Nasal valve collapse occurs when the structures within the nose that regulate airflow weaken or narrow. This condition significantly impedes breathing through the nose. The nasal valve is an area that controls how air enters the respiratory system, crucial for efficient nasal respiration.
Anatomy and Function of the Nasal Valve
The nasal valve is the narrowest segment of the nasal airway, acting as a gateway for air. It is located in the middle to lower part of the nose, extending from the nostrils into the nasal passages. This area is primarily supported by cartilage and soft tissues.
The nasal valve consists of two main parts: the internal nasal valve and the external nasal valve. The internal nasal valve is a slit-like opening about 1.5 centimeters inside the nostril, formed by the septum and upper lateral cartilages. The external nasal valve encompasses the nostril opening, including the alar rim and columella, supported by the lower lateral cartilages. Both valves work together to regulate the volume and speed of inhaled air, ensuring proper conditioning before it reaches the lungs.
Causes and Symptoms
A variety of factors can contribute to the weakening or narrowing that leads to nasal valve collapse. Trauma to the nose, such as an injury, can damage cartilage and bone structures, disrupting nasal valve anatomy. Previous nasal surgeries, particularly rhinoplasty, are also common causes, as they can weaken supporting cartilage and tissues.
Aging naturally weakens the cartilage that supports the nasal valves, making them more prone to collapse over time. Some individuals may also have congenital anatomical differences, such as a deviated septum, narrow nostrils, or an over-projecting nose, increasing the risk of collapse. Inflammation, scar tissue, or enlarged tissues within the nasal cavity can further contribute to the narrowing of the airway.
Individuals experiencing nasal valve collapse often report a persistent sensation of nasal obstruction or congestion. Difficulty breathing through the nose is a common symptom, often worsening during physical activity or when lying down. This restricted airflow can lead to mouth breathing during the day and snoring at night, which may cause a dry mouth upon waking and disrupt sleep quality.
Diagnosis and Treatment Approaches
Diagnosis of nasal valve collapse begins with a medical history and physical examination by a healthcare professional, such as an otolaryngologist. A common diagnostic technique is the Cottle maneuver, where the examiner gently pulls the cheek to the side of the nose to temporarily widen the nasal valve. If breathing significantly improves with this maneuver, it suggests a nasal valve issue. Further evaluation may involve a nasal endoscopy, which uses a thin, flexible tube with a camera to visualize the internal structures of the nose.
Treatment options for nasal valve collapse range from non-surgical interventions to surgical procedures, with the goal of improving airflow and alleviating symptoms. For mild cases, non-surgical methods can offer temporary relief. These include external nasal breathing strips, which adhere to the outside of the nose to gently pull open nasal passages, and internal nasal dilators, soft devices inserted into the nostrils to keep them open. Nasal sprays and decongestants may also reduce swelling, providing short-term relief, but they do not address the underlying structural issue.
For more lasting correction, surgical interventions are often considered, especially for more significant collapse. Grafting techniques are common, involving the use of cartilage, often taken from the patient’s septum, ear, or rib. Spreader grafts, for instance, are thin pieces of cartilage placed between the septum and upper lateral cartilages to widen the internal nasal valve. Alar batten grafts are used to support the external nasal valve by reinforcing the sidewalls of the nostrils, preventing inward collapse during inhalation.
Other surgical approaches include suture suspension techniques, which use specialized stitches to stabilize weakened areas. Implants like Latera also provide structural support and are absorbed over time. If a deviated septum contributes to the collapse, a septoplasty may be performed to straighten it, and turbinate reduction can address enlarged turbinates obstructing airflow.