2. TOPOGNOSTICTESTING
1. Schirmer test for lacrimation (GSPN)
2. Stapedial reflex test (Stapedial branch)
3. Taste testing (Chorda tympani nerve)
4. Salivary flow rates & pH (Chorda tympani)
ELECTROPHYSIOLOGICTESTS
Nerve excitability test (NET)
Electromyography(EMG)
Maximal stimulation test (MST)
Electroneuronography (ENoG)
Testing of Facial Nerve
3. Topographic Diagnosis
To determine the anatomical level of a peripheral lesion
Lacrimation Geniculate ganglion
Stapedius reflex motor nerve of stapedius muscle
Taste chorda tympani
6. Schirmer's Test
Geniculate ganglion & petrosal nerve function test
Schirmer’s test +ve when
Affected side shows less than half the amount of lacrimation seen
on the normal side
Sum of the lengths of wetted filter paper for both eyes less than 25
mm
Lesion at or proximal to the geniculate ganglion
7. Stapedius reflex
Nerve to stapedius muscle test
Impedence audiometry can record the presence or absence
of stapedius muscle contraction to sound stimuli 70 to 100 db
above hearing threshold
An absence reflex or a reflex less than half the amplitude is
due to a lesion proximal to stapedius nerve
11. Electrogustometry
Normal : difference
< 20 uAmp
(thresholds differing
by more than 25%=
abnormal)
Total lack of
Chorda tympani :
No response at 300
uAmp
Disadvantage :
False +ve in acute
phase of Bell’s palsy
12. Salivary Flow Test
Chorda tympani
Warthins ducts are cannulated and salivary flow is
measured over time following a gustatory stimulus
65% citric acid on anterior part of tongue
<25% considered abnormal