Nasal Valve Collapse and Treatment

Nasal valve collapse is a breathing disorder that can result in severe nasal congestion, snoring and mouth breathing. Not all doctors may recognize when nasal valve collapse is present. Valve collapse can be a cause of nasal obstruction as well as sinus issues, so it is important that you explain all of your symptoms to your ENT or sinus specialist. If you think you may have, or have been diagnosed with valve collapse in the past, you would want to share this with your nasal surgeon. You should have a list of your medications and disclose any previous nose surgeries, especially past rhinoplasties. Luckily, there are a variety of conservative as well as surgical treatments available to treat nasal valve collapse. Keep reading below and you’ll be on your way to improved breathing!

What is the nasal valve?

There are actually an internal and an external nasal valve in each side of the nose.  The nasal valves are the part of the nose that are the most narrow in the nasal airway. They are found in the middle and lower parts of the nose.

The external valve is comprised of four parts:

  • the anterior septum
  • lateral nasal wall
  • head of the inferior turbinate
  • the bony lateral piriform aperture

The internal valve is comprised of two parts:

  • the nasal septum from under the nasal bones to near the tip
  • the upper lateral cartilage that extends laterally from the midline septum under the nasal bone on each side

 

There is often limited airflow in the nasal valves, since they are the narrowest part of the nasal airway and the valve often works to limit airflow. Resistance in the nose is important to give you the sensation that you are breathing and to help you warm, humidify and purify the air you breathe.

nasal_valve_collapse

This diagram of  the nose pinpoints the locations of the external & internal nasal valve.

What does nasal valve collapse look like?

If you suspect you might suffer from nasal valve collapse, make an appointment with a nasal specialist. He will give you an examination that assesses the various symptoms of the condition. For example, a “pinched” nose is one telltale sign. Your doctor might also ask you to take a deep breath and see if whether there is severe collapsing of the nasal sidewalls. An “overdone” cosmetic rhinoplasty, wherein the nose is extremely narrow, might also point to nasal valve collapse.

What is nasal valve collapse?

Nasal valve collapse is a condition that occurs when the nasal valve is weakened or narrowed. The condition is frequently noticed after a rhinoplasty since its occurrence is susceptible to any type of modification or changes to the nose’s basic structure.

Nasal valve collapse causes increased resistance when breathing, similar to the feeling of being unable to take in enough air to breathe properly.

What is the cause of nasal valve collapse?

The most commonly-encountered causes of nasal valve collapse are the following:

  • Previous cosmetic rhinoplasty procedures (including removal of a dorsal hump)
  • Nasal trauma or nasal fracture (causing inflammation, inflated tissue or excess scar tissue)
  • Congenital defect in the nasal cartilage (i.e. narrow nostrils, or a wide collumela)
  • Deviated septum
  • Aging (the aging process naturally causes weakness in the overall structure of the nose)

What are the symptoms of nasal valve collapse?

The most common symptoms of nasal valve collapse are listed below.

  • Severe nasal congestion and a pronounced difficulty in breathing inward from the nose
  • Obstruction of the nasal and sinus passageways

How is nasal valve collapse diagnosed?

It is recommended that you make an appointment with a board-certified otolaryngologist (ENT) doctor to determine whether you have nasal valve collapse. To test yourself at home to find out whether you should schedule a consultation, pull up your cheek on the side where you are having difficulty breathing. If you find that you are able to breathe better as a result, you may have a nasal valve problem.

Before and after: correction of external valve collapse (actual patient).

Nasal valve collapse is often difficult to diagnose by even the most qualified and skilled ENT doctors, because the symptoms of nasal valve collapse and other nasal breathing conditions often overlap. For example, the same symptoms associated with nasal valve collapse are also inherent in enlarged turbinates or a deviated septum.

In making a proper diagnosis, your doctor will likely ask for a detailed account of your past medical history, including any past nasal surgeries. He or she will also likely perform an examination of the nose, via a nasal endoscopy, whereby he or she uses a device called a nasal endoscope to look into the nasal cavities and pinpoint any problems. For some patients, your doctor may perform an acoustic rhinometry, whereby sound waves are used to determine whether the valve area in the nasal cavity is too narrow.

How is nasal valve collapse treated?

Before and after: Correction of right internal valve collapse due to a previous cosmetic rhinoplasty. Note the ‘inverted-V’ shape of the right nasal bone on the left pre-operative photo (actual patient).

Treatment No. 1 – Nasal Valve Surgery – Many patients who are diagnosed with nasal valve collapse elect for surgery to permanently correct their symptoms. During surgery, your doctor rebuilds your nose to give it more structural support. Most often, cartilage grafting in one or both of the internal and external nasal valves, called spreader grafts and alar batten graft, respectively, are placed to create this stability. Overall, doctors and medical researchers agree that surgery is the most permanent and effective treatment option for nasal valve collapse.

Note: Since nasal valve collapse can negatively affect your health, surgery to correct this condition is generally not considered elective or cosmetic. As a result, your insurance carrier is likely to cover the costs of surgery, leaving you with little to no out-of-pocket costs depending on your individual policy. The shape of your nose will change with this corrective surgery and your surgeon should be able to show you an image of the projected result.

Treatment No. 2 – Nasal Valve Dilator – Patients will sometimes opt for treatment via a nasal valve dilator. This mechanism, primarily worn at night, helps to manually widen the nasal valves and is most commonly sold in the form of Breathe Right strips, which are also worn by athletes and sufferers of sleep apnea. Nasal cones can be placed inside the nostrils to open the valves as well.

Treatment No. 3 – Medication –  Decongestants and nasal steroid sprays can shrink the nasal mucosa and open the nasal valves enough to improve breathing. Care must be taken not to use “Afrin” (oxymetazoline) nasal spray for more than 3 days in a row as it can cause severe rebound congestion.

Treatment No. 4 – Environmental Precautions –  DSometimes the difference in your nasal valves feeling OK and feeling obstructed can be a few millimeters. If you have untreated dust or seasonal allergies then just having a air purifier and performing a few houskeeping tasks can give you marked improvement. Go to the Allergy-Proof Your Home page to learn more.

Treatment No. 5 – No management –  If the pinched nose or inverted-V deformity doesn’t bother you, and your breathing is acceptable for you then you don’t have to do anything. If you change your mind later you won’t do additional damage by waiting.

If you have a functional problem that concerns you like nasal valve collapse, make an appointment with your ENT for evaluation. Your doctor will discuss the best treatment method with you, and you can begin to take steps to restore your breathing back to normal. Remember that this condition is one of the most over-looked causes of nasal airflow obstruction, so don’t forget to provide an exhaustive list of symptoms.

breathing easy

Many patients’ have improved breathing ability from nasal valve collapse surgery.

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