Dear Dr. Bustos-Rubilar,

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Take into account reviewers concerns

Rewrite the discussion section in order to focus more precisely in the results of the manuscript

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PLOS ONE

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Additional Editor Comments:

Take into account reviewers concerns

rewrite the discussion section in order to focus more precisely in the results of the manuscript

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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?

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

Reviewer #1: No

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: The study is interesting, important, relevant, and novel. It is well written, the reading is easy.

The main problem of the study is that: In the discussion there is an exploratory analysis and review of the cost of cochlear implants what is not directly related to the aim of the study. In this study the authors could use it as an example or for argumentation just to cite it the total cost cost but not to analyze extensively as the authors did in the discussion of the paper, since it is not the objective of the study. I would remove the extensive discussion and analysis of costs included in the discussion. Remove it from the discussion or just add it to supplementary, exploratory analysis. It is unnecessary, it is not mentioned in the abstract, not related to the main question of the study and also not related to the message that apparently the authors want to give. The authors state: “This study will characterize deaf children with CI in Chile and evaluate the impact of the CI in speech perception and production, social inclusion, and parental satisfaction.” The study is not about the total cost of CI

The discussion should present and discuss the main result, discuss other results related to the objectives, but not results not related to the objectives. The authors mainly discuss and repeat their results, and in the end they spoke about few limitations, actually recall bias is recognized but not named. They do not go deeply into the sample size although they recognize it might be not sufficient or be the reason for lack of significance. The sample size was not calculated, although the sample was about the 70 % of total CI. The future studies are not mentioned at the end of discussion but some were mentioned when discussing some results

The conclusion is correct but I would emphasize more about the take home message by ending the conclusion paragraph on that phrase, which is nearly but not the last phrase of the paper.

In variables characterization aethiology does not sound fine for congenital or late hearing loss, that is moment of presentation, I think it is more correct instead of aethiology. (see Table 1)

The abstract is good.

The methods are fine. A missing data of 3% reported is acceptable and they report methods of missing data management.

Reviewer #2: The article “Deaf children with cochlear implants in Chile: A national analysis of health determinants and outcomes in the Latin American context” is interesting and worth publishing, but needs some revisions.

Authors provide a description of a group of pediatric patients receiving cochlear implants in Chile, the first report of the country. In order for readers to understand some results I would suggest the authors to include a description of the cochlear program and how patients are selected. For example, if the patient has a deprived social context without family support he/she might be rejected from candidacy. This observation has a direct impact on the social description of the sample. Another issue is the observation that the majority of children with cochlear implants live either in Santiago, capital city, or Concepcion, second largest city of the country. Public hospitals authorized by the Health Minister to perform cochlear implant surgery are also located in these two cities, so maybe ENT from these geographical locations are more prone to propose candidates than ENT in smaller cities without cochlear implant programs.

Other observations that should be addressed by the authors:

Detection of hearing loss in newborns is mandatory since January 2020 for babies delivered in public hospital.

Authors excluded cochlear implants cases from private institutions, why?

In methods please explain socioeconomic health insurance. In Chile health provision by the government is different according to income, and people pay a percentage according to a classification (ranging from 0 to 50%). This classification might not reflect the total home income since it does not consider informal income.

Speech perception according to clinical records (Peer and Moog) differed from parent's perception (CAPII). For the clinical assessment 55% were in the two lowest categories, on the contrary, parents perceive that 62.6% were in the higher categories. Authors should comment on this discrepancy.

Include intervals of confidence for the correlation factors.

There is a table in the discussion that is out of place. The content was not included in the objectives nor in the results.

Revise grammar, for example page 10 line 259, page 11 second paragraph, page 14 line 274.

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Reviewer #1: No

Reviewer #2: Yes:  Mariela C. Torrente

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Deaf children with cochlear implants in Chile: A national analysis of health determinants and outcomes in the Latin American context.

PONE-D-24-43191R1

Dear Dr. Bustos-Rubilar,

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Kind regards,

Paul H Delano, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: