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Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary

Amanda Williams1,2, Nitaa Eapen1,2,3, Amit Kochar4

  • 1Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.

Journal of Child Neurology
|February 6, 2023
PubMed

Insights

Facial nerve function grading scales, House-Brackmann and Sunnybrook, show excellent agreement in children with Bell's palsy, though House-Brackmann is easier to administer. Both scales are applicable for assessing pediatric facial paralysis.

Area of Science:

  • Pediatric Neurology
  • Clinical Assessment
  • Facial Nerve Disorders

Background:

  • Limited evidence exists on the utility of facial nerve function grading scales in pediatric acute facial nerve paralysis.
  • Idiopathic facial paralysis (Bell's palsy) is a common condition in children requiring reliable assessment tools.

Purpose of the Study:

  • To evaluate the agreement and usability of the House-Brackmann and Sunnybrook scales in children diagnosed with Bell's palsy.
  • To compare the ease of administration of these two widely used facial nerve grading scales in a pediatric population.

Main Methods:

  • A randomized controlled trial involving children aged 6 months to 18 years with Bell's palsy was utilized.
  • The House-Brackmann and Sunnybrook scales were administered at baseline and at 1, 3, and 6 months post-symptom onset.
  • Agreement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots; ease of administration was measured via an 11-point Likert scale.

Main Results:

  • Excellent agreement (ICC=0.92) was observed between the House-Brackmann and Sunnybrook scales across all time points, with lower agreement at baseline (ICC=0.37).
  • The House-Brackmann scale demonstrated significantly higher ease of administration (median=3) compared to the Sunnybrook scale (median=7; P < .001).
  • Data from 169 children were analyzed, providing robust statistical power for the comparisons.

Conclusions:

  • The House-Brackmann and Sunnybrook scales exhibit excellent agreement in assessing facial nerve function in children with Bell's palsy, despite initial variability.
  • The House-Brackmann scale is preferred by clinicians due to its greater ease of administration.
  • Both scales are deemed applicable and useful for clinical evaluation and research in pediatric idiopathic facial paralysis.
Abstract

Keywords:
Bell's palsyHouse-Brackmann scaleSunnybrook scalechild

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