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PONE-D-21-01254

Knowledge, Attitude, and Practice of Hearing Screening and Management among Family Physicians in Kingdom of Saudi Arabia

PLOS ONE

Dear Dr. Alqudah,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 01 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Jorge Spratley, MD, PhD

Academic Editor

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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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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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: The content of the article is relevant and the objectives were achieved. Nevertheless there are some comments and suggestions I recommend to be considered during the revision of the paper:

I would suggest to include in the title the word children the Knowledge, Attitude, and Practice of Hearing Screening (in children) and Management among Family Physicians in Kingdom of Saudi Arabia, as the investigation relates to Hearing screening in children

When speaking about language, it should be stressed we spoken language is considered (mostly in oposition to sign language or as a complement to sign language?)

35: Methods: the total number of family physicians in the KSA that could have been enroled -that eligeble- should be mentioned

75: ....it is done before the baby is discharged home

127:They are also responsible for the identification of hearing loss and referring patients and discussing with parents the management plan; How exactly are family doctors responsible for the identification of the haering loss? What is their role? do they perform diagnostic tests? are all "refer" newborns referred do the family doctors for further diagnostic tests?

139: (related to 35) How many family medicine physicians were actually invited to participate in the study, and what is the universe of family physicians in the KSA ?

185:.... Conversely, around 51% (68/113) of participants have screened children for hearing loss and around 60% (80/113) were able to diagnose one or more children with hearing loss during their last five years of experience. How did they screened: did they participate in matternity based screening? and how did they diagnose hearing loss? do they performe diagnostic ABR or other audiological tests?

209 : Concernig #CConcerning

Figure 2 demonstrates the

221: referral options followed by the family physician for children diagnosed with a confirmed hearing loss. Who confirmed the hearing loss? The flowchart of the various stages from screening to intervention proposed in the KSA program should be explained. It seems that after the established diagnose the child goes back to the family doctor and is then referred for audiological intervention?

321: the role of surgical treatment in chronic otitis media in children should also be mentioned

322-324: this statment is a double negative. Does it mean that children with choclear implant or hearing aids do well without speech theray or hearing rehabilition ?

335:unilateral hearing loss or mild hearing loss impairs communication/hearing in noise (which is very prevalent in school/ kindergarten environment )as well as localization

Reviewer #2: The article is quite interesting and practical. It has the potential to help create awareness in the population of family physicians, on the importance of screening and diagnosis of hearing losss. It would be interesting to dive deeper into this question: if physicians have good knowledge of the assessment, but often fail to complete the diagnosis, why does this occur? Is it lack of time or attention? Which programmes or interventions could the authors suggest to improve this intention-action gap?

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Reviewer #1: No

Reviewer #2: Yes: Dr Paulo Pessanha

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PONE-D-21-01254R1

Knowledge, Attitude, and Practice of Hearing Screening in Children and Management among Family Physicians in Kingdom of Saudi Arabia

PLOS ONE

Dear Dr. Alqudah,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jul 08 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Jorge Spratley, MD, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

The revised manuscript addesses the reviewers' comments and is now tehcnically sound. However the English used on the new inserts in the paper is quite poor and contrasts with the rest of the paper. As such, the manuscript will only be considered for publication following a careful grammatical revision.

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-21-01254R2

Knowledge, Attitude, and Practice of Hearing Screening in Children and Management among Family Physicians in the Kingdom of Saudi Arabia

PLOS ONE

Dear Dr. Alqudah,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 07 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Jorge Spratley, MD, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

The title should be corrected to: Knowledge, Attitude and Management of Hearing Screening in children among Family Physicians in the Kingdom of Saudi Arabia

The sentence in Abstract Line 39 and Material and Methods line 157 : "Based on the information provided by the Saudi commission for health specialties, the total number of family physicians was 2,700; however, we could not get their contact information from representative authorities, so we followed networking and snowballing sampling techniques and were able to target 300 and recruit 133 family physicians" is redundant to the previous sentence in the same sections and should be removed. Instead, it should be rewritten and sent to the end of the manuscript as a limitation of the study (133 out of 2700 family physicians).

Correct grammar in Abstract line 27: "to develop normal spoking 28 language and academic skills during childhood".

The new sequencing of the references in the revised main text is now difficult to follow, with numbers in red and black side-to-side

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Knowledge, Attitude and Management of Hearing Screening in children among Family Physicians in the Kingdom of Saudi Arabia

PONE-D-21-01254R3

Dear Dr. Alqudah,

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,

Jorge Spratley, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thanks for the time and effort to correct the manuscript. Congratulations for achieving the level of publication at Plos One

Reviewers' comments: