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 a 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 is 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.

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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 Are The Causes 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)
  • Deviated septum

 

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

 

What Are The Risk Factors That Lead To Nasal Valve Collapse?

The most common risk factor that leads to nasal valve collapse are:

  • Aging (the aging process naturally causes weakness in the overall structure of the nose)
  • Congenital defect in the nasal cartilage (i.e. narrow nostrils, or a wide columella)

 

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.

 

Rhinoplasty Preparation

Dr. Bennett individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your surgery in detail to make sure all of your questions are answered.  Depending on whether you have functional/breathing issues insurance may cover part of your surgery.

 

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).

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.

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.

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.

Environmental Precautions

Sometimes 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 an air purifier and performing a few housekeeping tasks can give you marked improvement. Go to the Allergy-Proof Your Home page to learn more.

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.

breathing easy

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

 

Nasal Valve Collapse Recovery

The week after the procedure it is normal to have a mild headache for a day or two. You will be given some pain medicine, although most patients take only one or two doses and then switch to an over the counter pain medication. If you see scant, reddish fluid draining from the nose, you should place a dressing under the nostrils to avoid sniffling. You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery. You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more. You will return to the office one week after surgery to have the nasal dressing removed, then return as needed to have the nose checked. Avoid strenuous exercise for three weeks. Avoid wearing glasses for six weeks.

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.

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Meet Dr. Garrett Bennett

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Meet Dr. Garrett Bennett

Dr. Bennett is a New York City sinus surgery and rhinoplasty specialist. He is double board-certified with board certifications in Otolaryngology by the American Board of Otolaryngology, and Facial Plastic Surgery by the American Board of Facial and Reconstructive Surgery. He operates and has privileges at Lenox Hill Hospital, a signature acute care facility part of the Northwell Health System, and Gramercy Medical Center located in Manhattan, New York. Learn More »

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