• Intratympanic injection of hucMSC-EXOs effectively delivers exosomes to vestibular end organs, including utricle, saccule, and crista ampullaris.
• hucMSC-EXOs significantly attenuate gentamicin-induced vestibular dysfunction and hearing loss, outperforming dexamethasone in some behavioral tests.
• Exosome treatment reduces hair cell loss in key vestibular regions and modulates apoptosis and autophagy via the SNARE pathway.
• Findings support hucMSC-EXOs as a promising therapeutic strategy for gentamicin-induced ototoxicity.