Utility of a freehand frameless navigation system in computed tomography-assisted ventral bulla osteotomy for otitis media in calves

Takeshi Tsuka; Masamichi Yamahita; Yoshiharu Okamoto; Shunsuke Miyazaki; Jun Ishii; Kitaro Yoshimitsu; Yoshihiro Muragaki

doi:10.1371/journal.pone.0342569

Peer Review History

Original SubmissionAugust 22, 2025
25 Nov 2025 Decision Letter - Toru Miwa, Editor Dear Dr. Tsuka, 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 Jan 09 2026 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. 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'. 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Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: As discussed, the operational difficulty with the freehand frameless navigation system is influenced by the target size and its distance from the skin, which should be presented. From the preoperative CT scans, the following details should be included: 1. List the maximum diameter of the target bulla, including the horizontal and vertical section sizes, and the direct diameter if possible. 2. If available, describe the distance from the skin surface to the front wall of the bulla. 3. Note any diagnoses of middle ear disease, such as exacerbation of chronic otitis media or cholesteatoma otitis media infection, made through visual examination before or during surgery. 4. The presence or absence of sacral bone destruction and the extent of inflammation progression to surrounding tissues significantly impact the postoperative course. Therefore, these factors should be considered in the preoperative CT scan. 5. On page 43, line 641: It is important to note that while dizziness may occur due to the spread of middle ear infection to the inner ear, generalized convulsive seizures are unlikely and should be attributed to a brain event. This section requires further consideration. Even if the surgery is performed without issues, high-pressure cleaning in the presence of a skull base bone defect may provoke such occurrences. In human surgery, pressure irrigation is avoided in the middle ear and mastoid cavities, and only saline is used for sufficient cleaning without cytotoxic liquids. ****** 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 ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. Attachments Attachment Submitted filename: Comments for Manuscript, PONE-D-25-45935.docx https://doi.org/10.1371/journal.pone.0342569.r001
Revision 1
25 Dec 2025 Author Response For reviewer #1 Suggestion: As discussed, the operational difficulty with the freehand frameless navigation system is influenced by the target size and its distance from the skin, which should be presented. From the preoperative CT scans, the following details should be included: Response: Thank you for your kind suggestions. Suggestion: List the maximum horizontal diameter of the target bulla, and maximum straight diameter relative to it on horizontal CT, and the maximum diameter of bulla on vertical CT if possible. Response: According to this suggestion, in the revised version, we create Table 2, which includes CT measurements of the tympanic bulla’s size and the distance between the skin surface and the tympanic bulla. Additionally, in the Discussion section, the descriptions for the results are added. Suggestion: If available, describe the distance from the skin surface to the inferior wall of the bulla. Response: The distance between the skin surface and the tympanic bulla is measured in CT, and the result is written in Table 2. Suggestion: Note any diagnoses of middle ear disease, such as acute phase of chronic otitis media or cholesteatoma otitis media infection, made through visual examination before or during surgery. Response: The tympanic cavity could not be observed macroscopically through the skin opening during surgery. Almost all cases involved respiratory distress (pneumonia) and subsequently otitis media. These cases were considered to have chronic otitis media when treated with VBO at an average of 33.9 days after initial medical treatment. Thickening and extension in the tympanic bulla’s walls are the typical CT characteristics to show the chronic phase. These descriptions are added in lines 472-476 in the revised version. Suggestion: The presence or absence of skull bone destruction and the extent of inflammation progression to surrounding tissues significantly impact the postoperative course. Therefore, these factors should be considered in the preoperative CT scan. Response: Bone proliferation was assessed by measuring the increased width of the tympanic bulla’s wall on CT images (Table 2). Unfortunately, bone destruction (bone resorption) could not be evaluated because bone CT values (Hounsfield unit) were not measured in the cases examined. The CT examination could not assess the progression of inflammation into surrounding tissues. Suggestion: On page 43, line 641: It is important to note that while dizziness may occur due to the spread of middle ear infection to the inner ear, generalized convulsive seizures are unlikely and should be attributed to a brain event. This section requires further consideration. Response: We completely agree with this suggestion. Seizures are caused by mechanical damage to the inner ear structure and deeply located brain structure from a trocar used in the present VBO procedure. The sentences are changed and modified in lines 694-702 in the revised version. Suggestion: Even if the surgery is performed without issues, high-pressure cleaning in the presence of a skull base bone defect may provoke such occurrences. In human surgery, pressure irrigation is avoided in the middle ear and mastoid cavities, and only saline is used for sufficient cleaning without cytotoxic liquids. Response: In irrigation within the tympanic bulla, ozonated water was poured by manually pushing the piston of a 20 ml syringe via a catheter introduced through a trocar. The manual procedure to pour ozonated water was carefully performed. Thus, we believe that the pressure was not high within the cavity of the tympanic bulla during intra-ear irrigation. Because the pathogen was unknown at the time of medical treatments, ozonated water has been used in the present VBO procedure. Ozonated water inactivates immediately upon contact with biological tissues, leaving no residual irritants. However, we agree with the opinion that “only saline is used for sufficient cleaning without cytotoxic liquids”. Thus, in the revised version, the sentences are corrected in lines 615-637, by adding one new reference paper. https://doi.org/10.1371/journal.pone.0342569.r002
26 Jan 2026 Decision Letter - Toru Miwa, Editor Utility of a freehand frameless navigation system in computed tomography-assisted ventral bulla osteotomy for otitis media in calves PONE-D-25-45935R1 Dear Dr. Tsuka, 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. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . 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, Toru Miwa Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: (No Response) ****** 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 ******** https://doi.org/10.1371/journal.pone.0342569.r003
Formally Accepted
Acceptance Letter - Toru Miwa, Editor PONE-D-25-45935R1 PLOS One Dear Dr. Tsuka, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Toru Miwa Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0342569.r004

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