A Prognostic Multigene Classifier for Larynx Carcinoma

OBJECTIVE: 1) Evaluate whether a facial palsy protocol improves the clinical management of facial palsy. 2) Assess the efficacy of the House-Brackmann (HB) scale in prescribing eye care for patients. METHOD: A cross-sectional study of patients presenting with facial palsy was performed in a UK Otolaryngology out-patient department from January 2008 to December 2009. A specific Facial palsy management protocol was followed, developed from outcome assessment data in a previous 20052006 analysis. Documentation of diagnosis, side of palsy, trauma, upper or lower motor neuron lesion, cranial nerve examination, parotid and neck examination, otoscopy, audiology, examination of the oral cavity, HB grade and treatment with eye care, acyclovir and/or prednisolone were recorded, analyzed and compared to previous data. RESULTS: Ninety-four case notes were included with a mean age of 43.56 yrs (range 2-86) and 44/50 male to female ratio. The patients mean delays to initiating treatment and assessment in secondary care were 2.51 and 5.15 days respectively. Following the protocol introduction there was an improvement in documentation of assessment in facial palsy, particularly neck examination 6% to 57.4% and HB documentation from 61% to 83%. Patients diagnosed with a palsy of grade IV or above were 19 times more likely to receive eye care ( 2 18.056, p 0.025) than those with grade III or less. CONCLUSION: The departmental facial palsy protocol for junior inexperienced doctors improves management. Ensuring documentation of the HB scale significantly improves eye care prescription.