Reliability of the House and Brackmann grading system for facial palsy

The House and Brackmann grading system has been recommended as a universal standard for assessing the degree of facial palsy. This study examined the inter-observer reliability of this system. Three observers assigned a grade to each patient, examined independently, on the same day. Forty patients with a unilateral facial palsy of varying aetiology and severity were assessed. Of the 120 judgements, eight were in dispute, by a maximum of one grade, giving an inter-observer reliability of 93 per cent. We conclude that the House and Brackmann grading system is a simple and robust method of assessing facial function.