The Nottingham System: objective assessment of facial nerve function in the clinic

The House-Brackmann is the most widely accepted system for the clinical assessment of facial nerve function. It is, however, being subjective and discontinuous, prone to interobserver variation. The need for an objective system persists. The Nottingham System is described and compared to the Burres-Fisch system in a study of 29 subjects with varying degrees of facial nerve function, ranging from normal to total paralysis. Within-group component of variance analysis was 7% for the Nottingham System compared to 26% for the Burres-Fisch system. Bland and Altmans' analysis showed the Burres-Fisch system to be biased, overestimating small percentage scores, and underestimating large ones. The Nottingham System proved unbiased. The Nottingham System is recommended as an accurate objective continuous grading system for the rapid assessment of facial nerve function in the clinic.