I Can Breathe Better Pulling My Cheek — What Does That Mean?
- mrtimbiggs4
- Jan 10
- 3 min read
Many patients describe the same experience:
“If I pull my cheek sideways, I can breathe much better through my nose.”
This is not a coincidence, and it is an important clinical clue. In fact, it often points to a specific and commonly missed cause of nasal obstruction.
The Short Answer
If pulling your cheek sideways improves your breathing, it strongly suggests nasal valve collapse.
This means the narrowest part of your nasal airway lacks sufficient structural support and partially collapses when you breathe in.
What Is the Nasal Valve?
The nasal valve is the tightest point in the nasal airway and plays a critical role in airflow.
It sits:
Just inside the nostrils
Where cartilage, bone, and soft tissue meet
Because it is naturally narrow, even a small weakness can have a large impact on breathing.
Why Pulling the Cheek Helps you breathe better?
When you pull your cheek sideways, you are:
Manually widening the nasal valve
Preventing the sidewall from collapsing inward
Temporarily improving airflow
This manoeuvre is known clinically as the Cottle sign.
A positive Cottle sign (breathing improves when the cheek is pulled) is a strong indicator of nasal valve collapse.
Why This Is Often Missed
Nasal valve collapse is frequently overlooked because:
The septum may look straight
Scans can appear “normal”
The problem is dynamic (happens when you breathe in)
Routine examination may miss subtle collapse
This is why some patients are told:
“Everything looks fine — I don’t know why you feel blocked.”
Common Situations Where This Happens
Nasal valve collapse is more likely if you:
Have had previous septoplasty or rhinoplasty
Have a narrow nose naturally
Have had nasal trauma
Notice blockage during exercise
Are worse at night or on deep inspiration
Importantly, nasal sprays do not fix valve collapse, because it is a structural problem, not inflammation.
Why Septoplasty Often Doesn’t Help
Septoplasty straightens the septum but does not:
Strengthen weak sidewalls
Support the nasal valve
Prevent dynamic collapse
In some cases, septoplasty can even unmask valve collapse by removing internal support.
This explains why many patients say:
“My septoplasty didn’t work — but pulling my cheek still helps.”
What Actually Fixes the Problem?
The definitive treatment for nasal valve collapse is functional septorhinoplasty.
This involves:
Rebuilding structural support
Strengthening the nasal sidewalls
Supporting the valve area with cartilage grafts
Addressing septum, valves, and framework together
The goal is stable, reliable airflow, not cosmetic change.
Specialist Assessment Matters
Diagnosing nasal valve collapse requires:
Dynamic examination (watching the nose during breathing)
Understanding of nasal airflow physics
Experience with structural nasal surgery
Assessment in Hampshire is provided by Mr Tim Biggs, a Consultant ENT & Rhinology Surgeon with extensive experience in nasal valve reconstruction and functional septorhinoplasty.
Consultations take place at Adnova Clinic, with patients attending from Portsmouth, Southampton, Winchester, and across the South Coast.
When Should You Seek Help?
You should consider specialist assessment if:
Pulling your cheek improves breathing
Your nose blocks on deep inspiration
Symptoms persist despite nasal sprays
You’ve had septoplasty but remain blocked
Breathing worsens during exercise or at night
These are classic features of nasal valve collapse.
Key Takeaway
If you can breathe better by pulling your cheek, your nose is giving you valuable information.
This is not a habit, allergy, or coincidence — it is a sign of structural nasal valve weakness, and it requires a structural solution.
Correct diagnosis leads to correct surgery — and long-term relief.
To enquire or book an assessment:
📍 Adnova Clinic
More information:
