Nasal valve collapse happens when the narrowest part of the nasal airway is too weak or too tight, so the side walls of the nose pull inwards as you breathe in. It causes a blocked feeling, often worse on exercise or at night. It can be caused by the natural shape of the nose, ageing, injury or previous nasal surgery. Mild cases may respond to nasal strips or dilators; persistent collapse is usually treated with surgery that reinforces the side walls.
What are the nasal valves?
The nasal valves are the narrowest parts of the airway inside the nose, where resistance to airflow is highest. There are two:
- Internal nasal valve: the angle between the septum and the lower edge of the upper lateral cartilages, roughly under the middle of the nose. It is the main point of resistance.
- External nasal valve: the entrance to the nostril, formed by the lower lateral cartilages, the soft tissue of the nostril rim and the base of the septum.
Because airflow speeds up through a narrow point, a weak side wall can be sucked inwards by the pressure drop, much like a straw collapsing when you suck hard.
Symptoms
People with valve problems often describe a nose that feels blocked even though nothing seems to be inside it. Typical features include difficulty breathing on exercise, snoring or mouth breathing at night, a dry mouth on waking, and noticing the sides of the nose drawing in during a deep sniff. Symptoms may be one-sided or on both sides and do not usually improve with decongestant sprays, which helps distinguish valve collapse from nasal congestion or allergy.
What causes it?
- Anatomy: a narrow middle third of the nose, a projecting tip with thin side walls, or narrow slit-like nostrils.
- Ageing: the cartilages and supporting tissues soften over time and the tip can droop, narrowing the valve.
- Injury: a broken nose can displace the cartilages or twist the septum.
- Previous rhinoplasty: over-reduction of the cartilages or removal of a large hump without restoring support can narrow the internal valve.
- Septal deviation: a bent septum can narrow one valve and make collapse more likely.
How it is assessed
Mr Nassab will ask about your breathing, sleep, previous injuries and any nasal surgery, and will examine the nose at rest and during breathing. A simple test involves gently pulling the cheek outwards beside the nose (the Cottle manoeuvre) or supporting the side wall from inside with a small instrument; if breathing improves noticeably, valve narrowing is likely to be contributing. The septum, turbinates and lining of the nose are also checked, because several problems often coexist. If there are signs of chronic sinus disease or polyps, you may be advised to see your GP or an ear, nose and throat specialist.
Non-surgical options
External nasal strips worn at night lift the side walls slightly, and internal nasal dilators or cones hold the valve open. These can help mild cases, especially during sport or sleep, and are also a useful way of confirming that the valve is the problem. Treating allergies and congestion with advice from a GP or pharmacist can reduce swelling of the lining. None of these options changes the underlying structure.
Surgical treatment
Surgery aims to widen and strengthen the valve so it stays open. Techniques include spreader grafts, small strips of cartilage placed alongside the septum to widen the internal valve; batten or alar grafts, which stiffen weak side walls; and straightening a deviated septum. Cartilage is usually taken from the septum itself, or occasionally from the ear or rib. These techniques are often combined within a functional or cosmetic rhinoplasty, and the appearance of the nose can be preserved or refined at the same time.
Recovery, risks and cost
A splint is usually worn for about a week and the nose can feel more blocked than before for the first couple of weeks while swelling settles. Improvement in breathing typically continues over several months. Risks include bleeding, infection, graft visibility or movement, a slightly wider appearance to the middle of the nose and the need for further surgery. Rhinoplasty costs from £8,950 with the £150 consultation charged separately. Surgery is for adults aged 18 and over.
Frequently Asked Questions
Can nasal valve collapse be fixed without surgery?
Strips and dilators can relieve mild symptoms, but they need to be used continuously and do not correct the structure.
Will fixing my nasal valve change how my nose looks?
Changes are usually subtle. Spreader grafts can widen the middle of the nose slightly, which is discussed during planning.
Is nasal valve collapse the same as a deviated septum?
No, although they often occur together. The septum is the central wall; the valves are formed by the side walls and septum together.
Can valve collapse happen after rhinoplasty?
Yes. It can follow over-reduction of the cartilages, and revision surgery with grafts may help restore the airway.
