title: Significance and reliability of the House-Brackmann grading system for regional facial nerve function.
abstract: OBJECTIVE
  To determine the reliability of the House-Brackmann facial nerve grading scale in the setting of differential function across its branches.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Eleven physicians with different levels of clinical experience and three upper-level medical students were provided with digital video clips of 11 patients with differential facial nerve functioning, and asked to report facial nerve function as a traditional global score and as a regional score on the basis of the House-Brackmann scale for the forehead, eye, nose, and mouth. Agreements between the traditional global score and the regional scores, as well as inter-rater agreement, were analyzed.
  
  
  RESULTS
  In patients with variable facial weakness, a single House-Brackmann score did not fully communicate facial function. The single House-Brackmann score most strongly correlated with the regional scoring of the nose/midface (59%), followed by the mouth (51%), eye (48%), and forehead (35%). Overall inter-reader reliability was relatively strong for the midface (kappa = 0.503) and global scores (kappa = 0.541), followed by the mouth (k = 0.419), the forehead (k = 0.330), and the eye (k = 0.302). There was a marked tendency for reader agreement to increase among those with more clinical experience.
  
  
  CONCLUSIONS
  Regional assessment using the House-Brackmann grading scale more fully communicates facial function and increases in reliability with experience.
authors.affiliation: Department of Otolaryngology, New York University Medical Center, New York, NY, USA.
authors.forename: Shari D
authors.initials: SD
authors.lastname: Reitzen
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Anil K
authors.initials: AK
authors.lastname: Lalwani
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005154:Facial Nerve / Q000503:physiopathology*; D005158:Facial Paralysis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index