What Is the Nasal Valve? Nasal Valve Collapse Symptoms, Causes, and Whether Nasal Valve Supports Help
Do you feel you "can't get air in" through your nose, and breathing in harder only makes it worse? Besides swelling of the nasal lining from colds or allergies, the structure of the nose itself can also play a part, and one area that often comes up is the "nasal valve". This article draws on an ENT clinical consensus statement and a research review to explain what the nasal valve is, how nasal valve collapse shows up, and the current evidence on nasal valve supports (called "nasal valve supports" in the research literature, including both external nasal strips and internal nasal valve supports).
Please note: this article is general health information and is not a substitute for a doctor's diagnosis. If nasal congestion persists or keeps coming back, or comes with pauses in breathing during sleep, nosebleeds or facial pain, please see an ENT doctor.
What is the nasal valve?
The nasal valve is an area at the front of the nasal cavity, divided into the "internal nasal valve" and the "external nasal valve". According to a clinical consensus statement from the American Academy of Otolaryngology–Head and Neck Surgery, the internal nasal valve lies about 1.3 cm inside the nostril and is bounded by the septum, the front of the inferior turbinate and the upper lateral cartilage; the external nasal valve is the vestibule area under the nasal ala (the wing of the nostril).
The same consensus statement notes that the nasal valve (internal and external) has been described anatomically as the cross-section of the nasal cavity with the greatest resistance to airflow, making it the main gateway for breathing in. In other words, even slight narrowing here can make your nose feel noticeably blocked.
What is nasal valve collapse?
Nasal valve collapse (clinically also called nasal valve compromise) means the nasal valve area narrows or collapses, making it harder for air to move in and out through the nose. The clinical consensus treats it as a distinct cause of nasal obstruction.
Fixed narrowing vs. collapse when breathing in
Obstruction at the nasal valve can roughly be divided into two situations: in one, the structure itself is narrow; in the other, the nostril wing or side wall of the nose is sucked inward and collapses when you breathe in. The clinical consensus notes that visible inward collapse of the side wall or nostril rim when breathing in, and "nasal obstruction that gets worse with deep inspiration", are consistent with nasal valve compromise.
Common signs
- Feeling that you can't get air in through your nose, especially during activity or when lying down
- Often breathing through your mouth during the day
- Snoring at night
- Persistent nasal congestion
These symptoms are summarised from Cleveland Clinic's patient information. They can also be caused by other conditions such as a deviated septum, enlarged turbinates, allergies or sinusitis, so you can't tell it's nasal valve collapse from symptoms alone.
Possible causes
Risk factors listed by Cleveland Clinic include a deviated septum, the nasal structure you were born with, previous nose surgery, ageing and injury to the nose. When the cartilage and tissue supporting the nasal valve weaken, it is more likely to narrow or collapse.
To learn more about septum problems, see: Does a Deviated Septum Affect Breathing?
How do doctors examine the nasal valve?
Nasal valve problems are mainly assessed through a doctor's physical examination. The clinical consensus holds that anterior rhinoscopy (an endoscope isn't necessarily required) can be adequate to evaluate the nasal valve; the doctor may also use the "Cottle manoeuvre": gently pulling the cheek outward to open the nasal valve and seeing whether breathing becomes easier.
Keep in mind that if pulling your cheek at home makes breathing easier, this is only an observation you can mention to your doctor. It is not a diagnosis. Nasal congestion often has more than one cause and still needs a full examination by a doctor.
Do nasal valve supports help? What the research says
Nasal valve retainers are aids that physically open up the front part of the nose. They fall into two main types:
| Type | Where it's used | How it works | Things to note |
|---|---|---|---|
| External nasal strip | Stuck on the skin on both sides of the nose | The strip's spring pulls the side walls of the nose outward | Skin condition and adhesion affect how well it stays on; a new strip is needed each time |
| Internal nasal valve support | Placed inside the nostrils | Supports the nostrils and the area near the nasal valve from the inside | Choose the right size and keep it clean; remove it if it's uncomfortable |
Clinical consensus: an option for some patients
In the American Academy of Otolaryngology–Head and Neck Surgery clinical consensus, experts agreed that external nasal strips "can be used therapeutically for nasal valve compromise for some patients", and that internal devices such as nasal stents or cones "can be used for some patients" as well. Cleveland Clinic explains that nasal strips and internal nasal valve supports provide temporary relief, and that when longer-term structural correction is needed, a doctor may recommend surgery.
Systematic review: better nasal breathing, but not a treatment for sleep apnea
A 2016 systematic review and meta-analysis of studies on external nasal strips and internal nasal valve supports concluded that nasal valve supports improved nasal breathing but did not improve the main outcomes of obstructive sleep apnea; only a subanalysis of internal nasal valve supports showed a slight decrease in the apnea index. Results for snoring were also limited and inconsistent.
In other words, nasal valve supports can serve as an aid when nasal breathing isn't smooth, but if you suspect sleep apnea (for example, someone has noticed you stop breathing during sleep, or you're very sleepy during the day), you should see a doctor rather than relying on a nasal valve support alone. For other causes of snoring, see: Snoring Keeping Everyone Up Every Night? Causes and Solutions.
When to see a doctor first
- Nasal congestion lasts more than two weeks, or keeps coming back
- Congestion is on one side only and getting worse, or comes with nosebleeds or an unusual smell
- Someone has noticed pauses in your breathing during sleep, or you're very sleepy during the day
- It comes with a fever, facial pain or swelling
Further reading: What Is Nasal Congestion? Symptoms, Causes, Risk Factors, Diagnosis and Treatment
What type of nasal valve support is Gnasal?
Gnasal is an internal nasal valve support: made from 0.25 g of titanium alloy and LSR liquid silicone, it is placed in the nostrils and provides physical support from the inside. Its angle can be adjusted, it can be washed and reused, and it comes in several sizes from SS to 2L.
- This product is not a medical device; it only has an assistive function, has no therapeutic effect and is not a substitute for seeing a doctor.
- Not suitable for children under 5; children should use it only with an adult's help and under adult supervision.
- Choose the size according to the size of your nostrils, and remove it immediately if it causes pain or discomfort.
Before using it for the first time, we recommend reading the Size Guide and How to Wear. For wearing it during exercise, see Is Nose Breathing Important During Exercise?.
FAQ
Can I tell by myself whether I have nasal valve collapse?
No. The symptoms are similar to other causes of nasal congestion, and a doctor needs to assess it with a physical examination such as rhinoscopy. You can tell your doctor about observations like "it's more blocked when I breathe in deeply" or "it's easier to breathe when I pull my cheek outward" for reference.
Can nasal valve supports treat sleep apnea?
Current systematic reviews show that nasal valve supports can improve nasal breathing but have not improved the main outcomes of obstructive sleep apnea. If you suspect sleep apnea, please see a doctor.
Which is better: an external nasal strip or an internal nasal valve support?
They work in different places, and neither suits everyone. External strips pull the side walls of the nose outward from the outside; internal nasal valve supports support from inside the nostrils. Choose based on your nose shape, skin condition and how you'll use it, with a stable, comfortable fit as the guide.
How should I clean an internal nasal valve support?
Please follow the product instructions. In general, after use, wash it gently with water and a neutral cleanser, rinse thoroughly and let it air-dry before storing.
Key takeaways
- The nasal valve is the point of greatest airflow resistance in the nose; even slight narrowing can make it feel blocked.
- Nasal valve collapse may be a narrow structure or the side wall of the nose collapsing inward when you breathe in; a doctor needs to examine it.
- The clinical consensus considers nasal strips and internal devices an option for some patients, but they provide temporary support.
- Research shows nasal valve supports can improve nasal breathing, but they should not be treated as a treatment for sleep apnea.
Related articles
Before you buy: Size Guide | How to Wear
References
- Rhee JS, Weaver EM, Park SS, et al. Clinical Consensus Statement: Diagnosis and Management of Nasal Valve Compromise. Otolaryngology–Head and Neck Surgery. 2010;143(1):48–59.
- Camacho M, Malu OO, Kram YA, et al. Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis. Pulmonary Medicine. 2016.
- Cleveland Clinic. Nasal Valve Collapse: Symptoms, Causes, Test & Treatment (reviewed 2023-05-10)