Comparison of the Reliability of the House- Brackmann, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System for the Evaluation of Patients with Peripheral Facial Paralysis.

BACKGROUND: To compare the reliability of the House-Brackmann (HB), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SB) which are widely used in the evaluation of peripheral facial paralysis (PFP) patients. METHODS: Thirty-five video-recorded adult PFP patients were included in the study. The evaluators comprised 6 physicians. Evaluations were conducted twice independently, utilizing video recordings. Simultaneously, the evaluators were asked to keep time during the evaluation. For the analysis of reliability, Fleiss' kappa coefficient was used for the HB, and the intraclass correlation coefficient (ICC) was used for the FNGS 2.0 and SB. RESULTS: The mean evaluation time of 1 patient was found to be 1.06 ± 0.24, 1.47 ± 0.23, and 2.32 ± 0.41 minutes for the HB, FNGS 2.0, and SB, respectively. For interrater reliability, Fleiss' kappa for the HB was 0.495 and 0.403; ICC for the FNGS 2.0 was 0.966 and 0.958; ICC for the SB was 0.960 and 0.967 for the first and second measurements, respectively. For intrarater reliability, Fleiss' kappa for the HB was 0.391, 0.446, 0.564, 0.502, 0.626, and 0.455; ICC for the FNGS 2.0 was 0.87, 0.982, 0.966, 0.929, 0.933, and 0.948; ICC for the SB was 0.935, 0.96, 0.895, 0.941, 0.96, and 0.94 for the 6 raters, respectively. CONCLUSION: In the present study, statistically high intra- and interrater correlations were found for the FNGS 2.0 and SB, while a moderate correlation was found for the HB. Although the HB seems to be more practical, it has been concluded that the FNGS 2.0 and SB are more reliable.

The Effect of Intracochlear and Intratympanic Dexamethasone on Cochlear Implant Impedance.

Objective: This study investigated the impact of different local corticosteroid applications on impedance measurements in patients with cochlear implants. Methods: The study was designed as a controlled, randomized, and prospective study in which 34 consecutive patients who had undergone cochlear implant surgery were divided into three groups. The first group received intracochlear dexamethasone, in the second group the middle ear cavity was filled with dexamethasone, and the third group did not receive dexamethasone. Intraoperative, postoperative 1st week, 1st month, 3rd month, 6th-month neural response telemetry, and impedances were measured. The measurements were compared by electrode groups representing the different regions of cochlea like basal (1-7), middle (8-13), and apical (14-22) regions. Results: The intergroup analysis showed no statistically significant differences in impedance measurements of the basal, middle, and apical regions (p>0.05). However, the impedances were lower in the two dexamethasone groups, especially in the basal and middle parts. Sixth month impedances were also lower in the dexamethasone groups. There was apparent stability in the impedance of the basal region with the intracochlear application during the first week. Conclusion: Local dexamethasone applications had a potentially positive impact on the impedance of the basal and middle regions. Patients had lower impedances than the control group during follow-up and at the endpoint. The increase in the apical region may indicate that dexamethasone was not reaching the apical zone in local applications.