Sensory epithelia are composed of specialized cells arranged in specific patterns essential for function. The auditory epithelium of the organ of Corti features a highly conserved checkerboard pattern of mechanosensory hair and supporting cells, preventing direct hair cell contact and preserving epithelial integrity. In mice, disruption of this pattern results in deafness due to hair cell apoptosis caused by abnormal adherens and tight junction formation and structural fragility. This pattern is evolutionarily conserved across species, highlighting its functional significance. Direct hair cell contact, which normally does not occur, leads to abnormal adhesion molecule accumulation, altered ion permeability, and subsequent cell death. The checkerboard pattern likely evolved to optimize hair-supporting cell interactions while maintaining epithelial stability. This review explores the physiological significance of this cellular arrangement in auditory function and the consequences of its disruption, which leads to hearing loss. Understanding the mechanisms governing this pattern may provide insights into hearing disorders and potential therapeutic approaches.