Comparative value of facial nerve grading systems.

The Fisch Detailed Evaluation of Facial Symmetry (DEFS) and House-Brackmann grading system (HBGS) were compared by statistical examination for their reliability and interobserver variability. Furthermore, the correlation and agreement with a standard global evaluation were compared. Therefore 47 patients with facial palsy of different cause have been evaluated with the two systems, and the global overall evaluation was done by five otolaryngologists familiar with facial palsy. The DEFS showed a high reliability of 0.93 compared with a reliability of 0.77 with the HBGS (international standard requires a reliability of at least 0.8). The mean interobserver variability is 5.24% (SD = 3.2%) with the DEFS and 9.26% (SD = 5.0%) with the HBGS; with a confidence interval of 95%, it is 11.6% and 19.26%. The correlation of both gradings with the global evaluation was high, with r = 0.98 and r = 0.97. The DEFS shows an excellent agreement with the global overall evaluation in 41 (87%) of 47 cases and the HBGS in 32 (66%) of 47 cases.

The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases.

The subjective visual vertical, SV, was measured in the upright and side positions in 25 normal subjects and in 73 patients with various peripheral vestibular disorders. Significant deviations of SV (toward the affected ear) were found in 100% of the patients with vestibular nerve section and with Ramsay Hunt syndrome, in 89% of the patients with vestibular neuritis, and in 0% of the patients with benign paroxysmal positional vertigo. The deviation of SV gradually disappeared within a few weeks of the onset of the disease in all patients except in those with total VIIth nerve resection. SV is a parameter of tonic afferent differences between the two labyrinths similar to vestibular spontaneous nystagmus but is mediated by other parts of the inner ear (probably the otolith organs) and thus provides additional information on the labyrinthine function. SV measured in 90 degrees side positions, however, did not reveal asymmetric vestibular sensitivity, which is in contrast to SV tested during eccentric rotation in patients after vestibular neurectomy.

[Histopathology of the vestibular nerve in Menière's disease]. / Histopathologie des Nervus vestibularis beim Morbus Ménière.

Histological and morphometrical investigations of the vestibular nerve were performed on surgical specimens from 19 patients suffering from Ménière's disease and on 5 autopsy preparations from patients without inner ear disease. The number of lipofuscin granules and vacuoles in the ganglion cells of specimens from Ménière patients was not increased compared with control specimens of a similar age, nor did the amount of endoneuronal connective tissue in the vestibular nerve specimens differ between the two groups. The density of capillaries in Scarpa's ganglion and vestibular nerve was significantly increased in the Ménière patients compared with the control specimens. Furthermore, the ratio of nerve fibres with a larger diameter was higher in specimens from Ménière patients than in control preparations. There was no difference in the density of myelinated fibres between the two groups.