In each side of the nose, there is an internal and external nasal valve located in the middle and lower parts of the nose. The nasal valves are the narrowest part of the nasal airway and they work to limit airflow. When you breathe, your nose is where more than half of your airflow resistance occurs.
The anterior portion of the nose, including the internal and external nasal valves, is where most of the airflow resistance occurs, but it is the internal nasal valve where most of the flow resistance is created.
Resistance in the nose is important, as the nose processes the air that you breathe before it enters your lungs–it helps to warm, humidify, and purify the air you breathe to protect your health. This airflow resistance is important for good pulmonary function.
What Happens When You Have Problems with Nasal Airflow?
When patients have problems with nasal airflow, it is usually because the internal nasal valve has become more narrow restricting air from passing freely into the nose. This narrowing may occur when the turbinate swells or the nasal sidewall collapses during inspiration. Consequently, this nasal valve collapse makes it difficult for patients to breathe through their nose (nasal obstruction), causing nasal congestion and blockage.
How is a Nasal Valve Obstruction Diagnosed?
During your consultation, the ENT (ear, nose, and throat) doctor will ask you to inhale through your nose to see if the nasal sidewall moves inward and collapses leading to blockage of nasal airflow. Your doctor will also do a visual exam of your nasal cavity using a 4mm, lighted endoscope, evaluating the condition of your nasal valves as well as all adjacent structures. This is done not only to rule out all possible causes of your nasal obstruction (such as a deviated septum, enlarged turbinates, sinus masses, polyps, and enlarged adenoids), but also for proper diagnosis and treatment recommendation.
Another test your doctor may perform is the Cottle test, which is done to evaluate nasal valve stenosis (narrowing of a passage). With this test, the cheek of the evaluated side is gently pulled laterally with 1 or 2 fingers as you inhale, which opens the valve. If your breathing is better when this is done, then it implies that a collapse of the valve is present on that side. If breathing is not better, then that means there is another cause of the obstruction elsewhere in the nose.
What is the Treatment for Nasal Valve Collapse?
If septal surgery alone doesn’t correct nasal obstructive impairment, then nasal valve surgery should be considered. A straight septum is important for unimpaired nasal valve function. This surgery helps to restore normal anatomy of the nasal valve and improve airflow without increasing either rigidity or collapsibility of the nasal valve.
Nasal Valve Surgery FAQs
Patients who have weak or thin cartilage in the nasal valve area have inadequate support and are at higher risk for nasal valve collapse. This weakness may be due to a patient’s particular anatomy or may be secondary to a patient’s previous surgery (e.g., rhinoplasty [a nose job]), trauma or injury to the nose. For these patients, nasal valve surgery would be beneficial in helping to restore normal nasal airflow and breathing.
Depending on the specific surgical technique used, nasal valve surgery may involve a slight change in your nasal appearance, typically centered around the nasal valve area. Discuss any of your concerns with your doctor before surgery.
Nasal packing is not required for nasal valve surgery. If other procedures are involved alongside your nasal valve surgery, talk to your doctor about his/her standard practice.
Time off for recovery usually depends on the type of procedure performed as well as the type of anesthesia used. For patients who have nasal and sinus procedures performed under general anesthesia, you may need to take 3-4 days off of work. During this time, patients are advised to refrain from heavy lifting or vigorous activity for 1-2 weeks.
Nasal valve surgery typically takes 15-20 minutes. If other procedures are added alongside nasal valve surgery, this will extend the time. Discuss these details with your doctor.
Patients that have undergone nasal valve surgery have reported a significant reduction in nasal airway obstruction symptoms.
Depending on the results of your examination, your ENT doctor may suggest that you have other procedures done alongside nasal valve surgery to address the varying components of your nasal obstruction. For instance, if part of your nasal obstruction is due to a deviated septum, your doctor may recommend a septoplasty to correct the deviation. If you have enlarged turbinates, your doctor may recommend corrective surgery for this as well.
Most nasal valve surgery is performed with the patient asleep under general anesthesia.
Sutures are used in nasal valve surgery to sew the incision site at the end of surgery. These sutures are typically dissolvable and do not require removal.
You can expect to have pain, fatigue, nasal stuffiness, and mild nasal drainage after your surgery. The stuffiness typically results from swelling after the procedure and typically starts to improve after the first week. Most patients find that post-operative pain is easily managed with low-dose narcotic medications, such as Tylenol with Codeine, for 1-2 days. After that, they switch to regular or extra-strength Tylenol and ibuprofen (taken together to control both pain and swelling) for another week or so.
It is very common for nasal valve surgery to be performed in conjunction with a septoplasty procedure, and the cartilage removed during septoplasty is used for nasal valve repair. If a septoplasty is not being done at the same time, a small amount of ear cartilage is incised from behind the ear. In either case, cartilage is placed into a pocket that is created on each sidewall of the nose with an incision through the nose. This is done to support an area of narrowing or collapse to open the valve.