Cavitating Lesions around the Cochlea Can Affect Audiometric Threshold and Clinical Practice

Round 1

Reviewer 1 Report

It’s well well-written paper. I have the following minor suggestions to improve the manuscript.

1.                  Define “OW” in the abstract when this abbreviation is used the first time. Check the entire manuscript for similar errors.

2.                   In Figure 2, the asterisk is not visible. Redo the figure.

3.                  Same as above, in Figure 9, the asterisk is not visible. Redo the figure.

 

4.                  The sample size is too small to draw definitive conclusions. Authors should note this shortcoming in the discussion section and recommend doing a similar study with a large number of subjects.

Looks good. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors of the manuscript “Cavitating lesions around the cochlea can affect audiometric threshold and clinical practice” aimed to focus on the effect of cavitating lesions caused either by otosclerosis or osteogenesis imperfecta on hearing. They also provide information about these five patients' audiological outcomes after surgical intervention. Unfortunately, the entire work is scattered and lacks the main hypothesis.

The clinical picture of some patients agrees with the diagnosis of perilymphatic fistula. However, there is no mention of that condition in this paper. Please revise. 

The entire manuscript is largely based on imaging studies and very little on audiological findings, at least based on what is included in this work. In the last sentence of the Introduction, the authors state their goal: “In this study we want to describe patients with pericochlear cavity to analyze the audiological characteristics, the evolution of HL, and the treatments carried out to improve HL.”. Very little in the paper refers to audiological characteristics or the evolution of hearing loss (there are only two time points included). Surprisingly, the working hypothesis emerges in the Discussion “Our hypothesis is that the CHL that most of these patients develop may also be related to a third window effect, a defect in the bony structure of the otic capsule that locally reduces the hydrodynamic resistance of the perilymphatic space. In fact, when the damage is located in the anterior part of the labyrinth,  patients generally develop a CHL/MHL, without vestibular symptoms.” The working hypothesis should be presented in the Introduction and the arguments pro and contra - in the Discussion.

First paragraph – please define “third window pathology” (or rather, “third window syndrome”). Add a suitable reference (e.g., DOI=10.3389/fneur.2021.704095 – it is only a suggestion; please feel free to choose any other recent review paper on the topic).

When introducing the topic of otosclerosis, please also add a reference (e.g., DOI: 10.1016/j.otc.2017.11.001; this is also only a suggestion; please feel free to choose any other recent review paper on the topic).

Do not substitute “disease” with ”pathology,” as they have different meanings.

Third paragraph: instead of “Another pathology with similar behavior”  please use “Other condition causing similar symptoms”.

Second page: “Bone damage caused by otosclerosis has been better studied in the literature” – better than what?

“the destructive capacity of the otosclerosis was able to form permeable luminal cavities” – please revise this sentence. ( e.g. – “the destruction caused by otosclerosis results in the formation of permeable luminal cavities”)

The last paragraph in the Introduction: “No author has ever described this pericochlear cavity in OI, but we can assume the presence of the third-window effect in OI because of the similarity of the radiological morphology”. Please revise this sentence (e.g., The pericochlear cavity has never been described in OI, but the presence of the third window effect in OI cannot be excluded because of the similarity of the radiologic morphology.). What radiology results are you referring to? Please provide details. Similarities to what?

In the introduction, the authors mention that osteogenesis imperfecta has a genetic cause, but there is no indication in the patients' characteristics that genetic testing has been done. In addition, there are eight types of osteogenesis imperfecta - which of the eight was diagnosed in the patients? Please introduce the classification and explain how the patients were diagnosed with bona fide OI.

“In these patients, CHL may develop not only because of the stiffness of the stapes, but also because of the leakage of energy through this newly formed cavity” – leakage of energy? How is it measured?

 

The description of Figure 10 contains the following statement: “Authors should discuss the results and how they can be interpreted from the perspective of previous studies and of the working hypotheses. The findings and their implications should be discussed in the broadest context possible. Future research directions may also be highlighted.” It seems it is a part of the previous review, which the authors forgot to delete. I suggest rethinking this comment, reorganizing the manuscript, and revising the entire work. 

The meaning of the sentences is very often difficult to grasp. The statements collide. There is no flow, just scattered thoughts. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

The authors present a case series of five patients with hearing loss due to otosclerosis or osteogenesis imperfecta, in order to describe how cavitating lesions around the cochlea can affect the audiological characteristics and the evolution of hearing loss. It is an interesting topic, but the literature is rather poor. However, there is a number of issues that need to be addressed, prior to consideration for publication.

 

• Pages and line numbering probably is wrong.
• The abstract is well structured. Please add “OW” definition.
• The introduction provides a proper background, but it could probably be upgraded with additional references, especially the three first paragraphs.

The abbreviation of MHL, CHL is mentioned two times. Please do the adequate changes.

• Concerning the methodology part, please provide some information regarding the study period. Also, there is no mention about the inclusion of the patients; was it consecutive or not? It would be useful to specify the inclusion and exclusion criteria (age, epidemiologic characteristics, history, etc.)
• The results are clearly presented in the Table 1. There is only a description of the history of each patient, without any statistical analysis.

In the Figure 2 there is no visible with asterisk.

In the Figure 10 the comment “Authors should discuss the results and how they can be interpreted from the perspective of previous studies and of the working hypotheses. The findings and their implications should be discussed in the broadest context possible. Future research directions may also be highlighted.” is probably unnecessary and should be removed.

• In the discussion part the authors describe a rational assumption about the similarity of the radiological morphology between the otosclerosis and the osteogenesis imperfecta, but they present only one patient with osteogenesis imperfecta.

The authors try to support their assumptions with notable references but it could be upgraded with some more recent articles that are encountered in the literature.

In line 165 “controlareal” should be corrected.

 

We look forward to your revisions.

The quality of English language is quite good. A review by a native English speaking editor/service check for a number of minor but significant grammatical/syntax issues would be appreciated.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The manuscript improved greatly, although major professional English revisions are still necessary.

My only comment concerns the Discussion. Please start the Discussion by repeating your working hypothesis:

“This study was performed to test the hypothesis that patients with pericochlear cavities may develop a pseudo-CHL possibly related to a third window syndrome.”

 

Afterward, please provide arguments supporting (or not) this hypothesis that are based on your present findings. Please finish the discussion with a statement in which you will indicate if the hypothesis can or cannot be warranted. 

The text does not flow easily and the sentences are not logically connected (e.g. by using "therefore" or "because of that", etc.).

In addition, repetetive usage of same words should be correcting (e.g.,  "she had a progression with a worsening of the bone threshold, probably due to cochlear progression of the disorder")

Moreover, the overall syntax should be improved (e.g., "and in a few years (12 years) he had a severe progression to anacusis" should be "progressed within twelve years to total deafness".

Author Response

15th October 2023

Dear Editor,

I wish to resubmit in Audiology Research, Special Issue: Third Mobile Window Syndromes, revised main manuscript entitled “Cavitating lesions around the cochlea can affect audiometric threshold and clinical practice” (audiolres-2596017).

We highlighted the changes in the manuscript in yellow colour.

Manuscript revisions follow reviewer’ comments:

Reviewer 2 Comments

The manuscript improved greatly, although major professional English revisions are still necessary.

In according with the review, we have improve the quality of the English language and the syntax.

My only comment concerns the Discussion. Please start the Discussion by repeating your working hypothesis:

“This study was performed to test the hypothesis that patients with pericochlear cavities may develop a pseudo-CHL possibly related to a third window syndrome.”

Afterward, please provide arguments supporting (or not) this hypothesis that are based on your present findings. Please finish the discussion with a statement in which you will indicate if the hypothesis can or cannot be warranted.

In according with the review, we have rewritten the discussion paragraph and we started the discussion with the suggested sentence.

Comments on the Quality of English Language

The text does not flow easily and the sentences are not logically connected (e.g. by using "therefore" or "because of that", etc.).

We rewrite some parts of the paper (in particular discussion paragraph) using connector word

In addition, repetetive usage of same words should be correcting (e.g.,  "she had a progression with a worsening of the bone threshold, probably due to cochlear progression of the disorder")

We replace the sentence with: “she had a progression with a worsening of the bone threshold, probably due to cochlear evolution of the disorder”

Moreover, the overall syntax should be improved (e.g., "and in a few years (12 years) he had a severe progression to anacusis" should be "progressed within twelve years to total deafness".

In according with the review, we have improve the quality of the English language and the syntax. We replace "and in a few years (12 years) he had a severe progression to anacusis" with the sentence suggest.

 

Please address all correspondence concerning this manuscript to me at s.ghiselli@ausl.pc.it

 

Thank you for your consideration of this manuscript.

Sincerely,

Sara Ghiselli MD