A quiet place: The impact of the word "quiet" on clinical workload.

Purpose: This study aimed to determine the impact of uttering the word "quiet" on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness. Materials and Methods: A multicenter, single-blind, randomized-controlled trial was conducted. A total of 80 overnight call shifts covered by a pool of 10 residents were randomized to the quiet or to the control group. At the start of shift, residents were asked to state aloud, "Today will be a quiet night" (quiet group) or "Today will be a good night" (control group). Clinical workload, as measured by number of consults, was the primary outcome. Secondary measures included number of sign-out tasks, unplanned inpatient and operating room visits, number of phone calls and hours of sleep, and self-perceived busyness. Results: There was no difference in the number of total (P = 0.23), nonurgent (P = 0.18), and urgent (P = 0.18) consults. Tasks at signout, total phone calls, unplanned inpatient visits, and unplanned operating room visits did not differ between the control and quiet groups. While there were more unplanned operating room visits in the quiet group (29, 80.6%) compared to the control group (34, 94.4%), this was not found to be significant (P = 0.07). The majority of residents reported feeling "not busy" during control nights (18, 50.0%) compared to feeling "somewhat busy" during quiet nights (17, 47.2%; P = 0.42). Conclusion: Contrary to popular belief, there is no clear evidence that uttering the word "quiet" significantly increases clinical workload.

Audiologic comparison of classification systems of advanced otosclerosis.

OBJECTIVE: To identify which patients with advanced otosclerosis may have the greatest audiologic improvement with stapedotomy based on different classifications of advanced otosclerosis. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary neurotology center. METHODS: Patients were divided into different classifications of advanced otosclerosis based on either a bone conduction threshold of greater than 60 dB HL (Bone Conduction (BC) Group), a word recognition score of less than 70% (Word Recognition (WRS) Group), or pure tone average of greater than 85 dB HL (Pure Tone Average (PTA) Group). Audiologic outcomes and complication profiles were compared between these groups. RESULTS: Nineteen patients met criteria for one or more group. There were 18 patients in the PTA group, 11 in the BC group, and 12 in the WRS group. There was no significant difference in the pre- or postoperative audiologic status between the different groups. CONCLUSIONS: Patients with advanced otosclerosis have significant improvements in pure tone averages and air-bone gaps following stapedotomy regardless of the classification criteria used. Stapedotomy remains a reasonable primary intervention for the majority of patients with advanced otosclerosis.

Audiologic Outcomes of Footplate Drillout for Obliterative Otosclerosis.

OBJECTIVE: To evaluate the audiologic outcomes of microdrill fenestration for obliterative otosclerosis compared to traditional stapedotomy technique. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Adult patients undergoing stapedotomy for otosclerosis. MAIN OUTCOME MEASURES: Patients were separated into groups that underwent either microdrill or laser fenestration based on intraoperative severity of disease. Audiologic outcomes and complications were compared between the two groups. RESULTS: There were 588 ears in 519 patients that were evaluated. There was a significant postoperative improvement in pure tone average, air-bone gap, and mean bone conduction thresholds for both the obliterative and nonobliterative group (p < 0.001). There was no significant difference in the pre- or postoperative hearing status between the two groups. There was no significant difference in complications between the two groups, including no cases of postoperative profound hearing loss in the drill fenestration group. CONCLUSIONS: Audiologic outcomes are similar between microdrill fenestration and laser fenestration for otosclerosis. Pure tone average, air-bone gap, and mean bone conduction thresholds all improved postoperatively and were similar between groups.

Revision Stapes Surgery: Hearing Symptoms and Associations With Intraoperative Findings and Outcomes.

OBJECTIVE: Stapes surgery for otosclerosis occasionally requires revision due to recurrent or persistent conductive hearing loss (CHL). This study examines outcomes after revision stapes surgery. STUDY DESIGN: Retrospective review. SETTING: Single tertiary neurotology center. METHODS: Patients undergoing revision stapes surgery for otosclerosis from 2008 to 2017 were reviewed. Postoperative air-bone gaps (ABGs) were the primary outcome measure. RESULTS: During the study period, 150 patients underwent revision stapes surgery. One hundred patients (67%) had gradually progressive recurrent CHL; 16 (11%), sudden recurrent CHL; 13 (9%), persistent CHL; and 21 (14%), no CHL. For 129 patients with CHL, the mean ABG improved from 23.7 to 9.3 dB (P < .0005). The most common intraoperative findings for these patients were prosthesis displacement with incus necrosis (38%) or without it (43%), normal anatomy with seemingly good prosthesis placement (6%), and abundant scar tissue (6%). Patients with recurrent hearing loss achieved lower mean ABGs than patients with persistent hearing loss (8.8 vs 13.2 dB, P = .02). There were no associations between onset pattern of CHL or intraoperative findings and hearing outcomes (P > .05). Four patients (2.7%) developed sensorineural hearing loss after revision, defined as an increase in bone conduction pure tone average ≥15 dB, all of whom had previous replacement of a malpositioned prosthesis. CONCLUSIONS: Revision stapes surgery confers significant improvement in hearing for patients with persistent and recurrent CHL, although patients with persistent CHL after initial surgery see less improvement with revision.

Outcomes in primary and revision surgery for pediatric onset stapedial pathology.

OBJECTIVES: To analyze audiometric outcomes of surgery for pediatric onset stapedial pathology (POSP). STUDY DESIGN: Retrospective cohort study. SETTING: Single-institution database. METHODS: Retrospective analysis of 809 stapes procedures performed at a single high-volume tertiary referral otology practice, 75 of which were POSP cases. RESULTS: Oval window drillout for thick footplate and aborting the procedure were more common in POSP cases compared to the rest of the cohort (28.0% versus 9.8% [p < .001] and 5.3% versus 1.2% [p = .007], respectively). Postoperative complications were rare. Postoperative Air-Bone Gap (pABG) closure to ≤20 dB was significantly lower in the POSP group (80.0% versus 89.0%, p = .021). Rates of sensorineural hearing loss (SNHL) were not different between the two groups. Poor audiometric outcomes in the POSP group were largely driven by revision cases; pABG≤10 dB was 60.3% in primary cases but only 11.8% in revisions (p < .001), and postoperative SNHL was significantly higher in revisions (29.4% versus 0.0%, p < .001). In multivariate analysis, POSP was not a predictor of successful closure of the pABG at either level, nor did it predict significant postoperative SNHL. CONCLUSIONS: Surgery for pediatric onset stapedial pathology had significantly worse audiometric outcomes, particularly in revision cases, as compared to the rest of the cohort.

Effect of Surgical Start Time on Stapedotomy Outcomes.

OBJECTIVE: To examine if performing stapedotomy as the first case of the day provides improved outcomes compared with those performed later in the day. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Adult patients undergoing stapedotomy for otosclerosis. MAIN OUTCOME MEASURES: Patients were separated into either a first case group or a later case group based on surgical start time. Audiologic outcomes and complications were compared between the two groups. RESULTS: The first case group had a smaller postoperative air-bone gap (ABG) compared with the later case group of 9.81 dB HL compared with 11.73dB HL and 3.79 dB HL compared with 6.29 dB HL at 1000 and 2000 Hz, respectively (p = 0.03, p < 0.01). The mean postoperative ABG was 10.63 dB HL for the first start group compared with 12.12 dB HL for the later start group, which was statistically significant (p = 0.05). CONCLUSIONS: First start stapedotomy is associated with slightly improved audiologic outcomes compared with those starting later in the day, although both groups had significantly improved postoperative outcomes overall. There was no significant difference in complications when comparing stapedotomy by case start time.

Is Menière's Disease a Contraindication to Stapedectomy?

OBJECTIVE: Review surgical outcomes of stapedectomy for otosclerosis in patients with Menierè's disease. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients with otosclerosis and Menière's disease undergoing stapedectomy between 2010 and 2017. INTERVENTION: Stapedectomy. MAIN OUTCOME MEASURES: Pre- and postoperative hearing and complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone frequency, pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). RESULTS: Among 1,499 patients with otosclerosis, the incidence of concomitant Menière's disease was 1.7%. Fifteen patients with otosclerosis and Menière's disease underwent stapedectomy, 12 primary and three revisions. Mean AC PTA was 43 dB preoperatively, and 25 dB postoperatively (p = 0.0007), while the ABG improved on average from 20 to 5 dB (p = 0.0001). There was no significant difference in BC PTA or WRS postoperatively. Two patients experienced fluctuation of hearing in the postoperative period, one of which resolved with a course of steroids. The mean follow-up time was 41 months. CONCLUSIONS: In patients with otosclerosis and Menière's disease, stapedectomy provides excellent hearing outcomes in a majority of patients. As is characteristic of Menière's disease, some patients will continue to experience fluctuating hearing postoperatively, which may progress to severe sensorineural hearing loss. Menière's disease may not be an absolute contraindication to stapes surgery.

Outcomes in Revision Stapes Surgery.

OBJECTIVES: To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. STUDY DESIGN: Retrospective cohort study. SETTING: Large single-institution database. METHODS: Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. RESULTS: Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to ≤20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P < .001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. CONCLUSIONS: Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. LEVEL OF EVIDENCE: 4 (retrospective observational research).

Outcomes After Tympanic Membrane Perforation During Primary Stapes Surgery for Otosclerosis.

OBJECTIVE/HYPOTHESIS: Stapes surgery is occasionally complicated by an intraoperative tympanic membrane perforation (ITMP), traditionally indicating abortion of the procedure due to concerns for postoperative infection and sensorineural hearing loss (SNHL). This work examines outcomes and complications in completed primary stapes surgeries with and without ITMP. STUDY DESIGN: Retrospective review. METHODS: All patients diagnosed with otosclerosis between February 2008 and September 2017 at a tertiary otology referral center were reviewed retrospectively. Primary outcome measures were post-operative air-bone gap (ABG), air conduction and bone conduction pure tone averages, and post-operative complications. RESULTS: Review revealed 652 primary stapes operations meeting inclusion criteria, of which ITMP occurred in 10. There were no significant differences in pre-operative hearing metrics or demographic characteristics between ears with and without ITMP. There were also no significant differences in post-operative ABG (6.4 vs. 8.0 dB HL, P = .43) or change in ABG after surgery (-21.6 vs. -18.2 dB, P = .34) between these two groups. Patients with ITMP were more likely to complain of post-operative dysgeusia (30.0% vs. 5.3%, P = .015) but were no more likely to develop reparative granuloma, otitis media, or SNHL (P > .05). CONCLUSIONS: The first review of ITMP and hearing outcomes after stapes surgery is presented. Our findings suggest that it is likely safe and appropriate to proceed with primary stapes surgery and concurrent tympanoplasty in the presence of a small ITMP with minimal risk of infection, SNHL, or worsened hearing outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2026-E2030, 2021.

Association Between the Duration of Hearing Loss and Hearing Outcomes in Surgery for Otosclerosis.

INTRODUCTION: Hearing loss due to otosclerosis is effectively treated with surgery. The association between duration of hearing loss and surgical outcomes is unknown. STUDY DESIGN: Retrospective review. SETTING: Large otology referral center. METHODS: Patients undergoing primary stapes surgery for otosclerosis from 2005 to 2017 were evaluated according to their self-reported duration of hearing loss. Closure of the air-bone gap (ABG) was the primary outcome measure. RESULTS: A total of 580 stapes operations were included. Sixteen percent of patients reported hearing loss for ≤1 year; 25%, >1 to ≤5 years; 24%, >5 to ≤10 years; 24%, >10 to ≤20 years; and 12%, >20 years, respectively. Average pre- and postoperative ABGs were 26.1 and 9.6 dB (P < .0005). Patients with longer duration of hearing loss had worse preoperative ABGs (P < .0005). After surgery, patients with longer duration of hearing loss had a greater reduction in their ABGs (P < .0005) such that the remaining ABG was not associated with duration of hearing loss (P > .05). There were no significant associations between the duration of hearing loss and complication rates or the need for revision surgery. CONCLUSION: Otosclerosis is effectively treated with surgery even after a long duration of hearing loss, provided that sensorineural hearing and word recognition are favorable. Although far-advanced otosclerosis has known poorer hearing outcomes after stapes surgery, a long duration of hearing loss is an unreliable surrogate for this.

Hearing Outcomes and Complications in Stapes Surgery for Otosclerosis Performed Under General or Local Anesthesia.

OBJECTIVE: Stapes surgery is highly successful in reducing or eliminating the audiometric air-bone gap (ABG) related to otosclerosis, and it can be performed under general anesthesia or local anesthesia with sedation. Literature on the relative outcomes of these 2 modalities is lacking. The purpose of this study was to compare hearing outcomes for these 2 modalities in a large patient population. STUDY DESIGN: Retrospective review. SETTING: Large otology referral center. METHODS: Patients undergoing primary stapes surgery for otosclerosis from 2005 to 2017 were grouped by anesthetic modality and their cases reviewed. Pre- and postoperative ABGs were primary outcomes. RESULTS: A total of 580 patients undergoing stapes surgery were included: 46% received local anesthesia and 54% received general anesthesia. These 2 groups were similar in demographic and disease characteristics. Mean preoperative ABGs were 25.6 and 26.6 dB for patients undergoing local and general anesthesia, respectively (P = .2); mean postoperative ABGs were 9.5 and 9.7 dB (P = .9). There were no significant differences in the rates of complications, the need for revision surgery, or the need to abort surgery intraoperatively between local and general anesthesia. CONCLUSION: Consistent with limited prior data, in this cohort stapes surgery yielded similar hearing outcomes whether performed under general anesthesia or local anesthesia with sedation. While we report the largest sample size to date, this study, like previous work, carries the potential for sampling bias. Prospective study comparing local and general anesthesia for stapes surgery is needed.

Bone Cement Fixation of Stapedotomy Prostheses: Long-term Outcomes in Primary and Revision Stapes Surgery.

OBJECTIVES: To describe audiologic outcomes following hydroxyapatite bone cement fixation of stapedotomy prostheses. METHODS: A retrospective case review at a tertiary neurotology referral center was performed of patients undergoing primary or revision stapedotomy between 2010 and 2017. Patients with hydroxyapatite bone cement fixation of stapes prostheses were assessed. Pre- and postoperative hearing was compared, consisting of air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Short and long-term outcomes were assessed. RESULTS: Forty-six patients with otosclerosis underwent stapedotomy with bone cement fixation: 21 primary cases and 25 revision cases, with an average follow-up time of 17 months. Mean AC PTA was 56 dB preoperatively, and 34 dB postoperatively (P < .0001), while the ABG improved on average from 27 dB to 9 dB (P < .0001). There was no significant difference in postoperative ABG between primary and revision stapes surgery (6 dB vs 10 dB, P = .07). These results persisted through long-term follow-up in a subgroup of patients with significantly longer follow-up time (mean 44 months). There was no significant change in BC PTA or word recognition scores. Three patients underwent subsequent revisions, one patient developed sensorineural hearing loss. CONCLUSION: Stapedotomy with bone cement fixation of the prosthesis provides excellent hearing outcomes in both primary and revision treatment of otosclerosis. Results are consistent and stable through long-term follow-up. The use of bone cement should be incorporated into the surgical armamentarium of the otologist for the prevention and treatment of loose-wire syndrome and incus necrosis.

Stapes surgery with a persistent stapedial artery.

PURPOSE: To review surgical outcomes of stapes surgery for otosclerosis with persistence of the stapedial artery. MATERIALS AND METHODS: A retrospective case review of a tertiary neurotology referral center of patient with otosclerosis undergoing primary stapes surgery between 2010 and 2017 found to have a persistent stapedial artery. Stapedectomy was performed with or without cauterization of the stapedial artery. The primary outcome measures include pre- and postoperative hearing as well complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Neurologic complications, including facial nerve function, were assessed. RESULTS: Four patients out of 853 with otosclerosis undergoing stapedectomy were found to have a persistence of the stapedial artery. Mean AC PTA was 55 dB preoperatively, and 24 dB postoperatively (p = .0041), while the ABG improved on average from 31 dB to 6 dB (p = .0014). Mean follow-up time was 32 months, and there were no significant complications. Facial nerve function was preserved in all patients (House-Brackmann grade I/VI). CONCLUSIONS: In the case of a persistent stapedial artery, excellent hearing outcomes are achievable for otosclerosis via stapedectomy without an apparent increased risk of neurologic complication.

Adjuvant Chemotherapy Is Associated With Improved Survival for Late-Stage Salivary Squamous Cell Carcinoma.

OBJECTIVE: Salivary squamous cell carcinomas (SCCs) represent a unique disease entity because many are thought to represent metastases from primary cutaneous malignancies. Nevertheless, they represent a significant proportion of parotid gland cancers and have a notably poor prognosis. Recently, there has been controversy regarding the utility of adjuvant chemotherapy in the treatment of these malignancies, with most studies concluding that there is no survival benefit. We aim to determine the outcomes associated with the use of adjuvant radiotherapy and chemoradiotherapy in the treatment of early- and late-stage salivary SCC. METHODS: A retrospective study of 2,285 of surgically resected adult salivary SCC diagnosed from 2004 to 2014 in the National Cancer Database was conducted. Patients were divided into early- (I/II) and late-stage (III/IV) groups. Demographic, facility, tumor, and survival variables were included in the analyses. Multivariate Cox survival regressions, propensity-score matched analyses, and univariate Kaplan-Meier analyses were conducted. RESULTS: The use of adjuvant chemoradiotherapy for late-stage patients was associated with improved survival compared to the use of adjuvant radiotherapy alone (hazard ratio [HR] 0.774, P = 0.026). Five-year survival for late-stage patients treated with surgery alone, surgery with adjuvant radiotherapy, and surgery with adjuvant chemoradiotherapy was 31.1% (standard error [SE]: 2.5), 45.6% (SE: 2.2), and 58.9% (SE: 3.4). Use of adjuvant therapy (either chemoradiotherapy or radiotherapy alone) was associated with improved survival for early-stage patients (HR 0.746, P = 0.037). CONCLUSION: The addition of chemotherapy to the adjuvant therapy of late-stage patients with salivary SCC may result in improved long-term survival. Expanded use of adjuvant therapy for early-stage disease may also improve patient outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:883-889, 2019.

Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014.

OBJECTIVES/HYPOTHESIS: Oral cavity cancer is the most commonly occurring malignancy of the head and neck. There are limited data suggesting a change in prognosis of oral cavity cancers. We aimed to evaluate temporal trends in demographics, treatment, and prognosis of oral cavity cancer diagnosed between 1973 and 2014 inclusive. STUDY DESIGN: Retrospective database analysis. METHODS: A retrospective study of 16,030 adult patients diagnosed with oral cavity cancer between 1973 and 2014 inclusive and treated surgically in the Surveillance, Epidemiology, and End Results (SEER) 9 registry was conducted. A supplemental analysis was conducted using data from the National Cancer Database. Multivariate Cox survival regressions and univariate Kaplan-Meier analyses were conducted. RESULTS: The prognosis of both early- and late-stage disease has significantly improved between 1973 and 2014. Among patients with early-stage disease, 3-year survival increased from 78.0% (standard error [SE] = 1.3) for those diagnosed from 1973 to 1980 to 92.2% (SE = 1.1) for those diagnosed from 2011 to 2014. Among patients with late-stage disease, 3-year survival ranged from 51.9% (SE = 1.5) for those diagnosed from 1973 to 1980 to 70.3% (SE = 1.9) for those diagnosed from 2011 to 2014. For patients with late-stage disease, this improved prognosis occurred in tandem with increasing usage of chemoradiotherapy as adjuvant therapy. There has also been increasing utilization of neck dissection for early- and late-stage disease, along with higher nodal yields from performed dissections. CONCLUSIONS: The prognosis of oral cavity cancer has improved significantly from the early 1970s to recent years. In late-stage oral cancer, this change has been associated with an increased use of adjuvant therapy and adjuvant chemoradiotherapy in particular. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2762-2769, 2018.

Novel Role of the Mitochondrial Protein Fus1 in Protection from Premature Hearing Loss via Regulation of Oxidative Stress and Nutrient and Energy Sensing Pathways in the Inner Ear.

AIMS: Acquired hearing loss is a worldwide epidemic that affects all ages. It is multifactorial in etiology with poorly characterized molecular mechanisms. Mitochondria are critical components in hearing. Here, we aimed to identify the mechanisms of mitochondria-dependent hearing loss using Fus1 KO mice, our novel model of mitochondrial dysfunction/oxidative stress. RESULTS: Using auditory brainstem responses (ABRs), we characterized the Fus1 KO mouse as a novel, clinically relevant model of age-related hearing loss (ARHL) of metabolic etiology. We demonstrated early decline of the endocochlear potential (EP) that may occur due to severe mitochondrial and vascular pathologies in the Fus1 KO cochlear stria vascularis. We showed that pathological alterations in antioxidant (AO) and nutrient and energy sensing pathways (mTOR and PTEN/AKT) occur in cochleae of young Fus1 KO mice before major hearing loss. Importantly, short-term AO treatment corrected pathological molecular changes, while longer AO treatment restored EP, improved ABR parameters, restored mitochondrial structure, and delayed the development of hearing loss in the aging mouse. INNOVATION: Currently, no molecular mechanisms linked to metabolic ARHL have been identified. We established pathological and molecular mechanisms that link the disease to mitochondrial dysfunction and oxidative stress. CONCLUSION: Since chronic mitochondrial dysfunction is common in many patients, it could lead to developing hearing loss that can be alleviated/rescued by AO treatment. Our study creates a framework for clinical trials and introduces the Fus1 KO model as a powerful platform for developing novel therapeutic strategies to prevent/delay hearing loss associated with mitochondrial dysfunction. Antioxid. Redox Signal. 27, 489-509.

The efficiency of design-based stereology in estimating spiral ganglion populations in mice.

Accurate quantification of cell populations is essential in assessing and evaluating neural survival and degeneration in experimental groups. Estimates obtained through traditional two-dimensional counting methods are heavily biased by the counting parameters in relation to the size and shape of the neurons to be counted, resulting in a large range of inaccurate counts. In contrast, counting every cell in a population can be extremely labor-intensive. The present study hypothesizes that design-based stereology provides estimates of the total number of cochlear spiral ganglion neurons (SGNs) in mice that are comparable to those obtained by other accurate cell-counting methods, such as a serial reconstruction, while being a more efficient method. SGNs are indispensable for relaying auditory information from hair cells to the auditory brainstem, and investigating factors affecting their degeneration provides insight into the physiological basis for the progression of hearing dysfunction. Stereological quantification techniques offer the benefits of efficient sampling that is independent of the size and shape of the SGNs. Population estimates of SGNs in cochleae from young C57 mice with normal-hearing and C57 mice with age-related hearing loss were obtained using the optical fractionator probe and traditional two-dimensional counting methods. The average estimated population of SGNs in normal-hearing mice was 7009, whereas the average estimated population in mice with age-related hearing loss was 5096. The estimated population of SGNs in normal-hearing mice fell within the range of values previously reported in the literature. The reduction in the SGN population in animals with age-related hearing loss was statistically significant. Stereological measurements required less time per section compared to two-dimensional methods while optimizing the amount of cochlear tissue analyzed. These findings demonstrate that design-based stereology provides a practical alternative to other counting methods such as the Abercrombie correction method, which has been shown to notably underestimate cell populations, and labor-intensive protocols that account for every cell individually.