<p>Sensorineural hearing loss (SNHL) poses significant treatment challenges due to the inner ear's complex anatomy and limited regenerative capacity. To overcome these challenges, novel biomaterials with multifunctional therapeutic properties are being explored. However, conventional treatments are often inadequate due to restricted drug penetration and systemic toxicity. Therefore, the aim of this review is to examine the potential of fucoidan—a sulfated polysaccharide derived from brown algae—as both a therapeutic agent and a nanocarrier for targeted drug delivery in the treatment of SNHL. Emphasis is placed on its antioxidant, anti-inflammatory and biocompatible properties, as well as its ability to overcome biological barriers. This review evaluates fucoidan’s structural and biological features relevant to otological applications, including its role in modulating signaling pathways (e.g., Notch, Wnt/β-catenin), promoting stem cell homing, and supporting cochlear hair cell regeneration. Fucoidan-based nanoparticles which can be tuned in size from 5 to 900&#xa0;nm can penetrate the blood-labyrinth barrier, enhance stem cell homing, support cochlear regeneration, and minimize systemic toxicity. Their functionalization with magnetic components allows for localized delivery. Fucoidan shows significant antioxidant and anti-inflammatory effects, promotes mesenchymal stem cell migration, and activates Lgr5 + supporting cells, making it effective in restoring cochlear homeostasis. Fucoidan's multifunctional properties support its development as both a therapeutic agent and drug delivery platform for inner ear disorders. Fucoidan-based nanomedicine represents a promising strategy for next-generation SNHL treatments, although challenges such as variability in molecular composition and delivery barriers require further investigation for clinical translation.</p> Graphical Abstract <p></p>