When a deep breath causes one side of your nose to pinch closed, you are experiencing dynamic nasal valve collapse, a common form of nasal airway obstruction. This is a functional issue where the structure of the nasal passage cannot withstand the force of inhalation. The nasal valve is the narrowest part of the airway, and when it lacks sufficient support, the negative pressure created during inspiration pulls the soft tissues inward, restricting airflow. This condition can significantly impact quality of life, affecting sleep, exercise tolerance, and overall comfort.
What Causes the Nostril to Collapse?
The collapse occurs within the nasal valve area, a complex structure that regulates air entering the nasal cavity. This valve is formed by the septum, the upper and lower lateral cartilages, and the soft tissue of the nostril. When the cartilage and surrounding tissue are weak, they are easily drawn inward by the vacuum effect of a strong inhale, much like a soft straw collapsing under suction. This weakness can be present from birth, making some individuals naturally prone to the issue.
The insufficient rigidity of the lateral nasal cartilage is the direct cause of the dynamic collapse. Aging contributes to this issue, as the natural loss of elasticity and strength in the tissues allows the wall to sag and collapse more easily. Trauma to the nose, such as a fracture, can permanently damage the supporting cartilages, leading to instability. Previous nasal surgery, such as a rhinoplasty, can also weaken the supportive framework if too much cartilage was removed.
A deviated septum, where the wall separating the nasal passages is crooked, worsens the problem by narrowing the space within one side of the nose. This narrowing increases the velocity of the air passing through, which elevates the negative pressure against the lateral wall. The increased suction acts on the already weakened cartilage, making a collapse more likely and severe. Chronic inflammation from conditions like rhinitis or allergies exacerbates the issue by causing the internal lining of the nose to swell. This swelling reduces the available space, increasing airflow resistance and making the nasal valve more susceptible to inward movement.
How Doctors Diagnose Nasal Airway Obstruction
Diagnosis of nasal valve collapse relies on a detailed physical examination and a specific in-office maneuver demonstrating the functional nature of the obstruction. A physician, often an Ear, Nose, and Throat (ENT) specialist, visually inspects the external nose while the patient inhales deeply to observe the inward movement of the nostril or sidewall. This observation helps pinpoint the location and severity of the structural weakness.
The Cottle maneuver is the standard test used to confirm nasal valve involvement. During this maneuver, the patient places one or two fingertips on the cheek adjacent to the collapsing side of the nose. The patient then gently presses and pulls the cheek tissue outward to temporarily prop open the nasal valve area. If the patient reports immediate improvement in breathing through that side, the test is positive for nasal valve dysfunction. This temporary widening simulates structural support and confirms the collapse is the source of the difficulty.
To gain a clearer view of the internal nasal anatomy, the physician may perform a nasal endoscopy (rhinoscopy). This involves inserting a thin, flexible tube with a camera into the nasal passage. The endoscope allows for a magnified, illuminated view of the entire airway, including the internal nasal valve, the septum, and the turbinates. While a CT scan is sometimes used to rule out other issues, endoscopy is superior for visualizing soft tissue abnormalities and confirming the location of the dynamic collapse.
Non-Surgical Ways to Improve Breathing
For individuals with mild to moderate collapse, non-surgical interventions offer temporary relief by mechanically supporting the weak nasal wall. External nasal dilators, commonly known as nasal strips, are widely used solutions. These adhesive strips contain flexible bands placed across the bridge of the nose. The tension of the bands pulls the skin and underlying lateral cartilage outward to stabilize the nasal sidewall.
Another effective option involves internal nasal dilators, which are small, flexible cones or stents made of soft silicone or plastic. These devices are inserted directly into the nostrils before sleep or exercise. They work by physically expanding the nasal passages from the inside, applying constant outward pressure to the internal valve area. This internal scaffolding helps prevent the inward collapse that occurs with negative inspiratory pressure, resulting in improved airflow.
Managing underlying inflammatory conditions is an important non-surgical strategy. When chronic allergies or rhinitis contribute to congestion, the swelling of the internal nasal lining exacerbates the obstruction. Topical corticosteroid nasal sprays are often prescribed to reduce this inflammation and swelling. These sprays inhibit the body’s inflammatory response, which helps increase the available space in the nasal valve and lessen the pressure on the weak cartilage.
Surgical Options for Lasting Relief
When non-surgical aids provide insufficient relief, surgical procedures offer a permanent solution by structurally reinforcing the nasal valve. The goal of nasal valve repair surgery is to provide support to the weakened cartilages to prevent their inward movement during inhalation. These procedures often involve cartilage grafts harvested from the patient’s own body, typically from the septum, ear, or rib. The collected cartilage is then shaped and secured to the existing nasal framework.
Specific grafting techniques are chosen based on the location of the collapse (internal or external nasal valve). For internal nasal valve collapse, located near the nasal bridge, spreader grafts are the preferred method. These small strips of cartilage are placed between the upper lateral cartilage and the nasal septum, acting as internal struts to widen the angle of the valve. This structural widening creates a more open airway and stabilizes the mid-vault region.
To address external nasal valve collapse, which affects the nostril rim and sidewall, alar batten grafts are utilized. These grafts are placed deep beneath the skin along the lateral nasal wall, often extending over the lower lateral cartilages. They function to stiffen the soft tissue and cartilage, acting as a fixed splint to resist the dynamic inward movement of the nostril. When a deviated septum is a contributing factor, a septoplasty is frequently performed with the valve repair. Correcting the septal deviation removes an obstruction and provides the surgeon with a source of native cartilage for reinforcing grafts.