J. Gail Neely - Academia.edu (original) (raw)
Papers by J. Gail Neely
Otolaryngology -- Head and Neck Surgery, 1984
Over the last 19 years there has been increasing interest in the conservation of hearing while ac... more Over the last 19 years there has been increasing interest in the conservation of hearing while acoustic tumors are being resected. As enthusiasm has increased for the conservation surgery, so has controversy. The key to the controversy is a dissociation between gross anatomic and histologic observations. The purpose of this paper is to summarize our laboratory experiments and clinical observations in three areas: (1) Our experiments and observations suggest that it is probably not possible to totally resect an acoustic tumor medial to Scarpa's ganglion and conserve hearing. (2) It has not been possible to predict from preoperative auditory and vestibular function tests the number of fibers present within the cochlear and vestibular nerves lateral to the tumor, nor the number of fibers in small aggregates that may pass the tumor periphery. (3) If microscopic amounts of tumor are left behind, is that significant? It is too early to answer this question.
Laryngoscope Investigative Otolaryngology, 2016
Journal of the American Academy of Audiology, 1995
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2013
&... more "Comparative effectiveness research" (CER) is not a new concept; however, recently it has been popularized as a method to develop scientifically sound actionable data by which patients, physicians, payers, and policymakers may make informed health care decisions. Fundamental to CER is that the comparative data are derived from large diverse populations of patients assembled from point-of-care general primary care practices and that measured outcomes include patient value judgments. The challenge is to obtain scientifically valid data to be acted upon by decision-making stakeholders with potentially quite diversely different agenda. The process requires very thoughtful research designs modulated by complex statistical and analytic methods. This article is composed of a guiding narrative with an extensive set of tables outlining many of the details required in performing and understanding CER. It ends with short discussions of three example papers, limitations of the method, and how a practicing physician may view such reports.
Seminars in plastic surgery, 2004
Systematic evaluation of facial nerve paralysis allows the clinician to determine objectively the... more Systematic evaluation of facial nerve paralysis allows the clinician to determine objectively the severity of disability, record and communicate this information to colleagues, and evaluate response to therapy. An ideal grading system would be precisely calibrated-at once accurate, reliable, and conducive to use in both the clinic and the research laboratory. Developing such a system has proved difficult, however. The complexity of facial nerve anatomy allows tremendous variation in clinical presentation, and assessments of facial expression are inherently subjective in nature. Carefully defined parameters are therefore crucial in performing objective and quantitative analyses. This article reviews the clinical considerations involved in grading facial function and traces the evolution of current approaches. Emphasis is placed upon advances in computer-based facial nerve grading.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1993
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
The Bionic Human, 2006
Chapter 17 on ossicular implants is well written and comprehensive. This commentary focuses on th... more Chapter 17 on ossicular implants is well written and comprehensive. This commentary focuses on the primary mission of this textbook: the long-term care and follow-up of patients with implanted prosthetic devices.
The Laryngoscope, 1982
Two consecutively operated-on adult cases with spontaneous cerebrospinal fluid otorrhea were revi... more Two consecutively operated-on adult cases with spontaneous cerebrospinal fluid otorrhea were reviewed. Three meningoencephaloceles through tegmental defects were found. Each cele was peduculated through a small dural dehiscence partially obstructed by herniated brain. The otic capsule was normal in both cases. Bipolar cautery was used to reduce the size of the meningoencephalocele and to allow this tissue to assist in the closure of the defect. Conchal cartilage was placed through the tegmental defect to act as a self maintaining intracranial repair of the bony dehiscence. These cases and the literature suggest that fistulization of dura is more frequently the cause of spontaneous cerebrospinal fluid otorrhea in adults than is a defect in the otic capsule. Thus, direct surgical inspection of these areas is required.
Otolaryngology - Head and Neck Surgery, 2010
A systematic review is a transparent and unbiased review of available information. The published ... more A systematic review is a transparent and unbiased review of available information. The published systematic review must report the details of the conduct of the review as one might report the details of a primary research project. A meta-analysis is a powerful and rigorous statistical approach to synthesize data from multiple studies, preferably obtained from a systematic review, in order to enlarge the sample size from smaller studies to test the original hypothesis and/or to generate new ones.
The Laryngoscope, 1989
The adaptation of implantable auditory prostheses for use in children has raised questions concer... more The adaptation of implantable auditory prostheses for use in children has raised questions concerning both what effect growth may have on the implant and what effect the implant may have on growth. The purpose of this study is to describe temporal bone lateral surface dimensions in children of different ages to draw inferences about growth rates. Using a surface projected grid and point calipers, 158 intact temporal bones from 103 individuals of known ages between birth and 20 years were measured at six points from a fixed reference. These specimens were located in the skeletal collections of the Smithsonian Institute's Museum of Natural History, the Medical Museum of Walter Reed Hospital at the Armed Forces Institute of Pathology, and the Cleveland Museum of Natural History. Linear regression analysis helped clarify a bimodal pattern of growth in which marked increases in dimension occur from birth to 4 years of age and much less change is seen from age 4 to 20 years. These data suggest that implantation in children under 4 years of age is subject to maximal growth effects.
The Laryngoscope, 2002
Muscle strength is a fundamental measure of function for neuromuscular systems; however, mimetic ... more Muscle strength is a fundamental measure of function for neuromuscular systems; however, mimetic facial muscle strength has never been recorded. The objective of the present feasibility project was to measure facial muscle strength. The study design was a prospective experimental trial in 10 normal subjects. Descriptive statistics, tests, and analysis of variance were used to summarize and compare data. Subjects were selected by convenience following submission and approval of a prospectively designed protocol and consent form to the Human Studies Committee. Application of a force transducer to the central eyebrow and commissure during eyebrow raising, eyelid closing, smiling, and puckering was performed by two methods: surface adhesion method (n = 5) and direct probe application method (n = 5). Data were recorded in pounds. Three repetitions of each movement were made. Rank order of muscle strengths (in pounds) by the surface adhesion technique was as follows: brow, 0.758; eye, 0.549; pucker, 0.387; and smile, 0.307. By direct probe application the rank order of muscle strengths was as follows: eye, 0.880; brow, 0.773; and smile, 0.730. Objective measures of facial motion are crucial for quantitative investigations of preventative, therapeutic, reconstructive, and rehabilitative interventions for facial nerve and muscle lesions. Until the present, objective measures required cross-correlations with current standards that were subjective. This is the first time an actual physical measure of facial muscle function has been performed. The purpose of presenting this preliminary work is to stimulate advancement along this line of research.
The Laryngoscope, 1996
Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its preventi... more Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its prevention and treatment are less than adequate. Improved therapeutic interventions await better understanding of its pathogenesis. In this study, 11 patients with synkinesis and 11 normal control subjects were quantitatively assessed using a new computer-assisted, motion-sensitive system. Two additional, informative cases presenting at the completion of the study are also briefly reported. The observed synkinetic patterns appear predictable and nonrandom. In addition, these observations tend to raise doubts that the aberrant fiber regeneration hypothesis is the sole explanation of synkinesis. They further implicate facial nuclear hyperexcitability as an explanation in at least some cases of synkinesis. Understanding these patterns enhances clinical detection and evaluation and may lead to a better knowledge of the fundamental pathophysiology of synkinesis and its prevention.
The Laryngoscope, 2001
This is the third in a series of sequential "Tutorials in Clinical Research.&... more This is the third in a series of sequential "Tutorials in Clinical Research." The objectives of this specific report are to enable the reader to rapidly dissect a clinical question or article to efficiently determine what critical mass of information is required to answer the question and what study design is likely to produce the answer. Tutorial. The authors met weekly for 3 months exploring clinical problems and systematically recording the logic and procedural pathways from multiple clinical questions to the selection of proper research approaches. The basic elements required to understand the processes of selection were catalogued and field tested, and a report was produced to define and explain these elements. Fundamental to a research approach is the assembly of subjects and the allocation of exposures. An algorithm leading to the selection of an approach is presented. The report is organized into three parts. The tables serve as a rapid reference section. The initial two-part narrative explains the process of approach selection. The examples section illustrates the application of the selection algorithm. Selecting the proper research approach has six steps: the question, logic and ethics,identification of variables, data display considerations, original data source considerations, and selection of prototypical approaches for assembly of subjects. Field tests of this approach consistently demonstrated its utility.
The Laryngoscope, 2010
This tutorial on comparative statistics has been written in two complementary segments. The first... more This tutorial on comparative statistics has been written in two complementary segments. The first paper (part A) focused on explaining the general concepts of the null hypothesis and statistical significance. This second article (part B) addresses the application of three specific statistical tests. These two articles should be read sequentially and the first article should be available for reference while one reads the second. Tutorial. The authors met weekly for 10 months to discuss clinical research articles and the applied statistics. The difficulty was not the material but the effort to make it easy to read and as short as possible. The article discusses the application of three common statistical indexes of contrast, chi2, Mann-Whitney U, and Student t-test and other concepts, such as sample size, degrees of freedom, errors, power, and confidence intervals. Statistical tests generate a number known as a statistic (chi2, U, t), which is sometimes called a "critical ratio" because it helps us to make a decision. This number is then associated with a probability, or P value. Sample size is a crucial element in the initial design of a research project and in the subsequent ability of the results to show statistical significance if the difference is clinically important. The example data used in this paper demonstrate the application of the three specific tests and illustrate the effect of sample size on the results.
Otolaryngology -- Head and Neck Surgery, 1984
Over the last 19 years there has been increasing interest in the conservation of hearing while ac... more Over the last 19 years there has been increasing interest in the conservation of hearing while acoustic tumors are being resected. As enthusiasm has increased for the conservation surgery, so has controversy. The key to the controversy is a dissociation between gross anatomic and histologic observations. The purpose of this paper is to summarize our laboratory experiments and clinical observations in three areas: (1) Our experiments and observations suggest that it is probably not possible to totally resect an acoustic tumor medial to Scarpa's ganglion and conserve hearing. (2) It has not been possible to predict from preoperative auditory and vestibular function tests the number of fibers present within the cochlear and vestibular nerves lateral to the tumor, nor the number of fibers in small aggregates that may pass the tumor periphery. (3) If microscopic amounts of tumor are left behind, is that significant? It is too early to answer this question.
Laryngoscope Investigative Otolaryngology, 2016
Journal of the American Academy of Audiology, 1995
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2013
&... more "Comparative effectiveness research" (CER) is not a new concept; however, recently it has been popularized as a method to develop scientifically sound actionable data by which patients, physicians, payers, and policymakers may make informed health care decisions. Fundamental to CER is that the comparative data are derived from large diverse populations of patients assembled from point-of-care general primary care practices and that measured outcomes include patient value judgments. The challenge is to obtain scientifically valid data to be acted upon by decision-making stakeholders with potentially quite diversely different agenda. The process requires very thoughtful research designs modulated by complex statistical and analytic methods. This article is composed of a guiding narrative with an extensive set of tables outlining many of the details required in performing and understanding CER. It ends with short discussions of three example papers, limitations of the method, and how a practicing physician may view such reports.
Seminars in plastic surgery, 2004
Systematic evaluation of facial nerve paralysis allows the clinician to determine objectively the... more Systematic evaluation of facial nerve paralysis allows the clinician to determine objectively the severity of disability, record and communicate this information to colleagues, and evaluate response to therapy. An ideal grading system would be precisely calibrated-at once accurate, reliable, and conducive to use in both the clinic and the research laboratory. Developing such a system has proved difficult, however. The complexity of facial nerve anatomy allows tremendous variation in clinical presentation, and assessments of facial expression are inherently subjective in nature. Carefully defined parameters are therefore crucial in performing objective and quantitative analyses. This article reviews the clinical considerations involved in grading facial function and traces the evolution of current approaches. Emphasis is placed upon advances in computer-based facial nerve grading.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1993
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
The Bionic Human, 2006
Chapter 17 on ossicular implants is well written and comprehensive. This commentary focuses on th... more Chapter 17 on ossicular implants is well written and comprehensive. This commentary focuses on the primary mission of this textbook: the long-term care and follow-up of patients with implanted prosthetic devices.
The Laryngoscope, 1982
Two consecutively operated-on adult cases with spontaneous cerebrospinal fluid otorrhea were revi... more Two consecutively operated-on adult cases with spontaneous cerebrospinal fluid otorrhea were reviewed. Three meningoencephaloceles through tegmental defects were found. Each cele was peduculated through a small dural dehiscence partially obstructed by herniated brain. The otic capsule was normal in both cases. Bipolar cautery was used to reduce the size of the meningoencephalocele and to allow this tissue to assist in the closure of the defect. Conchal cartilage was placed through the tegmental defect to act as a self maintaining intracranial repair of the bony dehiscence. These cases and the literature suggest that fistulization of dura is more frequently the cause of spontaneous cerebrospinal fluid otorrhea in adults than is a defect in the otic capsule. Thus, direct surgical inspection of these areas is required.
Otolaryngology - Head and Neck Surgery, 2010
A systematic review is a transparent and unbiased review of available information. The published ... more A systematic review is a transparent and unbiased review of available information. The published systematic review must report the details of the conduct of the review as one might report the details of a primary research project. A meta-analysis is a powerful and rigorous statistical approach to synthesize data from multiple studies, preferably obtained from a systematic review, in order to enlarge the sample size from smaller studies to test the original hypothesis and/or to generate new ones.
The Laryngoscope, 1989
The adaptation of implantable auditory prostheses for use in children has raised questions concer... more The adaptation of implantable auditory prostheses for use in children has raised questions concerning both what effect growth may have on the implant and what effect the implant may have on growth. The purpose of this study is to describe temporal bone lateral surface dimensions in children of different ages to draw inferences about growth rates. Using a surface projected grid and point calipers, 158 intact temporal bones from 103 individuals of known ages between birth and 20 years were measured at six points from a fixed reference. These specimens were located in the skeletal collections of the Smithsonian Institute's Museum of Natural History, the Medical Museum of Walter Reed Hospital at the Armed Forces Institute of Pathology, and the Cleveland Museum of Natural History. Linear regression analysis helped clarify a bimodal pattern of growth in which marked increases in dimension occur from birth to 4 years of age and much less change is seen from age 4 to 20 years. These data suggest that implantation in children under 4 years of age is subject to maximal growth effects.
The Laryngoscope, 2002
Muscle strength is a fundamental measure of function for neuromuscular systems; however, mimetic ... more Muscle strength is a fundamental measure of function for neuromuscular systems; however, mimetic facial muscle strength has never been recorded. The objective of the present feasibility project was to measure facial muscle strength. The study design was a prospective experimental trial in 10 normal subjects. Descriptive statistics, tests, and analysis of variance were used to summarize and compare data. Subjects were selected by convenience following submission and approval of a prospectively designed protocol and consent form to the Human Studies Committee. Application of a force transducer to the central eyebrow and commissure during eyebrow raising, eyelid closing, smiling, and puckering was performed by two methods: surface adhesion method (n = 5) and direct probe application method (n = 5). Data were recorded in pounds. Three repetitions of each movement were made. Rank order of muscle strengths (in pounds) by the surface adhesion technique was as follows: brow, 0.758; eye, 0.549; pucker, 0.387; and smile, 0.307. By direct probe application the rank order of muscle strengths was as follows: eye, 0.880; brow, 0.773; and smile, 0.730. Objective measures of facial motion are crucial for quantitative investigations of preventative, therapeutic, reconstructive, and rehabilitative interventions for facial nerve and muscle lesions. Until the present, objective measures required cross-correlations with current standards that were subjective. This is the first time an actual physical measure of facial muscle function has been performed. The purpose of presenting this preliminary work is to stimulate advancement along this line of research.
The Laryngoscope, 1996
Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its preventi... more Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its prevention and treatment are less than adequate. Improved therapeutic interventions await better understanding of its pathogenesis. In this study, 11 patients with synkinesis and 11 normal control subjects were quantitatively assessed using a new computer-assisted, motion-sensitive system. Two additional, informative cases presenting at the completion of the study are also briefly reported. The observed synkinetic patterns appear predictable and nonrandom. In addition, these observations tend to raise doubts that the aberrant fiber regeneration hypothesis is the sole explanation of synkinesis. They further implicate facial nuclear hyperexcitability as an explanation in at least some cases of synkinesis. Understanding these patterns enhances clinical detection and evaluation and may lead to a better knowledge of the fundamental pathophysiology of synkinesis and its prevention.
The Laryngoscope, 2001
This is the third in a series of sequential "Tutorials in Clinical Research.&... more This is the third in a series of sequential "Tutorials in Clinical Research." The objectives of this specific report are to enable the reader to rapidly dissect a clinical question or article to efficiently determine what critical mass of information is required to answer the question and what study design is likely to produce the answer. Tutorial. The authors met weekly for 3 months exploring clinical problems and systematically recording the logic and procedural pathways from multiple clinical questions to the selection of proper research approaches. The basic elements required to understand the processes of selection were catalogued and field tested, and a report was produced to define and explain these elements. Fundamental to a research approach is the assembly of subjects and the allocation of exposures. An algorithm leading to the selection of an approach is presented. The report is organized into three parts. The tables serve as a rapid reference section. The initial two-part narrative explains the process of approach selection. The examples section illustrates the application of the selection algorithm. Selecting the proper research approach has six steps: the question, logic and ethics,identification of variables, data display considerations, original data source considerations, and selection of prototypical approaches for assembly of subjects. Field tests of this approach consistently demonstrated its utility.
The Laryngoscope, 2010
This tutorial on comparative statistics has been written in two complementary segments. The first... more This tutorial on comparative statistics has been written in two complementary segments. The first paper (part A) focused on explaining the general concepts of the null hypothesis and statistical significance. This second article (part B) addresses the application of three specific statistical tests. These two articles should be read sequentially and the first article should be available for reference while one reads the second. Tutorial. The authors met weekly for 10 months to discuss clinical research articles and the applied statistics. The difficulty was not the material but the effort to make it easy to read and as short as possible. The article discusses the application of three common statistical indexes of contrast, chi2, Mann-Whitney U, and Student t-test and other concepts, such as sample size, degrees of freedom, errors, power, and confidence intervals. Statistical tests generate a number known as a statistic (chi2, U, t), which is sometimes called a "critical ratio" because it helps us to make a decision. This number is then associated with a probability, or P value. Sample size is a crucial element in the initial design of a research project and in the subsequent ability of the results to show statistical significance if the difference is clinically important. The example data used in this paper demonstrate the application of the three specific tests and illustrate the effect of sample size on the results.