***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Authors report an experiment performed in a r and omized group of newborns to evaluate the frequency of post-partum septal deviations . A number of 423 subjects out of 1142 have been examined in a 17-month period . Newborns have been examined with an otoscope and two different kinds of nasal lesions have been considered : ( 1 ) pyramid deformation with septum dislocation and columella deviation ; ( 2 ) deviation and subluxation of the septum . A number of 315 newborns were naturally delivered and 108 by cesarean section .  In the former group , 10 pyramid deformations and 12 septal deviations have been found ; in the latter , only septal deviations have been revealed ( 5 infants ) . Pyramid deformations may be related to delivery(labor)trauma while for septal deviations a developmental defect may be postulated Objective . The sphenoidal process of the septal cartilage ( SP ) is a small strip of cartilage between the perpendicular plate of ethmoid bone and vomer . The present study was performed to evaluate the clinical significance of the SP in the development of nasal septal deviation . Study Design . Prospect i ve , controlled . Setting . Academic rhinologic practice . Subjects and Methods . The authors examined 136 patients with nasal septal deviation . The length of SP was measured during septal surgery , and values were compared with the deviation angle . The distance between the anterior nasal spine ( ANS ) and the breakpoint of the suture line between the septal cartilage and the perpendicular plate of the ethmoid bone ( ANS-PPE ) and that from the ANS to the point where the choana meets the sphenoid sinus ( ANS-CS ) were determined and compared according to the age . Results . The mean length of SP in patients with a deviated nasal septum was 25.90 ± 7.82 mm and decreased with age . The average deviation angles at the level of the ostiomeatal unit and nasal valve area were 8.28 ° ± 3.50 ° and 10.37 ° ± 4.38 ° , respectively . These angles increased with the length of SP ( P < .01 ) . The mean length of ANS-PPE showed a significant negative correlation with age . The mean length of ANS-CS had no correlation with age . Conclusion . SP was longer with increasing deviation angle in patients with nasal septal deviation . A long SP , a remnant cartilaginous tail of the nasal septum result ing from delayed ossification of the nasal septum , contributes to the exacerbation of septal deviation OBJECTIVE A high incidence of septal deviation with significant inter-rater variability has been reported . An explanation could be the presence of physiological septal deviation besides pathological ones . We differentiated an unselected cohort by their nasal resistance into groups with physiological normal and pathologically increased resistance to detect differences and analogies in comparison to healthy subjects and a pathological cohort . STUDY DESIGN Prospect i ve cohort study . SETTING A total of 356 patients were assessed using rhinoresistometry , acoustic rhinometry , endoscopy and visual analogue scales .  After definition of a benchmark between physiological and pathological nasal resistance , group differences were calculated and correlations analysed . RESULTS The normal one-sided inspiratory nasal resistance was defined as less or equal to 0.35 sPa/cm^3 at a flow-velocity of 250 cm^3/s ( R250 ) . Using this benchmark , the unselected group of non-rhinological patients was differentiated into 114 subjects with physiological nasal resistance and 44 with pathological septal deviation . Nasal resistance after decongestion was significantly lower for normal or patients with a physiological septal deviation in comparison to the rhinological one on both nasal sides . Healthy subjects and patients with physiological septal deviation showed similarities in objective rhinological parameters as well as rhinological patients and patients with pathological septal deviation derived from the unselected group of non-rhinological patients . Furthermore , this benchmark of nasal resistance shows significant correlations with subjective assessment of nasal breathing . CONCLUSION Inspiratory nasal resistance obtained at a flow-velocity of 250 cm^3/s using rhinoresistometry may be useful to distinguish patients with physiological and pathological septal deviation . Correlation with subjective assessment and endoscopic findings is improved OBJECTIVES /HYPOTHESIS Septoplasty is a frequently performed surgical procedure with the most common indication being nasal airway obstruction . Almost universally , health insurance companies m and ate a trial of medical therapy consisting of intranasal corticosteroids prior to performance of septoplasty regardless of clinical assessment . Evidence for this requirement is lacking . We sought to evaluate the initial clinical assessment as a predictor of response to this m and ated trial of medical treatment . STUDY DESIGN Retrospective review of prospect ively collected data on 137 consecutive patients who presented with symptoms of nasal obstruction and a deviated nasal septum on physical examination . METHODS Patients were placed into one of three cohorts based on prediction of 1 ) failure of medical therapy with subsequent septoplasty , 2 ) success of medical therapy without subsequent septoplasty , or 3 ) unable to make a prediction . Patients from each cohort were assessed for subsequent response to medical therapy and ultimate need for septoplasty .  RESULTS Overall clinical assessment had a sensitivity of 86.9 % , specificity of 91.8 % , positive predictive value of 93.6 % , and negative predictive value of 96.4 % for detecting/predicting need for septoplasty . The accuracy of the overall clinical assessment is considerably better than severe deviation at any one septal anatomical site . Of patients whose response to medical therapy could not be predicted , 61.3 % failed medical therapy and needed surgery ; this is statistically equivalent to a 50/50 distribution between either needing septoplasty or not . CONCLUSIONS Clinical assessment at initial presentation of patients with nasal obstruction and deviated septum is highly accurate in predicting which patients will need septoplasty The aim of the present study was to assess the clinical utility of acoustic rhinometry ( AR ) compared with active anterior rhinomanometry ( AAR ) in the evaluation of nasal patency in subjects with nasal septal deviation . Fifty patients were divided into three groups based upon the part of the nasal cavity where the septal deviation was situated ( anterior : up to 2.5 cm ; middle : between 2.5 and 4.5 cm ; posterior : between 4.5 and 8 cm measured from the columella ) . The control group consisted of 15 subjects with no nasal complaints and no history of nasal disease .  Inspiratory and expiratory nasal airway resistance ( NAR ) at 75 Pa and at 150 Pa before and after decongestion were measured by AAR .  Minimal Cross-sectional Area ( MCA ) , distance of MCA , and nasal volume ( Vol ) were measured before and after decongestion by AR ( Rhino 2000 ) . Subjective nasal patency was assessed by Visual Analogue Score ( VAS ) . In the statistical analysis the deviated unilateral nasal cavities were compared with the r and omly chosen unilateral nasal cavities of normal subjects . Both techniques AR and AAR were sufficiently sensitive to reveal severe deviations in the anterior nasal cavity ( MCA , Volant , NAR75 , NAR150 , p < 0.05 ) . The techniques were less sensitive in cases of middle and posterior deviations ( MCA , Volmid , Volpost , MCAmid , MCApost , NAR75 , p > 0.05 ) . The nondecongested inspiratory and expiratory NAR at 150 Pa were the only parameter that differed from normal in cases of posterior deviations . The VAS correlated better with NAR than with MCA . MCA correlated more frequently with expiratory than with inspiratory NAR BACKGROUND A subjective feeling of nasal airflow obstruction is a common symptom . An objective method for quantitative measurement of nasal airflow has long been desired . Rhinomanometry and acoustic rhinometry have been developed for anatomical and physiological evaluation of nasal obstruction . This study was design ed to determine the usefulness of a portable spirometer in assessing upper airway obstruction . METHODS One hundred and ninety-six patients were assessed with nasal inspiratory spirometry to determine nasal airflow . All patients also underwent paranasal sinus computed tomography  to determine anatomical abnormalities . Spirometry was performed on each nostril separately . RESULTS Sensitivity and specificity levels were high . This portable and easy to use device may be useful in respiratory assessment . Correlation between anatomical obstructions and subjects ' complaints was statistically significant ( p < 0.001 ) , but no definite correlation between septal deviation severity and spirometric values was found . CONCLUSION Portable spirometry is an objective and useful method of evaluating nasal obstruction , but needs more investigation to establish a st and ardised test OBJECTIVE The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation ( NOSE ) scale for  septoplasty ( without turbinate reduction )  in comparison with other examination methods . METHODS Prospect i ve observational study was undertaken in otolaryngology department of university hospital .  NOSE scale for quality of life assessment  ,  visual analog scale for examination findings , acoustic rhinometry and coronal computed tomography were performed before and after septoplasty .  The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed . RESULTS Twenty-seven patients underwent septoplasty ;  there was a very significant improvement in mean NOSE scores of patients ( 60.2 versus 11.28 , p<0.01 ) . There was no correlation between NOSE scores and acoustic rhinometry . Correlation was found between NOSE scores and examination and computed tomography findings ( p<0.05 ) . CONCLUSION NOSE scale that is well correlated with examination findings and computed tomography , is very useful tool to evaluate the effectiveness of pure septoplasty Two auxiliary methods of diagnosing nasopharyngeal airway obstruction were compared . Cephalometric radiography and nasopharyngeal videoendoscopy were evaluated for efficacy in terms of reproducibility and validity . Thirty orthodontic patients ( 7 to 12 years of age ) seeking otorhinolaryngologic treatment for mouth breathing , or mouth and nose breathing , had nasopharyngeal endoscopy and radiographic examinations performed on the same day . Two otorhinolaryngologists analyzed the results . Nasopharyngeal endoscopy was more reliable in identifying all the obstructive nasopharyngeal processes . Endoscopy obtained kappa index scores of almost perfect agreement for diagnosis of posterior nasal septum deviation , of substantial agreement for anterior nasal septum deviation and lower turbinate hypertrophy , and of moderate agreement for middle turbinate hypertrophy . Lateral cephalometric radiography obtained scores of perfect agreement for imaging hypertrophy of the middle turbinate , of almost perfect agreement for imaging hypertrophy of the posterior portion of the inferior turbinate , and of substantial agreement for imaging hypertrophy of the inferior turbinate . Radiographic diagnoses of hypertrophy of the middle and lower turbinates exhibited high sensitivity and low specificity when compared with diagnoses by nasopharyngeal endoscopy 
    Output:
    
Conclusions Diagnostic modalities such as acoustic rhinometry , rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity , but these tests in isolation are of limited utility .
Compared to anterior rhinoscopy , nasal endoscopy , and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence , location , and severity of NSD