The nasal valve is a critical area within the nasal airway, acting as the narrowest passage that regulates the flow of air. Nasal valve collapse (NVC) occurs when the supportive structures in this area weaken, leading to a physical obstruction that makes breathing difficult. This condition is a common cause of chronic nasal obstruction, and the structural nature of NVC raises concern about whether the obstruction will become more pronounced over time.
Understanding the Nasal Valve and Its Collapse
The nasal valve is divided into the internal and the external valve. The internal nasal valve is the narrowest segment of the entire nasal passage, located about a centimeter and a half inside the nostril. This region is bordered by the septum, the floor of the nose, and the lateral nasal wall, which is supported primarily by cartilage.
The external nasal valve is the opening of the nostril itself, supported by the lower lateral cartilages. Collapse occurs when these supporting structures, particularly the cartilage of the lateral nasal wall, fail to withstand the negative pressure created during inhalation. This results in the dynamic or static narrowing of the airway.
Initial causes of NVC are often structural, such as a congenital weakness in the cartilage or an acute injury. Previous nasal surgeries, like a rhinoplasty, can also destabilize the structure of the valve, leading to collapse. A deviated septum, a common structural issue, can place chronic stress on the lateral wall, increasing the likelihood of failure.
Factors Driving the Worsening Over Time
The answer to whether NVC worsens over time is generally yes, due to a combination of biological and mechanical factors acting on an already weakened structure. The most significant biological factor is the natural aging process, which causes a gradual loss of collagen and elastin in the nasal tissues. This loss reduces the rigidity and elasticity of the supporting cartilage, making the lateral nasal wall less able to resist the inward pull of air during inspiration.
Chronic stress on the cartilage from the constant force of inhalation also contributes to the progression of collapse. This mechanical fatigue, combined with the decreased tissue strength of aging, allows gravitational effects on the nose to have a greater structural impact. Furthermore, the presence of chronic inflammatory conditions, such as severe allergies or persistent rhinitis, can accelerate the process.
Persistent inflammation causes chronic swelling of the soft tissues lining the nasal passage, which further compromises the limited airway space. This constant swelling and irritation can lead to progressive changes in the soft tissue structure, compounding the underlying mechanical weakness. In cases following trauma or surgery, scar tissue contracture can occur months or years later, slowly deforming the valve structure and increasing the obstruction.
Identifying Signs of Progression
For individuals with existing NVC, recognizing signs of progression involves noticing consistent changes in breathing quality and related symptoms. A worsening condition often manifests as an increased reliance on mouth breathing, particularly during physical activities or while sleeping. Patients may find that their usual feeling of persistent nasal stuffiness or blockage is becoming more severe or more constant.
A noticeable decline in the quality of sleep, often marked by louder snoring or the emergence of symptoms suggesting sleep apnea, is a common indicator that the collapse is more pronounced. Many people with progressive NVC also report that over-the-counter external nasal strips no longer provide the same level of relief. A simple self-assessment tool is the Cottle maneuver, where a person gently pulls the cheek skin outward to manually open the valve area. If the improvement in breathing with this maneuver becomes significantly more dramatic, it suggests a greater degree of underlying collapse.
Management and Treatment Options
Effective treatment options range from non-surgical interventions to definitive surgical solutions. Non-surgical management is typically the first step, involving the use of external nasal dilator strips or internal nasal cones that mechanically prop the airway open. These devices offer temporary relief by providing external support to the weakened lateral wall, thereby reducing the dynamic inward collapse during breathing.
For a lasting correction, surgical approaches are often necessary to reinforce the structural integrity of the nasal valve. A common technique involves the use of cartilage grafting, where small pieces of cartilage are placed strategically to buttress the lateral nasal wall. Surgeons may use spreader grafts to widen the internal valve angle or lateral crural strut grafts to stabilize the external valve area.
Newer, minimally invasive procedures include the placement of resorbable implants or the use of suture suspension techniques to physically lift and stabilize the collapsed lateral wall. These surgical methods are designed to provide permanent structural support, preventing the mechanical failure that drives the symptoms of NVC.