Good correlation between original and modified house Brackmann facial grading systems


  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

  • Presented at the Hartopp-Dixon Meeting, Royal National Throat Nose and Ear Hospital, London, England, March 11, 2010.



Subjective scales of facial function were plagued with reporting variations until the House-Brackmann scale was described in 1985. Despite its utility, weaknesses were identified, including noninclusion of synkinesis phenomena and insensitivity to segmental weakness. Therefore, the scale was recently revised to address these weaknesses. The objective of this investigation was to determine agreement between the original and the updated House-Brackmann scales.

Study Design:

Prospective clinical trial.


Fifty consecutive new facial paralysis patients underwent standardized facial videography while performing facial movements. Video clips were scored by three independent facial nerve clinicians. The time it took to produce a score for each method was tracked. Interobserver correlations were calculated, and comparisons were made between scores by using the original and modified House-Brackmann scales.


Interobserver correlation was high for both House-Brackmann scales. Overall scores were in excellent agreement (difference of 0.1 ± 0.5, no statistical difference), although the modified scale took substantially longer to calculate (120 seconds ± 20 seconds vs. 30 seconds ± 10 seconds, P < .001).


We found substantial grading correlation between the original and the newly modified House-Brackmann scales. Because of specific zonal and synkinesis scoring, the modified scale took longer to score. Laryngoscope, 2011