Nasal valve collapse causes the airways in the nose to narrow. This can result in breathing difficulties and significantly affect a person’s quality of life. Surgery is often necessary, but nonsurgical treatments can help.

The nasal valves are openings in the nose that allow air to flow in and out.

When a nasal valve collapses, the airway between the middle and bottom of the nose becomes obstructed. When a person breathes in, their nostrils may collapse inward, restricting airflow into and out of the nose and causing shortness of breath. This condition may also impair a person’s sleep and cause other complications.

This article discusses the causes, diagnosis, and treatment of nasal valve collapse.

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A nasal valve collapse is a narrowing or weakening of the cartilage that supports one of the nasal valves. The nose has two valves, one internal and the other external. Cartilage supports both nasal valves, which are crucial for regulating airflow into and out of the nose.

  • Internal valve: The internal nasal valve is a slit-like opening in the middle of the nose, around 1.5 centimeters from the nostril. It is in the narrowest part of the nasal cavity.
  • External valve: The external nasal valve is the opening of the nostrils on each side of the nose that is typically a round or oval shape.

A weak or narrow nasal valve does not allow typical airflow through it, and a person may have difficulty breathing. For some people, the nasal valve collapses only when breathing in, but for others, the valve is always collapsed.

An external valve collapse may be easier to diagnose as it often causes the nostril to collapse inward visibly when a person breathes in. An internal nasal valve collapse may appear as a pinching in the middle of the nose.

How common is nasal valve collapse?

Nasal valve collapse is fairly common and affects up to 13% of the population. It is also implicated in 95% of nasal obstruction cases following septoplasty, which is surgery for a deviated septum.

A nasal valve collapse happens when the cartilage supporting the valve weakens. This may happen due to cosmetic surgery on the nose, anatomical differences, aging, and trauma.

  • Cosmetic surgery: Surgery to the nose, or rhinoplasty, can weaken the cartilage supporting the nasal valves and impair their function.
  • Anatomical differences: Nose anatomy varies. Factors that can impair nasal valve function include:
    • wider nostrils
    • a wider columella — the cartilage separating the nostrils
    • a more prominent or “hooked” nose
    • a deviated septum
  • Aging: The cartilage supporting the nasal valves weakens and thins as people age.
  • Trauma: An injury to the nose can weaken the bones and tissues supporting the nasal valves.

How does a deviated septum relate to nasal valve collapse?

A deviated septum is a bent or crooked septum — the thin strip of bone and cartilage down the middle of the nose. It can make one nostril narrower than the other, which may weaken the nasal valve and cause it to collapse.

People may be born with a deviated septum, or the septum can deviate due to injury or previous nose surgeries.

The symptoms of nasal valve collapse include:

  • impaired ability to breathe through the nose
  • shortness of breath
  • lack of good-quality sleep
  • a dry mouth from mouth breathing, particularly on waking up
  • difficulty exercising due to impaired breathing

Nasal valve collapse can affect breathing through one nostril (unilateral) or two nostrils (bilateral).

When a person has symptoms of nasal obstruction, a specialist must pinpoint the exact cause so they can recommend the best treatment. A doctor specializing in ear, nose, and throat (ENT) problems is an otolaryngologist.

A doctor will first ask about a person’s symptoms, medical history, and whether they have had an injury to the nose. They may use the nasal obstruction symptom evaluation (NOSE) questionnaire, which ranks symptoms from mild to extreme.

Diagnosis may also involve:

  • Nasal examination: A doctor will assess the nose’s external and internal structures for signs of valve collapse.
  • Cottle maneuver: This involves gently pulling the cheek on the side of the affected nostril. An improvement in breathing suggests a nasal valve collapse. They may use a small instrument inside the nostril as they perform the technique to help pinpoint the area of collapse.

Doctors may sometimes recommend nasal endoscopy to help identify other causes of nasal obstruction. Endoscopy involves inserting a tube fitted with a camera and a light into the nose to look at the internal structures.

In mild cases, doctors may advise conservative treatments, such as nasal cones and nasal dilator adhesive strips, to manage the symptoms of nasal valve collapse. These devices widen the nostrils to improve airflow. They are available over the counter without a prescription.

Although these methods may give short-term relief, they do not address the source of the problem, and surgery may be necessary.

Surgery can stabilize and widen nasal valves to help improve airflow and make a person’s breathing easier.

Surgical procedures include:

  • Grafting: A surgeon removes cartilage from another body part, such as the ear, rib, or septum, and attaches it to the inside of the nose to widen the nasal valve.
  • Suture suspension: A surgeon attaches a suture between the collapsed valve and the rim of the eye via a tiny incision beneath the eye. This widens the nasal valve to improve airflow.
  • Implants: Doctors may use a bioabsorbable nasal implant to stabilize the nasal walls. However, a 2023 report shows adverse effects, such as abscesses and implant protrusion, are possible.
  • Radiofrequency ablation: This minimally invasive procedure uses a temperature-controlled device to deliver radiofrequency energy to the nasal valve. This heats the tissue, causing it to remodel and retighten.

Sometimes, surgeons perform several procedures during one operation to address nasal valve collapse and other causes of nasal obstruction. A septoplasty addresses a deviated septum, and turbinate reduction reduces the size of turbinates, which are bony structures inside the nose.

People who find it difficult to breathe through their nose should discuss their symptoms with a doctor.

Nasal stuffiness is a common symptom of a cold or allergies, but nasal obstruction related to a nasal valve collapse continues after allergy or cold symptoms have resolved.

In a nasal valve collapse, the cartilage supporting a nasal valve becomes unstable, causing the valve to collapse. This narrows the airways, making it difficult to breathe. It can impair sleep quality and lead to other complications, significantly affecting a person’s quality of life.

An ENT specialist can diagnose a nasal valve collapse and recommend treatments based on a person’s specific situation.

Nonsurgical methods to manage symptoms include using nasal dilator strips and nasal cones. However, surgery is often necessary to correct the anatomical cause. Surgeons may use grafting or suture suspension to widen the nasal passages and improve airflow.

Anyone with persistent nasal obstruction and difficulty breathing through their nose can talk with a doctor about diagnosis and treatment.