ABSTRACT The long-term goals of this research are to elucidate the molecular mechanisms underlying noise-induced hearing loss (NIHL) and to propose rational therapeutic interventions for prevention. Based on our previous findings and consistent with findings in other systems, we will test the hypothesis that prolonged activation of AMPKα (T172) by calcium/calmodulin-dependent kinase kinase 2 (CaMKK2) and liver kinase B1 (LKB1) or reactive oxygen species (ROS) triggers outer hair cell (OHC) death. We further propose that activated CaMKK2 facilitates translocation of nuclear factor of activated T-cells (NFAT) into OHC nuclei, causing release of cytokine genes. Finally, we will use siRNA and pharmacological compounds to block multiple death pathways for potential synergistic protection against NIHL. We will employ a comprehensive experimental approach including in-vivo studies with adult mice to define the underlying molecular mechanisms using short hairpin RNA (shRNA) via virus transfection, single cell RNA-seq (scRNA-seq) with gene set enrichment analysis (GSEA), and fluorescence in-situ hybridization with RNAscope. These studies investigating innovative therapeutic strategies are designed to identify novel avenues for the prevention of NIHL, benefiting the quality of life of affected individuals and reducing healthcare costs. In addition, the data generated by this proposal will make a significant contribution to our understanding of a broad range of inner ear disorders since similarities have been shown in the molecular events associated with noise-induced, drug-induced, and age-related hearing loss.