The sensation of the nostrils closing inward during deep inhalation is a common experience, often perceived as a struggle to get enough air. This feeling, which can worsen during exercise or sleep, indicates restricted airflow in the nasal passage. The medical term for this is dynamic nasal obstruction, suggesting the nose’s structure fails to maintain an open airway during the suction created by breathing in. This significantly compromises the nose’s function of regulating and filtering the air we breathe.
Understanding Nasal Valve Collapse
The mechanism behind this inward movement relates to the nasal valve, the narrowest point of the nasal airway and the primary regulator of airflow resistance. The nose contains two valve areas: the external nasal valve and the internal nasal valve. The external valve is located at the nostril opening, supported primarily by the lower lateral cartilage and surrounding soft tissues.
The internal nasal valve is located deeper, about 1.3 to 1.5 centimeters inside the nostril. It is defined by the nasal septum, the caudal edge of the upper lateral cartilage, and the head of the inferior turbinate. This area is the most restrictive segment of the airway, where the forces of inhalation have the greatest effect.
When inhaling quickly or deeply, the rapid movement of air causes a drop in internal pressure, known as the Bernoulli effect. This negative pressure acts as a vacuum, pulling the unsupported tissues of the lateral nasal wall inward. If the cartilage is not strong enough, the sidewall collapses, resulting in nasal valve collapse. The collapse can be visually obvious (external valve) or occur internally, where it is equally obstructive.
Factors Contributing to Nostril Closure
The susceptibility of the nasal structure to collapse often results from underlying issues that weaken the lateral walls. Naturally weak or thin lateral nasal cartilage can be a congenital factor, making the structure less able to resist the negative pressure of inhalation. If the lower lateral cartilage supporting the nostril is structurally weak or poorly shaped, the external valve is vulnerable to dynamic obstruction.
Previous trauma, such as a nasal fracture, may have altered the structural support of the cartilage, leading to permanent weakness. Surgical procedures, such as rhinoplasty, are also common causes if they inadvertently destabilized the supporting cartilage structures. For example, reduction rhinoplasty maneuvers can sometimes cause the upper lateral cartilage to collapse into the internal valve area.
The natural process of aging also contributes, as cartilage loses elasticity and soft tissue support decreases over time. Temporary swelling from conditions like allergic rhinitis or chronic congestion can exacerbate an existing weakness. This inflammation narrows the passageway, increasing airflow velocity and magnifying the negative pressure that causes the inward collapse.
Diagnosing Dynamic Nasal Obstruction
An Ear, Nose, and Throat (ENT) specialist confirms the diagnosis through patient history and a targeted physical examination. The most common diagnostic test is the Cottle Maneuver, a simple, non-invasive assessment performed in the office. During this maneuver, the patient places fingertips on the cheek, lateral to the nose, and gently pulls the skin outward while inhaling.
If the patient reports immediate and significant improvement in breathing, the test is positive, suggesting the obstruction is at the nasal valve. A positive Cottle Maneuver confirms a structural or dynamic weakness, as mechanically propping the lateral wall open resolves the symptom. The physician also uses a nasal speculum or endoscope to visually inspect the internal anatomy and assess the degree of collapse upon forced inspiration.
Management and Treatment Pathways
Management pathways are divided into non-surgical, temporary solutions and permanent surgical interventions aimed at structural reinforcement. Non-surgical methods offer temporary relief by mechanically supporting the weak nasal wall.
Non-Surgical Options
Non-surgical options include:
- External nasal dilator strips, such as adhesive strips placed over the bridge of the nose, which gently pull the skin and underlying cartilage outward.
- Internal nasal cones or stents, which are flexible devices inserted into the nostrils to physically prop open the valve area from within.
These temporary supports are effective for mild collapse or for use during specific activities like exercise or sleep. While decongestants and nasal sprays can reduce mucosal swelling, they do not address the underlying structural deficiency.
Surgical Interventions
For definitive, long-term correction, surgical interventions are often necessary to stabilize the nasal structure. Common permanent solutions include:
- Using cartilage grafts, often harvested from the nasal septum, to reinforce and widen the internal nasal valve. These spreader grafts act as internal splints.
- Suture suspension techniques, which use specialized stitches to lift and stabilize the weakened portions of the valve.
- Minimally invasive options, such as the placement of tiny, bioabsorbable implants into the lateral wall.
- Office-based procedures like radiofrequency treatment, used to stiffen the tissue and provide additional support.