PONE-D-22-14616Insight into postural control patterns in unilateral sensorineural hearing loss, vestibular hypofunction and age-matched controlsPLOS ONE

Dear Dr. Lubetzky,

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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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: I read the manuscript entitled “Insight into postural control patterns in unilateral sensorineural hearing loss, vestibular hypo function and age-matched controls” with great interest.

I would like to acknowledge the time and effort the authors put into writing such an interesting manuscript.

Major issues:

1. Considering that the authors aimed to compare multi sensory integration between individuals with USNHL ( and no vestibular complaints), individuals with vestibular hypo function and age-matched controls , I suggest adding a few extra lines to describe and compare causes of hearing loss and vestibular dysfunction, classification of hearing loss (sensorineural or mixed/conductive hearing loss, severity of hearing loss) and vestibular dysfunction.

2. All participants in the control group reported no hearing impairment and no vestibular symptoms but it was not formally tested. This information is important and should be added to the manuscript.

3. USNHL group was not submitted to vestibular tests. This information is important and should be added to the manuscript.

Reviewer #2: This “PONE-D-22-14616” manuscript intitle “Insight into postural control patterns in unilateral sensorineural hearing loss, vestibular hypofunction and age-matched control” is a study developed to identify postural strategies in response to sensory perturbations (visual, auditory, somatosensory). The article compares multisensory integration between individuals with unilateral hearing loss (and no vestibular complaints), individuals with vestibular hypofunction and age-matched controls in a well-established protocol using virtual reality glasses where auditory stimuli were added.

I congratulate the initiative of this clinical study which, despite having an extremely restricted number of volunteers and patients in each group, is well written with a clear design that carefully used different auditory and positional sensory tests to verify the postural sway responses in unilateral hearing loss and vestibular hypofunction.

Because it is a pilot study whose limitations are well-punctuated, and the conclusions only suggest possible patterns of compensatory responses that lead to future studies that can confirm this insight; this manuscript has become very extensive with figures and tables that overlap. I suggest checking the need for all figures, tables and video.

Reviewer #3: Although the manuscript is generally interesting, I have a few concerns:

1) Title:

- The title is too wordy. I would recommend describing only the main objective of the study, without including methods (e.g., age-matched controls). .

2) Purpose of the study

- There is a small inconsistency between the purpose of the study between the abstract (..."identify postural strategies in response to sensory perturbations") and the body of the manuscript ("compare multisensory integration ... and characterize postural responses to sensory perturbations").

3) Material and methods:

- It is important to characterize the Hearing Loss using validated methods, such as WHO,2020 (https://www.who.int/publications/i/item/basic-ear-and-hearing-care-resource) or even a different one, and not only based on the asymmetry article that was referenced. Furthermore, the reference used to justify these methods is quite old

- Control participants self-reported normal hearing and absence of vestibular symptoms. As they were not evaluated before the beginning of the study, this could be considered a shortcoming of your study and thereby could have compromised the validity of some of your findings. Can you further clarify?

- In the table it is written that the patients have a unilateral hearing loss for years and this may imply a better use of the other somatosensory cues. Patients with vestibular hypofunction have had these symptoms for a much shorter time as compared with the hearing loss, which could have deemed a more important vestibular symptomatology as compared with the hearing loss.

- As this is a pilot study, these data (and further variables) could have been better controlled.

4) Results

- A statistical analysis could be performed between the three groups or between USNHLxVestibular groups?

- The results of the questionnaires are described in the tables, but I do not see them discussed in the text.

5) Conclusion:

- The conclusions must be reformulated in view of the objectives.

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Reviewer #1: Yes: Thais Gomes Abrahao Elias

Reviewer #2: No

Reviewer #3: No

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Insight into postural control in unilateral sensorineural hearing loss and vestibular hypofunction

PONE-D-22-14616R1

Dear Dr. Lubetzky,

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 #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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

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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 #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 #2: Yes

Reviewer #3: Yes

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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 #2: Thank you for thoroughly addressing the comments. The authors have provided corresponding information and the manuscript has improved overall.

Reviewer #3: (No Response)

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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 #2: No

Reviewer #3: No

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