Is Skull Vibration-Induced Nystagmus Useful in Vestibular Neuritis Follow Up?

Round 1

Reviewer 1 Report

This paper shows the correspondence of VOR gain differences between the ears and

SVIN SPV.  Their results suggest that clinicians could use SVIN SPV to quantify recovery over time after neuritis. 

Line 20 say Odds ratio rather than OR here (and later)

Line 57 should be VN not NV.

Please use  SVIN SPV since SPV is ambiguous – there is SPV in vHIT.

The key measure is what's given in lines 83 where they actually look at the VOR gain differences over time.

What is the “estimate” mentioned in line 84 . Is this a regression coefficient?

There has to be a much better explanation as to why the patients were divided into groups.

The important values are of course VOR gain and they are presented.

line 80 they say all of values decrease to 12 months  to .15  etc. But please reword the sentence so it is clear which value decreases to what.

line 68. The frequency of what greater than one per second.

So lines 135 to 138 need to be changed because these neuritis are mainly patients who almost certainly recovered.  The important thing about the Dumas result is the permanence of the loss after surgical section. Their SVIN does not recover and so is permanent.  They realize that in the next sentence but it is misleading to suggest your results disagree with Dumas.

Author Response

Please see the attachment.

Reviewer 2 Report

This is a well designed study regarding follow-up of modern vestibular testing in patients with vestibular neuritis. The authors have shown that in the process of compensation diffentet measures have changed.

The paper is suitable to publish nut there are some issues to solve before

Major

I miss some clinical data that would enlighten the new information: 1) on clinical grounds, how many patients consider their clinical status as poor? Are they in the VIN>0??? 2) spontaneous nystagmus on follow-up is a sign to explain SVIN and some refutation saccades...was that present at any time? could that confound results?

Minor.

There are so many "V"s..I suggest to modify the legends in figures...they can be more literal, not so schematic...

Author Response

Dear Reviewer 2,

We sincerely thank again the reviewers for their work, which has undoubtedly contributed to improving the quality of the manuscript: “Is the skull vibration-induced-nystagmus useful in vestibular neuritis follow up?”.

In response to the second reviewer, we have added the clinical limitations of the study (lines 177-181) and we have clarified the exclusion criteria of the study in material and methods (lines 56-62). In addition, we have improved the legends of the figures.

The changes made are highlighted in the text.

Please see the attachment

We hope that with these adjustments you will consider the article for your journal.

Yours sincerely,

Mª Piedad García Díaz

Author Response File: Author Response.docx

Reviewer 3 Report

General comments

This manuscript is very short and lacking important description which I pointed out below. Prior to reconsideration of publication, extensive revision should be required.

Specific comments

There is little description of diagnostic criteria of VN, inclusion criteria and exclusion criteria. Description of these criteria is essential.

What is PR score? Explain haw to calculate it and describe its physiological significance.

Why did the authors use VOR difference instead of VOR gain in the affected side? Decreasing of VOR difference can be achieved not only recovery of VOR gain in the affected side but also decreasing of VOR gain in the unaffected side.

Have the authors assessed only the lateral canal? How about the anterior and posterior canals?

VIN was always toward the unaffected ear?

Fig.1 and Fig2 What did the line and shaded area indicate?

This study is lacking data of stabilometric findings as well as subjective feeling of disequilibrium such as DHI and. It should be stated as one of limitations of this study.

Fig.3 and Fig.4

Results concerning PR score are not the same as VOR gain difference. Although significant difference was shown concerning VOR gain difference, no significant difference concerning PR score. The authors’ statement in Line 103 is not correct.

Citation of references was biased. Furthermore, original studies of VIN are ignored.

There is little description of diagnostic criteria of VN, inclusion criteria and exclusion criteria. Description of these criteria is essential.

What is PR score? Explain haw to calculate it and describe its physiological significance.

Why did the authors use VOR difference instead of VOR gain in the affected side? Decreasing of VOR difference can be achieved not only recovery of VOR gain in the affected side but also decreasing of VOR gain in the unaffected side.

Have the authors assessed only the lateral canal? How about the anterior and posterior canals?

VIN was always toward the unaffected ear?

Fig.1 and Fig2 What did the line and shaded area indicate?

This study is lacking data of stabilometric findings as well as subjective feeling of disequilibrium such as DHI and. It should be stated as one of limitations of this study.

Fig.3 and Fig.4

Results concerning PR score are not the same as VOR gain difference. Although significant difference was shown concerning VOR gain difference, no significant difference concerning PR score. The authors’ statement in Line 103 is not correct.

Citation of references was regionally biased. Furthermore, original studies of VIN are ignored.

Author Response

Dear Reviewer 3,

We sincerely thank again the reviewers for their work, which has undoubtedly contributed to improving the quality of the manuscript: “Is the skull vibration-induced-nystagmus useful in vestibular neuritis follow up?”.

In response to the third reviewer, we have clarified the inclusion and exclusion criteria of the study in material and methods (lines 56-62). We have described what the PR score is and how we calculate it (lines 43-47). We have explained the usefulness of taking the VOR difference as a characteristic to be analysed (lines 68-71). In addition, we have explained why we have only used the horizontal semicircular canal (lines 73-75).

About this comment: “Results concerning PR score are not the same as VOR gain difference. Although significant difference was shown concerning VOR gain difference, no significant difference concerning PR score. The authors’ statement in Line 103 is not correct.” We didn´t find the error you refer to, we would like to correct it if you explain the reason more clearly.

In the original manuscript we had foccused in original papers that compared VHIT with VIN because we are interested in this correlation. But taking into account your aprecciation about a possible bias, we had added references to a original papers in which it was studied the evolution of the velocity of VIN in VN (lines 51-52, line 165).

As the article is addressed to a special journal about VIN, we didn´t want to delve into the technique or the specific results of VIN in VN. Considering that it will be discussed extensively in the different articles. Therefore, we have focused on discussing the relationships of the both techniques in VN.

The changes made are highlighted in the text.

Please see the attachment.

We hope that with these adjustments you will consider the article for your journal.

Yours sincerely,

Mª Piedad García Díaz

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The work is well done

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

I do not think that the manuscript was properly revised. I have to recommend rejection.

Author Response

Please see the attachment

Author Response File: Author Response.docx