Postauricular Muscle Reflex as a Potential Objective Measure of Auditory Function in Normal-Hearing Adults

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. The authors are requested to clarify why 80 dB was recorded as the threshold. It would be helpful to specify whether this treatment was based on a predefined criterion or was adopted as an empirical decision in the present study.
2. The manuscript states that acoustic stimulation was calibrated using dB(A) / LAF. The authors are encouraged to clarify whether this calibration approach is consistent with the standard frameworks commonly used in previous studies, and to discuss the extent to which the present results can be directly compared with the existing literature.
3. The response detection criteria appear somewhat empirical in the current form. The authors may wish to provide a clearer justification for these criteria, particularly with regard to the identification of the mid-latency component and whether it can be confidently regarded as an independent physiological response.
4. The description of artifact rejection remains relatively limited. It is recommended that the authors provide additional details regarding the rejection procedure and the criteria applied, in order to improve the reproducibility and methodological transparency of the study.
5. In the current statistical analysis, ear-level data appear to have been treated as independent observations. Given the repeated-measures nature of the dataset, the authors are encouraged to further justify this analytical strategy and discuss whether a hierarchical or mixed-effects framework would be more appropriate.
6. The analyses of amplitude and latency appear to be based mainly on detected responses only. The authors may wish to comment on the potential selection bias introduced by this approach and its possible influence on the interpretation of the findings.
7. Several parts of the Results section appear to require further checking and clarification, including the reported prevalence of the mid-latency response, certain statistical descriptions, and some unit annotations. A careful consistency check throughout the manuscript is recommended.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

The work sounds satisfactory  but needs improvement. 

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

1. The novelty is not yet convincing. The mid-latency component is presented as new, but the evidence remains mostly descriptive and does not fully rule out alternative explanations (artifacts or unrelated muscle activity). I suggest to author for adding validation (waveform consistency across trials and subjects) and stronger physiological justification would strengthen this claim.
2. The statistical analysis is questionable. Treating ear-level data as independent ignores within-subject dependence and may inflate significance. A more appropriate approach would be to use a mixed-effects model that accounts for repeated measures within participants or clearly justify the current method.
3. The threshold analysis is limited by the 80–100 dB(A) range. Since many thresholds are capped at 80 dB(A), this creates a floor effect and may not reflect true thresholds. These results should be interpreted more cautiously, or described as detection levels, and future work could include lower intensities.
4. The calibration method is a weakness. Using dB(A) instead of peak-equivalent SPL (ISO 389-6) limits comparability with prior studies. The implications should be discussed more clearly, generalization claims should be toned down, and the method should ideally follow standard calibration or be better justified.
5. The data-processing procedure lacks detail. It is unclear who performed artifact rejection, whether it was blinded, and how many trials were excluded. I suggest to author for providing clear criteria, reporting exclusion rates, and considering a more automated approach would improve transparency and reliability.
6. There are several inconsistencies (identical threshold values reported as significantly different, mixed units for amplitude, inconsistent inclusion criteria). These should be carefully checked and corrected to ensure accuracy and credibility.
7. Excluding absent responses may bias the analysis. While reasonable for waveform analysis, it ignores response detectability. Including an analysis of response presence (logistic regression) would strengthen the study’s clinical relevance.
8. Some interpretations are too speculative. Explanations and clinical implications go beyond what the data directly support. The Discussion should more clearly separate findings from hypotheses and keep conclusions more cautious.
9. The stapedius reflex data are underused. Their relationship with PAMR is not analyzed. This should either be clarified as descriptive only or expanded with correlation analysis to support convergent validity.
10. The writing needs further polishing. There are minor grammatical issues, inconsistencies, and misalignment between text, figures, and tables. Improving clarity and reporting effect sizes and confidence intervals more consistently would strengthen the presentation

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I have no comments; it's better to accept as current version 

Comments on the Quality of English Language

It is good for me at current version

Reviewer 3 Report

Comments and Suggestions for Authors

All of my questions have been addressed