Sensory hair cells rely on otoferlin as the calcium sensor for exocytosis and encoding of sound preferentially over the neuronal calcium sensor synaptotagmin. Although it is established that synaptotagmin cannot rescue the otoferlin KO phenotype, the large size and low solubility of otoferlin have prohibited direct biochemical comparisons that could establish functional differences between these two proteins. To address this challenge, we have developed a singlemolecule colocalization binding titration assay (smCoBRA) that can quantitatively characterize full-length otoferlin from mammalian cell lysate. Using smCoBRA, we found that, although both otoferlin and synaptotagmin bind membrane fusion SNARE proteins, only otoferlin interacts with the L-type calcium channel Cav1.3, showing a significant difference between the synaptic proteins. Furthermore, otoferlin was found capable of interacting with multiple SNARE and Cav1.3 proteins simultaneously, forming a heterooligomer complex. We also found that a deafness-causing missense mutation in otoferlin attenuates binding between otoferlin and Cav1.3, suggesting that deficiencies in this interaction may form the basis for otoferlin-related hearing loss. Based on our results, we propose a model in which otoferlin acts as a calcium-sensitive scaffolding protein, localizing SNARE proteins proximal to the calcium channel so as to synchronize calcium influx with membrane fusion. Our findings also provide a molecular-level explanation for the observation that synaptotagmin and otoferlin are not functionally redundant. This study also validates a generally applicable methodology for quantitatively characterizing large, multivalent membrane proteins.exocytosis | membrane fusion | calcium | otoferlin | calcium channel S ensory hair cells encode sound by converting mechanical motion into chemical signals. Hair cell synapses accommodate this unique functional demand via a set of adaptations that distinguish it from neuronal synapses, including reliance on the L-type calcium channel Cav1.3 in place of the P-and N-type calcium channels found at most neuronal synapses ( Fig. 1 A and B) (1-6). During maturation, hair cells also cease expression of the two C2 domain protein synaptotagmin I, which serves as the calcium sensor for neurotransmitter release at neuronal synapses (7). Although lacking synaptotagmin, mature hair cells express the six C2 domain protein otoferlin, which is proposed to function as the calcium sensor for exocytosis in mature sound-encoding synapses (8). In agreement with this belief, KO studies have linked otoferlin to sensory hair cell exocytosis, and in vitro studies on otoferlin have concluded that several C2 domains bind SNARE proteins and stimulate membrane fusion in a calcium-sensitive manner (2,(8)(9)(10). However, a recent cell-based study concluded that synaptotagmin cannot rescue the otoferlin KO phenotype, arguing against a simple functional redundancy between these C2 domain proteins (11). The functional differences between synaptotagmin and otofer...