Clinical Application of FEMA Grading System

Lee, Won Sang; Yoon, Pyung Moon; Kim, Dong Young; Lee, Ju Hyoung

Abstract

BACKGROUND AND OBJECTIVES: The facial nerve grading system proposed by House and Brackmann is the most widely accepted for the clinical assessment of facial nerve injury. It is, however, subjective and discontinuous, and prone to interobserver variation. In order to remove subjectivity from analysis, we have therfore proposed the FEMA grading system at the Korean Otologic Study Group in 1995. This study describes the FEMA grading system and determines its reliability and usefulness by comparing it with the House-Brackmann system in assessing facial paralysis.
MATERIALS AND METHODS
Ten experienced otolaryngologists using the FEMA and H-B systems studied 30 patients with various degrees of facial palsy.
RESULTS
In the average of coincidence rate, the FEMA system showed 84.4% and the H-B system was 73.7% (p<0.05). The standard deviation in the grading by the FEMA system was lower than that by the H-B system (p=0.082).
CONCLUSION
The study found that the FEMA grading system is more exact and objective in describing the severity of facial palsy than the House-Brackmann grading system. Especially, the FEMA grading system is more convenient to use in patients with partial weakness.