title: Clinical consensus statement: Diagnosis and management of nasal valve compromise.
abstract: 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.
authors.affiliation: Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226-3522, USA. jrhee@mcw.edu
authors.forename: John S
authors.initials: JS
authors.lastname: Rhee
authors.forename: Edward M
authors.initials: EM
authors.lastname: Weaver
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Park
authors.forename: Shan R
authors.initials: SR
authors.lastname: Baker
authors.forename: Peter A
authors.initials: PA
authors.lastname: Hilger
authors.forename: J David
authors.initials: JD
authors.lastname: Kriet
authors.forename: Craig
authors.initials: C
authors.lastname: Murakami
authors.forename: Brent A
authors.initials: BA
authors.lastname: Senior
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rosenfeld
authors.forename: Danielle
authors.initials: D
authors.lastname: DiVittorio
mesh_terms: 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