We are now at a point where technology can offer immense opportunities to rapidly analyse data in real time and provide and objective output. However, the objective output is still subjectively interpreted by the clinician and the patient. The proliferation of assessment scales suggests we are looking at “more and more about less and less”. This does not dispute the validity of such scales, but is it feasible in the short- to medium-term to document so many different aspects? In the long term we need to incorporate objective outcome measures as well as subjective measures as there is no strong correlation between what the clinician sees as a good result and how the patient perceives it. PROM (patient-reported outcome measure) studies are underway and may bridge the gap between these two standpoints or at least provide an insight into how the patient interprets the results of their treatment. Should we have (do we want?) scales for every aspect of our management? Can we ever produce a unified scale that comprises all aspects of the effects of facial palsy from multiple perspectives or is this too reductionist? These questions are difficult to answer: yes we need to objectively to measure our outcomes in order to maintain standards but as suggested above, this may not correlate to patient satisfaction. A unified scale may be a very difficult thing to develop and achieve consensus based on our experience with grading scales so far. What do you think? I am genuinely interested to hear whether this is ultimately a fruitless search for an objective scale that ultimately reflects a subjective opinion.
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