Nasal Obstruction
Nasal valve collapse.
The nasal valve is the narrowest segment of the whole airway, just inside the nostril. When its sidewall is weak or narrow it can fall inward on breathing in, blocking a nose whose septum is perfectly straight. It is one of the most overlooked causes of nasal obstruction, and one worth assessing properly.
The nasal valve is the narrowest point of the airway, just inside the nostril, and a sidewall that collapses inward on breathing in can block a nose whose septum is straight. Dr. Justin Khetani assesses valve collapse in Burlington with examination and nasal endoscopy. An OHIP-insured assessment begins with a referral from your physician or nurse practitioner.
Written and reviewed by Dr. Justin Khetani, MD, FRCSC, Otolaryngology–Head and Neck Surgery · Last reviewed
Fellowship-trained in rhinology & anterior skull base surgery (University of Alberta) · The daily surgical work of the practice is the nasal airway · Surgery at Joseph Brant Hospital
General education only. Your diagnosis, options and coverage are individual, and are established at your consultation.
The Condition
The narrowest point, falling inward.
Every breath through the nose passes a bottleneck. The internal nasal valve is the slit-like angle between the septum and the sidewall cartilage a short way inside the nostril; the external valve is the nostril opening itself, held in shape by the rim of cartilage around it. Together they form the narrowest segment of the airway, which gives them outsized influence: a small loss of width here costs more airflow than the same loss anywhere else in the nose.
Collapse happens in two ways. Some valves are simply built narrow, so the nose runs blocked at rest. Others are wide enough standing still but too soft to hold their shape, so the faster you breathe in, the harder the sidewall is pulled inward — the nose that blocks on the stairs, in exercise, or in deep sleep, and springs open the moment you stop. Many noses have some of each.
The valve is one of three structures that narrow the airway, alongside the septum and the turbinates, and they frequently conspire. A septum deviated at the valve angle narrows it from one side; an enlarged turbinate crowds it from the other. That is why the assessment looks at all three before anyone talks about treatment.
Symptoms that suggest the valve is involved
- Blockage that worsens with brisk breathing in — exercise, stairs, deep breaths
- A nose that stays blocked although the septum is straight
- Breathing that frees when the cheek is gently drawn sideways
- Dilator strips or cones that help noticeably
- Obstruction that began or worsened after a previous rhinoplasty
- Visible indrawing of the sidewall in the mirror on breathing in
Having several of these does not confirm the diagnosis, and having few does not exclude it. The examination does that.
Why It Happens
Built narrow, worn soft, or changed by surgery.
Some valves are narrow by construction: the angle between septum and sidewall cartilage is simply tight from growth, or a septal deviation sits exactly at the valve and closes it from within. Others soften with time — cartilage loses stiffness with age, and a sidewall that held its shape for decades begins to draw inward on every breath.
And some collapse follows surgery. Rhinoplasty that narrowed the nose or reduced its supporting cartilage can leave the sidewall without the stiffness it needs, sometimes years later. This is a recognised cause, not a rarity, and it is part of why modern rhinoplasty planning treats breathing and appearance as one problem rather than two.
The narrowest point
Because the valve is the tightest segment of the airway, small changes in its width produce large changes in airflow — in both directions.
Dynamic or fixed
A valve can be too narrow at rest, too soft under airflow, or both. The distinction matters, because the treatments differ.
After rhinoplasty
Previous nasal surgery that reduced or weakened the sidewall cartilage is a recognised cause of valve collapse.
The strip test
An external dilator strip that clearly improves breathing is a strong clue the valve is involved — a piece of information worth bringing to the consultation.
Assessment First
How the valve is assessed.
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History
When the blockage strikes — at rest, in exercise, in sleep — which side, what helps, previous injuries and operations on the nose, and what has been tried.
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Examination
The outside and the inside of the nose, watching the sidewall and the valve on breathing in. Where indicated, nasal endoscopy shows the septum, the turbinates and the valve angle directly.
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Supporting the sidewall
A simple bedside check: the sidewall or cheek is gently supported while you breathe in. If breathing frees, the valve is implicated — the same information a helpful dilator strip gives at home.
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Separating structure from swelling
Response to medical treatment of the lining, and examination after a decongestant spray, establish how much of the blockage is fixed structure and how much is reversible swelling.
Your Options
The options, with their trade-offs.
Set out side by side so you can weigh them yourself. Which of them fits your nose is established at consultation, and the decision is yours.
| Option | What it involves | Trade-offs to weigh |
|---|---|---|
| Leave it alone | No treatment. Reasonable when symptoms are mild, intermittent, or confined to heavy exertion. | Nothing changes, and nothing is risked. You can return if your situation changes. |
| External or internal supports | Dilator strips worn across the bridge, or soft internal supports worn in the nostrils, hold the sidewall open mechanically — at night, in sport, or whenever it matters most. | Not a cure, and something to wear rather than a one-time fix. For some people it is a perfectly workable answer; for everyone it is useful diagnostic information. |
| Treating the co-contributors | Where a deviated septum or enlarged turbinates are doing most of the narrowing, septoplasty and turbinate reduction address the airway the valve opens into. | Effective when the valve is a passenger rather than the driver — and insufficient alone when the valve itself is the main problem. The examination is what tells these apart. |
| Surgical support of the valve | Cartilage grafts, usually taken from the septum, widen the valve angle or stiffen the sidewall so it no longer collapses under airflow. This is rhinoplasty technique applied to breathing. | An operation, with staged healing over months. The breathing component may be insured; the rhinoplasty component needs Ministry pre-approval, and the insured and uninsured parts are identified separately, in writing, before anything is decided. |
Because grafting at the valve uses rhinoplasty techniques, valve surgery is planned with the nose's outward appearance explicitly in mind — and discussed with the same candour, before anything is decided.
- Coverage
- Insured under OHIP when medically necessary — OHIP pays the surgeon and the hospital.
- Referral
- Begins with a referral from your physician or nurse practitioner.
When not to wait
Valve collapse itself is rarely urgent. But new obstruction after a recent injury should be seen promptly at an emergency department — a septal hematoma needs draining quickly and a displaced fracture should be repositioned within the first one to two weeks — and blockage on one side that is progressive, or accompanied by bleeding, deserves prompt assessment: ask your physician to mark the referral urgent. Go to an emergency department for uncontrolled bleeding or clear watery drainage after a head injury.
Common Questions
Nasal Valve Collapse, answered plainly.
Because the septum is only one of three structures that narrow the airway. The nasal valve — the narrowest point, just inside the nostril — can be built narrow or collapse inward on breathing in, and the turbinates can be enlarged. A straight septum with a blocked nose is exactly the pattern that puts the valve under suspicion.
No — it means the valve is probably involved, which is valuable information. Some people settle on strips or internal supports as their long-term answer, particularly when symptoms are confined to sleep or sport. Surgery is for those who want the problem corrected rather than managed, and only after assessment confirms the valve is the cause.
Yes. Surgery that narrowed the nose or reduced its supporting cartilage can leave the sidewall too soft to resist airflow, sometimes years later. It is a recognised cause of obstruction after rhinoplasty, and it is assessed the same way: examination of the valve on breathing in, with endoscopy where indicated.
Valve surgery uses rhinoplasty techniques, so the combined-operation rules apply: the breathing component may be insured; the rhinoplasty component needs Ministry pre-approval, and the insured and uninsured parts are identified separately, in writing, before anything is decided. The details are on the What OHIP covers page.
The aim is breathing. But because grafts sit in the wall of the nose, a subtle change in its outward appearance is possible, and the honest way to plan valve surgery is to treat appearance and airflow as one conversation — which is how it is done here, before anything is decided.
Assessment first. Then the options are yours.
If your nose collapses shut on a deep breath, assessment settles whether the valve, the septum or both are to blame. An OHIP-insured assessment begins with a referral from your physician or nurse practitioner.