Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction

Kaushlendra Kumar; Krishnapriya S; Anupriya Ebenezer; Mohan Kumar Kalaiah; Deviprasad D

doi:10.12688/f1000research.122677.3

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Research Article

Revised

Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction

[version 3; peer review: 2 approved, 1 approved with reservations]

Kaushlendra Kumar¹, Krishnapriya S¹, Anupriya Ebenezer ¹, Mohan Kumar Kalaiah¹, Deviprasad D²

Kaushlendra Kumar¹, Krishnapriya S¹, [...] Anupriya Ebenezer ¹, Mohan Kumar Kalaiah¹, Deviprasad D²

PUBLISHED 18 Oct 2023

Author details Author details

¹ Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
² Department of Otorhinolaryngology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

Kaushlendra Kumar
Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing

Krishnapriya S
Roles: Data Curation, Investigation, Writing – Review & Editing

Anupriya Ebenezer
Roles: Data Curation, Formal Analysis, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Mohan Kumar Kalaiah
Roles: Formal Analysis, Visualization, Writing – Review & Editing

Deviprasad D
Roles: Resources, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background: Among individuals with vestibular dysfunction, the loss of vestibular sensory information is found to alter cognitive abilities that coordinate spatial and non-spatial information. P300 is an event-related potential commonly used to assess cognitive processing. The aim of the present study was to compare the latency and amplitude of cortical auditory evoked potential and P300 between individuals with vestibular dysfunction and individuals with no vestibular dysfunction.

Methods: Forty adults with a mean age of 40.5 ± 13.07 participated in the study. Group I included 20 adults diagnosed with vestibular dysfunction and group II included 20 age-matched adults with no vestibular dysfunction. The P300 was recorded from the electrode site Cz and Pz. It was elicited using pure-tones in odd-ball paradigm. The latency and amplitude of peaks P1, N1, P2, and N2 of the cortical auditory evoked potential and the P300 were measured.

Results: Significant amplitude difference was observed in cortical potentials at Cz and Pz. The P300 was present only in 70% of individuals with vestibular dysfunction compared to 100% among individuals with no vestibular dysfunction. The mean amplitude of the P300 was slightly larger in group 1 compared to group 2 and the mean latency of the P300 was similar in both groups. However, the difference in amplitude of the P300 between groups was not statistically significant.

Conclusions: Knowing the cognitive function of individuals with vestibular dysfunction enables planning vestibular rehabilitation therapy, which enhances the quality of life in these individuals by improving their vestibular and cognitive functions.

Keywords

cognition, vestibular dysfunction, vertigo, P300, dizziness, event related potentials, cortical auditory evoked potentials, VEMP

Corresponding author: Anupriya Ebenezer

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Kumar K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Kumar K, S K, Ebenezer A et al. Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction [version 3; peer review: 2 approved, 1 approved with reservations]. F1000Research 2023, 11:1013 (https://doi.org/10.12688/f1000research.122677.3) First published: 07 Sep 2022, 11:1013 (https://doi.org/10.12688/f1000research.122677.1) Latest published: 18 Oct 2023, 11:1013 (https://doi.org/10.12688/f1000research.122677.3)

Revised Amendments from Version 2

In the current version, the modifications were made in manuscript text, figure and citation. In figure1 labeling of N4 peak in the grand average waveform was done. Regarding citation, a new cite inserted in the discussion section, in-text citation error and citation numbering error are resolved in the discussion section with the respective correction in the bibliography. And a few sentences were rephased as per the reviewer's concern for better clarity and understanding.

See the authors' detailed response to the review by Sangamanatha Ankmnal Veeranna
See the authors' detailed response to the review by Prawin Kumar
See the authors' detailed response to the review by Aravind Kumar Rajasekaran

Introduction

Vestibular dysfunction is caused by pathologies in the peripheral and central vestibular system. The peripheral pathologies constitute 90% of cases with vertigo.¹ It involves lesion in the end organs of the inner ear and/or the eighth cranial nerve. The central vestibular pathologies involve lesion in the cortical and sub-cortical pathways of the vestibular system. Vestibular dysfunction results in several adverse physical outcomes such as postural instability, abnormal gait and falls. Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.² In addition, the loss of vestibular sensory information is shown to alter cognitive abilities related to the processing of spatial and non-spatial information.³

Several studies have investigated the cognitive abilities of individuals with vestibular dysfunction. According to literature, parabrachial nucleus and the hippocampus are the anatomically two regions that account for the relation between the vestibular system and neural networks involved in cognitive and emotional processing.⁴ The different cognitive skills associated with vestibular function include attention, visuospatial orientation, executive function, memory, metacognition, and self-control.⁵ Research on cognition assessment pertaining to vestibular function has mainly been based on spatial orientation, attention, memory, and executive function.⁵ Smith (2017)⁶ reported that cognitive impairment is usually seen in any vestibular dysfunction such as either peripheral or central vestibular dysfunction.

The P300 is an event-related potential, elicited when the target stimuli in the odd-ball paradigm is identified by the participant. It serves as an index for the assessment of cognitive ability to assess cerebral information processing in the context of various neurological diseases.⁷ Several studies have documented abnormal P300 in individuals with cognitive dysfunctions such as autism spectrum disorder,⁸ attention deficit hyperactivity disorder,⁹ schizophrenia,¹⁰ and migraine.¹¹ It is usually performed with minimum attention to the stimuli and without secondary tasks. The P300 is used to evaluate age-related cognitive dysfunction, reflecting attention and memory processes and overlapping function in cognitive deficit.¹² Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.¹³ The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.⁷ The P300 amplitude response mainly depends on stimulus probability, stimulus significance, task effort, motivation, and attentiveness.¹⁴ P300 amplitude is directly related to the amount of attention paid to perform a particular task associated with superior memory performance.¹⁵ P300 latency reflects stimulus processing time in contrast to response processing time, which corresponds to stimulus evaluation time and is independent of the response section.¹⁶^,¹⁷

Behavioural cognitive abilities are reported to be affected in individuals with vertigo.⁵^,¹⁸ Especially in individuals with vestibular dysfunction, the cognitive deficit is not only observed in terms of spatial orientation, but also with respect non spatial activities which includes recognition memory and attention. Whereas, the authors had suggested that there might be an inverse proportionality between the cognitive dysfunction and frequency of vertigo. Therefore, the individuals who achieved vestibular compensation might also experience cognitive deficit.¹⁹ Moreover, considering the findings of the previous research there is a necessity to study the direct measure of brain response to cognitive task by recording an event related potentials. Especially the cortical potentials to read the sensory aspects and cognitive potentials to read the cognitive aspects of individuals with vestibular dysfunction. Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Methods

Participants

A total of 40 adults aged between 20 and 60 years (mean = 40.5, SD = 13.1) participated in this study. Group I included 20 adults, (mean = 40.5 years, SD = 13.1) 10 males and 10 females with vestibular dysfunction. All participants in group I had underwent detailed vestibular evaluation. The tests administered were subjective vestibular assessment, oculomotor examination, and vestibular evoked myogenic potentials (VEMPs). The oculomotor examination was performed using videonystagmography (VNG), the subtests included were saccade test, tracking test, and optokinetic test. VEMP testing included both cervical VEMP (cVEMP) and ocular VEMP (oVEMP). The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study. Group II included 20 age-matched adults (mean = 40.5 years, SD = 13.1) 10 males and 10 females with no vestibular dysfunction. Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion. All participants in the study had hearing sensitivity within normal limits in both ears with pure-tone average (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) less than 25 dBHL. The mean pure-tone average was 18.18 dBHL (SD = 5.16) for right ear, 18.20 dBHL (SD = 5.58) for left ear in group I and was 15.96 dBHL (SD = 4.59) for right ear, 16.43 dBHL (SD = 3.69) for left ear in group II. Individuals under medication for vertigo and individuals diagnosed as having an autoimmune disease, systemic illness or neurodegenerative disorders were excluded from the study. The study was approved by the institutional ethics committee of Kasturba Medical College, Mangalore (IECKMCMLR11-18/456) and written informed consent was obtained from all participants before they participated in the study.

Dizziness Handicap Inventory (DHI)

All participants in group I completed a Dizziness Handicap Inventory (DHI) questionnaire.²⁰ It assesses quality of life of participants on three domains: functional (nine questions), emotional (nine questions) and physical (seven questions). The participants were instructed to provide responses such as “Yes” when the symptom is present always, “Sometimes” when the symptoms is present sometimes, and “No” when it is absent. Item scores were summed, and the maximum score was 100 and the minimum score was 0. Answers were graded according to 0 for a “No” response, 2 for a “Sometimes” response and 4 for a “Yes” response.

Recording of P300

The P300 was recorded using the IHS Smart EP version 3.92 evoked potential system (Intelligent Hearing Systems, USA). During the recording of the P300, participants were made to sit comfortably on a reclining chair in a sound-treated room. The electrode sites were cleaned using Nu-prep Skin Prep Gel (Weaver and Company, USA). Gold plated disc electrodes were placed on the electrode sites using conduction paste and it was secured using adhesive tape. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz). Inverting electrodes were placed on both ear mastoid (linked mastoid), and the ground electrode was placed on low forehead (Fpz). The electrode impedance was maintained below 5 kΩ for each electrode and the inter-electrode impedance was less than 2 kΩ. The P300 was elicited using pure-tones of 1000 Hz and 2000 Hz in an odd-ball paradigm. The 1000 Hz pure-tone served as standard stimuli (80%) and the 2000 Hz pure-tone served as deviant stimuli (20%). The standard and target stimuli were presented at a ratio of 4:1. The pure-tones were presented to both ears of participants at 80 dB SPL using ER-3A insert earphones (Intelligent Hearing Systems, USA). A total of 300 stimuli were presented at a repetition rate of 1.1 stimuli/sec and the ongoing EEG was differentially recorded from the scalp. The EEG was amplified 50,000 times and filtered using a bandpass filter of 1 to 30 Hz. Sweeps with amplitude greater than ±50 µV were rejected from averaging. The duration of the analysis window was 600 msec with a pre-stimulus duration of 100 msec. The participants were instructed to count the target stimuli and report at the end of the recording. All participants had a practice trial on the task before ERPs were recorded.

Data analysis

The waveforms obtained from all participants for standard and target stimuli were grand averaged separately to identify various components or peaks of event related potentials. The averaged waveforms included peaks P1, N1, P2, and N2 between 50 msec and 250 msec. The broad positive peak after 250 msec from the stimulus onset in the waveform of target stimuli was referred to as P300. And the negativity peak following the P300 was considered as N4 (late negativity). The latency (in msec) and peak amplitude (in μV) of peaks P1, N1, P2, N2, P300 and N4 was measured at the electrode sites Cz and Pz. The peak amplitude was measured relative to the pre-stimulus baseline and the latency was measured from the stimulus onset. The dataset is published as underlying data in Mendeley Data.²¹

Statistical analysis

Statistical analysis was conducted using IBM SPSS software version 26 (RRID:SCR_002865). Initially, descriptive analysis and the Shapiro-Wilk test were carried out to check the normality of the data. The latency and peak amplitude of peaks P1, N1, P2, N2, P300, and N4 were normally distributed. Thus, the independent t-test was administered to investigate if the mean latency and amplitude of peaks were significantly different between groups. The P300 association between group I and II was analysed using chi-square test. Pearson’s correlation analysis was carried out to investigate the relationship between the DHI score and latency and amplitude of P300 in group I.

Results

The grand averaged waveforms for standard and deviant stimuli for both groups are shown in Figure 1. In the figure, it is evident that both pure-tones elicited obligatory P1-N1-P2 response for the stimulus onset among participants in both groups. Further, the waveform for target stimuli showed a large positive peak at a latency of 280 ms following the P1-N1-P2 response in both groups of participants, referred to as P300. The identification rate of peak responses varied across groups at Cz and Pz positions, which is depicted in Figures 2 and 3 respectively. The P300 was absent in a greater number of individuals with vestibular dysfunction compared to the control group. To investigate the association between vestibular dysfunction and P300, a chi-square test was carried out. The result showed a statistically significant association between vestibular dysfunction and the presence or absence of P300 (χ²(1) = 8.53, p = 0.003) with an odd ratio of 15.83.

Figure 1. Grand average waveforms of P300 recorded at Cz and Pz for 1000 Hz standard tone (dashed line) and 2000 Hz deviant tone (solid line) for group I (black) and group II (gray).

Figure 2. Identification rate of peaks P1, N1, P2, N2, P300 and N4 at Cz position in both the groups.

Figure 3. Identification rate of peaks P1, N1, P2, N2, P300 and N4 at Pz position in both the groups.

Table 1 shows the mean latency of peaks P1, N1, P2, and N2 at electrode sites Cz and Pz for both groups. The mean latency of peaks P1, N1, P2, and N2 were similar between groups at the electrode sites Cz and Pz. To investigate if the mean latency of peaks were significantly different between groups, the independent t-test was carried out. It showed no significant difference for the latency of peaks P1 [t(37) = -1.083, p = 0.286)], N1 [t(37) = -1.008, p = 0.320)], P2 [t(36) = 1.007, p = 0.321)], and N2 [t(32) = 1.822, p = 0.078)] at the electrode site Cz. Similarly, at Pz the latency of peaks P1 [t(28) = -0.029, p = 0.977)], N1 [t(31) = -0.029, p = 0.977)], P2 [t(30) = -1.059, p = 0.298)], and N2 [t(27) = 0.56, p = 0.956)] were not significantly different between groups.

Table 1. Descriptive analysis of peaks P1, N1, P2 and N2 latency and amplitude at Cz position.

	Latency (msec)				Amplitude (μV)
	P1	N1	P2	N2	P1	N1	P2	N2
Group I (Cz)
Mean	55.50	105.63	168.20	226.07	0.86	3.69	2.44	1.22
SD	5.16	7.52	15.58	16.71	1.58	2.81	1.95	1.97
n	19	19	18	14	19	19	18	14
Group II (Cz)
Mean	57.70	107.70	163.35	214.10	2.34	-3.15	3.09	1.35
SD	7.15	5.12	14.57	20.18	1.78	2.69	1.85	0.85
n	20	20	20	20	20	20	20	20

Table 2 shows the mean amplitude of peaks P1, N1, P2, and N2 at electrode sites Cz and Pz for both groups. The mean amplitude of peaks was larger in individuals with no vestibular dysfunction (group II) at both Cz and Pz. To investigate if the mean amplitudes of peaks are significantly different between groups, independent t-test was carried out separately for Cz and Pz. It revealed no significant difference for the amplitude of peaks P1 [t(30) = -2.733, p = 0.10)], N1 [t(37) = -0.614, p = 0.543)], P2 [t(36) = -1.061, p = 0.296)] and N2 [t(32) = -0.268, p = 0.790)] at the electrode site Cz between groups. Similarly, the amplitude of peaks P1 [t(28) = -1.742, p = 0.093)], N1 [t(31) = -1.326, p = 0.194)], P2 [t(28) = -1.742, p = 0.093)] and N2 [t(27) = -0.318, p = 0.756)] at the electrode site Pz showed no significant difference between the groups. On peak-to-peak analysis between groups showed no significant difference in P1-N1 and N1-P2 peak to peak amplitude at Cz and Pz.

Table 2. Descriptive analysis of peaks P1, N1, P2 and N2 latency and amplitude at Pz position.

	Latency (msec)				Amplitude (μV)
	P1	N1	P2	N2	P1	N1	P2	N2
Group I (Pz)
Mean	62.81	110.00	163.92	227.36	1.36	-2.38	1.69	1.06
SD	10.64	8.63	16.87	23.20	0.79	2.17	0.88	1.26
n	11	14	14	11	11	14	14	11
Group II (Pz)
Mean	62.94	110.10	170.50	226.94	2.17	-1.44	2.79	1.22
SD	12.60	11.60	17.82	17.32	1.40	1.87	1.28	1.32
n	19	19	18	18	19	19	18	18

Table 3 shows the mean latency and amplitude of peaks P300 and N4 at Cz and Pz for both groups. A noticeable difference was observed for the mean amplitude of N4 between groups at both the electrode sites. The mean amplitude of P300 was larger in group I compared to group II, this finding is contrary while comparing the grand average waveform of both groups shown in Figure 1. The mean amplitude of P300 was found to be largest in group 1 compared to group II. To investigate if the mean difference for latency and amplitude were significantly different between groups, an independent samples t-test was carried out. The results showed no significant difference in the latency of P300 [Cz: t(32) = -0.173, p = 0.866); Pz: t(30) = -0.357, p = 0.724)] and amplitude of P300 [Cz: t(32) = 0.218, p = 0.829); Pz: t(29) = 0.797, p = 0.432)] at both Cz and Pz. Whereas no statistical significant difference was found for the N4 latency [Cz: t(16) = 0.415, p = 0.684); Pz: t(16) = 0.786, p = 0.443)] and significant difference was observed in N4 amplitude [Cz: t(14) = -2.178, p = 0.047); Pz: t(15) = -2.107, p = 0.052)] at both positions.

Table 3. Descriptive analysis of peaks P300 and N4 latency and amplitude at Cz and Pz positions.

	Latency (msec)				Amplitude (μV)
	Cz		Pz		Cz		Pz
	P300	N4	P300	N4	P300	N4	P300	N4
Group I
Mean	344.07	440.75	344.83	449.00	4.46	-0.01	3.72	0.87
SD	26.02	6.84	21.70	21.37	4.97	6.32	3.17	4.49
n	14	4	12	5	14	4	12	5
Group II
Mean	345.55	436.14	347.85	439.23	4.16	-6.66	3.06	-4.86
SD	23.39	21.47	23.93	24.30	2.98	4.99	1.41	3.13
n	20	14	20	13	20	14	20	13

To investigate the relationship between the latency of P300 and DHI score, Pearson’s correlation analysis was carried out. The results showed a weak negative correlation between the latency of P300 and the DHI score; however, the correlation was not significant at both electrode sites [Cz: r = -0.201, p = 0.490; Pz: r = -0.401, p = 0.196]. Further, no correlation was found between the amplitude of the P300 and DHI score at both electrode sites [Cz: r = -0.167, p = 0.569; Pz: r = 0.087, p = 0.787].

The mean latency of late latency response and P300 of individuals diagnosed with peripheral vestibular lesion and central vestibular lesion are depicted in Tables 4 and 5 respectively.

Table 4. Descriptive analysis of peaks P1, N1, P2, N2 and P300 latency among individuals with peripheral vestibular lesion.

Latency	Cz			Pz
msec	n	Mean	SD	n	Mean	SD
P1	11	56.09	5.12	6	65.33	12.50
N1	11	104.54	9.63	7	107.71	9.12
P2	10	166.00	14.03	7	167.42	16.71
N2	8	230.37	15.74	5	235.20	13.19
P300	9	345.22	25.49	7	349.57	25.99

Table 5. Descriptive analysis of peaks P1, N1, P2, N2 and P300 latency among individuals with central vestibular lesion.

Latency	Cz			Pz
msec	n	Mean	SD	n	Mean	SD
P1	8	54.75	5.47	5	59.80	8.19
N1	8	107.12	2.90	7	112.28	8.13
P2	8	171.12	17.88	7	160.42	17.58
N2	7	188.85	84.81	6	220.83	28.72
P300	5	342.00	29.88	5	338.20	13.68

Discussion

The present study compared the latency and amplitude of cortical (P1, N1, P2 and N2) and cognitive potentials (P300) among individuals with and without vestibular dysfunction. The cortical potential includes auditory late latency responses P1, N1, P2, and N2. As per a review, it is clear that cognitive impairment is observed in individuals with vestibular dysfunction, with respect to attention, spatial orientation, executive function and memory.⁵

The results of the present study showed no significant difference in the latency and amplitude of peaks P1, N1, P2, and N2 of the cortical auditory potentials. The cortical findings of the present study could be explained based on the hearing sensitivity of participants in both groups and the characteristics of the P1-N1-P2 response. The P1-N1-P2 response is elicited for the onset of stimuli, therefore, the characteristics of the response are dependent on the onset of the stimuli. Further, the participants in both groups had hearing sensitivity within normal limits. Thus, the latency and amplitude of the peaks are expected to be similar in both groups.

The P300 was found to be absent in a greater number of individuals with vestibular dysfunction compared to the control group. It was absent in 30–40% of the individuals with vestibular dysfunction; this finding is consistent with the results of the previous study.²² Further, when the P300 was present, the mean latency and amplitude of the P300 in both groups were similar. In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.²³ The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. In the literature studies majorly included individuals with abnormal caloric function suggestive of having either unilateral or bilateral lateral semicircular canal dysfunction.²³^,²⁴ The findings of the earlier investigation showed prolongation of P300 latency in individuals with unilateral caloric hypofunction compared to the control group.²⁴ Whereas, the participants in the present study had peripheral vestibular lesion with abnormal findings on cVEMP and oVEMP indicating a lesion in the saccule and utricle. Therefore, the contrasting findings observed the difference in the P300 findings of the present study could be a consequence due to variation in the site of the lesion. In addition, contrasting findings observed in the present study could be also due to the degree of dizziness handicap due to vestibular dysfunction. The degree of handicap might have an influence on the latency and amplitude of P300 showing a direct proportionality that higher the degree of dizziness, higher is the cognitive impairment.²⁵

Studies on cognitive function assessment using a cognitive failure questionnaire in individuals with vestibular dysfunction revealed that cognitive dysfunction is prevalent in individuals with central and peripheral vestibular pathologies.²⁶ The literature also showed a positive correlation between cognitive dysfunction and dizziness handicap in terms of a self-rated questionnaire. DHI helps in evaluating the dizziness handicap based on its impact physically, functionally, and emotionally with a limited profile on cognition.²⁷ In the current study, the correlation between DHI scores and P300 showed no significant correlation. The lack of correlation between the two measures could be due to the different areas of assessment. DHI is a measure of self-help obtained primarily based on daily activities, whereas the P300 is an electrophysiological measure that assesses cognitive functioning.¹³ Because of this direct correlation between DHI and P300 was found to be inconclusive in the present study. Similarly, no significant correlation was observed between P300 and vertigo symptoms, whereas another study stated that severity of vestibular symptoms seems to correlate with P300 responses.²⁸ In support of the current study, a randomized controlled trial showed cognitive behaviour therapy influenced patients with chronic subjective dizziness with a significant reduction in DHI and no changes in psychological outcome measures.²⁹ Similarly, other literature has reported that the functional and physical parameters of DHI showed a negative correlation, and the emotional parameter showed a weak significant positive correlation in 369 participants evaluated for functional tests such as electronystagmography, rotational testing, and platform posturography.³⁰ The findings of various studies by several investigators have emphasized the role of the vestibular system’s role on cognition, such as perceptual/visuospatial ability, memory, attention, and executive function. Knowing the cognitive function of individuals with vestibular dysfunction facilitates the setting of vestibular rehabilitation therapy goals. Evidence reveals that in patients with intractable dizziness following vestibular rehabilitation there is a significant improvement in vestibular function and cognitive function including attention, visuospatial ability and executive function with coincidental improvement in DHI.³¹ The findings of this study are circumscribed to oddball auditory tasks only, which might be a limitation. The majority of participants in the present study had mild handicap, this might have an influence on the findings.

Conclusions

In the present study, the P300 was absent in a greater number of individuals with vestibular dysfunction, suggesting cognitive impairment. However, when the P300 was present, the peak latency and amplitude were not significantly different in both groups.

Data availability

Underlying data

Mendeley Data: Underlying data for ‘Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction’ https://www.doi.org/10.17632/hn6z8x5vkk.1.²¹

This project contains the following underlying data:

• Data file 1. Description.txt
• Data file 2. Event related potentials in individuals with vestibular dysfunction.xlsx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Consent

Written informed consent for publication of the participants’ details was obtained from the participants.

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18. Balci B, Naziye Senyuva GA: Definition of Balance and Cognition Related To Disability Levels in Vestibular Migraine Patients. Arch. Neuropsychiatry. 2018; 9–14.
19. Smith PF, Zheng Y, Horii A, et al.: Does vestibular damage cause cognitive dysfunction in humans? J. Vestib. Res. Equilib. Orientat. 2005; 15(1): 1–9. PubMed Abstract | Publisher Full Text
20. Jacobson N: The development of the Dizziness Handicap Inventory. Arch. Otolaryngol. Head Neck Surg. 1990; 116(4): 424–427. Publisher Full Text
21. Ebenezer A, Kalaiah MK, Kumar K: Event Related Potentials in Individuals with Vestibular Dysfunction - Mendeley Data.2022 [cited 2022 Aug 3]. Publisher Full Text
22. Polich J, Herbst KL: P300 as a clinical assay: Rationale, evaluation, and findings. Int. J. Psychophysiol. 2000; 38(1): 3–19. PubMed Abstract | Publisher Full Text
23. Filha VAVdS, Bruckmann M, Garcia MV: Short- and long-latency auditory evoked potentials in individuals with vestibular dysfunction. Codas. 2018; 30(2): 1–10.
24. El-Gharib A, Nada E, Lasheen R: Auditory P300 and mismatch negativity (MMN) in patients with peripheral vestibular hypofunction. Hear Balanc. Commun. 2018; 16(1): 36–40. Publisher Full Text
25. Ma X, Shen J, Sun J, et al.: P300 Event-Related Potential Predicts Cognitive Dysfunction in Patients with Vestibular Disorders. Biomedicines. 2023; 11(9): 2365. PubMed Abstract | Publisher Full Text | Free Full Text
26. Rizk HG, Sharon JD, Lee JA, et al.: Cross-Sectional Analysis of Cognitive Dysfunction in Patients with Vestibular Disorders. Ear Hear. 2020; 41: 1020–1027. PubMed Abstract | Publisher Full Text
27. Donaldson LB, Yan F, Liu YF, et al.: Does cognitive dysfunction correlate with dizziness severity in patients with vestibular migraine? Am. J. Otolaryngol. - Head Neck Med. Surg. 2021; 42(6): 103124. PubMed Abstract | Publisher Full Text
28. Agarwal A, Barua N, Walia BS, et al.: Title p-300 wave in patients with post concussion vertigo: A prospective study of 15 cases. Indian J. Otolaryngol. Head Neck Surg. 1996 [cited 2019 Aug 8]; 48(2): 121–124. Publisher Full Text
29. Edelman S, Mahoney AEJ, Cremer PD: Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am. J. Otolaryngol. 2012 Jul 1 [cited 2019 Aug 8]; 33(4): 395–401. PubMed Abstract | Publisher Full Text Reference Source
30. Jacobson GP, Newman CW, Hunter L, et al.: Balance function test correlates of the Dizziness Handicap Inventory. J. Am. Acad. Audiol. 1991; 2(4): 253–260. PubMed Abstract
31. Goto F, Sugaya N, Arai M, et al.: Psychiatric disorders in patients with intractable dizziness in the department of otolaryngology. Acta Otolaryngol. 2018; 138(7): 646–647. PubMed Abstract | Publisher Full Text

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Version 3

VERSION 3 PUBLISHED 07 Sep 2022

Author details Author details

Kaushlendra Kumar
Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing

Krishnapriya S
Roles: Data Curation, Investigation, Writing – Review & Editing

Anupriya Ebenezer
Roles: Data Curation, Formal Analysis, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Mohan Kumar Kalaiah
Roles: Formal Analysis, Visualization, Writing – Review & Editing

Deviprasad D
Roles: Resources, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (3)

version 3

Revised

Published: 18 Oct 2023, 11:1013

https://doi.org/10.12688/f1000research.122677.3

version 2

Revised

Published: 16 Nov 2022, 11:1013

https://doi.org/10.12688/f1000research.122677.2

version 1

Published: 07 Sep 2022, 11:1013

https://doi.org/10.12688/f1000research.122677.1

© 2023 Kumar K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kumar K, S K, Ebenezer A et al. Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction [version 3; peer review: 2 approved, 1 approved with reservations]. F1000Research 2023, 11:1013 (https://doi.org/10.12688/f1000research.122677.3)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 3

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PUBLISHED 18 Oct 2023

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Reviewer Report 22 Nov 2023

Aravind Kumar Rajasekaran, Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Approved

https://doi.org/10.5256/f1000research.157492.r216594

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Author Response 18 Jan 2024

Anupriya Ebenezer, Manipal Academy of Higher Education, India

18 Jan 2024

Author Response

Thank you for reviewing. And also for providing valuable suggestions and feedback.
Competing Interests: No competing interests were disclosed.
Thank you for reviewing. And also for providing valuable suggestions and feedback.
Thank you for reviewing. And also for providing valuable suggestions and feedback.
Competing Interests: No competing interests were disclosed. Close
Report a concern
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COMMENTS ON THIS REPORT

Author Response 18 Jan 2024

Anupriya Ebenezer, Manipal Academy of Higher Education, India

18 Jan 2024

Author Response

Thank you for reviewing. And also for providing valuable suggestions and feedback.
Competing Interests: No competing interests were disclosed.
Thank you for reviewing. And also for providing valuable suggestions and feedback.
Thank you for reviewing. And also for providing valuable suggestions and feedback.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Version 2

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PUBLISHED 16 Nov 2022

Revised

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Reviewer Report 25 Aug 2023

Aravind Kumar Rajasekaran, Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Approved with Reservations

https://doi.org/10.5256/f1000research.140797.r191649

Section: Introduction

Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Section: Introduction

Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.
Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.
Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.
Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.
Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.
Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.
Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Section: Method

Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either?
Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?
Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).
Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Section: Results

Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Section: Discussion

Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?
Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.
Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.
Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Auditory processing, Electrophysiology, Auditory Neuroscience , Vestibular science

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 16 Nov 2023

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2023

Author Response

We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed ... Continue reading We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed below;

Section: Introduction
1. Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.

Response: Appropriate changes made.

2. Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.

Response: Appropriate changes made.

3. Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.

Response: Appropriate changes made.

4. Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.

Response: Appropriate changes made.

5. Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.

Response: Appropriate changes made.

6. Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.

Response: Appropriate changes made.

7. Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Response: For analysis we considered the ERP waves till 500 msec duration. And we thought of showing the data as per the ERPs peaks analyzed so we included N4 which was present in few individuals in both the groups even thought it was not under our objective. And also we have made the appropriate changes required to maintain the flow of information.

Section: Method
1. Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either? (You have to answer this..)

Response: All the participants had undergone VEMP and VNG testing. Few patients who had normal VEMPs findings showed abnormal oculomotor function tested using VNG and few patients had findings in reverse. Based on their vestibular test reports and the complaints they were categories under peripheral or central vestibular lesion accordingly.

2. Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?

Response: Especially patients diagnosed with central vestibular lesion were referred from Department of Neurology with MRI report indicative of either cerebellar atrophy, vestibular schwannoma or acoustic neuroma and also indicated abnormal vestibular findings. Considering vestibular assessment, the patients were having abnormal sacculo-collic reflex and/or utriculo-ocular reflex with prolonged latencies or absent cVEMP and /or oVEMP reflexes. And also with delayed saccadic movement, abnormal tracking gain and abnormal slow phase velocity in optokinetic test at 20°/sec and 40°/sec.

3. Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).

Response: Appropriate changes made.

4. Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Response: The negative peak following the P300 is generally referred as late negativity, we have labelled it as N4. Comparison of late negativity was not an objective of the study. We have labelled the peak N4 in the averaged waveforms.

Section: Results
1. Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Response: Appropriate changes made.

Section: Discussion
1. Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?

Response: It was a referencing error by mistake. We have corrected it.

2. Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.

Response: There was in text citation numbering error while modifying the version 1 manuscript, we are sorry for that. Correction done.

3. Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.

Response: There are no studies available specifically with abnormal VEMP findings. Majority of the studies was done on individuals with abnormal caloric findings and /or oculomotor findings. Caloric test mainly assesses the lateral semicircular canal whereas, VEMP assess the otolith function (utricle and saccule). Though both the lateral semicircular canal and the otolith organ belong to the peripheral vestibular system but their functionalities are different.

4.Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Response: A recent study by Ma et al, 2023 have found a correlation between the ERPs and different degrees of DHI severity. Indicating a direct proportionality that higher the degree of dizziness, the higher the cognitive impairment.
We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed below;

Section: Introduction
1. Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.

Response: Appropriate changes made.

2. Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.

Response: Appropriate changes made.

3. Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.

Response: Appropriate changes made.

4. Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.

Response: Appropriate changes made.

5. Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.

Response: Appropriate changes made.

6. Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.

Response: Appropriate changes made.

7. Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Response: For analysis we considered the ERP waves till 500 msec duration. And we thought of showing the data as per the ERPs peaks analyzed so we included N4 which was present in few individuals in both the groups even thought it was not under our objective. And also we have made the appropriate changes required to maintain the flow of information.

Section: Method
1. Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either? (You have to answer this..)

Response: All the participants had undergone VEMP and VNG testing. Few patients who had normal VEMPs findings showed abnormal oculomotor function tested using VNG and few patients had findings in reverse. Based on their vestibular test reports and the complaints they were categories under peripheral or central vestibular lesion accordingly.

2. Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?

Response: Especially patients diagnosed with central vestibular lesion were referred from Department of Neurology with MRI report indicative of either cerebellar atrophy, vestibular schwannoma or acoustic neuroma and also indicated abnormal vestibular findings. Considering vestibular assessment, the patients were having abnormal sacculo-collic reflex and/or utriculo-ocular reflex with prolonged latencies or absent cVEMP and /or oVEMP reflexes. And also with delayed saccadic movement, abnormal tracking gain and abnormal slow phase velocity in optokinetic test at 20°/sec and 40°/sec.

3. Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).

Response: Appropriate changes made.

4. Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Response: The negative peak following the P300 is generally referred as late negativity, we have labelled it as N4. Comparison of late negativity was not an objective of the study. We have labelled the peak N4 in the averaged waveforms.

Section: Results
1. Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Response: Appropriate changes made.

Section: Discussion
1. Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?

Response: It was a referencing error by mistake. We have corrected it.

2. Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.

Response: There was in text citation numbering error while modifying the version 1 manuscript, we are sorry for that. Correction done.

3. Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.

Response: There are no studies available specifically with abnormal VEMP findings. Majority of the studies was done on individuals with abnormal caloric findings and /or oculomotor findings. Caloric test mainly assesses the lateral semicircular canal whereas, VEMP assess the otolith function (utricle and saccule). Though both the lateral semicircular canal and the otolith organ belong to the peripheral vestibular system but their functionalities are different.

4.Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Response: A recent study by Ma et al, 2023 have found a correlation between the ERPs and different degrees of DHI severity. Indicating a direct proportionality that higher the degree of dizziness, the higher the cognitive impairment.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 16 Nov 2023

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2023

Author Response

We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed ... Continue reading We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed below;

Section: Introduction
1. Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.

Response: Appropriate changes made.

2. Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.

Response: Appropriate changes made.

3. Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.

Response: Appropriate changes made.

4. Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.

Response: Appropriate changes made.

5. Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.

Response: Appropriate changes made.

6. Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.

Response: Appropriate changes made.

7. Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Response: For analysis we considered the ERP waves till 500 msec duration. And we thought of showing the data as per the ERPs peaks analyzed so we included N4 which was present in few individuals in both the groups even thought it was not under our objective. And also we have made the appropriate changes required to maintain the flow of information.

Section: Method
1. Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either? (You have to answer this..)

Response: All the participants had undergone VEMP and VNG testing. Few patients who had normal VEMPs findings showed abnormal oculomotor function tested using VNG and few patients had findings in reverse. Based on their vestibular test reports and the complaints they were categories under peripheral or central vestibular lesion accordingly.

2. Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?

Response: Especially patients diagnosed with central vestibular lesion were referred from Department of Neurology with MRI report indicative of either cerebellar atrophy, vestibular schwannoma or acoustic neuroma and also indicated abnormal vestibular findings. Considering vestibular assessment, the patients were having abnormal sacculo-collic reflex and/or utriculo-ocular reflex with prolonged latencies or absent cVEMP and /or oVEMP reflexes. And also with delayed saccadic movement, abnormal tracking gain and abnormal slow phase velocity in optokinetic test at 20°/sec and 40°/sec.

3. Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).

Response: Appropriate changes made.

4. Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Response: The negative peak following the P300 is generally referred as late negativity, we have labelled it as N4. Comparison of late negativity was not an objective of the study. We have labelled the peak N4 in the averaged waveforms.

Section: Results
1. Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Response: Appropriate changes made.

Section: Discussion
1. Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?

Response: It was a referencing error by mistake. We have corrected it.

2. Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.

Response: There was in text citation numbering error while modifying the version 1 manuscript, we are sorry for that. Correction done.

3. Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.

Response: There are no studies available specifically with abnormal VEMP findings. Majority of the studies was done on individuals with abnormal caloric findings and /or oculomotor findings. Caloric test mainly assesses the lateral semicircular canal whereas, VEMP assess the otolith function (utricle and saccule). Though both the lateral semicircular canal and the otolith organ belong to the peripheral vestibular system but their functionalities are different.

4.Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Response: A recent study by Ma et al, 2023 have found a correlation between the ERPs and different degrees of DHI severity. Indicating a direct proportionality that higher the degree of dizziness, the higher the cognitive impairment.
We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed below;

Section: Introduction
1. Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.

Response: Appropriate changes made.

2. Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.

Response: Appropriate changes made.

3. Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.

Response: Appropriate changes made.

4. Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.

Response: Appropriate changes made.

5. Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.

Response: Appropriate changes made.

6. Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.

Response: Appropriate changes made.

7. Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Response: For analysis we considered the ERP waves till 500 msec duration. And we thought of showing the data as per the ERPs peaks analyzed so we included N4 which was present in few individuals in both the groups even thought it was not under our objective. And also we have made the appropriate changes required to maintain the flow of information.

Section: Method
1. Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either? (You have to answer this..)

Response: All the participants had undergone VEMP and VNG testing. Few patients who had normal VEMPs findings showed abnormal oculomotor function tested using VNG and few patients had findings in reverse. Based on their vestibular test reports and the complaints they were categories under peripheral or central vestibular lesion accordingly.

2. Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?

Response: Especially patients diagnosed with central vestibular lesion were referred from Department of Neurology with MRI report indicative of either cerebellar atrophy, vestibular schwannoma or acoustic neuroma and also indicated abnormal vestibular findings. Considering vestibular assessment, the patients were having abnormal sacculo-collic reflex and/or utriculo-ocular reflex with prolonged latencies or absent cVEMP and /or oVEMP reflexes. And also with delayed saccadic movement, abnormal tracking gain and abnormal slow phase velocity in optokinetic test at 20°/sec and 40°/sec.

3. Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).

Response: Appropriate changes made.

4. Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Response: The negative peak following the P300 is generally referred as late negativity, we have labelled it as N4. Comparison of late negativity was not an objective of the study. We have labelled the peak N4 in the averaged waveforms.

Section: Results
1. Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Response: Appropriate changes made.

Section: Discussion
1. Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?

Response: It was a referencing error by mistake. We have corrected it.

2. Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.

Response: There was in text citation numbering error while modifying the version 1 manuscript, we are sorry for that. Correction done.

3. Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.

Response: There are no studies available specifically with abnormal VEMP findings. Majority of the studies was done on individuals with abnormal caloric findings and /or oculomotor findings. Caloric test mainly assesses the lateral semicircular canal whereas, VEMP assess the otolith function (utricle and saccule). Though both the lateral semicircular canal and the otolith organ belong to the peripheral vestibular system but their functionalities are different.

4.Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Response: A recent study by Ma et al, 2023 have found a correlation between the ERPs and different degrees of DHI severity. Indicating a direct proportionality that higher the degree of dizziness, the higher the cognitive impairment.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 05 Dec 2022

Prawin Kumar, Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka, India; University of Mysore, Mysore, Karnataka, India

Approved

https://doi.org/10.5256/f1000research.140797.r155890

The answer to the comments/queries raised is satisfactory. There are ... Continue reading

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VERSION 1

PUBLISHED 07 Sep 2022

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Reviewer Report 18 Oct 2022

Prawin Kumar, Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka, India; University of Mysore, Mysore, Karnataka, India

Approved

https://doi.org/10.5256/f1000research.134699.r149808

Authors formulated the research very well except for a few observations.

In Abstract, authors can add N4 potential.
In last paragraph of Introduction section, it should be mentioned as Cognitive potentials

Authors formulated the research very well except for a few observations.

In Abstract, authors can add N4 potential.
In last paragraph of Introduction section, it should be mentioned as Cognitive potentials (P300 and N4) instead of cortical potential.
In Method, the rationale for considering only two electrode sites i.e. Cz and Pz should be mentioned.
The two groups are considered based on abnormal finding of the VNG & VEMP. No gold standard tests were used to differentiate the peripheral and central lesions. That could also be one of the reasons for minimal differences in the performance between two groups for ALLR and P300.
Overall, preliminary finding of the present study throws light for researchers to explore more comprehensive behavioral cognitive assessment along with electrophysiological measures such as multi-channel ERP recording.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Diagnostic Audiology including Electrophysiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2022

Author Response
1. Appropriate changes incorporated.
2. Appropriate changes incorporated.
3. The clinical AEP instrument which we used for the study has the facility to perform only
... Continue reading
Appropriate changes incorporated.

Appropriate changes incorporated.

The clinical AEP instrument which we used for the study has the facility to perform only 2 channel recording. So, EEG has been recorded for 2 electrode sites. Literature studies have shown greater amplitude for P300 at Cz and Pz electrode sites. Therefore, Cz and Pz electrode sites were selected to record P300.

Group I was selected based on the vestibular test findings. Group II was normal healthy individuals with no complaint of vertigo. The vestibular assessment test battery included subjective vestibular assessment, VEMP, and VNG.

Thank you for the encouraging words.
Appropriate changes incorporated.

Appropriate changes incorporated.

The clinical AEP instrument which we used for the study has the facility to perform only 2 channel recording. So, EEG has been recorded for 2 electrode sites. Literature studies have shown greater amplitude for P300 at Cz and Pz electrode sites. Therefore, Cz and Pz electrode sites were selected to record P300.

Group I was selected based on the vestibular test findings. Group II was normal healthy individuals with no complaint of vertigo. The vestibular assessment test battery included subjective vestibular assessment, VEMP, and VNG.

Thank you for the encouraging words.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2022

Author Response
1. Appropriate changes incorporated.
2. Appropriate changes incorporated.
3. The clinical AEP instrument which we used for the study has the facility to perform only
... Continue reading
Appropriate changes incorporated.

Appropriate changes incorporated.

The clinical AEP instrument which we used for the study has the facility to perform only 2 channel recording. So, EEG has been recorded for 2 electrode sites. Literature studies have shown greater amplitude for P300 at Cz and Pz electrode sites. Therefore, Cz and Pz electrode sites were selected to record P300.

Group I was selected based on the vestibular test findings. Group II was normal healthy individuals with no complaint of vertigo. The vestibular assessment test battery included subjective vestibular assessment, VEMP, and VNG.

Thank you for the encouraging words.
Appropriate changes incorporated.

Appropriate changes incorporated.

The clinical AEP instrument which we used for the study has the facility to perform only 2 channel recording. So, EEG has been recorded for 2 electrode sites. Literature studies have shown greater amplitude for P300 at Cz and Pz electrode sites. Therefore, Cz and Pz electrode sites were selected to record P300.

Group I was selected based on the vestibular test findings. Group II was normal healthy individuals with no complaint of vertigo. The vestibular assessment test battery included subjective vestibular assessment, VEMP, and VNG.

Thank you for the encouraging words.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 13 Sep 2022

Sangamanatha Ankmnal Veeranna, College of Nursing and Health Professions, School of Speech and Hearing Sciences, J.B. George Building, University of Southern Mississippi, Hattiesburg, MS, USA

Approved with Reservations

https://doi.org/10.5256/f1000research.134699.r149811

Abstract:
The whole abstract should be rewritten so that the readers can follow. It is not clear whether P300 should be used to understand cognitive deficits in individuals with vestibular dysfunction.

The Results section should be ... Continue reading

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.
If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

Introduction:

I would not use “etc.” in a manuscript.
There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?
The age range of Group I and Group II? How many male and female participants were included?
Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.
The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).
What was the artifact rejection?
The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.
Was all the testing carried out in one session or multiple sessions?

Data analysis:

Who marked the peaks?
The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Paragraph 1: Most of this content should be in the introduction not in the discussion.
Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.
Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.
The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.
The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

Limitations:
Authors should list limitations.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Auditory Evoked Potentials, Auditory Processing Disorders, Psychoacoustics

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Author Response 16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2022

Author Response
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.
- In the manuscript, the authors have mentioned that there are no statistical differences
... Continue reading
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.

Appropriate changes were made.

If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

The abstract was rewritten with appropriate changes.

Introduction:

I would not use “etc.” in a manuscript.

Appropriate changes incorporated.

There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Respective citation added, and appropriate changes were made in the Reference section.

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?

Yes, both the oculomotor function test (VNG) and VEMP (cVEMP and oVEMP) were performed to rule out vestibular dysfunction in Group I.

The age range of Group I and Group II? How many male and female participants were included?

Details are added in the Method section first paragraph.

Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.

Group II included individuals with no vestibular dysfunction.

The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).

The mean and standard deviation of the hearing threshold of the participants are added in the Method section under the heading 'Participants'.

What was the artifact rejection?

Sweeps with amplitude greater than ±50µV were rejected from averaging. The same has been added to the manuscript.

The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.

Yes, all subjects had a practice trial on the task before ERPs were recorded. The same has been added to the manuscript under the Method section.

Was all the testing carried out in one session or multiple sessions?

Yes, all the testing was carried out in one session.

Data analysis:

Who marked the peaks?

Peaks were identified separately by 3 investigators. Peaks were considered to be present when the markings of 2 investigators were in agreement

The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Descriptive statistical analysis (mean and SD) was done for both age and hearing thresholds. Descriptive statistics of age, as well as the hearing threshold, have been added to the Method section.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Thank you for the suggestion. The Discussion section is modified to improve the flow of information.

Paragraph 1: Most of this content should be in the introduction not in the discussion.

Appropriate changes incorporated.

Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.

Statistical analysis of the hearing threshold is added to the Method section first paragraph.

Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.

Thank you for the suggestion. We performed a chi-square test and a significant difference was observed (X²(1) = 8.53, p= 0.003) with the odd ratio 15.83. The same has been added to the manuscript under the Result section.

The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.

cVEMP and oVEMP were administered for the Group I participant selection. The same is mentioned in the Method.

The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

By severity, we were speaking about the dizziness handicap. The word 'severity' is replaced with the word 'handicap'. Appropriate changes were incorporated for better understanding.

Limitations:
Authors should list limitations.

Some of the limitations were added to the Discussion in the last paragraph.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

The conclusion is rewritten with appropriate changes.
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.

Appropriate changes were made.

If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

The abstract was rewritten with appropriate changes.

Introduction:

I would not use “etc.” in a manuscript.

Appropriate changes incorporated.

There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Respective citation added, and appropriate changes were made in the Reference section.

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?

Yes, both the oculomotor function test (VNG) and VEMP (cVEMP and oVEMP) were performed to rule out vestibular dysfunction in Group I.

The age range of Group I and Group II? How many male and female participants were included?

Details are added in the Method section first paragraph.

Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.

Group II included individuals with no vestibular dysfunction.

The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).

The mean and standard deviation of the hearing threshold of the participants are added in the Method section under the heading 'Participants'.

What was the artifact rejection?

Sweeps with amplitude greater than ±50µV were rejected from averaging. The same has been added to the manuscript.

The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.

Yes, all subjects had a practice trial on the task before ERPs were recorded. The same has been added to the manuscript under the Method section.

Was all the testing carried out in one session or multiple sessions?

Yes, all the testing was carried out in one session.

Data analysis:

Who marked the peaks?

Peaks were identified separately by 3 investigators. Peaks were considered to be present when the markings of 2 investigators were in agreement

The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Descriptive statistical analysis (mean and SD) was done for both age and hearing thresholds. Descriptive statistics of age, as well as the hearing threshold, have been added to the Method section.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Thank you for the suggestion. The Discussion section is modified to improve the flow of information.

Paragraph 1: Most of this content should be in the introduction not in the discussion.

Appropriate changes incorporated.

Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.

Statistical analysis of the hearing threshold is added to the Method section first paragraph.

Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.

Thank you for the suggestion. We performed a chi-square test and a significant difference was observed (X²(1) = 8.53, p= 0.003) with the odd ratio 15.83. The same has been added to the manuscript under the Result section.

The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.

cVEMP and oVEMP were administered for the Group I participant selection. The same is mentioned in the Method.

The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

By severity, we were speaking about the dizziness handicap. The word 'severity' is replaced with the word 'handicap'. Appropriate changes were incorporated for better understanding.

Limitations:
Authors should list limitations.

Some of the limitations were added to the Discussion in the last paragraph.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

The conclusion is rewritten with appropriate changes.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

16 Nov 2022

Author Response
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.
- In the manuscript, the authors have mentioned that there are no statistical differences
... Continue reading
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.

Appropriate changes were made.

If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

The abstract was rewritten with appropriate changes.

Introduction:

I would not use “etc.” in a manuscript.

Appropriate changes incorporated.

There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Respective citation added, and appropriate changes were made in the Reference section.

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?

Yes, both the oculomotor function test (VNG) and VEMP (cVEMP and oVEMP) were performed to rule out vestibular dysfunction in Group I.

The age range of Group I and Group II? How many male and female participants were included?

Details are added in the Method section first paragraph.

Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.

Group II included individuals with no vestibular dysfunction.

The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).

The mean and standard deviation of the hearing threshold of the participants are added in the Method section under the heading 'Participants'.

What was the artifact rejection?

Sweeps with amplitude greater than ±50µV were rejected from averaging. The same has been added to the manuscript.

The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.

Yes, all subjects had a practice trial on the task before ERPs were recorded. The same has been added to the manuscript under the Method section.

Was all the testing carried out in one session or multiple sessions?

Yes, all the testing was carried out in one session.

Data analysis:

Who marked the peaks?

Peaks were identified separately by 3 investigators. Peaks were considered to be present when the markings of 2 investigators were in agreement

The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Descriptive statistical analysis (mean and SD) was done for both age and hearing thresholds. Descriptive statistics of age, as well as the hearing threshold, have been added to the Method section.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Thank you for the suggestion. The Discussion section is modified to improve the flow of information.

Paragraph 1: Most of this content should be in the introduction not in the discussion.

Appropriate changes incorporated.

Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.

Statistical analysis of the hearing threshold is added to the Method section first paragraph.

Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.

Thank you for the suggestion. We performed a chi-square test and a significant difference was observed (X²(1) = 8.53, p= 0.003) with the odd ratio 15.83. The same has been added to the manuscript under the Result section.

The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.

cVEMP and oVEMP were administered for the Group I participant selection. The same is mentioned in the Method.

The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

By severity, we were speaking about the dizziness handicap. The word 'severity' is replaced with the word 'handicap'. Appropriate changes were incorporated for better understanding.

Limitations:
Authors should list limitations.

Some of the limitations were added to the Discussion in the last paragraph.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

The conclusion is rewritten with appropriate changes.
Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.

Appropriate changes were made.

If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

The abstract was rewritten with appropriate changes.

Introduction:

I would not use “etc.” in a manuscript.

Appropriate changes incorporated.

There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Respective citation added, and appropriate changes were made in the Reference section.

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?

Yes, both the oculomotor function test (VNG) and VEMP (cVEMP and oVEMP) were performed to rule out vestibular dysfunction in Group I.

The age range of Group I and Group II? How many male and female participants were included?

Details are added in the Method section first paragraph.

Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.

Group II included individuals with no vestibular dysfunction.

The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).

The mean and standard deviation of the hearing threshold of the participants are added in the Method section under the heading 'Participants'.

What was the artifact rejection?

Sweeps with amplitude greater than ±50µV were rejected from averaging. The same has been added to the manuscript.

The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.

Yes, all subjects had a practice trial on the task before ERPs were recorded. The same has been added to the manuscript under the Method section.

Was all the testing carried out in one session or multiple sessions?

Yes, all the testing was carried out in one session.

Data analysis:

Who marked the peaks?

Peaks were identified separately by 3 investigators. Peaks were considered to be present when the markings of 2 investigators were in agreement

The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Descriptive statistical analysis (mean and SD) was done for both age and hearing thresholds. Descriptive statistics of age, as well as the hearing threshold, have been added to the Method section.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Thank you for the suggestion. The Discussion section is modified to improve the flow of information.

Paragraph 1: Most of this content should be in the introduction not in the discussion.

Appropriate changes incorporated.

Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.

Statistical analysis of the hearing threshold is added to the Method section first paragraph.

Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.

Thank you for the suggestion. We performed a chi-square test and a significant difference was observed (X²(1) = 8.53, p= 0.003) with the odd ratio 15.83. The same has been added to the manuscript under the Result section.

The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.

cVEMP and oVEMP were administered for the Group I participant selection. The same is mentioned in the Method.

The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

By severity, we were speaking about the dizziness handicap. The word 'severity' is replaced with the word 'handicap'. Appropriate changes were incorporated for better understanding.

Limitations:
Authors should list limitations.

Some of the limitations were added to the Discussion in the last paragraph.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

The conclusion is rewritten with appropriate changes.
Competing Interests: No competing interests were disclosed. Close
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Version 3

VERSION 3 PUBLISHED 07 Sep 2022

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Version 2 (revision) 16 Nov 22		read	read
Version 1 07 Sep 22	read	read

Sangamanatha Ankmnal Veeranna, University of Southern Mississippi, Hattiesburg, USA
Prawin Kumar, All India Institute of Speech and Hearing, Mysore, India; University of Mysore, Mysore, India
Aravind Kumar Rajasekaran, National Institute of Mental Health and Neurosciences, Bengaluru, India

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7 Views

22 Nov 2023 | for Version 3

Aravind Kumar Rajasekaran, Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

7 Views Cite this report Responses(1)

Approved

Authors may consider the following

1. Authors have already given the basis on which they had differentiated peripheral and central vestibular conditions as a response to my previous query. The same can be incorporated into the manuscript. Similar inclusions can be done if deemed fit.

2. A different terminology to mark the negativity post-P3.

Beyond that, I have no further comments to make.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Auditory processing, Electrophysiology, Auditory Neuroscience , Vestibular science

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

16 Views

25 Aug 2023 | for Version 2

Aravind Kumar Rajasekaran, Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

16 Views Cite this report Responses(1)

Approved With Reservations

Section: Introduction

Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.
Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.
Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.
Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.
Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.
Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.
Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Section: Method

Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either?
Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?
Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).
Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Section: Results

Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Section: Discussion

Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?
Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.
Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.
Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Auditory processing, Electrophysiology, Auditory Neuroscience , Vestibular science

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Responses (1)

Author Response

16 Nov 2023

Anupriya Ebenezer, Manipal Academy of Higher Education, India

We thank you for reviewing the manuscript and giving your valuable comments. We have made the necessary modifications as per the feedback and answered few queries. The modifications are listed below;

Section: Introduction
1. Manuscript: Different areas of the brain that provide the generation of P300 response include subcortical structures, auditory regions in the cortex and frontal lobe and various association areas neocortex.

Suggestion: Rephrase - Different areas of the brain that generate P300 response include subcortical structures, auditory cortical regions, frontal lobe and various association areas.

Response: Appropriate changes made.

2. Manuscript: The subcomponents for P300, P3a is generated from the frontal working memory which helps in early attention whereas P3b is an attention-driven stimulus generated from the temporal and parietal structures.

Suggestion: Rephrase - The subcomponents of P300, P3a and P3b are generated by different neural structures. The frontal lobe is the primary generator of P3a, reflecting the working memory, which helps in early attention. The P3b reflects an attention-driven stimulus-generated response and is generated from the temporal and parietal structures.

Response: Appropriate changes made.

3. Manuscript: In the case of individuals with vertigo, the literature has reported reduced behavioural cognitive abilities

Suggestion: Rephrase - Behavioural cognitive abilities are reported to be affected in individuals with vertigo.

Response: Appropriate changes made.

4. Manuscript: A national health and nutrition examination survey done in the US revealed an association between vestibular and cognitive function in the adult population.5 There is a steady accumulation of evidence that the vestibular lesion leads to a cognitive deficit.

Suggestion: May delete redundant information and mark it as a reference in the previous sentence.

Response: Appropriate changes made.

5. Manuscript: It is not essentially directly related to reflexive signs and perceptual disturbances associated with vestibular dysfunction.

Suggestion: Does not fit in the flow of information. Rephrase.

Response: Appropriate changes made.

6. Manuscript: And there is minimal scientific evidence on cortical potentials in individuals with vestibular dysfunction.

Suggestion: Appears to be a sudden statement. Again affecting the flow. Rephrase.

Response: Appropriate changes made.

7. Manuscript: Hence, the current study aims to compare the findings of cortical potentials (P1, N1, P2, and N2) and cognitive potentials (P300 and N4) between individuals with and without vestibular dysfunction. The objective was to investigate the relationship of cortical and cognitive potentials peak latency and peak amplitude in individuals with and without vestibular dysfunction and the correlation between DHI score with P300 findings among individuals with vestibular dysfunction.

Suggestion/Query: The ‘need statement’ should be written as a derivative of the previous statements in the article. Where is the need to have cortical potentials? The author can explicitly mention the reason. Further, N4 does not fit the narrative.

Response: For analysis we considered the ERP waves till 500 msec duration. And we thought of showing the data as per the ERPs peaks analyzed so we included N4 which was present in few individuals in both the groups even thought it was not under our objective. And also we have made the appropriate changes required to maintain the flow of information.

Section: Method
1. Manuscript: The patients having abnormal findings on oculomotor examination or VEMPs assessment was considered for this study.

Query: Why either? (You have to answer this..)

Response: All the participants had undergone VEMP and VNG testing. Few patients who had normal VEMPs findings showed abnormal oculomotor function tested using VNG and few patients had findings in reverse. Based on their vestibular test reports and the complaints they were categories under peripheral or central vestibular lesion accordingly.

2. Manuscript: Twenty individuals with vestibular dysfunction in group I included 12 individuals diagnosed with peripheral vestibular lesion and eight individuals with central vestibular lesion.

Query: What central conditions?

Response: Especially patients diagnosed with central vestibular lesion were referred from Department of Neurology with MRI report indicative of either cerebellar atrophy, vestibular schwannoma or acoustic neuroma and also indicated abnormal vestibular findings. Considering vestibular assessment, the patients were having abnormal sacculo-collic reflex and/or utriculo-ocular reflex with prolonged latencies or absent cVEMP and /or oVEMP reflexes. And also with delayed saccadic movement, abnormal tracking gain and abnormal slow phase velocity in optokinetic test at 20°/sec and 40°/sec.

3. Manuscript: Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal lobe (Pz).

Suggestion: Rephrase. Two non-inverting electrodes were placed on the scalp, one on the vertex (Cz) and the other on the parietal (Pz).

Response: Appropriate changes made.

4. Manuscript: And the negativity peak following the P300 was considered as N4 (late negativity)

Query: The author may state why they have included N4 in the method. This does not appear to be the aim or the objective of the study. Further, it is not even marked in the waveforms.

Response: The negative peak following the P300 is generally referred as late negativity, we have labelled it as N4. Comparison of late negativity was not an objective of the study. We have labelled the peak N4 in the averaged waveforms.

Section: Results
1. Manuscript: The mean amplitude of P300 was larger in group I compared to group II, this finding is controversial

Suggestion: Use a different term instead of ‘...controversial...’

Response: Appropriate changes made.

Section: Discussion
1. Manuscript: Para 2: These findings are not in agreement with results of earlier investigation

Suggestion: The authors refer to an article which evaluated patients with Tinnitus, why so?

Response: It was a referencing error by mistake. We have corrected it.

2. Manuscript: Para 3: In contrast to the findings of the present study, earlier investigations have reported prolonged latency for P300 in individuals with vestibular dysfunction compared to the control group.^20,22

Query: The articles referred to by the author is not related to the vestibular dysfunction.

Response: There was in text citation numbering error while modifying the version 1 manuscript, we are sorry for that. Correction done.

3. Manuscript: The contrasting findings observed in the present study and earlier investigations could be because of differences in the site of vestibular lesion across studies. Studies in the literature have included individuals with peripheral vestibular lesions where the site of the lesion was localized to the lateral semicircular canal.

Query: Referred studies have not done VEMP, and the current study did not perform caloric.

Response: There are no studies available specifically with abnormal VEMP findings. Majority of the studies was done on individuals with abnormal caloric findings and /or oculomotor findings. Caloric test mainly assesses the lateral semicircular canal whereas, VEMP assess the otolith function (utricle and saccule). Though both the lateral semicircular canal and the otolith organ belong to the peripheral vestibular system but their functionalities are different.

4.Manuscript: The majority of the participants with peripheral vestibular lesion in the present study were found to have mild handicap based on DHI scores. The degree of handicap might have an influence on the latency and amplitude of P300.

Query: How did authors come to this conclusion?

Response: A recent study by Ma et al, 2023 have found a correlation between the ERPs and different degrees of DHI severity. Indicating a direct proportionality that higher the degree of dizziness, the higher the cognitive impairment.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

15 Views

05 Dec 2022 | for Version 2

Prawin Kumar, Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka, India; University of Mysore, Mysore, Karnataka, India

15 Views Cite this report Responses(0)

Approved

The answer to the comments/queries raised is satisfactory. There are no additional comments. The revised manuscript is acceptable from my side.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Diagnostic Audiology including Electrophysiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

26 Views

18 Oct 2022 | for Version 1

Prawin Kumar, Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka, India; University of Mysore, Mysore, Karnataka, India

26 Views Cite this report Responses(1)

Approved

Authors formulated the research very well except for a few observations.

In Abstract, authors can add N4 potential.
In last paragraph of Introduction section, it should be mentioned as Cognitive potentials (P300 and N4) instead of cortical potential.
In Method, the rationale for considering only two electrode sites i.e. Cz and Pz should be mentioned.
The two groups are considered based on abnormal finding of the VNG & VEMP. No gold standard tests were used to differentiate the peripheral and central lesions. That could also be one of the reasons for minimal differences in the performance between two groups for ALLR and P300.
Overall, preliminary finding of the present study throws light for researchers to explore more comprehensive behavioral cognitive assessment along with electrophysiological measures such as multi-channel ERP recording.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Diagnostic Audiology including Electrophysiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

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Author Response

16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

Appropriate changes incorporated.
Appropriate changes incorporated.
The clinical AEP instrument which we used for the study has the facility to perform only 2 channel recording. So, EEG has been recorded for 2 electrode sites. Literature studies have shown greater amplitude for P300 at Cz and Pz electrode sites. Therefore, Cz and Pz electrode sites were selected to record P300.
Group I was selected based on the vestibular test findings. Group II was normal healthy individuals with no complaint of vertigo. The vestibular assessment test battery included subjective vestibular assessment, VEMP, and VNG.
Thank you for the encouraging words.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

52 Views

13 Sep 2022 | for Version 1

Sangamanatha Ankmnal Veeranna, College of Nursing and Health Professions, School of Speech and Hearing Sciences, J.B. George Building, University of Southern Mississippi, Hattiesburg, MS, USA

52 Views Cite this report Responses(1)

Approved With Reservations

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.
If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

Introduction:

I would not use “etc.” in a manuscript.
There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?
The age range of Group I and Group II? How many male and female participants were included?
Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.
The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).
What was the artifact rejection?
The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.
Was all the testing carried out in one session or multiple sessions?

Data analysis:

Who marked the peaks?
The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Paragraph 1: Most of this content should be in the introduction not in the discussion.
Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.
Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.
The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.
The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Auditory Evoked Potentials, Auditory Processing Disorders, Psychoacoustics

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Author Response

16 Nov 2022

Anupriya Ebenezer, Manipal Academy of Higher Education, India

Abstract:

Thank you for the suggestions. As per the suggestion, the abstract was rewritten.

In the manuscript, the authors have mentioned that there are no statistical differences in the amplitude between Cz and Pz but in the abstract authors have mentioned that there is a significant difference.

Appropriate changes were made.

If there are no statistically significant differences in the P300 amplitude, why are the authors discussing this?

The abstract was rewritten with appropriate changes.

Introduction:

I would not use “etc.” in a manuscript.

Appropriate changes incorporated.

There are sections where authors should provide references. For example, “Further, the majority of individuals with vestibular dysfunction are also found to have anxiety and depression.”

Respective citation added, and appropriate changes were made in the Reference section.

Methods:
A lot of key information is missing in the Methods section.

For Group I, did the authors assess oculomotor function and VEMP or both?

Yes, both the oculomotor function test (VNG) and VEMP (cVEMP and oVEMP) were performed to rule out vestibular dysfunction in Group I.

The age range of Group I and Group II? How many male and female participants were included?

Details are added in the Method section first paragraph.

Authors have vaguely mentioned that participants in Group 2 had peripheral and central vestibular lesions. Authors should provide more details on peripheral vs central lesions.

Group II included individuals with no vestibular dysfunction.

The authors reported that all participants' hearing thresholds were within normal limits. Do the authors mean < 15 dB HL or 20 dB HL? Some participants were 60 years old, there could be some age-related hearing loss in these participants. The authors should provide hearing thresholds for all the participants (control and experimental groups).

The mean and standard deviation of the hearing threshold of the participants are added in the Method section under the heading 'Participants'.

What was the artifact rejection?

Sweeps with amplitude greater than ±50µV were rejected from averaging. The same has been added to the manuscript.

The authors stated that “The participants were instructed to count the target stimuli and report at the end of the recording”, did participants correctly count the target stimuli? The authors should add this information.

Yes, all subjects had a practice trial on the task before ERPs were recorded. The same has been added to the manuscript under the Method section.

Was all the testing carried out in one session or multiple sessions?

Yes, all the testing was carried out in one session.

Data analysis:

Who marked the peaks?

Peaks were identified separately by 3 investigators. Peaks were considered to be present when the markings of 2 investigators were in agreement

The authors carried out the statistical analysis using multiple t-tests. But the authors did not include age and hearing thresholds in their analysis. The authors should use different statistical analyses.

Descriptive statistical analysis (mean and SD) was done for both age and hearing thresholds. Descriptive statistics of age, as well as the hearing threshold, have been added to the Method section.

Discussion:
I was not happy with the discussion section; I feel it is all over the place.

Thank you for the suggestion. The Discussion section is modified to improve the flow of information.

Paragraph 1: Most of this content should be in the introduction not in the discussion.

Appropriate changes incorporated.

Paragraph 2: The authors did not report hearing thresholds, or they did not include hearing thresholds in the statistical analysis.

Statistical analysis of the hearing threshold is added to the Method section first paragraph.

Paragraph 3: The authors reported that 30-40% of individuals with vestibular dysfunction demonstrated an absence of P300, is this statistically significant? The Chi-square test may help in determining whether it is statistically significant or not.

Thank you for the suggestion. We performed a chi-square test and a significant difference was observed (X²(1) = 8.53, p= 0.003) with the odd ratio 15.83. The same has been added to the manuscript under the Result section.

The authors are talking about cVEMP and oVEMP in the discussion, but they did not talk about these measures in the method.

cVEMP and oVEMP were administered for the Group I participant selection. The same is mentioned in the Method.

The authors are also discussing the severity of dizziness, which was not mentioned in the Methods section.

By severity, we were speaking about the dizziness handicap. The word 'severity' is replaced with the word 'handicap'. Appropriate changes were incorporated for better understanding.

Limitations:
Authors should list limitations.

Some of the limitations were added to the Discussion in the last paragraph.

Conclusions:
The authors should write the conclusion based on findings from this study. I do not see that conclusion here. This section should be rewritten.

The conclusion is rewritten with appropriate changes.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Cortical auditory potentials and cognitive potentials in individuals with and without vestibular dysfunction

Abstract

Keywords

Revised Amendments from Version 2

Introduction

Methods

Participants

Dizziness Handicap Inventory (DHI)

Recording of P300

Data analysis

Statistical analysis

Results

Figure 1. Grand average waveforms of P300 recorded at Cz and Pz for 1000 Hz standard tone (dashed line) and 2000 Hz deviant tone (solid line) for group I (black) and group II (gray).

Figure 2. Identification rate of peaks P1, N1, P2, N2, P300 and N4 at Cz position in both the groups.

Figure 3. Identification rate of peaks P1, N1, P2, N2, P300 and N4 at Pz position in both the groups.

Table 1. Descriptive analysis of peaks P1, N1, P2 and N2 latency and amplitude at Cz position.

Table 2. Descriptive analysis of peaks P1, N1, P2 and N2 latency and amplitude at Pz position.

Table 3. Descriptive analysis of peaks P300 and N4 latency and amplitude at Cz and Pz positions.

Table 4. Descriptive analysis of peaks P1, N1, P2, N2 and P300 latency among individuals with peripheral vestibular lesion.

Table 5. Descriptive analysis of peaks P1, N1, P2, N2 and P300 latency among individuals with central vestibular lesion.

Discussion

Conclusions

Data availability

Underlying data

Consent

References

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