Assessing Facial Palsy: Does Feedback Improve Assessment Using the eFACE and Sunnybrook Facial Grading System?

Tessa E Bruins*, Romy F Lammens, Martinus M van Veen, Katalin Tamási, Pieter U Dijkstra, Paul M N Werker, Dieuwke C Broekstra

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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OBJECTIVE(S): To explore learning effects when applying the clinician-graded electronic facial function scale (eFACE) and the Sunnybrook Facial Grading System (Sunnybrook).

METHODS: Surgeons, facial rehabilitation therapists, and medical students were randomly allocated to the eFACE (n = 7) or Sunnybrook (n = 6) and graded 60 videos (Massachusetts Eye and Ear Infirmary open-source standard set); 10 persons with normal facial function and 50 patients with a wide variation of facial palsy severity. Participants received an introduction and individual feedback after each set of 10 videos. Scores were compared to the reference score provided with the set. Multilevel analysis was performed to analyze learning effect.

RESULTS: A learning effect was only found for the eFACE, with significant difference scores in set 1 and 2 compared to set 6, and no significant difference scores in the following sets. The difference score was associated with the reference score (severity of facial palsy) for eFACE (β = -0.19; SE = 0.04; p < 0.001) and Sunnybrook (β = -0.15; SE = 0.04; p < 0.001). Age of participants was also associated with the difference score in the eFACE group (β = 0.18; SE = 0.03; p < 0.001). No differences in scores were found between groups of participants.

CONCLUSION: The eFACE showed a learning effect of feedback while the Sunnybrook did not.

LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Original languageEnglish
Number of pages7
Publication statusE-pub ahead of print - 13-Jan-2024


  • eFACE
  • facial palsy
  • facial paralysis
  • learning
  • Sunnybrook


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