Sensorineural hearing loss, which is often caused by degeneration of hair cells in the auditory epithelium, is permanent because lost hair cells cannot be replaced in mammals. In recent years, important progress has been made in understanding the mechanisms involved in hair cell damage and, more importantly, the reasons why hair cells cannot be regenerated spontaneously in mammals. The knowledge of the factors implicated in hair cell fate determination and of the mechanisms of hair cell regeneration in birds could help in the effort to find a treatment for hearing loss. Although cochlear implant technology is advanced, it still provides only moderate hearing capacity in sensorineural deaf individuals. Inducible stem cells and molecular therapies are appealing alternatives to the cochlear implant as they hold the promise of a cure. It is important to develop a safe and effective means to deliver stem cells or genes to the correct sites to stimulate regeneration in the right place. This review aims to synthesize the present knowledge in the field of sensorineural hearing loss, focusing on the mechanisms involved in hair cell development and regeneration, with the specific purpose of identifying new therapeutic strategies. Despite tremendous progress in this field, most of the concepts discussed in this review are still in the experimental stage.