Cardiovascular Risk Profile in Ménière’s Disease and Posterior Circulation Infarction: A Comparative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Sirs, I find this work of great interest, as it may provide new avenues of research into the causes of Meniere¨s dissease. Below are some questions I would like to raise:

MATERIAL AND METHODS:

Could you indicate if in your protocol for treating Meniere patients, brain MRI is performed in all cases?

Could you indicate the reason for excluding 11 patients after the assesment of the clinical data?

Could you specify in the group of 6 patients excluded after performing MRI among the 70 patients with MD if any of them presented auditory or vestibular symptoms

Regarding the CRVFs, I believe it would be more appropriate to better define the assessment criteria. Additionally , we need to consider the high  percentage of underdiagnosed patients for most of this conditions ( hypertension, diabetes, hypercholesterolemia). Concerning tobacco consumption, it would be more suitable to analyze consumtion over the entire smoking history. If we only assess the past year, we might have a percentage of patients who quit smoking more than a year ago and therefore would be erroneously considered "non smokers" in the study

RESULTS:

I am concerned about the sigfnificant difference in sex between the two Meniere-POCI groups, as the prevalence of CVRfs differs between men and women, and this may be a bias to consider

I believee the results would be easier to interpretate if figure 3 were replaced with a data table. And in the case of figure 4, changing the percentage to de number of patients

DISCUSSION:

I think this type of study, where we attempt to correlate different CVRFs with other conditions, requires a prospective analysis, and its almost obligatory to compare with a control group without MD or POCI

 

 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The work is interesting in its conception. It aims to correlate the cardiovascular risk factors in Meniere's disease and compare them to those present in posterior ischemia. However, the results obtained are not encouraging. Such a wide variability is observable, and it is impossible to attribute a specific correlation to the data with a possible cardiovascular or cerebral event. If, on the one hand, hyperlipidemia is present in POCI SVO, why isn't obesity also present? And then why did the authors compare Menière's disease with posterior ischemic damage? It was logical that the result would be the presence of the risk factors we already know. Finally, why were those patients who suffered an ischemic event excluded? Perhaps evaluating those patients would have shed light on the mechanisms of ischemic damage the authors sought. It seems like a chaotic data set to which the authors want to attribute a diagnostic and prognostic value. Focusing on the particular finding on cardiovascular risk factors in Menière disease would have been more helpful. Ultimately, in my opinion, the results provided do not support the conclusions

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors I think that this study is very interesting and I encourange you to continúe researching in this field

Reviewer 2 Report

Comments and Suggestions for Authors

at the present form, the paper is very improved. I think that is a novel approach to Improving our knowledge of Menière disease.