Nasal Valve Insufficiency & Collapse

May 30, 2020    -    Nose

“Are you tired of wearing those sticky strips to help you breathe? Are you a constant “mouth breather”? You could be suffering from nasal obstruction.

What is nasal obstruction? It’s a blockage in the nose that can be due to a structural issue or a problem with the nasal valves, septum or turbinates. Poor breathing through the nose is one of the most common complaints I see in my clinical practice, and we now have new options available to successfully treat the condition.

This is how it all works. Your nose is an engineering marvel that is built like a roof of a house or a suspension bridge. It has structural walls, beams and joists that provide structural support to your nose.

The outside is covered with skin and subcutaneous tissues akin to a canvas of a tent. Middle layer of nose has supporting layers of cartilage that act like tentpoles. The whole structure of your nose is interconnected with ligaments that anchor bone and cartilage in an intricate framework.

Inside the nose there is a central wall called septum that partitions nasal cavities. Each nasal airway is a narrow tunnel that leads to the back of the nose where it joins up again in a common space called nasopharynx.

Housed in each nasal cavity are long fingerlike structures that look like hot dogs. They are called turbinates. They are responsible for regulating airflow. Turbinates act like resistors; they swell and shrink in a regular alternating pattern called nasal cycle, This is why we can often breathe only through one side of our nose at a time.

Nasal valve is a triangular area inside your nose that is shaped like an hourglass. This space can collapse leading to sensation of reduced airflow.

Traditionally, ENT doctors focused on deviation of the septum and enlargement of turbinates as primary causes of nasal obstruction, but recently there has been additional focus on treating the nasal valves. Nasal valve insufficiency or collapse occurs when the side walls are weakened due to lack of support. This can occur due to trauma, aging process or structural issues since birth.

Imagine a partially opened umbrella. The fabric just flops in the wind unless umbrella is fully opened and the mechanism is taught. When umbrella mechanism is broken, there is no tension in the fabric. The rigidity provided by underlying structure of the nose gives it the support it needs to suspend the overlying skin soft tissue envelope. Many treatment options for nasal valve insufficiency/collapse are based on the concept of restoring rigidity of the nasal tissues.

Treatment options for nasal valve dysfunction can include the following:

Nonsurgical Options

Breathe-Right Strips

How it works: a strip of sticky single use tape with springlike elastic band is glued across the nasal bridge.

Advantages: cheap, readily available in most drug stores. Can wear them during exercise.

Disadvantages: Can’t really wear them during the day or in public for prolonged period of time, strips leave sticky residue, can irritate skin and easily fall off in the middle of the night. Hard to keep on with oily skin.

Nasal Cones

How it works: soft silicone cones gently insert and dilate nostrils, some have side clips to hold them in place.

Advantages: Not as cheap as strips but are fairly affordable, tend to tolerate better than strips, soft and pliable silicone cones easily slide in the nostrils.

Disadvantages: Hard to keep in the nose all night, impractical to wear during the day and exercise. Some may not tolerate foreign object in nostrils.

Minimally Invasive Office-Based Options

Latera Implant

How it works: a rod-like absorbable rod is implanted in the nasal sidewall this rod supports the nasal valve for up to two years.

Advantages: minimally invasive procedure, can be done in the office under local anesthesia, fairly painless with quick recovery, great for individuals who don’t want surgery, are not surgical candidates or who have already had previous surgery and need additional valve support.

Disadvantages: expensive, may not be covered by insurance, implant longevity beyond 2 years is not known, implant can be palpable and sometimes visible and can make its way out through skin in small percentage of patients requiring removal.

Radio-Frequency Nasal Airway Remodeling

How it works: the inner nasal lining is gently heated with a probe creating contraction of collagen fibers and thus stiffening and widening nasal passage.

Advantages: minimally invasive procedure, can be done in the office under local anesthesia, fairly painless with quick recovery, great for individuals who don’t want surgery, are not surgical candidates or who have already had previous surgery and need additional valve support.

Disadvantages: expensive, may not be covered by insurance, treatment longevity beyond 1 year is not known. May need multiple procedures to achieve lasting sustainable effect.

Surgical Treatment Options

Spreader Grafting

How it works: slivers of cartilage are implanted between septum and sidewall cartilages. This increases cross sectional diameter of the nasal airway.

Advantages: permanent solution, ideal for narrow nasal anatomy, and certain saddle deformities of the nose.

Disadvantages: requires general anesthesia, often access requires an open rhinoplasty approach; longer procedure time; grafts could be palpable or sometimes visible.

Alar Batan / Rim Grafting

How it works: septal or ear cartilage is harvested and shaped into thin strips that are then implanted into the lateral nasal sidewall in the area of greatest collapse.

Advantages: permanent solution, ideal for dynamic lateral nasal valve collapse or insufficiency; shorter operating time; can be done with closed or endonasal approach.

Disadvantages: requires sedation or general anesthesia, grafts could migrate, be palpable or sometimes visible.

Butterfly Grafting

How it works: a butterfly wing shaped spring loaded graft is implanted under nasal skin over nasal cartilages and serves as a permanent breathe strip.

Advantages: short operative time, great option for older patients who may not have other alternatives.

Disadvantages: requires general anesthesia and ear cartilage graft harvest. Can result in ear and nose deformity.

Nose Tip Lift

How it works: a football ellipse of skin is excised from the bridge of the nose lifting the tip and alar cartilages of the nose.

Advantages: ideal procedure for elderly who cannot tolerate anesthesia or longer procedures, can be done in office under local anesthetic.

Disadvantages: unacceptable cosmetically to a younger person, must accept scar across the bridge of nose.”

By Joseph Shvidler, MD

If you are suffering from nasal obstruction symptoms, a trial of medical therapy, diagnostics and medical evaluation by an otolaryngologist or facial plastic surgeon may be required. If you would like to learn more please contact Dr. Joseph Shvidler at (253) 530-8293 or on our Contact page.