<p>Exosomes, characterized by their distinctive structural and functional properties, are increasingly recognized as an important focus of research in otology, offering considerable promise for both diagnostic and therapeutic purposes. This review provides a systematic summary of the biological foundations of exosomes, with particular emphasis on their potential applications in the diagnosis and treatment of ear diseases. We begin by evaluating the translational utility of exosomes as biomarkers for the early detection of otologic diseases. We then explore the therapeutic mechanisms mediated by exosomes derived from mesenchymal stem cells (MSCs), various tissues, body fluids, and plant sources. Owing to their natural capacity to encapsulate biological cargo, exosomes represent highly promising delivery vehicles capable of efficiently transporting drugs, functional proteins, and nucleic acids to target sites within the ear, thereby offering innovative avenues for the treatment of otological conditions. Finally, this review outlines prospective research directions and critically examines the major scientific challenges that must be addressed to facilitate clinical translation.</p> Graphical Abstract <p></p>