KCNQ4 is a voltage-gated potassium channel subunit that forms tetrameric complexes crucial for inner ear physiology 1. The channel conducts slowly activating and deactivating potassium currents, promoting K+ efflux during action potential repolarization to regulate membrane potential of sensory cells in the cochlea 1. KCNQ4 maintains potassium ion homeostasis essential for normal hearing and sensory perception of sound 2. Channel activation depends on the signaling lipid phosphatidylinositol 4,5-bisphosphate (PIP2), which bridges the voltage-sensing and pore domains to facilitate opening 1. Pathogenic KCNQ4 variants cause autosomal dominant nonsyndromic hearing loss (DFNA2), accounting for ~2.5% of autosomal-dominant cases in European populations 3. Mutations impair potassium ion selectivity and protein stability, disrupting inner ear ion homeostasis and leading to progressive, typically high-frequency hearing loss 42. KCNQ4 activators represent a therapeutic strategy for hereditary, noise-induced, and age-related hearing loss 2. Beyond auditory function, low KCNQ4 expression correlates with improved survival in certain cancers and may serve as a prognostic indicator 56.