The sensation of your nose collapsing when you take a breath is a common and frustrating symptom that signals a structural issue within the nasal passages. This difficulty in drawing air inward is typically due to a temporary narrowing of the airway that worsens with the force of inhalation. This phenomenon, known as nasal valve collapse or lateral wall insufficiency, restricts the flow of oxygen, often leading to chronic discomfort, mouth breathing, and poor sleep quality. The symptom is a recognized medical condition that arises when the internal support structure of the nose can no longer resist the pressure changes that occur during deep breathing. Understanding the specific mechanics and underlying causes of this structural problem is the first step toward finding effective relief.
Understanding the Nasal Valve and Airflow Dynamics
The primary site for regulating airflow resistance in the nose is the nasal valve, which is the narrowest segment of the entire nasal passage. This region is divided into the external valve (the nostril opening) and the internal valve, located about half an inch inside the nose. The internal valve is formed by the nasal septum, the upper lateral cartilage, and the inferior turbinate.
The mechanism for the physical collapse during inhalation is explained by Bernoulli’s Principle. This principle states that as the velocity of air increases, the pressure exerted by that air decreases. When a person inhales, air accelerates as it passes through the narrow nasal valve, causing a drop in internal pressure. This drop creates a negative pressure difference. If the cartilage forming the lateral nasal wall is structurally weak, this negative pressure overcomes its rigidity, causing the side wall to collapse inward. The resulting collapse dynamically obstructs the airway, which is why the symptom is most noticeable during deep breaths or exercise.
Factors That Cause the Collapse
The loss of rigidity in the nasal wall structure stems from several distinct underlying factors. One frequent cause is previous trauma or injury to the nose, such as a nasal fracture or a sports-related impact. Such incidents can damage or weaken the supporting cartilage and soft tissues, leading to instability in the nasal valve area.
The natural aging process also contributes to the weakening of the nasal structure over time. As people age, the cartilage loses elasticity and flexibility, making it less capable of resisting the negative pressure generated during breathing. This loss of support can lead to a gradual worsening of the collapse.
In some individuals, the issue is present from birth due to genetic predisposition or natural anatomical differences. This includes naturally weak cartilage or structural characteristics like a highly deviated septum, which narrows the airway and places extra stress on the lateral wall. Furthermore, complications from prior nasal surgery (iatrogenic causes) can inadvertently weaken supporting structures, particularly if a procedure like rhinoplasty altered the cartilage framework.
Confirming the Condition
Confirming nasal valve collapse involves a targeted physical examination and specific diagnostic maneuvers performed by a healthcare professional. A simple visual inspection is the first step, where the clinician observes the nostril during a forced inhalation to see if the lateral wall visibly caves inward. This dynamic observation helps to pinpoint the area of weakness.
The primary diagnostic tool is the Cottle maneuver, a subjective test that assesses the integrity of the nasal valve. To perform this, the patient places fingertips on the cheek next to the nose and gently pulls the skin outward. This action temporarily widens the nasal valve angle.
A positive result occurs if the patient reports immediate, significant improvement in breathing while performing the maneuver. The relief of obstruction confirms that the underlying problem is located in the nasal valve area, indicating that mechanical support is needed. The clinician may also perform a modified Cottle maneuver, using a small instrument inside the nostril to localize the exact site of collapse.
Options for Restoring Airflow
For patients experiencing mild or intermittent symptoms, non-surgical interventions offer a temporary way to manage the obstruction and provide support. External nasal dilator strips, such as adhesive breathing strips, are placed across the bridge of the nose and mechanically pull the skin outward. This gentle lifting action helps to widen the nasal passages, making them useful for temporary relief during sleep or physical activity.
Internal nasal dilators, which include soft, flexible cones or stents, are inserted into the nostrils. These devices function as internal scaffolding, pressing the cartilage outward to keep the nasal valve open during inhalation. While non-surgical methods are effective for symptom relief, they do not correct the underlying structural weakness and are not considered viable long-term solutions for moderate to severe collapse.
For definitive correction, surgical interventions are often necessary to strengthen and stabilize the weakened cartilage framework. A common and effective technique is the use of spreader grafts, which involve harvesting a small piece of cartilage, often from the nasal septum. This cartilage is then strategically placed between the upper lateral cartilage and the septum to act as a permanent strut, widening the internal nasal valve.
Alternative surgical options include the use of specialized suture suspension techniques or implants designed to stiffen the lateral wall. Tiny absorbable implants can be placed inside the nasal wall to provide structural support, which is often later replaced by the body’s own scar tissue to maintain the widened airway. Another technique is the alar batten graft, which uses cartilage to reinforce the external valve area, directly preventing the side wall from collapsing.