Psychometric evaluation of the Pittsburgh Sleep Quality Index among South African women participating in the Bukhali trial: Healthy Life Trajectories Initiative.

Cochlear nerve deficiency (CND), encompassing both cochlear nerve aplasia and hypoplasia, represents a significant structural malformation affecting approximately 15.4% of children with severe to profound sensorineural hearing loss (SNHL) [,]. Cochlear implantation (CI) employs the conversion of acoustic signals to electrical stimuli, directly activating spiral ganglion neurons to facilitate auditory signal transmission through cochlear nerve fibers to brainstem auditory nuclei. This intervention represents the gold standard treatment for patients with bilateral severe to profound SNHL []. Patients with CND have reduced spiral ganglion neuron (SGN) fiber density, which consequently impairs neural substrate availability for electrical stimulation. This patient population presents unique therapeutic challenges attributable to their diminished spiral ganglion cell populations, which fundamentally compromise the neural interface required for effective auditory signal processing []. Although technological advances have expanded CI eligibility criteria to include younger patients and those with various inner ear malformations, pediatric CND patients consistently demonstrate variable and often suboptimal outcomes following CI []. This variability underscores the critical importance of precise preoperative evaluation and outcome prediction. However, this area remains a substantial research gap in the field. The current diagnostic paradigm for CND relies predominantly on noninvasive imaging techniques, particularly magnetic resonance imaging (MRI). A comprehensive analysis at a tertiary academic center examining 69 ears with cochlear nerve anomalies highlighted significant limitations in current imaging methodologies []. While imaging can identify gross anatomical abnormalities, it often fails to provide a detailed functional assessment of the cochleovestibular nerve and accurate prediction of CI outcomes. This diagnostic challenge is particularly pronounced in pediatric cases, where anatomical structures are smaller and more difficult to evaluate, creating a pressing need for more reliable and clinically feasible evaluation methods. Preoperative auditory brainstem response (ABR) testing in CND patients typically yields no measurable thresholds because of severely compromised residual hearing. Electrical stimulation auditory brainstem response (EABR) testing has emerged as a valuable diagnostic tool for evaluating neural function in CI recipients [,]. However, comprehensive analyses of audiological profiles in CND patients and their predictive value for CI outcomes remain limited. Previous studies have documented a significant negative deflection (3–4 ms latency) in the ABR results of large vestibular aqueduct syndrome (LVAS) patients, with an acoustically evoked short latency negative response (ASNR) dependent on proper saccular function [,]. In our research group’s study, ASNR was elicited in more than 60% of the LVAS ears. This investigation aimed to evaluate the diagnostic significance of specific ABR waveform characteristics in CND patients. The response of interest manifests as a reproducible positive deflection within a latency period of 4–5 ms after the appearance of a high-intensity sound. By identifying reliable prognostic indicators, this research seeks to optimize preoperative assessment protocols and refine patient selection criteria for CI in CND patients.