Indication and timing of electrodiagnostic tests in facial palsy
Reviewed by Gauri Mankekar

This excellent review describes the benefits and limitations of electrodiagnostic testing for patients with facial paralysis. Tests such as Schirmer, stapedial reflex and electrogustometry have been largely replaced by neurophysiologic tests like nerve excitability test (NET), electroneuronography (ENoG), surface electromyography (nEMG, sEMG), blink reflex testing and transcranial magnetic stimulation (TMS). ENoG and EMG are superior to NET and considered the two necessary tests for the electrodiagnostic workup of a patient with facial palsy. ENoG can be predictive of recovery within the three-to-21-day window after facial palsy but cannot be used alone because it cannot differentiate neuropraxia from severe nerve injury. The authors recommend using ENoG together with EMG in patients with complete facial paralysis as it provides information about the type of injury which is important for treatment planning. They conclude that neurophysiologic tests are invaluable and help to determine prognosis of facial paralysis. As otolaryngologists, we encounter patients with facial paralysis frequently. In the absence of international consensus guidelines, individual physicians must determine indication and timing for the electrodiagnostic tests to be done. Hopefully we can have an international consensus statement on this important topic.

Electrodiagnostic/neurophysiologic testing in facial paralysis: A review of techniques and applications.
Zaccor N, Wang W.
OPER TECH OTOLAYNGOL HEAD NECK SURG
2022;33(1):2-11.