There Is No Relation between Epitympanic Recess Volume and Chronic Otitis Media

Round 1

Reviewer 1 Report

Thank you for the opportunity to review your paper. The issue is interesting for an ENT-surgeon.

I would advice you to differentiate between the otitis media chronica mesotympanalis and the otitis media chronica epitympanalis. Perhaps this could cause a difference in your results. 

Only malleus and incus are to be found in the epitympanon (line 48).

The chapter from line 39 till 42 is quite colloquial in my opinion ("down the road").

I suggest to use mm³

Author Response

Dear Editor,

Thank you for giving us the opportunity to submit a revised draft of the manuscript. We appreciate the time and effort that you and the reviewers dedicated to providing feedback on our manuscript and are grateful for the insightful comments on and valuable improvements to our paper. We have incorporated most of the suggestions made by the reviewers. Those changes are highlighted with track changes function through the manuscript. Please see below for a point-by-point response to the reviewers’ comments and concerns.

 

Reviewer 1 report:

Comments to authors
 I would advice you to differentiate between the otitis media chronica mesotympanalis and the otitis media chronica epitympanalis. Perhaps this could cause a difference in your results. 

 

Only malleus and incus are to be found in the epitympanon (line 48).

 

The chapter from line 39 till 42 is quite colloquial in my opinion ("down the road").

 

I suggest to use mm³

 

 

Response:

We thank the reviewer fort he valuable comment however we could not perform such a classification. We stated the situation as a limitation: “Differentiating the cases as otitis media chronica mesotympanalis and otitis media chronica epitympanalis may alter the results, but we do not have enough number of cases to execute such a classification, the statistical significance would be lost after the grouping.”   

 

The sentence “The epitympanum, also known as the epitympanic recess, is a hollow in the dorsal (tegmental) wall that houses the auditory ossicles.” was changed to “The epitympanum, also known as the epitympanic recess, is a cavity in the dorsal (tegmental) wall that houses the malleus and incus ossicles.”.

The sentences “It’s important for people who experience symptoms associated with chronic otitis such as pain or drainage from their ears to seek medical attention right away so that they don’t develop more serious issues down the road. Early diagnosis and treatment will ensure better outcomes for those affected by this condition” was changed to “People who experience chronic otitis symptoms, such as pain or drainage from the ear, should seek medical attention immediately so that they do not develop more severe problems in the future. Early diagnosis and treatment will improve the prognosis for those affected by this disease.”

 

The statement about "mm³" was corrected. mm³

Reviewer 2 Report

This study demonstrated the difference in upper tympanic volume between control and chronic otitis media inflammation. There have been studies that have shown a significant difference was found between normal ears and ears with cholesteatoma in terms of anterior However, there is a logical problem here: cholesteatoma itself has the invasive feature of destroying bone, which will destroy the bone around the upper tympanic recess, resulting in changes in the volume of the upper tympanic recess size, rather than the size of the upper tympanic recess size.

The following points need to be modified:

1. In The abstract, the author mentions that The aim of this study was to evaluate the relationship between the development of chronic otitis media and the  volume of the epitympanic recess. However, the authors did not clearly show changes in the volume of the upper tympanic recess during the onset of chronic otitis media, which may be one of the reasons for the non-significance. It is recommended to stratify the cases, or to pair the ear with the ear in unilateral chronic otitis media cases.

2. The age, sex and reasons for exclusion of the patients included in the study should be listed.

3. The resolution of all pictures and schematics needs to be improved.

We don't want to jump to a negative result in this area of expertise, we want to dig out the real differences behind the results.

Minor editing of English language required.

Author Response

Dear Editor,

Thank you for giving us the opportunity to submit a revised draft of the manuscript. We appreciate the time and effort that you and the reviewers dedicated to providing feedback on our manuscript and are grateful for the insightful comments on and valuable improvements to our paper. We have incorporated most of the suggestions made by the reviewers. Those changes are highlighted with track changes function through the manuscript. Please see below for a point-by-point response to the reviewers’ comments and concerns.

 

Reviewer 2 report:

 

This study demonstrated the difference in upper tympanic volume between control and chronic otitis media inflammation. There have been studies that have shown a significant difference was found between normal ears and ears with cholesteatoma in terms of anterior However, there is a logical problem here: cholesteatoma itself has the invasive feature of destroying bone, which will destroy the bone around the upper tympanic recess, resulting in changes in the volume of the upper tympanic recess size, rather than the size of the upper tympanic recess size.

The following points need to be modified:

1. In The abstract, the author mentions that The aim of this study was to evaluate the relationship between the development of chronic otitis media and the  volume of the epitympanic recess. However, the authors did not clearly show changes in the volume of the upper tympanic recess during the onset of chronic otitis media, which may be one of the reasons for the non-significance. It is recommended to stratify the cases, or to pair the ear with the ear in unilateral chronic otitis media cases.

 

2. The age, sex and reasons for exclusion of the patients included in the study should be listed.
3. The resolution of all pictures and schematics needs to be improved.

 

We don't want to jump to a negative result in this area of expertise, we want to dig out the real differences behind the results.

 

Response:

 

1.We apologize for the mistake in the purpose part. The relevant sentence has been corrected. “ The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume.”

2. The age, sex and reasons for exclusion of the patients included in the study were listed.
3. All pictures and schematics have been reposted in a separate zip file to improve resolution.

Reviewer 3 Report

Re: Chronic otitis media and epitympanic recess volume…

 

The present manuscript describes a radiological study which attempts to elucidate a possible relation between chronic otitis media (COM) and the epitympanic recess or attic volume. The epitympanic recess volume of 197 patients with COM was compared to the epitympanic volume of 99 healthy controls. 165 patients with unilateral COM and bilateral involvement in 32 patients. CT images were collected in three planes and by use of a 3D volumetric measurement function of the PACS system the volumes of the epitympanic recess were calculated. There was no statistically significant difference between the epitympanic recess volume values of unilateral and bilateral individuals with COM and the epitympanic recess volume of health individuals. One has to keep in mind that the SD of the various measurements are great.

 

This is a rather simple study of a hypothetized possible relationship between epitympanic recess volume and COM – and any difference was not found. The results are worth publishing in Tomography but prior to that the authors have to respond to the following comments/questions:

 

·      Page 1 line 29. – “It is caused by an eardrum hole…”. This is a wrong statement. COM is not caused by a tympanic membrane perforation. COM is an inflammatory disease which influences the various middle ear tissues of which the tympanic membrane is one.

 

 

The manuscript holds 5 tables which could be reduced in number.

 

·      Table 1 – this table can be omitted.  All data is presented in text under the Results section lines 108-116.

 

·      Table 2 – this table describes the epitympanic recess volumes of COM patients. The volume data of the healthy controls should be included here.

 

·      Table 5 – this table should be omitted and the data of the healthy individuals included in the present Table 3.

 

·      In the manuscript Figure 1 contains a duplicate of pictures.  

 

·      The title reads – “Chronic otitis media and epitympanic recess volume. Is there a relation?”  It might be more accurate and interesting to read “ There is no relation between epitympanic recess volume  and chronic otitis media”.

 

 

 

The manuscript should be checked by an English-speaking individual.

Author Response

Dear Editor,

Thank you for giving us the opportunity to submit a revised draft of the manuscript. We appreciate the time and effort that you and the reviewers dedicated to providing feedback on our manuscript and are grateful for the insightful comments on and valuable improvements to our paper. We have incorporated most of the suggestions made by the reviewers. Those changes are highlighted with track changes function through the manuscript. Please see below for a point-by-point response to the reviewers’ comments and concerns.

 

Reviewer 3 report:

 

    Page 1 line 29. – “It is caused by an eardrum hole…”. This is a wrong statement. COM is not caused by a tympanic membrane perforation. COM is an inflammatory disease which influences the various middle ear tissues of which the tympanic membrane is one.

 

The manuscript holds 5 tables which could be reduced in number.

 

• Table 1 – this table can be omitted.  All data is presented in text under the Results section lines 108-116.

 

• Table 2 – this table describes the epitympanic recess volumes of COM patients. The volume data of the healthy controls should be included here.

 

• Table 5 – this table should be omitted and the data of the healthy individuals included in the present Table 3.

 

• In the manuscript Figure 1 contains a duplicate of pictures.  

 

• The title reads – “Chronic otitis media and epitympanic recess volume. Is there a relation?”  It might be more accurate and interesting to read “ There is no relation between epitympanic recess volume  and chronic otitis media”.

 

 

Response:

 

The sentence “It is caused by an eardrum hole, and can be recurrent if not properly treated.” was changed to “It is an inflammatory disease which influences the various middle ear tissues and can be recurrent if not properly treated.”

 

The title “Chronic otitis media and epitympanic recess volume. Is there a relation?” was changed to read “ There is no relation between epitympanic recess volume  and chronic otitis media”.

 

The originals of the Figures are attached as a zip file.

 

Table 1 and 5 are omitted. Tables have been renumbered and arranged.

 

Table 2. Comparison of epitympanic recess volumes in Bilateral and Unilateral Chronic otitis media cases and healthy control group.

 

	Unilateral M [min-max]	Bilateral M [min-max]	Healthy control group	p
Epitympanic recess volume	72.30 [41.45-145.96]	75.00 [52.85-114.92]	74.73 [39.49- 126.76]	0.682

P value was obtained from Mann Whitney U test. M:Median.

 

 

Table 3. Descriptive statistics of epitympanic recess volume of chronic otitis media cases and healthy control group.

	n	mean±sd	M [min-max]
Epitympanic recess volume (Unilateral)	165	77.06±24.67	72.30 [41.45-145.96]
Epitympanic recess volume (Bilateral)	32	76.61±17.66	75.00 [52.85-114.92]
Epitympanic recess volume (Healthy control group)	99	84.125±43.625	74.73 [39.49- 126.76]

M:Median.

 

 

 

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The major concern have been solved.

Althogh it is recommended to stratify the cases, or to pair the ear with the ear in unilateral chronic otitis media cases. But considered it's another research topic.