“Nasal valves” are areas in the nose that are narrow and cause difficulties in breathing. There are 2 nasal valves, an “internal” and an “external” nasal valve. The external nasal valve is the “nostril” of the nose and is made up of the ala, the round fleshy area on the sides of the nose. The ala is supported by cartilages located in the tip of the nose. The internal valve is located inside the nose and is the area between the nasal septum and the lowest portion of the upper lateral cartilage, which are cartilages located on the sides of the nose.
There are many reasons for a nose to be congested and blocked. These include a deviated septum, enlargement of the natural tissues of the nose (also known as inferior turbinate hypertrophy), nasal polyps, and/or allergies. Another reason is lack of support on either side of the nose when you breathe inward. The “valves” should be strong and resist airflow when breathing in. Weak cartilages can cause the one or both valves of the nose to collapse inward causing blockages and nasal congestion. Sometimes the blockages can be a combination of all of the above-mentioned problems. A thorough evaluation by a specialist is needed to determine the cause of the blockage and the best treatment options for nasal valve collapse.
External valve collapse is apparent when you breathe inward and the nostril on one or both sides partially or completely closes on itself. Internal valve collapse may be less apparent on the outside but the upper middle portion of the nose on either side may narrow significantly on breathing in. Lifting up the skin around your nose, or using common aids like “Breathe-Rite” strips can alleviate blockages caused by the internal nasal valve, and can help in making the diagnosis. In addition, on the outside of your nose, you may see an upside-down triangle under the nasal bones which is an area of detachment of your upper cartilage. This is called an “inverted-V deformity” and is more common after a bump is removed or aggressive nasal surgery.
External valve collapse is apparent when you breathe inward and the nostril on one or both sides partially or completely closes on itself. Internal valve collapse may be less apparent on the outside but the upper middle portion of the nose on either side may narrow significantly on breathing in. Lifting up the skin around your nose, or using common aids like “Breathe-Rite” strips can alleviate blockages caused by the internal nasal valve, and can help in making the diagnosis. In addition, on the outside of your nose, you may see an upside-down triangle under the nasal bones which is an area of detachment of your upper cartilage. This is called an “inverted-V deformity” and is more common after a bump is removed or aggressive nasal surgery.
Weakness or upward orientation of the cartilages in the tip of your nose can cause the external valves to narrow with inspiration. If you have had a previous rhinoplasty, then the lower lateral cartilages may have been partially removed which will also weaken the external valves. Having widening of the skin and cartilage between your nostrils or a septum that you see deviated into one nostril will contribute to external valve narrowing.
Medications sometimes help. Nasal steroids like Flonase may slightly decrease swelling inside the nose and just 1 millimeter of additional breathing room can feel amazing. Likewise, nasal saline rinses can sometimes make the nose feel more open by washing away mucous and cleaning the inside of the nose. If you have allergies, then antihistamines like Claritin and Zyrtec will decrease the tissue swelling. Decongestants like pseudoephedrine and those contained in Claritin-D will decrease swelling in the nose. Breathe-Rite strips can open the valves by pulling on the outside skin of the nose. Should over the counter and prescription medications not work then you may need a nasal valve surgery to improve your breathing.