PONE-D-25-46934Impact of Contralateral Sensorineural Hearing Loss on Prognosis in Idiopathic Sudden Sensorineural Hearing LossPLOS One

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ACADEMIC EDITOR:Please reply to Reviewer 2 comments, revise your manuscript and re-submit

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Academic Editor

PLOS One

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Partly

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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

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Reviewer #1: Well written and analyzed. The authors make clear their limitations of not investigating the cause of hearing loss. That in many ways can influence treatment. That would be a very influential factor. Since this is a retrospective analysis, perhaps this could influence future prospective study designs

Reviewer #2: Issues and Questions to be Addressed

Throughout the Manuscript:

- Instead of using “effective/ineffective”, consider using something like “recovery/no-recovery”. Effective/ineffective could imply that there a prospective clinical trial, designed with a specific treatment protocol that includes a treatment or placebo control, was studied.

- Instead of stating “…the contralateral was…”, always state “…the contralateral ear ….”. Contralateral is usually used as an adjective, not a noun.

Introduction:

- Add references for prior research that considered the contralateral ear. Cite these at end of next-to-last paragraph in Introduction.

- Also, add references for last paragraph in Introduction, including after the statement, “Building upon existing evidence…”.

Statistical Methods and Variables:

- Consider magnitude of sudden hearing loss as a co-variable.

- Consider the time of treatment onset relative to the onset of the sudden hearing loss as a co-variate.

- Consider the magnitude of recovery in reference to the hearing threshold in the affected ear prior to the sudden hearing loss. See 2nd paragraph in Methods, Hearing Assessment.

- Consider ”diabetic peripheral neuropathy” as a co-morbidity.

- The use of ototoxic medications prior to onset of sudden hearing loss (within some time period) should be an exclusion criterion. Alternatively, use it as a variable in the statistical analyses.

Methods:

- Inclusion criteria: elaborate on “no prior treatment”.

- Change from “anonymized” to “de-identified”.

- Hearing assessment: Reconcile the dB used for mild and profound hearing loss with the audiogram patterns (e.g., >= 25 dB at 0.25 and 0.5 Hz for hearing loss threshold, and > 81 dB at all frequencies for total deafness).

- For complete recovery, why is “10 dB of the contralateral ear” used instead of “10 dB of baseline (pre-onset of sudden loss) of the affected ear itself”?

Results:

- For those with complete recovery (based on PTA at discharge), what was the PTA at 1 month post-discharge (as reported for those without complete recovery)? Any significant change at 1 month (compared to end of discharge)?

Discussion:

- Is there an example of a possible “individualized patient assessment protocols”, as proposed in the Introduction, in addition to “assessment and intervention of the patient’s mental health”.

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Reviewer #1: Yes:Christopher de Souza

Reviewer #2: Yes:John H Anderson

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Impact of Contralateral Sensorineural Hearing Loss on Prognosis in Idiopathic Sudden Sensorineural Hearing Loss

PONE-D-25-46934R1

Dear Dr. Sanlin Xie,

Thank you for responding to the reviewer's comments and submitting the revised manuscript. 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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Kind regards,

Gauri Mankekar, MD,PhD,FACS

Academic Editor

PLOS One