Review Reports - A Non-Surgical Wearable Option for Bone Conduction Hearing Implants: A Comparative Study with Conventional Bone Conduction Hearing Aids Mounted on Eyeglasses

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for inviting me as a reviewer of the manuscript entitled “A Non-Surgical Wearable Option for a Bone Conduction Implantable Device: A Comparative Study with Conventional Bone Conduction Hearing Aids”. The aim of the study was to compare the audiological benefits of SoundArc to traditional BC hearing aids mounted on eyeglasses in patients with moderate to severe conductive or mixed hearing loss. I believe that this research outcomes are important for clinical audiology in future. However, there are some missing information and unclear descriptions.

1) Why did the authors have to target the elderly people? In case of this type of study, the young people with hard of hearing are appropriate as subjects. The reason is that they are not affected by aging and long-term use of hearing aids. Please describe the why authors target elderly people.

2) Do the subject have congenital or acquired hearing loss?

3) Did subjects use any hearing aids other than BCHA? The subjects without congenital ear canal atresia or microtia can use regular ACHA.

4) Please describe whether the subjects had any cognitive problems, and show the evidence. This is because authors include an elderly person who aged 88 years old.

5) Which subjects have conductive hearing loss or mixed hearing loss? Please show them in Table 1.

6) Please describe the detail of SSQ and FIS. There are many versions of SSQ, which one did authors use? The detailed information about the FIS is also missing.

7) Fig1 is unclear. Please show clear figure. And what does the horizontal axis indicate?

8) What do the colored dots shown in Figures 2 and 3 mean?

9) Table２ and ３　Wilcokon ⇒　Wilcoxon？

10) The author showed only p-values and no statistics ones in Figures and text. Please show the statistics ones.

11) Please do not present the history of BC, but your research outcomes at the beginning of the discussion.

12) Please discuss the thinking of authors including previous research on similar hearing aids, such as cartilage-conduction hearing aid and Adhear.

Author Response

Reply to Reviewers

We thank the reviewer for her/his useful comments.

Done. We agree with the reviewer, but the selection criteria of the control group (conventional bone condution HA mounted on eye glasses used abitually for many years) which is the conventional option was more frequent in the elderly in our casistics. This might be a limit of the study that we added in discussion

2) Do the subject have congenital or acquired hearing loss?

Acquired. Added

3) Did subjects use any hearing aids other than BCHA? The subjects without congenital ear canal atresia or microtia can use regular ACHA.

Some of them did it in the past, but all of them were using BCHA preferring it to BCHA. We clarified it in the text.

4) Please describe whether the subjects had any cognitive problems, and show the evidence. This is because authors include an elderly person who aged 88 years old.

No, we have a psychologist in the staff , even Mild cognitive impairment was a criteria of exclusionwe thank you for the comment we added it in the method section.

5) Which subjects have conductive hearing loss or mixed hearing loss? Please show them in Table 1.

done

6) Please describe the detail of SSQ and FIS. There are many versions of SSQ, which one did authors use? The detailed information about the FIS is also missing.

added

7) Fig1 is unclear. Please show clear figure. And what does the horizontal axis indicate?

we clarified it

8) What do the colored dots shown in Figures 2 and 3 mean?

Quartiles, we added the explanation.

9) Table２ and ３　Wilcokon ⇒　Wilcoxon？

Corrected Wilcoxon

10) The author showed only p-values and no statistics ones in Figures and text. Please show the statistics ones.

done

11) Please do not present the history of BC, but your research outcomes at the beginning of the discussion.

We moved the research outcomes at the beginning

12) Please discuss the thinking of authors including previous research on similar hearing aids, such as cartilage-conduction hearing aid and Adhear.

Added

Reviewer 2 Report

Comments and Suggestions for Authors

The authors compared the audiological benefits of a bone conduction implant mounted on an arch to a bone conduction hearing aids mounted on eyeglasses. It was an interesting study and may help those involved in managing hearing impaired patients as regard to the choice of hearing amplification. The manuscript was well written.

Comments:

1. I believed the term "non-implanted bone conduction hearing implant" is not correct. The term "bone conduction hearing aids" should be used.

2. To state the reason of only measure the ABG at 0.25, 1 and 2 KHz.

3. What do the authors mean by preserved BC thresholds? Apart from patients #1 and #3, certain other patients, for example, patient # has a bone threshold of below 20dB.

Author Response

I believed the term "non-implanted bone conduction hearing implant" is not correct. The term "bone conduction hearing aids" should be used.

- Thank you, We modified it throughout the text

writing "bone conduction hearing aid" instead of "non-implanted bone conduction hearing implant"

To state the reason of only measure the ABG at 0.25, 1 and 2 KHz

- Regarding the fact that testing BC above 4 KHz might be misleading, and it is not standardized with the bone transducers available on clinical audiometers, we added it in the text.

What do the authors mean by preserved BC thresholds? Apart from patients #1 and #3, certain other patients, for example, patient # has a bone threshold of below 20dB.

- We agre, we modified the text accordingly. The meaning was “good” but it was unclear, we better clarified it.