Cochlear Implantation After Temporal Bone Fracture: A Systematic Review of Preoperative Predictors and Timing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your efforts on this work. I like Figure 2 that shows the scheme of treatment process and when a good or bad audiological results to be expected.

Please find below list of things that can be improved.

1. The paper is about temporal bone fracture. But the introduction section is not saying much about the TBF. for example, you can say what is the rate of TBF if this info is available in the literature.
2. To my limited understanding, fracture mostly happens at the junction of cochlea and vestibule. Any additional information on where the fracture happens can make this paper even more interesting.
3. If possible, in Table 3, add one more column to show the rate of success please.

Best regards.

 

Author Response

Please see attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Major Comments

1.1 Systematic Review Methodology & PRISMA Compliance

1. Search strategy transparency
   • The manuscript states that broad MeSH terms were intentionally used (Methods, lines ~83–87), but this raises concern about reproducibility.
   • Please add:
     • Full electronic search strings for PubMed, Scopus, and Google Scholar (preferably as Supplementary Material).
     • Exact date of the last search.

2. Google Scholar use
   • Google Scholar is not fully reproducible. This limitation is mentioned later, but should be explicitly acknowledged in the Methods as a potential source of bias.
3. Study selection logic
   • The exclusion of case reports and inclusion of studies with ≥4 patients is reasonable but arbitrary.
   • Please justify this threshold explicitly and cite methodological guidance (e.g., JBI or Cochrane recommendations).
4. PRISMA flow diagram
   • Figure 1 is informative, but it does not fully conform to PRISMA 2020:
     • Reasons for exclusion at full-text stage should be itemized numerically.
     • The flow should distinguish clearly between “records” and “reports”.
   • Recommend updating Figure 1 to a PRISMA 2020–compliant numeric layout.

 

1.2 Risk of Bias Assessment

1. Tool justification
   • The use of the JBI Case Series Checklist is appropriate; however:
     • Please justify why ROBINS-I was not used, as several included studies are comparative (e.g., Alves et al., Khwaja et al.).

2. Presentation
   • Table 1 is detailed but visually dense.
   • Consider adding a traffic-light summary figure (green/yellow/red) to improve readability and align with MDPI standards.
3. Interpretation
   • The statement “no study met the criteria for low risk of bias” is important and should be:
     • Reiterated more explicitly in the Discussion as a limitation impacting certainty of conclusions.

 

1.3 Results Synthesis

1. Heterogeneity
   • The heterogeneity of:
     • Audiological tests (BKB, CUNY, CNC, Freiburg, etc.)
     • Follow-up intervals (months to decades)
   • makes quantitative synthesis impossible.
   • This is acknowledged, but please:
     • Add a short subsection explicitly stating why meta-analysis was not feasible (I² not calculable, outcome inconsistency).

2. Timing of implantation
   • The conclusion favoring implantation within 12 months is clinically sound, but:
     • Evidence remains observational.
     • Please soften causal language (e.g., replace “confers benefit” with “is associated with improved outcomes”).

 

1.4 Discussion and Interpretation

This is the strongest section of the manuscript.

Strengths:

• Excellent discussion of facial nerve stimulation, ossification, and hidden hearing loss/synaptopathy.
• Integration of imaging metrics (nerve diameter, modiolar integrity) is sophisticated and clinically valuable.

Suggestions:

1. ABI vs CI
   • The conclusion that CI is superior to ABI is reasonable, but should be clearly framed as:
     • “Based on limited comparative observational evidence”.

2. Novelty
   • Explicitly state how this review adds beyond Eastwood et al. 2021:
     • Emphasize timing, imaging biomarkers, and synaptopathy framework.

 

2. Minor Comments (Language & Style)

• Multiple grammar and syntax issues are present and require professional English editing:
• Examples:
• “material which support hearing function” → materials that support
• “acoustical rehabilitation” → auditory rehabilitation (preferred)
• Inconsistent pluralization of “cochlear implant(s)”
• Ensure consistent terminology:
• Use either CI or CIs consistently.
• Some references contain typographical errors (author initials, journal formatting).
• Please revise references according to MDPI reference style.

 

Author Response

Please see attachment

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Accept