Nasal Valve Collapse

What is nasal valve collapse?

Nasal valve collapse occurs when the airway inside your nose, or nasal valve, narrows. Your nasal valve is the passageway that filters the air you breathe through your nostrils. It extends from the middle of your nose to the bottom.

A collapsed nasal valve prevents air from flowing freely through your nose, making breathing harder. Your nose may look thinner or sunken where your nasal valve has narrowed. A nasal valve collapse isn’t always visible.

Types of nasal valve collapse

Your nasal valve consists of two major sections, the internal nasal valve and the external nasal valve. They’re located at different places within your nasal cavity and surrounded by different supporting structures.

• Internal nasal valve collapse: This is the most common type of nasal valve collapse. Your internal nasal valve is the passageway in the middle of your nose.
• External nasal valve collapse: Your external nasal valve is at the bottom of your nose, near your nostrils. This type is rarer, but it’s easier to see because it causes one or both of your nostrils to collapse when you breathe in through your nose.

How common is nasal valve collapse?

Nasal valve collapse is one of the most common causes of nasal obstruction, a condition that otolaryngologists (ear, nose and throat specialists) frequently treat. A nasal obstruction occurs when there’s a blockage that’s restricting airflow in your nasal cavity.

What are the symptoms of nasal valve collapse?

Nasal valve collapse makes it harder to breathe through one or both nostrils.

Symptoms include:

• Trouble breathing (which may worsen during physical activity or when you’re lying down).
• Mouth breathing during the day and snoring at night.
• Nasal congestion (stuffy nose).

Your nose may look different (thinner or asymmetrical in places), especially if your external nasal valve collapsed.

What causes nasal valve collapse?

With nasal valve collapse, the tissue that supports your nasal valve (primarily cartilage) weakens. As a result, the airway narrows. Anatomical differences, surgery and injury can all contribute to the weakening.

Risk factors

The most common risk factors for nasal valve collapse include:

• A deviated septum. Most people with nasal valve collapse also have a deviated septum. Your septum is a thin strip of cartilage and bone in the center of your nose. A septum that’s “deviated” is crooked or bent. It divides your nasal valve into two, unequally sized parts. The uneven structure can lead to a collapse in one or both sides.
• The nasal structure you’re born with. You may be born with characteristics that increase your risk of nasal collapse, including a deviated septum. Narrow nostrils, a widened area between your nostrils (columella) and a nose that sticks out from your face (over-projecting nose) can also increase your risk.
• Nose job. A nasal valve collapse can happen following surgery on your nose (rhinoplasty). When this happens, it’s much more common to have slight narrowing rather than more severe collapse.

Other risk factors include:

• Aging. Tissue that supports your nasal valve can lose strength with age.
• Injury. Trauma to the bones and tissues inside your nose can weaken their support.

How is nasal valve collapse diagnosed?

A healthcare provider will ask about your medical history and symptoms. They may ask you questions from the nasal obstruction symptom evaluation (NOSE) questionnaire. NOSE ranks your symptoms from mild to extreme. Questions determine how breathing difficulties, stuffiness and trouble sleeping impact your quality of life.

Your provider will perform a thorough physical exam of your nose and throat that may include multiple tests.

Nasal valve collapse tests

Tests include:

• Endoscopy: A nasal endoscopy uses an endoscope (flexible tube with a light and camera) to look inside your nose.
• Cottle maneuver: Your healthcare provider may gently pull your cheek to the side to widen your nasal valve. They may perform a modified technique that uses a small instrument or cotton swab to widen your nostril on the affected side. The Cottle maneuver can help your provider identify where the collapse is.

How is nasal valve collapse treated?

Nasal valve collapse often requires surgery. If your symptoms are mild, your provider may recommend managing symptoms without surgery first.

Nasal valve collapse surgery

Your healthcare provider will recommend the best surgical techniques to fix nasal valve collapse. Most surgeries are outpatient, which means you can go home the same day of your surgery.

Options include:

• Grafting: Your healthcare provider removes cartilage or bone from another part of your body, like your ear or rib, and inserts (“grafts”) the tissue into your nose. The extra tissue widens your nasal valve. There are several grafting techniques, but the most common is called the Alar Batten graft.
• Implants: Your provider implants a device that supports fallen cartilage into your nose. Implants may include a butterfly-shaped device (the titanium butterfly) and an injectable implant called Latera®.
• Suture suspension: Your provider uses sutures to connect tissue from your nasal valve to tissue beneath your eye. This procedure lifts your nasal valve upward and outward, widening the space.

You may need surgery to address structural issues that can contribute to nasal valve collapse, including:

• Septoplasty: Surgery to correct a deviated septum.
• Turbinate reduction: Surgery to decrease the size of your turbinates, bony structures inside your nose.

Nasal valve collapse treatment without surgery

• Breathing strips stick to the outside of your nose, lifting the skin and opening your nostrils. They may help you breathe easier and sleep better at night.
• Internal nasal dilators go inside each nostril, pressing the cartilage outward to widen your nasal valve. Like breathing strips, they may help you sleep easier.

Does nasal valve collapse get worse?

Not in all cases, but it’s possible. Nasal valve collapse happens when there’s weakening in the structures that support your nasal passages. Without treatment to reinforce weak areas, these structures can continue to fall.

What is the outlook for nasal valve collapse?

Most people report that their symptoms improved after nasal valve collapse surgery. Fixing the collapse can help you breathe easier and sleep better.

What questions should I ask my doctor?

Questions include:

• How severe is the collapse?
• Will I need surgery to repair it?
• What types of surgery would you recommend?
• What are the potential risks of surgery?
• What’s the success rate of the recommended surgery?
• How long will it take to recover?

A note from Cleveland Clinic

See a healthcare provider if you’ve got a stuffy nose that doesn’t get better or if you’re having trouble breathing. These symptoms may relate to a structural abnormality in your nose, like nasal valve collapse. If the collapse is mild, your provider may recommend treatments to manage the discomfort. In some cases, surgery is the best option to ensure you’re getting enough air through your nasal cavity. Your provider can recommend the best options for you.