Nasal Valve Collapse: Symptoms and Treatment Options

Breathing Difficulties May Be a Sign of Airflow Obstruction

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The nasal valve is the narrow area in the nose through which air passes. It refers to the opening from the middle to the bottom of the nose. When this passage becomes blocked it’s a condition known as nasal valve collapse. 

The nasal valve is the narrowest part of the nasal airway, and there’s naturally a great deal of air flow resistance. If any weakness or further narrowing of the nasal valve occurs, it can block airflow and make breathing difficult. A nasal valve collapse can be treated surgically and non-surgically to prevent or correct breathing problems.

Woman with bandaged nose
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Types of Nasal Valve Collapse

The nasal airway is anatomically complex since it’s made up of several structures, including:

  • Lateral nasal wall
  • Anterior septum
  • Head of the inferior turbinate
  • Osseous piriform aperture

Overall, the nasal valve is divided into two sections, which means that there are two types of nasal valve collapse:

Internal nasal valve collapse: This is an obstruction of the narrowest section of the nasal airway about halfway up the nose.

External nasal valve collapse: This refers to a collapse of the nostrils. It’s easier to see and diagnose since you can see the nostrils are pressed in during inhalation.

Causes

Most people with a nasal valve collapse also have a deviated septum, which is when the cartilage and bone that separates the nasal cavity are not straight, so one nasal passage is smaller than the other.

Trauma to the nose can cause a deviated septum and lead to nasal valve collapse, or such injuries could directly result in an internal or external nasal cavity collapse.

However, nasal valve collapse most frequently occurs as a result of cartilage being weakened from rhinoplasty (plastic surgery to the nose).

Risks of Nasal Valve Collapse

Trauma or nose surgery can cause nasal valve collapse as a result of inflammation, enlarged tissue, or possibly the formation of scar tissue in the nasal passages.


Nasal valve collapse can also occur without any trauma or history of nose surgery, and may actually be the result of inherited anatomical characteristics such as:

  • An over-projecting nose
  • Narrow nostrils
  • Wide columella (the part of the nose that separates the two nostrils)
  • Other congenital conditions

You may be more likely to develop nasal valve collapse as you age since the structures that make up the nasal valve naturally weaken with time.

Symptoms

With a nasal valve collapse, your breathing is obstructed and you have to work harder to get air into your lungs through the nose. This leads to nasal valve collapse symptoms such as:

  • Congestion or stuffiness
  • Difficulty breathing through the nose
  • Bloody nose
  • Crusting around the nostrils

Symptoms of nasal valve collapse are graded based on a scale known as the Nasal Obstruction Symptom Evaluation (NOSE) scores. This looks at the degree that you experience nasal congestion, blocked nasal passages, trouble breathing through the nose, trouble sleeping, and problems getting air through the nose during exercise. 

Diagnosis

An otolaryngologist (ear, nose, and throat or ENT doctor) usually diagnoses nasal valve collapse.

It's a difficult diagnosis to make, especially since an enlarged turbinate or deviated septum can cause the same symptoms and may be overlapping conditions. Your medical history can be important in obtaining a diagnosis, particularly if you have had a history of nasal surgeries.

To examine the nose, your healthcare provider may conduct an endoscopy. Several more complicated nasal valve collapse tests may be done as well, such as:

  • Cottle's maneuver: The nasal valve area is widened by pulling it in a lateral direction. If breathing improves when the nasal valve area is manually widened, it is an indication of nasal valve collapse.
  • Bachman's maneuver: The nasal valve is widened using instruments and then improvements in breathing are assessed.
  • Anterior rhinomanometry: You sit upright and blow your nose while a pressure-sensing tube in one nostril measures nasal airflow.
  • Acoustic rhinometry: Sound waves are used to assess changes in the nasal cavity.

Treatments

There are a number of ways that healthcare providers relieve symptoms and correct the cosmetic problems related to nasal valve collapse. These options include:

Nose Surgery

The most common treatment for nasal valve collapse is surgery. Specifically, a collapse of the nasal valve is usually corrected via structural cartilage grafting, which requires your surgeon to take cartilage from one part of your body and place it along the nasal valve to reinforce that structure.

A procedure known as alar batten grafting is the most common surgical approach. Surgeons place a thin piece of cartilage or bone over the sidewall of the nasal passage to strengthen it.

In addition to grafting, newer procedures involve placing an implant in the nose. These implants can reduce symptoms and maintain the valve walls' shape. More research is needed, though, to understand how effective this treatment is compared to grafting.


Along with fixing the structure of the valve, surgeons may need to repair issues that contributed to the collapse of the nasal valve. These procedures may include:

  • Septoplasty: The repair or reposition of a deviated septum; cartilage removed during this procedure may be used in a graft to strengthen the nasal valve
  • Turbinate reduction: Reduces enlarged turbinates, sections of tissue in the nose that warm and humidify the air you breathe.

Risks of Surgery

Like all operations, surgical repair of a nasal valve collapse does carry some risks. These include general surgical risks related to anesthesia or infection. Additional things to be aware of include:

  • Possible need for ongoing treatment for breathing such as decongestant medication
  • Scarring, including visible scars on the nose or internal scar tissue
  • Changes in nasal sensations such as pain or numbness in the area that was operated on
  • Nasal septal perforation, a hole in the septum that might need to be surgically repaired as well
  • Need for other follow-up surgeries

Non-Surgical Options

If the damage to your nasal valve is minor or if you want to delay surgery, you may be able to manage the symptoms with an over-the-counter nasal decongestant that contains pseudoephedrine, which will decrease swelling in the nose and allow you to breathe more easily.

Nasal valve dilators are materials that manually open up the valve. A nasal valve dilator is usually worn at night.

Breathe-Rite strips, one over-the-counter option, are adhesive strips that can be stretched across the nose. They then open the valves and improve breathing by pulling on the outside skin of the nose. Other dilators are made of silicone and are worn internally.

The use of nasal valve dilators as a therapy or treatment for nasal valve collapse has not been adequately studied at this time.

Recovery After Surgery

Surgery for nasal valve collapse is a one-day procedure. Your doctor will instruct you to limit activity for several days or weeks after, but, in general, you should be able to return to all activities within a few weeks.

There may be pain and swelling after nasal valve collapse surgery, but they should be manageable with medication. You may bleed for a short time as well. It can take up to a full year for all of the swelling to go down.

Frequently Asked Questions

  • How do you fix a collapsed nasal valve?

    Nasal valve collapse is usually corrected with surgery. The surgeon removes cartilage from another area of the body such as the ear and places it in your nasal passage to reinforce the valve.

  • Can nasal valve collapse get better on its own?

    No. Once the valve has collapsed, you can manage symptoms that make it hard to breathe, but the problem won't heal on its own. You need to see a doctor that specializes in nasal conditions.

  • How long does nasal valve collapse surgery take?

    It can take several hours for surgeons to repair a collapsed nasal valve. The amount of time needed will depend on whether you have additional procedures done at the same time, such as repairing a deviated septum, and how badly the collapsed valve is damaged.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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