Alexithymia in Patients with Ménière Disease: A Possible Role on Anxiety and Depression

Round 1

Reviewer 1 Report

The title of this article is ‘Alexithymia in patients with Meniere’s disease: a possible role on anxiety and depression’.

Authors concluded that the presence of alexithymia may constitute a risk factor for the development of anxiety and depression symptoms and greater perceived stress in patients with MD.

Results

Table 4

The authors studied the number of crises in the last year compared between alexithymic and non-alexithymic group, and showed no significant difference between them. How about the duration of MD between alexithymic and non-alexithymic group?

Disccussion

#1 The authors used the criteria of MD established by the Barany Society Committee. On the other hand, the presence of endolymphatic hydrops in patients with MD is accepted as the hallmark of this disease. Is it possible for you to discuss the relationship between the endolymphatic hydrops and alexithymia?

#2 Do authors think that alexithymia is the cause of MD or that individuals are more likely to have alexithymia by suffer from MD?

#3 How do authors think that the results of the present study should be linked to the treatment of alexithymic MD patients?

Author Response

Comments and Suggestions for Authors

The title of this article is ‘Alexithymia in patients with Meniere’s disease: a possible role on anxiety and depression’.

Authors concluded that the presence of alexithymia may constitute a risk factor for the development of anxiety and depression symptoms and greater perceived stress in patients with MD.

Results

Table 4

The authors studied the number of crises in the last year compared between alexithymic and non-alexithymic group, and showed no significant difference between them. How about the duration of MD between alexithymic and non-alexithymic group?

The duration was not included since we thought it was a redundant information, considering that both onset and age at inclusion were overlapping

Disccussion

#1 The authors used the criteria of MD established by the Barany Society Committee. On the other hand, the presence of endolymphatic hydrops in patients with MD is accepted as the hallmark of this disease. Is it possible for you to discuss the relationship between the endolymphatic hydrops and alexithymia?

#2 Do authors think that alexithymia is the cause of MD or that individuals are more likely to have alexithymia by suffer from MD?

#3 How do authors think that the results of the present study should be linked to the treatment of alexithymic MD patients?

Thank you for the questions; a common reply for all 3 points. We added a sentence in the discussion trying to clarify our opinion. Obviously our data do not support the possibility that alexithymia may be a causal factor to MD; it can be hypothesized that alexithymic subjects may be more prone to develop MD, although further studies are needed. On the other hand this personality trait should be considered in treatment of MD, since an increased anxiety and depression has been found in these subjects

Reviewer 2 Report

The current study assessed alexithymia (AX) in patients with M. Meniere (MM). In order to this, they recruited 179 patients with a diagnosis of MM and provided them with questionaries (AX, Depression, Anxiety, QOL).

Interestingly, 105/179 patients were classified as alexithymic. However, the main problem of the study is the lack of the control group. It remains questionable, how many of non-MM patients would be classified ad alexithymic.

Furthermore, between AX and non-AX group, only the number of crises in the last year appears to be different (nevertheless, even that was not significant). 

The results of this study are rather poor; however, I understand these are seen as preliminary results. In order to make this paper more interesting for the journal's readership, authors need to discuss it further, in particular on the potential causality, limitations and possible further study ideas in this regard. What would authors recommend to be the next step in assessing alexithymia in MM? How would they recruit the patients? and the control group?

Lastly, the English language appears acceptable; I would only recommend eventually shortening the syntax in some instances.

Author Response

Comments and Suggestions for Authors

The current study assessed alexithymia (AX) in patients with M. Meniere (MM). In order to this, they recruited 179 patients with a diagnosis of MM and provided them with questionaries (AX, Depression, Anxiety, QOL).

Interestingly, 105/179 patients were classified as alexithymic. However, the main problem of the study is the lack of the control group. It remains questionable, how many of non-MM patients would be classified ad alexithymic.

We agree, nonetheless results of TAS-20 have been compared with the normative data in Italian general population. It should be also considered that the main finding of our work is that alexithymic subjects more easily develop anxiety and depression leading in turn to a lower quality of life

Furthermore, between AX and non-AX group, only the number of crises in the last year appears to be different (nevertheless, even that was not significant).

We agree, it could be hypothesized that on a larger sample a statistical significance could be detected

The results of this study are rather poor; however, I understand these are seen as preliminary results. In order to make this paper more interesting for the journal's readership, authors need to discuss it further, in particular on the potential causality, limitations and possible further study ideas in this regard. What would authors recommend to be the next step in assessing alexithymia in MM? How would they recruit the patients? and the control group?

A sentence has been added in the discussion on this

Lastly, the English language appears acceptable; I would only recommend eventually shortening the syntax in some instances.

Round 2

Reviewer 2 Report

The paper can now be accepted in my opinion.