PONE-D-20-31693

Associated factors, health-related quality of life, and reported costs of chronic otitis media in adults at two otologic referral centers in a middle-income country

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Rafael da Costa Monsanto, M.D.

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PLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This manuscript “PONE-D-20-31693” is a study designed to address the epidemiological, clinical, sociodemographic, and economic aspects of chronic otitis media whose scientific methodology is well designed for the population analysis of Bogota. I must emphasize that the statistical analysis is well structured with sample calculation, multivariate analysis, which shows the sample power of this study.

I congratulate this initiative because we really need studies that assess the burden of chronic otitis media and its impact on quality of life that can help the development of preventive and therapeutic public health strategies needed to reduce chronic otitis media prevalence in Latin American countries.

However, we would like to point out some aspects that need clarification.

1) In the method in line 139 of the definition of chronic otitis media, it would be important to clarify that this diagnosis comprises a very broad spectrum with different clinical characteristics and that aspects of activity and inactivity were also addressed. This was only addressed in the otoscopic evaluation, leaving this definition very imprecise.

2) How the socioeconomic level of the sample was assessed as well as the level of education and this study was carried out in two university centers and there was an extremely small number of individuals in the upper-middle class as well as in the higher levels of education. This data may be a potential bias in the sample as it is not described whether these two services assess all social classes or if they preferentially attend to low socioeconomic status.

3) The sentence in Line 413 of the discussion is incomplete "that suggests a mild to moderate conductive hearing loss in patients with [37–39]." compromising the understanding for this I suggest revising it.

4) Still in line 416 of the discussion, where audiometric assessments were discussed, with no differences between cases with otitis activity and inactivity being observed, this data may present an extremely important bias since all audiometries were performed in different places where it cannot be controlled. both the acoustic isolation and the dependent effect of the examiner, for this reason their findings differ from others in the literature, mainly in relation to the non-finding of mixed and sensorineural losses in their sample, which is really large. I think that these clarifications should be made with your analysis and not only when addressing the limitations of this study.

Reviewer #2: Despite CSOM being a disease that has already been vastly discussed in medical literature, indeed there are few published articles exposing the financial burden, impact on quality of life and associated factors related to CSOM in low-income countries, especially in Latin America. Therefore, this manuscript may fill gaps in the current literature about this particular theme.

Regardless of the large number of variables assessed in this study, the authors seemed to have considered all the variables thoroughly. Furthermore, all the Materials and Methods section was carefully described – including the statistical analysis, which increases the reliability of the results.

In addition, this manuscript has some interesting points, such as delimitating the financial impact on the family’s income and pointing to the longer period of CSOM before medical treatment - which may reflect the difficulty in accessing specialized medical support, among other factors. These findings are particularly common in low-income countries, but surprisingly publications addressing the sociodemographic factors related to COM/CSOM are scarce. Other clinical features described in this manuscript were already published before (hearing loss, impact on quality of life using specific questionnaires, risk factors associated with CSOM), but these findings corroborated well with the medical literature and allowed to have a global view of the CSOM patient.

Finally, this study has some limitations – which were honestly pointed by the authors. In my opinion, it is a very interesting manuscript as it analyses all aspects of the burden of having CSOM.

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Reviewer #1: No

Reviewer #2: Yes: Ana Luiza Kasemodel

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Associated factors, health-related quality of life, and reported costs of chronic otitis media in adults at two otologic referral centers in a middle-income country

PONE-D-20-31693R1

Dear Dr. Peñaranda,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Rafael da Costa Monsanto, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

Thank you for addressing all comments made by the reviewers. Please just add the final consideration made by Reviewer #1 to the final version of the manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I have previously reviewed the original manuscript and thank you for thoroughly addressing the comments. The authors have provided corresponding information and the manuscript has improved overall.

I just suggest that you review line 177 where "or congenital abnormalities of the middle" is described and the term “middle” has become vague

Reviewer #2: I believe that the authors have addressed all the suggestions and questions raised by the reviewers.

I have no further considerations.

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Reviewer #1: No

Reviewer #2: No