What is the nasal valve?
The nasal valve is the space just inside the nose, just over 1cm beyond the front of the nose. In everyone, it is the narrowest point of the inside of the nose. Because of this, it is the most important area in regulating the flow of air through the nose into the lungs.
How does nasal valve collapse occur?
Even small changes in the size or aperture of the nasal valve can affect the flow of air through the nose significantly. The size of the nasal valve itself does vary from person to person. In fact it is not necessarily the case that someone with a big nose will have a big nasal valve and vice versa. It is possible to have a reasonable sized nose but for the lower half to be ‘pinched’, causing a narrowing at the valve area, which in turn will give a tendency towards having a slightly blocked nose.
Alternatively, the size of the nasal valve may be perfectly adequate, but the strength of the sidewalls of the nose (usually made up of skin, fat and cartilage) may be weaker than normal. This can happen due to the normal ageing process, after an injury or accident or following previous nasal surgery. A weak sidewall will be less able to resist the tendency of the nose to collapse inwards, particularly when breathing hard such as during exertion.
How can nasal valve weakness be treated?
There are a number of options available to help improve symptoms arising from nasal valve weakness. These include some surgical options as well as non-surgical treatments.
Non-surgical treatments:
You may already have tried steroid nasal sprays or drops and this remains an option to treat nasal blockage due to inflammation of the nasal lining. This treatment would however not be expected to improve nasal block due to weakness of the nasal valve, for which surgery is the most effective solution. One alternative is to try an external nasal splint such as a ‘Breathe Right strip’ which is placed on the outside of the nose and has the effect of springing the side walls of the nose outwards, thereby resisting the tendency of the nose to collapse on breathing in. Some people find them quite effective, in some cases sufficiently so that surgery is not required. However the benefit is only realised whilst using the strips, which can cause a problem to some patients who cannot, for work or other reasons, wear them during the day. If the breathing problem is only at night then they are certainly worth a try. Even if surgery is being considered, your surgeon may suggest that you have a trial of the strips. If the strips are not effective then you will be more convinced that surgery is the only way forward. If the strips are effective but you do not like the idea of wearing them all of the time, then again surgery remains a viable way forward. Other options include nasal alar dilators that are made of soft silicone and are inserted inside the nostrils and prevent the nasal sidewalls from collapsing inwards when you breathe in.
Surgical options:
1. Intranasal Z-plasty: This procedure involves using stitches and carefully placed skin flaps to widen and stiffen the internal nasal valve area. The flaps are sutured in place using fine absorbable stitches via a keyhole approach through the nostrils without the need for any external cuts.
2. Titanium Nasal Implant: Titanium BreatheTM Implants are small, carefully fashioned sheets made of the metal titanium, which are used to improve breathing through the nose in people with narrow noses, a narrow nasal valve or nasal valve collapse. Titanium as a metal is quite inert, meaning that the body does not tend to reject titanium. This means that it is generally well tolerated and incorporates well into the existing body tissues, creating stability. It usually requires an external skin incision for placement although it can in some cases be inserted through a closed approach.
3. Cartilage augmentation: This involves using cartilage to strengthen and rebuild the narrow and weak nasal valve area. The cartilage is usually taken from your own body tissues, usually your own nasal septal cartilage, or if this is not available or sufficient, then it is common to use some ear cartilage. Rarely rib cartilage might be required if you are undergoing a more comprehensive reconstruction of other aspects of the nose at the same time where a larger volume of cartilage might be required.
4. LateraTM: LateraTM is an injectable implant that can be inserted under a local anaesthetic, through a small incision just within the nostril margin. It is bioabsorbable, meaning that it will eventually dissolve fully in time, usually by about 18-24 months. By this time, the implant has created a pocket of scar tissue around it that continues to strengthen the side wall of the nose and provide resistance to collapse even after the LateraTM implant has disappeared.
5. Other operations: Occasionally other procedures may be required in addition to nasal valve surgery such as cautery to the inferior turbinates or septoplasty.
Of course you can decide not to have any treatment if you are happy to put up with your symptoms. This is because the proposed operation is elective and is not being undertaken as an emergency; therefore you could elect to live with your symptoms if you prefer not to go through an operation. One consequence of this is that your underlying condition could gradually get worse with time, in which case surgery might need to be considered in the future if medical or other treatments fail.