Learning Objectives: At the completion of this talk the attendee will understand the history of facial nerve monitoring, proper use of the facial nerve monitor and requirements for resident training.

Facial nerve integrity monitoring(NIM) using subcutaneous EMG needles has been established as standard of care for neurotologic and skull base surgery for decades. Several studies have shown that facial NIM is cost effective and best practice for otologic surgery. Despite this level of evidence, there are still several points about routine use of facial NIM that remain controversial.

There is no standard to say in which otologic cases it should be used. Controversy exists over who should be doing the monitoring – otologists, neurologists, audiologists or neurophysiologists. This leads to questions about which specialty has the appropriate training to make them most qualified to do facial NIM. The American Clinical Neurophysiology Society has published guidelines on proper training and method for facial NIM. The American Board of Otolaryngology has mandated training in facial NIM as a core requirement for otolaryngology residency, although there is no core curriculum to teach facial NIM in a uniform manner. Yet another controversy exists over billing for facial NIM. Although CPT codes exist for facial nerve monitoring, these codes cannot be billed concurrently with surgery codes.

The American Academy of Otolaryngology has set up a task force to look at these controversies and come up with an educational plan to ensure that all otolaryngology residents are trained appropriately. The task force will also survey residency directors to assess how facial NIM is being taught.