Comparisons of Audiologic Characteristics in Patients with Continuous and Intermittent Tinnitus

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Author (s);

I have reviewed the manuscript. My response is given in a point-by-point manner below.

Sincerely

 

 

Comparisons of Audiologic Profiles in Patients with Continuous and Intermittent Tinnitus 

Title:

·         The title is good, but I suggest you to use the “characteristics” instead of “profiles”.

Abstract:

·         Apply the “audiologic” instead of “auditory” in Background section. 

·         It’s better to be more cautious in describing the findings. For example, at the end of abstract, I recommend you to write as below: “Based on the findings of current paper, it seems that audiologic characteristics may be differ between patients with continuous and intermittent tinnitus”.

·         In keywords section, add the “Pure tone audiometry”, “Auditory brainstem response” and “Otoacoustic emissions”.

·         In keywords section, remove the “Audiologic profile” and “Hearing loss”.

 

Main Text:

1. Introduction

·         Using the “vertigo” instead of “dizziness” in 2^nd line.

 

·         In last paragraph, it’s better to start with this “Based on the authors investigations, no studies to date …”

2. Materials and Methods

2.1 Study Design

·         In 1st paragraph, using the “tympanic membrane” instead of “TM”.

 

·         In 2^nd paragraph, add the “reference of the acute and chronic tinnitus”.

2.2. Pure tone audiometry (PTA)

 

·         Do you have any reference or document for this section in describing 6-division methods? It’s better to present the PTA thresholds of 250-8000 KHz for Ac, and 250-4000Hz for BC. Revise this section. 

2.3. Frequency and loudness of tinnitus

·         Frequency of tinnitus (Pitch Matching) and Loudness of tinnitus (Loudness Matching) were evaluated wrongly in this paper! Unfortunately, It’s not practical and evidence-based.

 

·         Do you evaluate the Minimum Masking Level (MML) and Residual Inhibition (RI) of tinnitus?

2.4. Auditory brainstem responses (ABR), distortion product otoacoustic emissions (DPOAEs), and transient evoked otoacoustic emissions (TEOAEs)

·         In this section you should describe the ABR in detail. For example, ABR electrode array, intensity, polarity and so on. 

2.5. Statistical analysis

·         It’s OK.

3. Results

·         As mentioned above, in 2nd paragraph, Pitch matching and Loudness matching of tinnitus in not correct.

 

·         In assessment of OAE, Its better to add the “TEOAE amplitude” and “DPOAE amplitude” results (like SNR). 

4. Discussion

·         The last paragraph of the Discussion section were presented in Conclusion, so it’s not necessary. Remove it. 

5. Conclusion

·         In 1^st line, use the “showed” instead of “confirmed”.Other parts of conclusion is good.

Author Response

We would like to thank the editor and reviewers for their helpful comments and suggestions. We have revised the manuscript in response to these comments, and our point-by-point responses to the suggestions of the reviewers are provided below.

Title:

• The title is good, but I suggest you to use the “characteristics” instead of “profiles”.

A : Thank you for your helpful comments. I have changed the title as you suggested.

Abstract:

• Apply the “audiologic” instead of “auditory” in Background section.

A : Thank you for your helpful comments. I have changed the background as you suggested.

• It’s better to be more cautious in describing the findings. For example, at the end of abstract, I recommend you to write as below: “Based on the findings of current paper, it seems that audiologic characteristics may be differ between patients with continuous and intermittent tinnitus”.

A : Thank you for your helpful comments. I have changed the paper as you suggested.

• In keywords section, add the “Pure tone audiometry”, “Auditory brainstem response” and “Otoacoustic emissions”.

A : Thank you for your helpful comments. I have changed the keywords section as you suggested.

• In keywords section, remove the “Audiologic profile” and “Hearing loss”.

A : Thank you for your helpful comments. I have changed the keywords section as you suggested.

 

 

 

 

 

Main Text:

1. Introduction

• Using the “vertigo” instead of “dizziness” in 2nd line.

A : Thank you for your helpful comments. I have changed the introduction as you suggested.

• In last paragraph, it’s better to start with this “Based on the authors investigations, no studies to date …”

A : Thank you for your helpful comments. I have changed the introduction as you suggested.

 

2. Materials and Methods

2.1 Study Design

• In 1st paragraph, using the “tympanic membrane” instead of “TM”.

A : Thank you for your helpful comments. I have changed the 1^st paragraph as you suggested.

• In 2nd paragraph, add the “reference of the acute and chronic tinnitus”.

A : Thank you for your helpful comments. I have changed the 2^nd paragraph as you suggested.

 

2.2. Pure tone audiometry (PTA)

 

• Do you have any reference or document for this section in describing 6-division methods? It’s better to present the PTA thresholds of 250-8000 KHz for Ac, and 250-4000Hz for BC. Revise this section.

A : Thank you for your helpful comments. In this study, we used the 6 division method for air conduction hearing and excluded bone conduction hearing from the analysis. The description of air conduction hearing was incorrect and has been revised.

 

 

 

 

2.3. Frequency and loudness of tinnitus

• Frequency of tinnitus (Pitch Matching) and Loudness of tinnitus (Loudness Matching) were evaluated wrongly in this paper! Unfortunately, It’s not practical and evidence-based.

A : Thank you for your valuable comments. As you mentioned, the content related to tinnitus pitch is based on methods practiced in Korea and may not be an international standard. We had not considered this aspect. Therefore, we have deleted this from the paper. However, we believe that the loudness and frequency of tinnitus are valid, as mentioned in references 11 and 15. If you have any objections, please feel free to contact us again.

 

• Do you evaluate the Minimum Masking Level (MML) and Residual Inhibition (RI) of tinnitus?

A : Thank you for the kind comment. In this study, we did not measure MML and RI.

 

2.4. Auditory brainstem responses (ABR), distortion product otoacoustic emissions (DPOAEs), and transient evoked otoacoustic emissions (TEOAEs)

• In this section you should describe the ABR in detail. For example, ABR electrode array, intensity, polarity and so on.

A : Thank you for the positive feedback. As you suggested, I have provided additional details on the electrode array, intensity, and polarity of the ABR in the study.

 

2.5. Statistical analysis

• It’s OK.

 

 

 

 

 

 

 

3. Results

• As mentioned above, in 2nd paragraph, Pitch matching and Loudness matching of tinnitus in not correct.

A : Thank you for your good question. The answer is the same as the response to the previous question.

 

• In assessment of OAE, Its better to add the “TEOAE amplitude” and “DPOAE amplitude” results (like SNR). 

A : Thank you for the kind comment. We do not have measured results of quantitative OAE amplitude at our hospital. As this study is retrospective, it may be challenging to revise this aspect. It would be beneficial to conduct further research on this topic in future studies.

 

4. Discussion

• The last paragraph of the Discussion section were presented in Conclusion, so it’s not necessary. Remove it.

A : Thank you for the positive comment. I will remove the duplicated content between the Discussion and Conclusion sections as you suggested.

 

5. Conclusion

• In 1st line, use the “showed” instead of “confirmed”.Other parts of conclusion is good.

A : Thank you for the kind comment. As you suggested, I have changed the wording as requested.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

To Editor and Authors:

I appreciate the chance to read and comment on this intriguing work. My remarks are mentioned here:

Introduction

The introduction's classification of tinnitus as conductive and sensorineural is not followed as standard. Sensorineural and objective tinnitus are often distinguished. Conductive or sensorineural hearing loss can coexist with tinnitus. Therefore, it is wrong to include tensor tympani syndrome or palatal myoclonus, in the group of tinnitus paired with conductive hearing loss. Sensations of hearing related to uncontrollably contracted palate muscles are not part of conductive hearing loss.

Materials and Methods

Study design verses 69–70: All patients also underwent impedance audiometry (Otometrics Madsen Zodiac 901, Natus, Denmark); if the result indicated type B or C, the patient was excluded from our investigation. The device description should go to the material and procedure section, and the criteria for exclusion from study curve B or C should be split off from the text.

Verse 80 is a bit confusing: "Otologic symptoms included hearing loss, auditory hypersensitivity, ear fullness, dizziness, and autophonia; baseline factors included hypertension, diabetes mellitus, and hyperlipidemia." By baseline factors, what do these authors mean?

Pure Tone Audiometry (PTA)

Why were thresholds of 500 Hz, 1000 Hz (tested twice), 2000 Hz (tested twice), and 4000 Hz selected for tone audiometry tinnitus  assessment? Why was the audiometric assessment limited when sensorineural hearing loss at higher frequencies is a hallmark of tinnitus?

DPOAEs, transient evoked otoacoustic emissions, and auditory brainstem responses

Why, if audiometry was assessed at up to 4 Hz, did the DPOAE evaluation use a range of up to 6,000 Hz? What led the authors to make such a decision? Probably, verse 120 has a mistake. A signal-to-noise ratio of more than 3 dB is the accepted response in TEOAE.

Results

The authors write about averaging the results for frequencies from 500 to 4  kHz and then give in the table the results of testing up to 8 thousand Hz; thus, the results of tonal audiometry should be made clear. Therefore, the statement ( Vers. 143) refers to the following results:. "Further analysis of the accompanying symptoms showed that in patients with hearing loss, continuous tinnitus was significantly more frequent than intermittent tinnitus (p<0.05)."

 The same is mentioned  in the Conclusions in verse 274.

The Discussion includes a lot of section results that repeat.

Although intensely fascinating, the work has to be improved.

 

 

 

 

 

 

Author Response

We appreciate the editor and reviewers for their insightful comments and suggestions. In response, we have revised the manuscript accordingly. Below, we provide detailed, point-by-point responses to each of the reviewers' suggestions.

1. Introduction

The introduction's classification of tinnitus as conductive and sensorineural is not followed as standard. Sensorineural and objective tinnitus are often distinguished. Conductive or sensorineural hearing loss can coexist with tinnitus. Therefore, it is wrong to include tensor tympani syndrome or palatal myoclonus, in the group of tinnitus paired with conductive hearing loss. Sensations of hearing related to uncontrollably contracted palate muscles are not part of conductive hearing loss.

A : Thank you for the good comment. As you suggested, I hadn't considered cases where conductive hearing loss and sensorineural hearing loss are mixed in the paper. Therefore, I have removed the content related to tensor tympani syndrome or palatal myoclonus.

2. Materials and Methods

Study design verses 69–70: All patients also underwent impedance audiometry (Otometrics Madsen Zodiac 901, Natus, Denmark); if the result indicated type B or C, the patient was excluded from our investigation. The device description should go to the material and procedure section, and the criteria for exclusion from study curve B or C should be split off from the text.

A : Thank you for the positive comment. As you suggested, I believe it's better to describe the content related to Impedance Audiometry separately. I have attached the information below the PTA section.

Verse 80 is a bit confusing: "Otologic symptoms included hearing loss, auditory hypersensitivity, ear fullness, dizziness, and autophonia; baseline factors included hypertension, diabetes mellitus, and hyperlipidemia." By baseline factors, what do these authors mean?

A : Thank you for the good comment. In the paper, the term "Baseline factor" refers to the underlying disease that the patient has. I have revised it accordingly.

 

 

3. Pure Tone Audiometry (PTA)

Why were thresholds of 500 Hz, 1000 Hz (tested twice), 2000 Hz (tested twice), and 4000 Hz selected for tone audiometry tinnitus assessment? Why was the audiometric assessment limited when sensorineural hearing loss at higher frequencies is a hallmark of tinnitus?

A : Thank you for your helpful comments. In this study, we used the 6 division method for air conduction hearing and excluded bone conduction hearing from the analysis. The description of air conduction hearing was incorrect and has been revised.

DPOAEs, transient evoked otoacoustic emissions, and auditory brainstem responses

Why, if audiometry was assessed at up to 4 Hz, did the DPOAE evaluation use a range of up to 6,000 Hz? What led the authors to make such a decision? Probably, verse 120 has a mistake. A signal-to-noise ratio of more than 3 dB is the accepted response in TEOAE.

A : Thank you for the nice comment. As mentioned earlier, regarding PTA, we conducted tests up to 8000Hz at our hospital and averaged the results. Additionally, for DPOAE and TEOAE, we conducted tests up to 6000Hz.

 

4. Results

The authors write about averaging the results for frequencies from 500 to 4  kHz and then give in the table the results of testing up to 8 thousand Hz; thus, the results of tonal audiometry should be made clear. Therefore, the statement ( Vers. 143) refers to the following results:. "Further analysis of the accompanying symptoms showed that in patients with hearing loss, continuous tinnitus was significantly more frequent than intermittent tinnitus (p<0.05)."

A : Thank you for the kind comment. As mentioned earlier, regarding PTA, we conducted tests up to 8000Hz at our hospital and averaged the results. I have updated this information in the paper as requested.

The same is mentioned in the Conclusions in verse 274.

A : Thank you for the kind comment. However, I cannot verify the specific duplication between line 274 and the Conclusion. Please specify exactly what needs to be addressed, and I will make the necessary revisions.

 

The Discussion includes a lot of section results that repeat.

A : Thank you for the nice comment. It seems that the background explanations for each audiological tests have become lengthy. If you can point out the duplicated content, I will minimize and simplify those sections as much as possible.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Author (s);

I have reviewed the revised manuscript. All of the comments are applied and changed point-by-point. Thanks for applying them. In my opinion, it does not need any more modifications.

Sincerely