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Objectives: Evaluate intra-rater and inter-rater variabilities of the Sunnybrook Facial Grading System (SFGS) and explore potential factors of variability., Study Design: Prospective test of hypothesis., Setting: University tertiary referral center., Participants/methods: Facial video recordings of 20 patients with variable degrees of peripheral facial palsy (PFP) were anonymized then presented to 31 independents raters in 2 trials. The raters were senior and junior professionals involved in the management of PFP: ENT specialists, physiotherapists, and speech therapists. The SFGS was used for grading paralysis., Main Outcome Measure: Intra-rater and inter-rater variabilities were estimated by intraclass correlation coefficient (ICC [95% confidence interval]) for the composite score and the three subscores of the SFGS. Factors of variability studied were: rater professions and rater experience (senior vs junior)., Results: For the total population, the intra-rater ICC was 0.915[0.900-0.929] for the composite score considered to represent almost perfect repeatability. Repeatability was important for symmetry at rest (0.694[0.646-0.737]), almost perfect for voluntary movements (0.903[0.886-0.918]), and important to almost perfect for synkinesis (0.810[0.778-0.838]). The inter-rater ICC for the composite score was 0.847[0.755-0.923] indicating important to almost perfect agreement between all raters. Agreement between raters was important to almost perfect for voluntary movements (0.839[0.746-0.919]), but moderate to important for symmetry at rest (0.553[0.408-0.730]) and weak to important for synkinesis (0.476[0.333-0.666]). Some variability was found between raters groups; however, repeatability and agreement were good for all raters., Conclusions: The SFGS is a reproducible scale. It can be used with good reproducibility by both novices and experts, and by all professionals involved in the management of PFP., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Purpose: To provide more data on the clinical presentation and natural evolution of facial nerve schwannomas and to provide guidance for therapeutic decision making., Methods: A retrospective case review of eighty patients diagnosed with a facial nerve schwannoma between 1990 and 2018 in ten tertiary referral centers in Europe was performed. Patients' demographics, symptomatology, audiometry, anatomical site (segments involved), size and whenever possible volume measurement were registered., Results: At presentation, transient or persistent facial palsy was the most common symptom, followed by hearing loss. The schwannoma involved more than one segment in the majority of the patients with the geniculate ganglion being most commonly involved. Initial treatment consisted of a wait and scan approach in 67.5%, surgery in 30% and radiation therapy in 2.5% of the patients. Tympanic segment schwannomas caused mainly conductive hearing loss and were more prone to develop facial palsy at follow-up. Internal auditory canal or cerebellopontine angle schwannomas presented with significantly more sensorineural hearing loss., Conclusions: Although modern imaging has improved diagnosis of this tumor, choosing the best treatment modality remains a real challenge. Based on the literature review and current findings, more insights into the clinical course and the management of facial nerve schwannomas are provided.

Objective: The preservation of acceptable facial nerve (FN) function after surgery is the key concern for most patients with vestibular schwannomas (VS). To assess predictive factors of early postoperative and long-term FN function in patients harboring large VS operated with a FN-sparing technique., Methods: Single-center retrospective cohort study with 169 consecutive large VS operated on between January 2003 and May 2015. Clinical, radiologic, and intraoperative factors were assessed according to FN function., Results: At last follow-up examination, among the 145 patients without preoperative FN palsy, FN function was good (House-Brackmann [HB] grades I or II) in 84% and moderate (HB grade III) in 15% of patients. Only 1 patient presented with poor HB grade IV function. Multivariate logistic regression model showed the mean preoperative VS extrameatal diameter as being an independent predictor of an unfavorable initial FN outcome (odds ratio [OR], 1.062; P = 0.038). Surgical anatomic preservation of the cochlear nerve was associated with better FN outcomes (OR, 0.237; P = 0.012). A history of previous surgery seemed to be related to long-term impaired FN function (OR, 71.405; P = 0.042), as well as early postoperative FN function (OR, 19.068; P = 0.000). No correlation was found between a history of previous Gamma Knife surgery treatment (P = 0.225) or the extent of resection (P = 0.438) and impaired FN outcomes. History of previous surgery was identified as an unfavorable predictive recovery factor of impaired postoperative FN function (P = 0.034)., Conclusions: As long as the extent of resection or additional Gamma Knife surgery have not been identified as predictive risk factors of postoperative FN palsy, we suggest that optimal resection is the main option for patients harboring large VS., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To translate and validate French versions of two health-related quality of life questionnaires for patients with peripheral facial palsy: Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale., Design: Prospective cohort study., Setting: University tertiary referral centre., Participants: A pilot test was performed on 10 subjects (5 patients with facial palsy of more than 1-month duration and 5 normal subjects), and then 67 adult patients with facial palsy were enrolled in the validation study., Main Outcome Measures: Translation of the original questionnaires has followed international guidelines using a forward-backward translation method. A pilot test and a validation study based on the translated questionnaires were performed. Internal consistency, test-retest reliability, validity and responsiveness were assessed. Validity was assessed by comparing to SF-36 and Sunnybrook/House-Brackmann grading systems. Subjects answered scales twice within a one-week interval., Results: Sixty-seven patients were enrolled, among which 63 completed scales one week later (retest). For physical and social functions of FDI and FaCE scores, Cronbach's α representing internal consistency was 0.88, 0.70 and 0.89, and test-retest reliability by intra-class correlation coefficients was 0.81, 0.86 and 0.89, respectively. The correlation of facial movement score of FaCE scale was good with Sunnybrook/House-Brackmann grading systems (0.73 and -0.75, P < 0.01). The correlation of social function of FaCE scale was excellent with social function of SF-36 (0.8, P < 0.01)., Conclusions: French versions of FDI and FaCE scale are psychometrically valid. Both questionnaires can be used for clinical studies to assess the quality of life of patients with peripheral facial palsy., (© 2019 John Wiley & Sons Ltd.)

Purpose: To present a prospective temporal bone fracture database, and study facial and cochleovestibular sequelae and their impact on quality of life., Materials and Methods: Prospective study of consecutive cases of 39 patients with 45 temporal bone fractures over 11-month period in a university tertiary referral center. Based on epidemiological data, clinical and imaging findings, treatment modalities and outcome of patients with follow-up of one year, the present study focused on facial and cochleovestibular sequelae and their impact on quality of life after one-year period., Results: After 12 months, 44% of patients present with balance problems, 56% with hypoacusis, 56% with tinnitus, and 15% with facial paralysis. In 75%-80% of patients, the cochleovestibular sequelae are described as disabling. Post-trauma quality of life was significantly impaired compared with pre-trauma quality of life, even after 12 months. Long-term cochleovestibular sequelae were significantly associated with poor long-term quality of life., Conclusions: The study demonstrates the need to focus on prevention of temporal bone fractures, notably by promoting the use of helmets and improvements in helmet design. The rapid diagnosis of temporal bone fracture is crucial as it enables effective initial management aimed at avoiding sequelae. The frequency of cochleovestibular sequelae after temporal bone fracture and their impact on quality of life demonstrate the importance of, and need for, ongoing follow-up by a local medical team who can diagnose and manage these long-term sequelae., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Unlabelled: Since its introduction, surgery for the placement of the Vibrant Soundbridge (VSB) device has been performed using a facial recess approach. Because of the size of the VSB device, this approach requires a large facial recess that can lead to complications, i.e., facial palsy and/or taste disturbance. The purpose of this study is to develop and compare transcanal surgical approaches for leading the VSB into the middle ear., Setting: Cadaver temporal bones in a university temporal bone laboratory., Materials and Methods: First, two experienced senior surgeons validated the three possible approaches in human temporal bone: 1) the classical facial recess approach; 2) a small mastoidectomy, elevation of a tympanomeatal flap, small atticotomy, 0.5-mm cutting of the bony external auditory canal (EAC) from the cortical plane on its approximately two-thirds to three-fourths and then a trough to pass the electrode array into the middle ear; and 3) similar to the second approach but with replacing the cutting of the bony EAC with a tunnel from the mastoid cavity to the EAC. Both the second and third approaches were transcanal. Next, five residents and six attending surgeons performed the three operations and evaluate these different approaches by using analog visual scales (VAS) for each procedure. They assess the following: 1) the ease of passing the electrode array and the Floating Mass Transducer (FMT) into the middle ear, 2) the ease for FMT clipping, and 3) their self-confidence using each approach. Time required for the three operations was measured. Measurements of landmarks were obtained on all temporal bones. Two patient cases illustrate the clinical application of this new surgical approach., Results: The two transcanal approaches were assessed to be easier, faster, and safer methods for VSB surgery than the classic facial recess approach., Conclusion: VSB surgery has been performed using a facial recess approach with risk for facial nerve and taste disturbance. Transcanal approaches are good alternative for this surgery. Three major limitations are to be assessed in future patient studies: the pathologic findings of the EAC, the design of the FMT regarding the axis of the ossicular chain, the long-term evaluation of the skin of the external ear canal.