Effectiveness of Aural-Oral Approach Based on Volubility of a Deaf Child with Late-Mapping Bilateral Cochlear Implants

Round 1

Reviewer 1 Report

The subject of the article "Effectiveness of Aural-Oral approach based on volubility of a deaf child with late-mapping bilateral cochlear implants. Schools as a Result of the COVID-19 Pandemic: Comparison with 2019 Data" is extremely actual. The topics is really hot.

I have the following comments and questions for the authors. There are many awkward phrases that I do not point out here; I only point out those where the meaning cannot be interpreted:

The table 2 is extremely hard to read, maximize the writing.

The paragraph between row 336 and 343 is not clear can be rewrite in more clear format.

The conclusion need to clear and specific. My recommendation is to focus on 3 short conclusions.

Please recheck the References order.

Please double check the article by a native English reader.

Thanks again for the chance of reading the article.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

The paper describes a case of a congenitally deafened sequentially bilaterally cochlear implanted (7months and 3;7 years) boy. Until the age of seven he never had any kind of therapy before. A conventional SLT was performed for one year and after this an aural-oral rehab programme started (AVT). After the SLT and after the AO therapy vocalisations were recorded and analysed. A significant increase of canonical babbling after AVT was observed  This was accounted to the superiority of the AVT.

By and large the paper is of interest and publication as case report is justified. However, neither writing style nor the statements are completely comprehensible and justified.

Regarding the methodology I think it is not valid to compare two ways of therapies when T1 is right after T2. I understand that the sequential design is inevitable when discussing a case report but this limits most of the conclusions drawn. It may be that the SLT acted as a priming therapy for the AVT.

Statistics is well describe but it should not be overrated. Hence, I am not sure if table 2, 3, and 4 are justified.

Table 1 is completely missing in my manuscript version.

I recommend a clear description of the AO therapy / AVT. I assume that AVT is a special case of AO therapy with special engagement of the caregivers. The SLT needs also a clear description. From lines46ff it seems that AO approach is complementary to AVT.

For example, the sentence (l85f) “There is no difference between the traditional Speech Therapy and the Aural/Oral approaches only, but even among the last one.” Is a complete miracle to me.

Sign language is not encouraged by AVT. But are they “allowed” or used by the parents. What was the previous (before SLT) way of communication of the boy? I assume that at least rudimentary sign language was used by the family. Did you investigate vocalisation before starting the SLT? This would be the actual baseline.

The structure of the paper is somewhat strange. Within the introduction a clear description of the AVT and its difference to conventional SLT should be presented. 

On the other side several paragraphs (e.g.(“Based on this framework…,” and “In speech-language therapy …” from Sec 2)  belong to the introduction.

Section 2.2 should clearly describe the procedure of the study, the tests  and the data analysis. It was hard to me to get the timeline of the procedure. This could be represented in a figure from birth to the end of AVT.

I recommend to use the child's birth as reference. E.g. years (2019 2020) in Fig. 1 are confusing.

Additionally, it seems that the first activation of the external parts (i.e. speech processor fitting) started at the age of two or three. I think this is an important issue and this makes the case very special. As far as I have seen the CI outcome for the described child are extremely poor. This should be underlined and I wonder about the actual causes for the non using period. 

The fitting process should be described in detail ( How many sessions?) and the daily hours of CI use.

I recommend to discuss the results with previous findings on speech production of CI children_:(e.g. Glaubitz et al.: Age-related language performance and device use in children with very early bilateral cochlear implantation. International Journal of Pediatric Otorhinolaryngology, 147 (2021)).

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf