PONE-D-20-39610

Functional Aspects of the Eustachian Tube by Means of 3D-Modeling

PLOS ONE

Dear Dr. Schuon,

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Kind regards,

Rafael da Costa Monsanto, M.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. 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

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

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3. 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

Reviewer #3: Yes

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4. 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

Reviewer #3: Yes

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5. 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: Thank you very much for the opportunity to review the manuscript titled "Functional Aspects of the Eustachian Tube by Means of 3D-Modeling". I congratulate the authors for this quite interesting study.

Reviewer #2: The presen study makes a contribution to the current litereature providing an analysis on the structure of ET using both histopathological and radiological 3D- reconstruction models. Cons of the study is that only one sample was investigated, and it was not a human sample. Pros of the study are the effort on the methodology, and information provided based on the structure of the ET. In the big picture, it deserves publication. However, in the prevoous literature, there exist a few studies (from the laboratory of Michael Paparella) conducted on human temporal bones, constituting 3d reconstruction models. I thimk these publications deserve citation:

1- Epitympanum volume and tympanic isthmus area in temporal bones with retraction pockets.

Monsanto RD, Pauna HF, Kaya S, Hızlı Ö, Kwon G, Paparella MM, Cureoglu S.

Laryngoscope. 2016 Nov;126(11):E369-E374. doi: 10.1002/lary.25937. Epub 2016 Apr 23.

PMID: 27107158

2- A three-dimensional analysis of the endolymph drainage system in Meniere disease.

Monsanto RD, Pauna HF, Kwon G, Schachern PA, Tsuprun V, Paparella MM, Cureoglu S.

Laryngoscope. 2017 May;127(5):E170-E175. doi: 10.1002/lary.26155. Epub 2016 Jul 21.

PMID: 27440440 Free PMC article.

Reviewer #3: This reviewer congratulates the authors in this meticulous work and great presentation. The points below will enhance the importance of this manuscript.

This reviewer is looking forward to their similar work on human cadaver specimens.

Line 87- TVPM is not parallel to the bony part of the ET. It is almost parallel with the cartilaginous part.

Line 202. Authors refer to a hypothesis here, but it is not clear what this refers to. They discuss the current literature on functional aspects and implications of these anatomical relationships. But they have not clearly identified any novel hypotheses. And obviously, this study is far from testing or proving any of the existing hypotheses. They can just provide suggestive information.

Line 208. After using arrows and labels on Figure 2, this will be more clear. It seems that unlike in humans, the cartilage extends into the bony ET beyond istmus.

Line 256. “analyses”

Line 451.Figue 1. Great demonstration of the methods.

Line 463.Figure 2. It is better to use labels in the bottom images, to identify the bone, cartilage, muscles.

Line 468-Figure 3. Additional combined images (top) from different perspectives (top down, bottom up, lateral to medial (perpendicular to this one) will enhance the reader’s perception.

Line 475. Figure 4. Additional fusion images that include the 2 key muscles will be useful.

Line 490-Fig 6. It would be great to have this figure in two other dimensions, perpendicular to the ET orifice axis, to better appreciate the relationship of the LVPM and the ET cartilage, to better emphasize the “functional” implications of this relationship. Need to be clear also is that this is not a functional model, this statis model though has functional implications due to the presumed changes in the vector and the length. This concept is hard for those readers not familiar with the functional anatomy, so need to expand on this in the text and on the figure.

It is also best to include this ET cartilage and LVPM relationship in multiple images starting from the nasopharyngeal orifice extending deeper, to demonstrate how this relative position shifts, for additional supportive information for the presumed “functional” implications.

Such images will be much more useful than those in Figure 5.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Cuneyt M. Alper

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Functional Aspects of the Eustachian Tube by Means of 3D-Modeling

PONE-D-20-39610R1

Dear Dr. Schuon,

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):

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

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: N/A

**********

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

Reviewer #3: Yes

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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

Reviewer #3: 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 congratulate the authors for the revision of their paper. The authors have added a substantial contribution to scientific knowledge about Eustachian tube function.

Reviewer #2: All recommendations were addressed carefully, thus, the revised version of the manuscript can be published.

Reviewer #3: Thanks for the revision.

THIS IS TO THE JOURNAL=

I don't think there should be a minimum character count to state that this reviewer accepts this revision

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Cuneyt M. Alper, MD.