Nasal Valve Collapse

Nasal valve collapse is a relatively common cause of nasal obstruction characterized by collapse of the cartilaginous part of the nasal tip with inspiration. Although a deviated (crooked) septum and enlarged turbinates are the most common cause of poor nasal breathing, nasal valve collapse may play a prominent role in up to one of four patients with these symptoms.

The nasal valve includes several structures; the most important area is where the upper lateral cartilages meet the septum. This is an extremely narrow area and even a very small decrease in diameter can cause major obstruction. Narrowing in this area often is the result of nasal trauma (i.e., a nasal fracture) or from prior nasal surgery, especially a cosmetic rhinoplasty. Some patients have no history of trauma or surgery, and in those cases the collapse is felt to be from congenitally weak nasal sidewall cartilages.

Diagnosis is usually made in the office but may also be made at home. On examination, when nasal breathing is improved by manually opening the nasal valve - pushing the cheek skin towards the ear or lifting the upper lateral cartilage up from inside the nose---then the diagnosis is confirmed. At home, when breathe right strips improve nasal breathing, then generally nasal valve collapse is contributing to the problem.

Treatment is both non-surgical and surgical. Nonsurgical treatment includes use of allergy medicines (antihistamines and steroid nasal sprays), as well as breathe right strips. Surgical treatment involves reconstructing the upper lateral and lower lateral cartilages to improve their tensile strength. This discourages collapse of the nose with inspiration, and in doing so, improves the nasal airway. Nasal valve surgery is performed through a small external incision at the base of the nose and the patient′s nasal septal, and sometimes ear cartilage, are used for reconstruction.

In summary nasal valve collapse is a common, but sometimes under-diagnosed, cause of nasal obstruction. There are both non-surgical and surgical treatments for this problem.

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