Comparison of Perioperative Electrophysiological Measurements and Postoperative Results in Cochlear Implantation with a Slim Straight Electrode
Round 1
Reviewer 1 Report
Please check the writing of the paper for typos and grammatical errors.
The captions of tables should be extended so they are self-explanatory. This is a general recommendation for all the tables in the paper.
The captions of figures should be extended so they are self-explanatory. This is a general recommendation for all the figures in the paper.
Improve the resolution of figure 1.
Enlarge the size of font of figures to improve text readability. This is a general recommendation for all figures in the paper.
Explain about new researches for communication between neurons. The authors can use the following key words: Axonal channel capacity, error probability analysis of neuro-spike communication.
Please bullet the main contributions of paper.
Author Response
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Author Response.pdf
Reviewer 2 Report
The authors tried to determine whether Neural Response Telemetry (NRT) threshold determines surgery success in adults. This was analyzing by other authors for example Allam and Eldegwi who recorded significant positive correlations between neural response telemetry levels and behavioral threshold levels, and between NRT levels and comfortable levels. Unfortunately, the heterogeneity of the study group makes this study biased. This is demonstrated by the authors themselves by trying to use an intra-group comparison of otosclerosis and SNHL samples. NRT value presented in study was evaluated by calculated average value of all 22 electrode thresholds in microvolts. The depth of electrode insertion was measured radiographically as degrees of angular rotation within the cochlea. The authors admit that mean electrode deep is 372 degrees in otosclerosis group and 437 degrees in SNHL group. Based on this the authors surprising stated that” the deeper the electrode insertion depth the lower the NRT”. It seems, therefore, that it is not possible to talk about full insertion in the group of patients with otosclerosis. In addition, surgical technique of electrode insertion in patients with ossificated cochlear is more aggressive and destructive and may destruct spiral ganglion cells. Also, from statistical point of view it is difficult to compare group of 4 patient with the sample of 18. Of course, the conclusion resulting from the comparison of those groups is not surprising, but in addition to ossification, it is influenced by the aforementioned differences in the depth of insertion (perhaps no response or significantly overestimated from electrodes numbered 1-4). I have also dilemma from ethical point of view. The authors are analyzing hearing preservations surgery with use of slim straight electrode when they may use in SNHL group less traumatic perimodiolar electrodes. The designated insertion time is also puzzling – below and above 2 minutes. This is definitely more than slow insertion and less than ultra-slow insertion. Where does such time come from? It should be also included in the material and methods. In general, the section of material and methods should be significantly detailed, I suggest to exclusion of a group of patients with otosclerosis. Finally, the work has no constructive conclusion and value: “positive NRT response tells us that the electrode is in the correct position for subsequent stimulation and presents a reference in case of complications” it is not satisfied especially in the light of introduced by described CI manufacture intraoperatively used software for checking correct electrode position.
Additionally,
The statement “At the top, the diameter is only 3 mm, and the depth of insertion could vary in case of hearing preservation” this statement is not clear what do the authors mean? If I’ve good understudy the author intention they should correct the diameter to 0,3mm.
Why do the authors include the statement: “It is reported that insertion of a CI electrode array into the scala tympani results in better postoperative speech perception compared to an electrode implanted in the scala vestibuli”. It is all known but they did not describe a case of scala vestibuli insertion and its analysis?
Author Response
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Reviewer 3 Report
The Authors describe a cohort of 23 patients receiving cochlear implant to
compare electrophysiological measurements and other variables with postoperative results. Unfortunately, the number of patients is too small to gain any significative results as it shown by their results making the manuscript ineffectual
"At the top, the diameter is only 3 mm" ??? they probably meant 0.3 mm
I wonder if the number of patients is sufficiently high for parametric analysis
They did not address to any question they proposed in the aim of the study the topic could be little relevant if it could draw any conclusion You should calculate the sample size and collect accordingly the sufficient number of procedures
Author Response
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Round 2
Reviewer 2 Report
Congratulation of your work
Author Response
Authors thank the respected reviewer for his or her contributions to improving our written article.
Reviewer 3 Report
I suggested to reject in my first report because the limitation of the manuscript cannot be corrected. As a matter of fact the Authors did not addressed any one of my criticism.
Author Response
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