Recurrent Acute Otitis Media Could Be Related to the Pro-Inflammatory State That Causes an Incorrect Diet

Round 1

Reviewer 1 Report

The required revisions have been addressed. 

Author Response

Thank you so much for your report.

Reviewer 2 Report

Please add the content of rebuttal letter to the discussion 

Author Response

Thank you so much for your comments.

We have already added at the beginning of the discussion, the rebuttal paragraph requested by you, in our opinion very correctly, since it clarifies our therapeutic disposition against mucositis. We have also added a small paragraph in the abstract, for the same purpose.

Reviewer 3 Report

The modifications have been made correctly.

Currently the content of the manuscript is adapted, and it is eligible for publication.

Author Response

Thank you so much for your report.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

I read with interest the paper entitled Recurrent acute otitis media could be related to the pro-inflammatory state that causes an incorrect diet.

Herein you can find attached some of my considerations regarding the research proposed for publication in Sinusitis Journal. 

The aim of the research is to  assess the effects of the Traditional Mediterranean Diet (TMD) on patients diagnosed with Recurring Acute Otitis Media (RAOM).

The main strenghts of the study are the homogeneus study population.

However, there are some concers that should be raised. 

First, it is not clear what are the exact definition and criteria for RAOM. This is crucial to define the final outcome of the study. Please specify if you consider the definition of American Academy of Pediatrics. 

Moreover, there is no hypothesis of a pathogenic mechanism causing inflammation that predispose to OAM (maybe HMGB1?).

Most of the outcomes are self-reported without objective assessment such as pure tone audiometry and tympanometry with valsalva maneuver to assess the eustachian tube function. Moreover, it is interesting to define the anatomic results after stabilization with TMD. Does the patient have retraction pocket or retracted tympanic membrane?

This is not a reliable method to report the outcomes of such patients, especially if considering that most of the item examined through the self-designed questionnaires were answered by parents. We should rely on anatomic and functional data to be sure if the TMD plays a significant role in AOM. It is reasonable to assume that a mediterranean diet might play a role in improving the immune response and protecting the child from upper airway infections.

Morevoer, the improvement in terms of AOM severity and recurrence might be related to the growth of the study population since we know that eustachian tube dysfunction becomes less significant with the age.  

In addition, some issues are herein suggested.

- definition of “Probable” cases of AOM, please specify what is the meaning of "Probable" 

- inclusion and exclusion criteria could be better highlighted and should be written in the study design subheading to improve the readability of the paper 

- in the paper we can assume that the aderence to the questionnaires was 100%. How many parents or legal tutor completed each questionnaire? Please specify in the results subheading. 


Grammatical tips:

-       line 10: missing space between full stop (.) and (M) Methods

-       line 13: missing space between full stop (.) and (R) Results

-       line 20: missing space between full stop (.) and (C) Conclusions

-       line 55: URIS should be written URIs (as in line 29, 90 and 170)

-       line 213: 0,5% episodes per year should be changed in 0,5 episodes per year 

-       line 224: missing space between notably and [30].

-       Line 249: two spaces between (intervention.) and (Dietary)

-       Line 290: two spaces between ([49].) and (It)

 

Reviewer 2 Report

It's an interesting study with interesting result
However, this manuscript doesn't match the scope of this journal
and could be accepted only after comprehensively discussing the relationship between TMD, RAOM and sinusitis.

Reviewer 3 Report

This is a prospective study that exposes the results of recurrent acute otitis media in the context of a Mediterranean dietary habit.

However, despite the effort in the study, as the authors acknowledge, there is no control group that allows a more significant comparison of the results.

However, the article is interesting to establish a precedent in the results of the effect of the Mediterranean diet on recurrent acute otitis media.