Across the breadth of brain and nervous system injury and disease, neurotrophin signalling is moving to the vanguard of neurotherapeutics. The potency of neurotrophins to stimulate neural repair following sensorineural hearing loss exemplifies this. The establishment of the afferent innervation of the cochlea occurs via a precise spatiotemporal program, where promiscuous spiral ganglion neurite outgrowth is followed by pruning and selective neuronal apoptosis; processes inherently tied to neurotrophin signalling. Sensori-neural hearing loss, for example with noise or chemical ototoxicity, causes loss of the neurotrophin source and consequent auditory nerve atrophy. Cell-based, drug or gene therapy strategies around the neurotrophin translational research platform in the cochlea promote vigorous auditory nerve regeneration, with directional guidance queues reminiscent of the developmental programming. Such control of neural repair provides an opportunity to enhance medical bionics neural prosthetic interfaces; a neurotrophin gene delivery platform we have developed has established proof of principle showing improve hearing performance with cochlear implants.