House J W
Laryngoscope. 1983 Aug;93(8):1056-69. doi: 10.1288/00005537-198308000-00016.
A comprehensive, accurate, and valid system for reporting results of facial nerve surgery and disease is needed. This study describes and statistically analyzes eight currently available systems for reliability, validity, and ease of use. They are divided into three grading categories: gross scales, regional systems, and specific scales. Botman and Jongkees, May, and Peitersen have proposed five-point gross scales. Janssen, Smith, Adour and Swanson, and Yanagihara have devised regional systems. Stennert has proposed a specific criteria scale. Fifteen otologists experienced with facial nerve problems used modifications of the existing scales to evaluate videotapes of 12 patients representing the complete range of facial function. The observers' responses were translated back to the original scales. Observers also ranked patients from least to most severe, to obtain an accurate assessment of facial function for patients in the study. A follow-up questionnaire examined observers' system preferences. Validity is measured by correlating responses to different scales and by comparing responses to each scale with observers' rankings. All scales have good validity except the scales of Stennert and Yanagihara. Consistency of responses is determined by reliability coefficients. Coefficients for all scales are high except for the gross scale, which is moderately reliable, and the Stennert scale, which is unreliable. Results indicate that all scales succeed in evaluating patients with normal function or total paralysis. The regional scales have the highest reliabilities but they also have wide response ranges. Most also assume a level of precision that is unsubstantiated. Gross scales have smaller ranges, which result in greater agreement of responses but lower reliability. Comparisons to more complex scales show that the simpler gross scales convey similar information about patients. The study concludes that a gross scale is the best type of system and proposes a new scale for international acceptance. This system has six categories, includes secondary defects, is designed to clearly differentiate between moderate degrees of dysfunction, and should facilitate interpretation and communication of facial nerve results.
需要一个全面、准确且有效的系统来报告面神经手术和疾病的结果。本研究描述并统计分析了目前可用的八个系统在可靠性、有效性和易用性方面的情况。它们分为三个分级类别：总体量表、区域系统和特定量表。博特曼和容基斯、梅以及彼得森提出了五点总体量表。扬森、史密斯、阿杜尔和斯旺森以及柳原设计了区域系统。施泰纳特提出了一个特定标准量表。15位有面神经问题经验的耳科医生使用现有量表的修改版来评估12名代表整个面部功能范围患者的录像带。观察者的回答被转换回原始量表。观察者还将患者从最轻微到最严重进行排序，以获得对研究中患者面部功能的准确评估。一份后续问卷调查了观察者对系统的偏好。有效性通过将不同量表的回答进行关联以及将每个量表的回答与观察者的排名进行比较来衡量。除施泰纳特和柳原的量表外，所有量表都具有良好的有效性。回答的一致性由可靠性系数决定。除总体量表可靠性为中等、施泰纳特量表不可靠外，所有量表的系数都很高。结果表明，所有量表都成功地评估了功能正常或完全瘫痪的患者。区域量表具有最高的可靠性，但它们的回答范围也很广。大多数还假定了一种未经证实的精确程度。总体量表的范围较小，这导致回答的一致性更高，但可靠性较低。与更复杂量表的比较表明，较简单的总体量表传达了关于患者的类似信息。该研究得出结论，总体量表是最好的系统类型，并提出了一个新的量表以供国际认可。这个系统有六个类别，包括继发性缺陷，旨在清晰区分中度功能障碍程度，并且应便于对面神经结果进行解释和交流。
