Nasal Obstruction in Adults: Understanding Nasal Valve Collapse and Stenosis

Nasal valve collapse is a functional respiratory condition where the structural integrity of the nose is compromised, leading to the narrowing or complete closure of the nasal airway during breathing. In the United Kingdom, chronic nasal obstruction is a frequent reason for GP consultations, yet valve collapse is sometimes overlooked in favour of more common diagnoses like hay fever or sinusitis.

The 'nasal valve' is actually two distinct areas: the internal nasal valve and the external nasal valve. The internal valve is the narrowest part of the entire human airway. If this area is even slightly smaller than normal—a condition known as nasal stenosis—the resistance to airflow increases significantly, making it feel as though you are breathing through a pinched straw.

The primary symptom of nasal valve collapse is a persistent sensation of nasal blockage that does not respond well to standard decongestants or steroid nasal sprays. Patients often report that the sensation is worse when breathing in deeply or during exercise.

• Difficulty breathing through the nose: A constant feeling of resistance.
• Visible collapse: You may notice the side of your nose sucking inward when you inhale deeply in front of a mirror.
• Crusting and dryness: Altered airflow can dry out the nasal mucosa.
• Nasal bleeding: Dryness can lead to frequent minor epistaxis.
• Snoring and sleep disturbance: Restricted nasal airflow often leads to mouth breathing at night.

While some people are born with naturally narrow nasal valves, most cases in adults are 'acquired'. According to British rhinological standards, the most common causes include:

Previous Nasal Surgery

Procedures such as rhinoplasty or septoplasty can occasionally weaken the supporting cartilage of the nose. If too much tissue is removed, the nasal sidewall may lose the strength required to stay open against the pressure of inhalation.

Trauma and Injury

A broken nose from a fall or sports injury can result in a deviated septum or scarred nasal valves, leading to permanent stenosis.

Ageing Processes

As we age, the proteins that provide elasticity and strength to our cartilage—collagen and elastin—begin to break down. This can cause the nasal tip to droop (ptosis) and the sidewalls to become 'floppy', increasing the likelihood of collapse.

In the UK, healthcare professionals often use a simple clinical test to identify nasal valve issues. You can even try a variation of this at home. This is known as the Cottle manoeuvre. To perform it, use one or two fingers to gently pull your cheek outwards away from your nose while breathing in. If your nasal breathing improves significantly during this action, it is a strong indicator that the nasal valve is the site of your obstruction.

NICE (National Institute for Health and Care Excellence) guidelines suggest that if symptoms persist despite the use of typical treatments for rhinitis, a structural cause like valve collapse or a deviated septum should be investigated by a specialist.

Management of nasal valve collapse depends on the severity of the obstruction and the impact on your quality of life. Treatments are generally divided into mechanical and surgical categories:

• Nasal Dilators: These are over-the-counter devices. External strips (like 'Breathe Right' strips) pull the valves open from the outside, while internal stents hold them open from the inside. They are particularly useful at night.
• Topical Treatments: While they won't fix a structural collapse, saline rinses can help manage the crusting and dryness associated with the condition.
• Surgical Reconstruction: For permanent relief, an ENT (Ear, Nose, and Throat) surgeon may perform a functional rhinoplasty. This often involves using 'spreader grafts' (small pieces of cartilage, usually taken from the septum) to reinforce the nasal sidewalls and widen the valve area.

If you are struggling with a perpetually blocked nose, speaking to a GP online is a sensible first step. Because nasal valve collapse shares symptoms with more common conditions like allergic rhinitis or nasal polyps, an online consultation can help rule out these causes through a detailed clinical history.

An online doctor can review your symptoms, discuss the results of your home Cottle manoeuvre, and advise on whether you require a private or NHS referral to an ENT specialist. If your symptoms are interfering with your sleep or daily activity, or if you have noticed a change in the shape of your nose following an injury, our team can provide the necessary medical guidance and, where appropriate, a sick note or referral letter.