Clinical consensus statement: Diagnosis and management of nasal valve compromise.
OBJECTIVE
To create a clinical consensus statement to address ambiguities and disparities in the diagnosis and management of nasal valve compromise (NVC).


METHODS
An updated systematic review of the literature was conducted. In addition, a Modified Delphi Method was used to refine expert opinion and facilitate a consensus position.


RESULTS
After two rounds of surveys and conference calls, 36 items reached consensus, six items reached near consensus, and 10 items reached no consensus. The categories that had the greatest percentage of consensus or near consensus items were as follows: definition, history and physical examination, outcome measures, and management. Conversely, the categories with greater percentage of no consensus items were adjunctive tests and coding.


CONCLUSIONS
The consensus panel agreed that NVC is a distinct clinical entity that is best evaluated with history and physical examination findings. Endoscopy and photography are useful but not routinely indicated, whereas radiographic studies are not useful in evaluating NVC. Other objective nasal outcome measures may not be useful or accepted for NVC. Nasal steroid medication is not useful for treatment of NVC in the absence of rhinitis, and mechanical treatments may be useful in selected patients. Surgical treatment is the primary mode of treatment of NVC, but bill coding remains ambiguous and confusing.
Rhee
John S
JS
Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226-3522, USA. jrhee@mcw.edu
Weaver
Edward M
EM
Park
Stephen S
SS
Baker
Shan R
SR
Hilger
Peter A
PA
Kriet
J David
JD
Murakami
Craig
C
Senior
Brent A
BA
Rosenfeld
Richard M
RM
DiVittorio
Danielle
D
D001291:Attitude of Health Personnel; D039702:Current Procedural Terminology; D003697:Delphi Technique; D006801:Humans; D055171:Nasal Cartilages; D009296:Nasal Cavity; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010036:Otolaryngology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012225:Rhinoplasty