The human body is made up of hundreds of bones and cartilages, like the nasal valve, that provides structure, creating passages that allow air to flow through the body. Many people experience breathing problems at some point in life, often thought to be the result of congestion or the common cold, but sometimes it can be more extensive, like a nasal valve collapse.
Breathing through the nose helps to boost oxygen intake, filter out allergens, and humidify the air you breathe. Therefore, treating conditions affecting the ability to breathe through the nose is crucial.
What is a nasal valve, and what is its purpose?
The nose is constructed of many smaller parts that must work alongside each other to allow air to adequately pass through the nasal passages to reach the lungs. One key part of the nose is the nasal valve. A valve is a type of structure that is designed to regulate the flow of air within the body. The nasal valve, located in the middle to lower region of the nose, is the narrow area of the nose that regulates air as it passes through on inhalation.
The nasal valve is known to withstand air resistance as it regulates the amount of air allowed into the nose during inhalation. However, too much resistance may result in a collapse of the structure, making breathing extremely difficult. A collapse may occur for many reasons and is often the result of narrowing or weakness of the valve.
Types of nasal valve collapse
The nasal valve is divided into two sections, meaning there are only two types of nasal valve collapse.
Internal nasal valve collapse: The internal nasal valve, located between the skin and respiratory epithelium, holds great power in ensuring adequate nasal resistance. This type of collapse obstructs the narrowest section of the nasal cavity, but it is often not seen from the outside of the nose. When the cartilages located in the upper lateral portion of the nose become too weak, a collapse of the internal nasal valve may occur during inhalation. It is also commonly seen in a patient with a deviated septum that has deviated towards the valve rather than away.
External nasal valve collapse: The external nasal valve is made up of the nasal rim, the nasal floor, and the skin that separates the two nostrils (columella). An external nasal valve collapse is easily seen upon examination as it involves the collapse of one or both nostrils. When only one nostril has collapsed, breathing becomes labored but doable. However, a bilateral external nasal valve collapse leaves a person unable to get air in or out through nasal breathing.
Nasal Valve Collapse Symptoms
Symptoms of a nasal valve collapse are similar, regardless of whether the collapse is internal or external. Both types of collapse are accompanied by an obstructed nasal passage that makes it increasingly difficult to get air into the lungs through nasal breathing. The severity may differ based on the severity of obstruction.
A bloody nose
Crusting on the outer rim of the nostrils
Difficulty breathing nasally
While symptoms of an internal or external nasal valve collapse can impact a person’s daily life, they are evaluated and graded on a special scale to determine the most appropriate treatment. This scale is known as the Nasal Obstruction Symptom Evaluation (N.O.S.E.) and is used to evaluate the degree to which you experience sleeping problems, breathing difficulties, and congestion.
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Causes of Nasal Valve Collapse
Many people who experience a nasal valve collapse, whether internal or external, are also diagnosed with a deviated septum. A deviated septum occurs when the bone and cartilage separating the nasal cavity are no longer straight, making one nostril more narrow than the other. This irregularity can weaken the nasal valve, resulting in a collapse.
Other causes include:
Trauma, such as a direct hit to the nose or even a bruise, can weaken the valve itself or cause a deviated septum.
Rhinoplasty, or plastic surgery on the nose, is the most common cause of a collapsed nasal valve as it weakens and narrows the cartilage.
A severe infection or respiratory condition, like asthma, leaves scar tissue in the nasal cavity that obstructs it over time.
Inherited characteristics, such as an over-projecting nose, narrow nostrils, or an abnormally broad columella, can cause a nasal valve collapse.
Diagnosing a Nasal Valve Collapse
An otolaryngologist, also known as an ENT, specializes in diseases involving the ears, nose, and throat. An ENT can diagnose a nasal valve collapse through a detailed medical history, physical examination, and specialized testing to determine a person’s ability to breathe through the nose. A person’s medical history is important in diagnosing a nasal valve collapse, especially in those who have a deviated septum or have had previous nasal surgery.
Endoscopy. With the use of a flexible tube, the doctor can view the body through the attached microscopic camera. This is a minimally invasive procedure that is often done under intravenous sedation medication rather than general anesthesia.
Cottle’s maneuver. This is a specialized type of test where an ENT applies traction in a lateral direction to assess if breathing worsens or improves.
Bachman’s maneuver. Similar to Cottle's maneuver, this maneuver uses special instruments to widen the nasal passages, allowing the doctor to reassess breathing.
Anterior rhinomanometry. This is done by having the patient sit upright with a pressure-sensing tube inserted into one nostril. The patient is then instructed to blow their nose while the tube measures airflow through the nostril.
Nasal Valve Collapse Treatment Options
There are many ways an ear, nose, and throat specialist can treat a nasal valve collapse. Treatment options range from symptom relief to surgical intervention to correct the cause of the collapse. The most appropriate treatment plan for each patient differs based on their Nasal Obstruction Symptom Evaluation, medical history, and doctor preference. Nasal valve collapse treatment options include:
In-office Treatment (Nasal Remodeling)
Performed in the office of your Otolaryngologist, the Vivaer procedure is performed using a special device designed to apply radio frequency energy at a low temperature to tighten and contract the cartilage and tissue that has been damaged in the nasal cavity. This treatment reshapes the nasal valve and the area surrounding it to allow for better airflow. Patients who have undergone this procedure report immediate relief in nasal breathing.
Minor damage to the nasal valve without a complete collapse may not warrant invasive treatment but rather be treated with:
Over-the-counter nasal decongestants that contain pseudoephedrine. The pseudoephedrine in these medications helps to reduce swelling and inflammation, making breathing easier.
Wearable devices like a nasal valve dilator or breathing strips help to open the valve adequately during the night to allow for a better night’s sleep.
The most common treatment option for a complete nasal valve collapse, whether internal or external, is Alar Batten grafting. This surgical intervention allows the doctor to remove an area of cartilage from another part of the body to be placed along the nasal valve to reinforce the sidewall and structure.
In addition to grafting, the root cause of the collapse is addressed during surgery through:
Septoplasty. A deviated septum is commonly the culprit of a nasal valve collapse. As a result, a septoplasty procedure is often performed to reposition the deviated septum with grafting of cartilage to strengthen the nasal valve in hopes to prevent future collapse.
Turbinate reduction. The turbinates are responsible for warming and humidifying air as you take a breath. When these areas become enlarged, the nasal valve is at an increased risk of collapsing. Turbinate reduction allows the doctor to reduce swelling to facilitate adequate breathing.
Treating Nasal Valve Collapse at Houston ENT and Allergy
At Houston ENT & Allergy, we specialize in disorders involving the ears, nose, and throat. With more than 100 years of serving the Houston community, you can rest assured our team is up-to-date on the latest technology and intervention methods, like Vivaer nasal airway remodeling, balloon sinuplasty, and other ENT and allergy services. If you’ve been diagnosed with nasal valve collapse or suspect you have it, reach out to us today.
Dr. Suchanova is a Diplomate of the American Board of Otolaryngology Head and Neck Surgery and a Fellow of the American Academy of Otolaryngology Head and Neck Surgery.
She is fluent in English, Czech, Slovak and conversational in Spanish.