Nasal valve collapse: causes, symptoms and treatment of a blocked nose

The nasal valve area is the narrowest part of the nasal airway, and so it is where airflow resistance is greatest. It is often described as having an internal and an external part. The Journal of Laryngology & Otology review notes that the exact site of the nasal valve is contentious and is frequently subdivided into the internal and external nasal valves.

Collapse means that the side wall of the nose is drawn inwards as you inhale, narrowing the passage further. The East and North Hertfordshire NHS Trust ENT team describes internal nasal valve incompetence as characterised by collapse during inspiration of the upper lateral cartilages, with a narrow angle between the septum and the upper lateral cartilages contributing to a lesser extent.

The same authors describe it as an often overlooked cause of nasal obstruction, one that can be mistakenly attributed to other anatomical variations such as septal deviation and turbinate hypertrophy. That matters because operating on the septum or turbinates will not help if the valve is the problem.

The review notes that nasal valve dysfunction can cause nasal obstruction, particularly in patients who have undergone previous reduction rhinoplasty, because removing cartilage or bone can weaken the support of the nasal sidewall. The sources used here do not set out other causes or give figures for how common each is, so an ENT surgeon is the right person to explain what applies in your case.

Many conditions can block the nose, and they often coexist. The NHS lists nasal polyps, for example, as painless soft growths causing a blocked or runny nose, reduced sense of smell and snoring. A GP can usually tell if there are polyps by looking inside the nose. Nasal valve collapse is a structural problem, so it tends not to respond to the sprays and tablets used for allergy or polyps.

The main symptom is nasal blockage or difficulty breathing through the nose, which may be worse on breathing in deeply or during exercise, and may affect one or both sides. In the UK case series, patients were assessed before surgery using nasal strips to see whether symptoms improved, and the response helped predict who would benefit from surgery.

Because a blocked nose also has other causes, the NHS advice for nasal polyps is a useful general guide: see a GP if you have difficulty breathing, your symptoms are getting worse, or you notice changes to your sense of smell. Persistent one-sided blockage, bleeding or crusting inside the nose, or a lump in the nose should be assessed rather than assumed to be a valve problem.

Assessment is clinical and is done by an ENT surgeon who looks inside the nose and watches how the sidewall moves with breathing. The review emphasises that accurate assessment is crucial for correct diagnosis and management planning because obstruction can be multifactorial. The sources used here do not describe the specific bedside manoeuvres or tests in detail, so ask the specialist what they will do and why.

In the UK the pathway is usually a GP appointment, a trial of treatment for common causes such as allergy, and then referral to ENT if blockage persists. In the UK case series, questionnaires scoring nasal blockage and quality of life, and a trial of external nasal strips, were part of the assessment before surgery.

The review states that various surgical and non-surgical techniques for addressing nasal valve collapse have been described. The choice of technique depends on the causative pathology, availability of graft material, surgical experience and patient preference. The case series used external nasal strips before surgery as a guide to likely surgical benefit.

A commonly described operation is the alar batten graft. In the East and North Hertfordshire series of 107 patients treated over 7 years, cartilage from the ear (conchal cartilage) was shaped into strips and inserted to support the upper lateral cartilage and prevent collapse. Of 67 patients who completed both pre- and postoperative questionnaires, 91% reported an improvement in nasal blockage and 88% an improvement in quality of life, with the greatest improvement seen at 6 months. The authors concluded that alar batten graft insertion as a single technique is a valid technique producing good outcomes.

Complications were uncommon but real. In that series, one patient developed nostril asymmetry needing cosmetic treatment, one developed an infection that settled with antibiotics, five had grafts that were resorbed and needed revision with ear cartilage, and one required graft removal because the operation had not improved airflow and the graft was unsightly. A small number of patients felt their breathing declined after surgery. This is a single-surgeon case series reporting questionnaire scores, not a controlled trial, so figures should be read as indicative.

Many people who have a clear valve problem and a good response to nasal strips experience a worthwhile improvement from surgery, but results vary and an experienced surgeon should explain the risks, including the possibility of revision.

On the NHS, functional nasal surgery is carried out by ENT surgeons after referral, and it is worth asking the ENT team how access to surgery is arranged locally. Some people choose a private ENT surgeon for quicker access. Whichever route you take, ask for a clear explanation of why the valve is thought to be the problem and what the alternatives are.

This page relies on a UK specialist case series and a UK journal review because we did not find an NHS patient information page on nasal valve collapse that we could read in full. It should be read as an explanatory overview and not a substitute for an ENT assessment.