PONE-D-19-22143

The characteristic of Patulous Eustachian Tube Patients diagnosed by the JOS Diagnostic Criteria

PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1: This study has merit for reporting on characteristic of PET patients as diagnosed using the Otological Society of Japan Diagnostic Criteria, which was not done before. However, a study done recently by Smith, 2018, albeit with a smaller number of subjects has a more detailed analysis of the diagnostic criteria used in their evaluation.

I believe figures 5,6,8,9 can be all combined into one with 4 subsection

Figure 2 and 3 can also be combined with subsections

Did your study have any inclusion/exclusion criteria?

Abstract page 3

Line 13 – define TTAG

Line 17 . In ninety-one percent of the ears… -> In 91% of the ears…

Line 18 ….lying / lordotic position… -> do you mean supine? (lordotic is not often used within English literature, please correct to supine within the manuscript)

Methods page 8

Line 14 Criteria 3C use -> Criteria 3C used

Page 9 Changes in probe tone SPL exceeding 10dB was regarded as

a positive finding of PET – was this something that you defined as significant or previously defined and accepted as a significant finding,

Line 16 define CT

Results

Page 12

Line 10 As the three ears exhibited both positive findings… what is meant by “three ears”

Page 13

It is a very interesting finding that 43 (58.1%) had severe handicap

Page 15

Line 13 please change annoying to bothersome

Page 16

Line 14 nostril to EACl - nostril to EAC

References

Please remove number 5 as it is repeated twice

Figure 4

Closed short is not very definite imaging, maybe adding a bracket to show where the region of closed portion of ET is being evaluated

Reviewer #2: Thank you for this interesting and timely review on an important patient condition. Your study is well designed to address the question at hand within the limitations you mention, namely the high likelihood of diagnosing PET in your study population based on the type of referrals your center receives. With that said, this paper contributes to our body of knowledge by detailing diagnostic techniques and criteria, and is especially valuable in the comparison of various diagnostic modalities.

Several comments and requested clarifications below could strengthen this paper.

Page 8, Line 4: How was 2B conductive specifically?

Page 8, Line 5,6: Presume that any movement of the TM is defined as positive? Please clarify.

Page 9, Line 9,10: Please clarify in the text what is being monitored at the level of the EAC (sound transmitted from the nasopharynx?)

Page 12, Line 10-12: Three ears were positive for both probe tone testing and an open plateau pattern?

Page 14, line 10-13: Any correlation between these delayed “Definite PET” and severity of symptoms? Perhaps less because they were intermittent?

Page 14, line 13: Consider, “PET symptoms ARE intermittent”.

Page 14, line 17: Consider, “out institute received.

Page 15, line 3: Consider a more formal term in lieu of “Annoying” when referring to PET symptoms.

Page 15, line 2-11: Largely restating results. Is there any significance or specific characteristics to the patients that did not improve with postural changes that clinicians should be monitoring for?

Page 16, line 14: EAC1?

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Reviewer #1: No

Reviewer #2: Yes: Pedrom C. Sioshansi, MD

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The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

PONE-D-19-22143R1

Dear Dr. Ikeda,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Jennifer Alyono

Academic Editor

PLOS ONE

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