PONE-D-24-01234Description and validation of a new low-cost and open-source audiometer: The AupiometerPLOS ONE

Dear Dr. Isnard,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Paul H Delano, Ph.D.

Academic Editor

PLOS ONE

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Additional Editor Comments:

Highlight in the title that this technology has been tested only in normal hearing individuals.

Would it be possible to separate sensori-neural versus conductive hearing loss?

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

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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

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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 work presents a new open-source audiometer based on a Raspberry Pi single-board computer. The manuscript describes the design details and validates it.

The paper is well-written and clear. The methodology is sound, and the results are interesting. In my opinion, the disclosure of this design is a contribution to the scientific community. It is important to highlight that the software is open-source and is available on GitHub. For these reasons, I recommend accepting the paper after the following issues are addressed:

* Major Issues

- There are missing elements in the determination of the device's cost in order to make a fair assessment and comparison of its cost. In particular, you need to include an estimation of labor cost and the calibration cost. I also miss the cost of the Raspberry case and the power supply. Along the same lines, please include in the photo of Figure 1 a view where one can observe the whole device, including the Raspberry Pi with its case and power supply.

- Regarding the experiments, clarify if all sixteen participants have normal hearing or not. If yes, is this a limitation of the study? Should future work include testing the device with participants with hearing loss?

- The experiments were performed in an audiometric booth. I understand this is a methodological requirement in the context of this manuscript. However, it is not clear to me if an audiometric booth is always required. Please include a discussion about this issue. In particular, clarify if using the device without the booth is possible. Moreover, if possible, state under which circumstances it is possible and under which limitations.

* Minor Issues

- Line 32: Replace "cognitive decline" with "and cognitive decline."

- Line 54: The writing of the sentence "automated and calibrated, designed based on a Raspberry Pi nanocomputer." is awkward. Please fix.

- Line 58: The writing of the sentence "it is a question of considering the use of the Aupiometer for a broader diagnosis including other hearing tests." is awkward. Please fix.

- In the paragraph starting at line 63, use "USD$" instead of "$" (assuming prices are in US dollars).

- Line 77: Explain what is "Fe" (I assume it is the sampling frequency, but please be explicit).

- Link your GitHub to a Zenodo repository (https://zenodo.org/). The service is free, you will get a DOI, and you can add your repository to your references.

Reviewer #2: The article “Description and validation of a new low-cost and open-source audiometer: The Aupiometer” propose a new device integration (raspberryPI + headphone + software) to performa PTA, and a validation comparing the new device with a clinical standard one.

In general, the article is clearly written, but it requires further explanations as it is intended as an OpenSource PTA.

Major comments

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Main motivation is to propose a low-cost device, then authors indicate that the final cost is about 50% of a commercial setup (main cost is headphone). For me 400 US$ is not low cost and 50% is not a huge price reduction, but at the same time PTA is usually performed is silent rooms, by specialized personnel, so comparison is not fair. Also, it is necessary the expensive headphone or the newer raspberryPI? Please clarify the argumentation.

Related with evaluation, were both devices evaluated in an isolated room? How sensitive to noise conditions and personnel are the measurements? How was the perception of the device by the uses? (usability of the system).

The proposed device requires a calibration step, which is standard, but that makes hard to think in telemedicine applications as that requires special equipment. Have the authors thought on how to address this issue?

I checked the git repository and did not find the data tables, just code. Could the authors provide the data of comparison?

Minor comments

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Abstract should include main results (dB mean difference, N subjects, frequency range).

Figures are low resolution. Figure 1, screen brightness prevents getting an idea of the software. Figure 2, is that really the interface or the mockup? Please provide final interface or at least a mockup with good resolution. Figure 4, I cannot read the legends (make plot vectorial for clear reading)

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Reviewer #1: Yes: Alejandro Weinstein

Reviewer #2: No

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PONE-D-24-01234R1Description of a new low-cost and open-source audiometer and its validation with normal-hearing listeners: The AupiometerPLOS ONE

Dear Dr. Isnard,

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.

(1) Include the cost of the Raspberry itself (only the cost of the display is included)

(2) Send Figures 1, 2, 4 with high resolution or vectorial file

Please submit your revised manuscript by Aug 02 2024 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: https://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,

Paul H Delano, Ph.D.

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:

All major concerns have been addressed.

A couple of minor changes:

(1) Include the cost of the Raspberry itself (only the cost of the display is included)

(2) Send Figure 1, 2, 4 with high resolution or vectorial

[Note: HTML markup is below. Please do not edit.]

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: All the comments have been addressed. I just noticed that the cost of the Raspberry itself is not included (only the cost of the display is included). Please add it.

Reviewer #2: The revised version of the article “Description of a new low-cost and open-source audiometer and its validation with normal-hearing listeners: The Aupiometer” made mainly clarifications about costs and methodology to compare with gold standard.

All major comments have been addressed.

About minor comments I still believe images are 1, 2, 4 are of poor resolution, and should be included vectorial or in high resolution.

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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: Yes: Alejandro Weinstein

Reviewer #2: No

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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.

Description of a new low-cost and open-source audiometer and its validation with normal-hearing listeners: The Aupiometer

PONE-D-24-01234R2

Dear Dr. Isnard,

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.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Paul H Delano, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: