense or splice variants can cause variable loss, sometimes milder or temperature-sensitive. PMC

Causes

Important note: DFNB9 is inherited in an autosomal recessive way. A person is affected when they inherit two harmful OTOF variants (one from each parent). “Causes” below explain the different ways OTOF can be disrupted and the biologic effects that follow.

Biallelic pathogenic OTOF variants (the fundamental cause). Two harmful variants—often different—lead to loss of otoferlin function. NCBI
Truncating variants (nonsense/frameshift) that shorten otoferlin so it cannot work at the synapse. PMC
Missense variants that change one amino acid and reduce calcium sensing or membrane binding. PMC+1
Splice-site variants that disrupt how RNA is processed, producing faulty protein. PMC
Exon deletions/duplications (copy-number changes) that remove or duplicate parts of OTOF. NCBI
Variants affecting the C2 domains (the calcium-binding modules) that are crucial for synaptic vesicle fusion. PMC+1
Variants disrupting the C-terminal region needed for fast exocytosis and rapid vesicle recycling. jneurosci.org+1
Promoter/regulatory variants that lower OTOF expression in inner hair cells. (Mechanism inferred from synaptic protein biology and reports of expression-level effects.) PMC
Founder variants in specific populations leading to higher local prevalence (reported in multiple cohorts). PMC
Compound heterozygosity (two different harmful variants in the two copies), the common inheritance pattern in outbred populations. NCBI
Synaptic ribbon dysfunction caused by otoferlin loss, impairing neurotransmitter release to the nerve. Cell
Defective calcium-triggered vesicle fusion at inner hair cell synapses. PMC
Reduced vesicle replenishment/ultrafast endocytosis after stimulation, depleting the “ready-to-release” pool. jneurosci.org
Abnormal synapse maturation/pruning in early life when otoferlin is missing. PMC
Heat-sensitive missense variants that destabilize otoferlin at febrile temperatures (explains temperature-sensitive DFNB9). PreventionGenetics
Haploinsufficiency is typically not causal for disease; one variant usually does not cause symptoms, explaining recessive inheritance (parents are carriers). NCBI
Variable expressivity due to the exact variant combination, which can shift severity and onset. PMC
Modifier genes may influence phenotype (area of active research). PMC
Synaptopathy rather than hair-cell death; outer hair cells may work early, producing present OAEs despite poor neural transmission. NCBI
Progressive synaptic change in some individuals, with OAEs disappearing over time even though the primary defect is synaptic. PMC

Symptoms and day-to-day signs

Very poor response to sound from birth or early infancy (often both ears). Parents may notice no startle to loud noises. NCBI
Delayed babbling and late first words because the child does not hear speech clearly. NCBI
Normal ear exam (no ear infection or blockage), since the issue is inside the cochlea/nerve connection. NCBI
Inconsistent responses: the child may react to some environmental sounds but not understand speech. Wiley Online Library
Difficulty understanding speech, especially in noise, out of proportion to tone test results. Wiley Online Library
Present OAEs early in life despite severe hearing problems; OAEs may fade later. NCBI
Absent or severely abnormal ABR tests. NCBI
Normal tympanometry (middle ear function usually normal). NCBI
Poor sound localization (hard to tell where sound comes from), typical of ANSD. Mass Eye and Ear
Temperature-sensitive worsening of hearing during fever in some patients. PreventionGenetics
No other body symptoms (nonsyndromic), so growth and development outside hearing are usually normal. NCBI
Possible mis-screening in newborn period: pass OAE screen but fail ABR-based screening. NCBI
Limited benefit from standard hearing aids (sound is amplified but not transmitted well to the nerve). Wiley Online Library
Good outcomes with cochlear implant (CI) in many cases, because the implant bypasses the faulty synapse and directly drives the nerve. PMC+2PMC+2
Family history may be negative (parents hear normally) yet both are carriers; siblings can also be affected. NCBI

Diagnostic tests

A) Physical examination (at the clinic)

Otoscopy (ear look-in)
The doctor checks the eardrum and ear canal. In DFNB9, the eardrum looks normal because the problem is not in the outer ear. This helps rule out earwax or infection as the cause. NCBI
General exam and developmental check
The clinician reviews motor and social milestones. Because DFNB9 is “nonsyndromic,” other body systems are usually normal. This supports an isolated hearing disorder. NCBI
Family history (three-generation pedigree)
Even if parents hear well, they may both be healthy carriers. This pattern points to autosomal recessive inheritance. NCBI
Middle-ear assessment (tympanometry)
This quick pressure test checks eardrum movement. In DFNB9, tympanograms are usually normal, which supports an inner-ear/nerve issue rather than middle-ear fluid. NCBI
Newborn hearing screen review
Clinicians confirm whether the baby passed OAE but failed ABR, a classic red flag for auditory neuropathy/synaptopathy like DFNB9. NCBI

B) Manual/behavioral audiology tests

Behavioral observation audiometry (BOA)
For infants, the audiologist watches for eye-blink or startle to sound. Poor or inconsistent responses prompt objective tests for ANSD. MedlinePlus
Visual reinforcement audiometry (VRA) / conditioned play audiometry (CPA)
For toddlers/children, these games measure hearing thresholds. Children with DFNB9 often show severe to profound thresholds, guiding treatment like cochlear implantation. MedlinePlus
Speech audiometry
Measures how well speech is recognized at different loudness levels. People with auditory neuropathy often understand speech poorly even when tones are audible. Wiley Online Library
Tuning fork tests (Rinne/Weber)
Simple bedside checks help separate sensorineural from conductive loss; DFNB9 shows a sensorineural pattern, steering evaluation toward inner-ear/nerve tests. MedlinePlus
Loudness growth and temporal resolution tasks
Behavioral tasks can reveal abnormal timing/processing (temporal cues) typical of auditory neuropathy, explaining poor speech clarity. Wiley Online Library

C) Laboratory & pathological (genetic) tests

Targeted multigene hearing-loss panel including OTOF
Modern panels read all exons of OTOF and other deafness genes. Finding two pathogenic OTOF variants confirms DFNB9. NCBI
OTOF sequencing with deletion/duplication (CNV) analysis
Adds detection of exon-level losses/duplications missed by sequencing alone. NCBI
Whole-exome or whole-genome sequencing
Used when panels are negative or to find unusual variant types; can also discover other rare causes of ANSD. NCBI
Segregation testing in parents/siblings
Confirms that each parent carries one OTOF variant and that the child inherited both. This proves recessive inheritance in the family. NCBI
Research-level functional studies (rarely needed clinically)
Scientific tests can show how a novel variant affects otoferlin’s calcium binding or vesicle fusion, supporting disease causality. PMC+1

D) Electrodiagnostic tests

Auditory brainstem response (ABR)
In DFNB9, ABR waves are absent or severely abnormal even at loud sounds, because the nerve does not receive a clean signal from the hair cells. NCBI
Otoacoustic emissions (OAEs)
These sounds made by outer hair cells are often present early, showing that outer hair cells work even though neural transmission fails—classic for auditory synaptopathy. OAEs can fade with time. NCBI
Auditory steady-state response (ASSR)
Provides frequency-specific thresholds in infants who cannot cooperate with behavioral tests; often shows severe sensorineural loss in DFNB9. Wiley Online Library
Cochlear microphonic (CM) and electrocochleography (ECochG)
These tests can record hair cell activity even when ABR is absent, supporting the diagnosis of synaptopathy/neuropathy. Wiley Online Library
Acoustic reflex testing
Stapedial reflexes are often absent in auditory neuropathy because the neural pathway is disrupted. This supports the diagnosis. Wiley Online Library

E) Imaging (to guide care and rule out other issues)

High-resolution CT or MRI of the temporal bones and internal auditory canals is usually normal in DFNB9 because anatomy is intact. Imaging is still useful to plan cochlear implantation and to rule out rare structural problems. NCBI

Treatment Overview

Cochlear implantation (CI) is the main proven therapy for children with OTOF-related auditory neuropathy, with consistently strong speech and hearing outcomes compared with other causes of auditory neuropathy. Early implantation supports spoken-language development. Hearing aids may help some children with milder loss but are often insufficient in DFNB9. SpringerOpen+3PMC+3Frontiers+3

Gene therapy for OTOF (e.g., DB-OTO, AK-OTOF) is in clinical trials and has shown early, clinically meaningful improvements in several children, including near-normal hearing in some cases. These are not yet FDA-approved, but trials are active and expanding. Children’s Hospital of Philadelphia+5investor.regeneron.com+5Fierce Biotech+5

There are no FDA-approved drug treatments that correct OTOF-related congenital hearing loss. Current U.S. guidance also notes no FDA-approved gene therapy for hearing loss yet; use of any drug is supportive (e.g., treating ear infections), not disease-modifying for DFNB9. nidcd.nih.gov+2Children’s Hospital of Philadelphia+2

Non-pharmacological treatments (therapies & other supports)

Cochlear Implantation (unilateral or bilateral).
Purpose: Provide access to sound for severe-to-profound loss.
Mechanism: Bypasses the faulty inner hair-cell synapse and directly stimulates the auditory nerve with electrical signals; in OTOF loss this typically restores synchrony needed for speech understanding. PMC+1
Early Identification & Amplification Pathway.
Purpose: Fast-track babies from diagnosis to CI candidacy discussions.
Mechanism: Newborn screening → diagnostic ABR/OAE → genetics → early referral improves language outcomes by reducing auditory deprivation. American Academy of Audiology
Consistent Device Use & Mapping (CI programming).
Purpose: Optimize hearing clarity over time.
Mechanism: Audiologists adjust CI settings (“maps”) to a child’s thresholds and comfort levels, improving detection and speech perception. PMC
Auditory-Verbal Therapy (AVT).
Purpose: Build listening and spoken-language skills after CI.
Mechanism: Structured listening tasks strengthen brain pathways for speech understanding. PMC
Speech-Language Therapy.
Purpose: Improve articulation, vocabulary, and communication.
Mechanism: Direct practice using auditory input from CI supports normal language milestones. PMC
Family-Centered Early Intervention.
Purpose: Coach caregivers to create rich listening/language environments.
Mechanism: Daily repetition and responsive interaction accelerate language growth. American Academy of Audiology
Classroom Acoustic Optimization (FM/remote-microphone systems).
Purpose: Improve hearing in noise and at distance.
Mechanism: Teacher’s mic streams voice directly to child’s processors, boosting signal-to-noise ratio. Texas Children’s
Educational Accommodations (IEP/504 supports).
Purpose: Ensure access to instruction.
Mechanism: Preferential seating, captioning, note-taking, and quiet classrooms reduce listening effort and support learning. American Academy of Audiology
Aural Rehabilitation (listening training apps/games).
Purpose: Improve discrimination of speech sounds.
Mechanism: Repetitive listening drills refine cortical processing of CI input. PMC
Sign Language (as family choice/backup).
Purpose: Ensure full communication access at all times.
Mechanism: Visual language provides a complete linguistic system while auditory skills develop. American Academy of Audiology
Hearing Conservation.
Purpose: Protect any residual hearing and the implant ear.
Mechanism: Avoid loud noise; use protection to prevent additional auditory injury. American Academy of Audiology
Routine Otologic Care & Vaccination Review.
Purpose: Reduce otitis media complications and meningitis risk post-CI.
Mechanism: Preventive vaccines (per CI recommendations) and timely ear care support implant safety and performance. Verywell Health
Tele-audiology & Remote Support.
Purpose: Maintain frequent follow-up for mapping and therapy.
Mechanism: Remote check-ins keep devices optimized and progress on track. PMC
Parent Education on Device Troubleshooting.
Purpose: Minimize downtime.
Mechanism: Quick fixes for cables, coils, batteries ensure continuous auditory input. PMC
Music Listening Training.
Purpose: Enrich auditory experience and pitch perception.
Mechanism: Structured music exposure may refine temporal and pitch cues through the CI. PMC
Social-Emotional Support.
Purpose: Address stigma, build confidence.
Mechanism: Counseling/peer groups reduce stress and support participation. American Academy of Audiology
Speech-in-Noise Strategies.
Purpose: Improve real-world understanding.
Mechanism: Face-to-face conversation, reducing background noise, and requesting repetition improve comprehension. PMC
Regular Device Upgrades (processors/software).
Purpose: Access better noise reduction and speech coding.
Mechanism: Newer CI processors can improve performance in challenging settings. PMC
Multidisciplinary Hearing-Loss Clinics.
Purpose: Coordinate audiology, ENT, genetics, therapy, and education.
Mechanism: Team care shortens time to effective interventions. American Academy of Audiology
Participation in OTOF Gene-Therapy Trials (where eligible).
Purpose: Potentially restore more natural hearing by replacing the missing otoferlin gene.
Mechanism: AAV vectors deliver functional OTOF to inner-ear cells; early data show meaningful hearing gains in many treated children (investigational). investor.regeneron.com+2ClinicalTrials+2

Drug treatments

There are currently no FDA-approved drugs to treat or reverse ARNSHL9/OTOF-related congenital hearing loss. Major U.S. clinical sources emphasize that no drug (and as of today, no FDA-approved gene therapy) is available for hereditary hearing loss; disease-modifying therapy remains investigational in trials (e.g., DB-OTO, AK-OTOF). Therefore, I cannot list “20 FDA-approved drugs from accessdata.fda.gov for this condition,” because such drugs do not exist. Care is centered on cochlear implantation, rehabilitation, education supports, and, for eligible families, clinical trials. nidcd.nih.gov+2Children’s Hospital of Philadelphia+2

If you need, I can compile a separate appendix of common supportive medications used around hearing care (e.g., routine vaccines per CI guidance, analgesics for post-op care, antibiotics for otitis media). These are not disease-specific or curative for DFNB9.

Dietary molecular supplements

Omega-3 (DHA/EPA).
Dose (typical pediatric/parental guidance varies by age; clinician-directed): DHA 100–250 mg/day in young children as part of total omega-3 intake.
Function/mechanism: Structural lipid for neural membranes; may support auditory neural processing and language learning indirectly. (No cure for DFNB9.) American Academy of Audiology
Iodine (only if deficient).
Dose: Per age-based RDA; avoid excess.
Function/mechanism: Supports thyroid hormone production essential for neurodevelopment; prevents cognitive delays that could compound communication challenges. (Does not treat OTOF defect.) American Academy of Audiology
Iron (if iron-deficient).
Dose: Per pediatric hematology guidance.
Function/mechanism: Prevents anemia-related fatigue and supports attention/learning needed for therapy participation. American Academy of Audiology
Vitamin D (if low).
Dose: Age-appropriate supplementation to reach sufficiency.
Function/mechanism: Bone/immune health; supports post-operative recovery and general wellness. American Academy of Audiology
Vitamin B12 (if deficient).
Dose: As prescribed based on deficiency.
Mechanism: Myelin/nerve health for global development; no evidence it corrects synaptopathy but supports overall neurologic function. American Academy of Audiology
Folate (dietary or supplement if low).
Dose: Per age RDA.
Mechanism: Nucleotide synthesis and neurodevelopment; supports learning and growth. American Academy of Audiology
Zinc (if low).
Dose: Age-based RDA.
Mechanism: Immune and tissue repair roles; general pediatric health. American Academy of Audiology
Calcium (dietary sufficiency).
Dose: Age-based RDA.
Mechanism: Bone health; critical in growing children, including CI recipients. American Academy of Audiology
Protein-rich nutrition (diet pattern).
Dose: Balanced age-appropriate intake.
Mechanism: Provides amino acids for tissue healing and learning demands during intensive therapy. American Academy of Audiology
General multivitamin (only for dietary gaps).
Dose: Pediatric formulation per label/clinician advice.
Mechanism: Covers common micronutrient shortfalls that could indirectly affect attention, energy, and therapy participation. American Academy of Audiology

Again, none of these treat OTOF mutations; they simply support overall health so children can benefit maximally from cochlear implants and therapy. PMC

Immunity-booster / regenerative / stem-cell drug concepts

AAV-based OTOF Gene Therapy (e.g., DB-OTO, AK-OTOF).
Dose/route: One-time inner-ear (intratympanic/cochlear) infusion in trials.
Function/mechanism: Delivers working OTOF to inner-ear cells to restore otoferlin; early trial data show hearing gains in many children. (Investigational.) investor.regeneron.com+1
Dual-vector OTOF gene delivery approaches.
Dose: Trial-specific.
Mechanism: Splits large OTOF cDNA into two AAVs that re-assemble in the cell; solution to OTOF’s size limit. (Investigational.) investor.regeneron.com
Alternate AAV capsids for inner ear (e.g., Anc80L65).
Dose: Trial design dependent.
Mechanism: Improved inner-ear cell transduction; platform underpins several programs. (Investigational.) nidcd.nih.gov
Non-viral gene delivery (preclinical).
Mechanism: Nanoparticles or other vectors to deliver OTOF safely; not yet in human DFNB9 trials. (Preclinical concept.) nidcd.nih.gov
Genome editing (CRISPR) strategies (preclinical).
Mechanism: Corrects specific OTOF variants in situ; no approved therapy; early research stage. (Preclinical.) nidcd.nih.gov
Hair-cell/neuronal regenerative drugs (general inner-ear pipeline).
Mechanism: Various growth and differentiation approaches; none approved for congenital OTOF loss. (Investigational.) nidcd.nih.gov

Surgeries

Cochlear Implantation (CI).
Procedure: Under general anesthesia, the surgeon places an electrode array into the cochlea and a receiver under the skin; the external processor is fitted later.
Why: Bypasses the faulty synapse in OTOF loss, providing reliable auditory input for speech development. Verywell Health+1
Bilateral CI (same-day or staged).
Procedure: Implants in both ears.
Why: Offers better localization and hearing in noise; often recommended in prelingual DFNB9. PMC
Revision CI Surgery.
Procedure: Replace/repair device if failure, migration, or infection occurs.
Why: Restore device function for continued access to sound. Verywell Health
Middle-ear procedures (as needed).
Procedure: Treat chronic otitis media (e.g., tubes).
Why: Keep the middle ear healthy around CI care and reduce complications. Verywell Health
Trial/Research Delivery of Inner-ear Gene Therapy.
Procedure: One-time infusion into the cochlea in a clinical trial setting.
Why: Attempt to restore otoferlin expression; still investigational, with early promising data. investor.regeneron.com

Practical preventions

Complete newborn hearing screening & follow-up ABR/OAE promptly. Early detection → early help. American Academy of Audiology
Genetic testing when auditory neuropathy is suspected. Confirms OTOF and guides CI timing/trials. PreventionGenetics
Vaccinations per CI guidelines (e.g., pneumococcal). Lowers meningitis risk post-implant. Verywell Health
Protect ears from loud noise. Prevents added damage. American Academy of Audiology
Treat ear infections quickly. Keeps the ear healthy for devices. Verywell Health
Consistent device wear and timely mapping. Maintains brain access to sound. PMC
Use remote-mic/FM systems in class. Improves hearing in noise. Texas Children’s
Language-rich home routines. Talk, read, sing daily. American Academy of Audiology
Regular multidisciplinary check-ups. Audiology/ENT/therapy coordination. American Academy of Audiology
Consider clinical-trial alerts/registers. For OTOF gene-therapy opportunities. ClinicalTrials

When to see a doctor

Immediately/ASAP:
- Newborn failed hearing screen → diagnostic ABR/OAE and genetics referral.
- Child not meeting listening/speech milestones despite hearing technology.
- Device problems (no sound, pain, infection at site).
- Recurrent ear infections or drainage with a CI. American Academy of Audiology+1
Routine (scheduled):
- Regular CI mapping and therapy follow-ups.
- Annual hearing/communication review with school supports. PMC

What to eat and what to avoid

Eat: Balanced diet for growth—lean proteins, fruits/vegetables, whole grains, dairy or fortified alternatives; ensure sufficient iron, iodine, vitamin D, zinc, and omega-3s as per age and doctor advice. Good nutrition supports energy, attention, and learning during therapy. American Academy of Audiology
Avoid: Excess sugar, ultra-processed snacks as staples, and high-sodium “junk” that displaces nutrient-dense foods. Avoid unproven “hearing cure” supplements or mega-doses; they do not fix OTOF mutations and can be harmful. American Academy of Audiology

FAQs

Is DFNB9 the same as auditory neuropathy?
DFNB9 is one genetic cause of auditory neuropathy; specifically an OTOF problem at the synapse. NCBI
Will hearing aids fix it?
They may help mild cases but often do not provide clear speech in DFNB9; cochlear implants are far more effective. PMC
Are cochlear implants successful in OTOF loss?
Yes—excellent and predictable outcomes are repeatedly reported. PMC
Is there a medicine that cures DFNB9?
No FDA-approved drug exists to reverse OTOF-mediated hearing loss. Mass Eye and Ear
Is gene therapy real for DFNB9?
Yes, but still in trials; early results show clinically meaningful hearing gains in many children. investor.regeneron.com
What age is best for CI?
Earlier is generally better for language development when criteria are met. PMC
Will my child talk normally after CI?
With early CI, consistent use, and therapy, many children develop strong spoken language. Outcomes vary. PMC
Do we still need therapy after CI?
Yes—mapping + auditory-verbal/speech therapy are essential. PMC
Can nutrition or supplements cure DFNB9?
No. Good nutrition supports learning and health but does not fix OTOF variants. American Academy of Audiology
Will school be challenging?
With FM/remote microphones and accommodations, many children thrive. Texas Children’s
Can both ears be implanted?
Yes; bilateral CI often improves hearing in noise and localization. PMC
What are CI risks?
Surgical risks are low but include infection and rare meningitis—vaccines reduce this risk. Verywell Health
Will CI work if the hearing nerve is absent?
CI needs a working auditory nerve; imaging helps check this before surgery. PMC
What is temperature-sensitive auditory neuropathy?
Some OTOF variants worsen hearing when body temperature rises; cooling resolves it. PreventionGenetics
Where can I follow OTOF trials?
ClinicalTrials.gov lists DB-OTO and AK-OTOF studies and natural-history cohorts. ClinicalTrials+1

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