What is the difference between a deviated septum and nasal valve collapse?

A deviated septum is an internal bend in the wall of cartilage and bone that divides the nose, narrowing one side of the airway. Nasal valve collapse is a structural support problem where the narrowest part of the airway (the nasal valve) collapses inward during breathing, especially on inspiration. They can cause similar symptoms but require different treatments.

What symptoms suggest a deviated septum rather than nasal valve collapse?

A deviated septum typically causes one nostril to be consistently worse, with blockage that feels fixed rather than changeable. Symptoms may have been present since childhood or after injury, and some people notice temporary improvement with decongestant sprays.

What symptoms suggest nasal valve collapse?

Nasal valve collapse often causes blockage despite a ‘straight’ septum. Breathing is commonly worse on deep inspiration, one nostril may visibly narrow or collapse when you breathe in, symptoms may be worse during exercise or at night, and breathing may improve when you pull the cheek sideways.

How can I test for nasal valve collapse at home?

A simple clue is whether breathing improves when you gently pull the cheek sideways on the blocked side (often called the Cottle manoeuvre). This does not confirm a diagnosis on its own, but it can suggest nasal valve weakness and should prompt specialist assessment.

Does septoplasty fix nasal valve collapse?

No. Septoplasty straightens the septum but does not strengthen weak sidewalls, support the nasal valves, or prevent dynamic collapse during breathing. If valve collapse is present, septoplasty alone may fail to improve symptoms and, in some cases, can unmask or worsen valve weakness.

Why do some people stay blocked after septoplasty?

The most common reason is that nasal valve collapse or other structural issues were missed. Many patients have more than one cause of obstruction, such as turbinate enlargement, narrow nasal bones, or weak cartilage support. Correcting only the septum may leave the airway compromised.

What is the best surgery for nasal valve collapse?

Nasal valve collapse is treated by restoring structural support, typically as part of functional septorhinoplasty. This procedure strengthens the nasal valves and sidewalls and addresses both internal and external contributors to obstruction to achieve durable airflow improvement.

When is septoplasty the right procedure?

Septoplasty is appropriate when the deviated septum is the primary cause of blockage and there is no significant nasal valve collapse or external structural weakness. A specialist examination is required to confirm whether the septum is the only problem.

Why are nasal valve collapse and deviated septum often confused?

They produce similar symptoms, and many patients have both. A septal deviation may be visible and blamed, but if nasal valve collapse is not identified and supported, septoplasty alone may not resolve obstruction.

How do specialists diagnose nasal valve collapse versus deviated septum?

Diagnosis involves external nasal examination, internal inspection of the nasal valves, dynamic assessment while breathing, and careful symptom history (including exercise and sleep). This is more informative than relying on scans alone, because valve collapse is often a dynamic problem.

When should I seek specialist reassessment?

You should seek reassessment if you are still blocked after septoplasty, symptoms worsen on breathing in, one nostril collapses during inspiration, you improve when pulling the cheek sideways, or you have been told the septum is straight but you still feel obstructed.

Where can I get specialist assessment for nasal obstruction in Hampshire?

In Hampshire, specialist assessment for nasal obstruction, including nasal valve collapse and failed septoplasty, is available with Mr Tim Biggs, Consultant ENT and Rhinology Surgeon, at Adnova Clinic in Fareham. Patients attend from Portsmouth, Southampton, Winchester and across the UK.

Nasal Valve Collapse vs Deviated Septum — How to Tell the Difference

mrtimbiggs4
Jan 10
3 min read

If you struggle with a blocked nose, you may have been told you have a deviated septum. Others are told “everything looks straight” — yet breathing is still poor. This is where confusion often arises.

Two of the most common causes of nasal obstruction are deviated septum and nasal valve collapse. They feel similar, but they are not the same problem, and they require different treatments.

Understanding the difference is crucial — especially if previous surgery hasn’t helped.

Nasal Valve Collapse vs Deviated Septum?

What Is a Deviated Septum?

The septum is the wall of cartilage and bone that divides the nose into left and right sides. A deviated septum occurs when this wall is significantly off-centre.

Typical symptoms of a deviated septum:

One nostril consistently worse than the other
Blockage that feels fixed rather than changeable
Symptoms present since childhood or after injury
Improvement when using decongestant sprays

A deviated septum is usually treated with septoplasty.

What Is Nasal Valve Collapse?

The nasal valve is the narrowest part of the nasal airway and is critical for airflow. When the valve is weak or unsupported, it can collapse inward during breathing, especially on inspiration.

Typical symptoms of nasal valve collapse:

Nose feels blocked despite a “straight” septum
Breathing worsens on deep inspiration
One nostril collapses when you breathe in
Breathing improves when you pull your cheek sideways
Symptoms worse during exercise or at night

Nasal valve collapse is a structural support problem, not a blockage that can be removed.

Key Differences at a Glance - Nasal Valve Collapse vs Deviated Septum

Feature	Deviated Septum	Nasal Valve Collapse
Cause	Internal septal deviation	Weak cartilage support
Visible externally	Often none	Sometimes nostril collapse
Changes with breathing	Usually constant	Worsens on inspiration
Helped by sprays	Often	Rarely
Fixed by septoplasty	Yes (if isolated)	No
Needs reconstruction	Rarely	Yes

Why These Two Problems Are Often Confused

Many patients have both conditions.

A septal deviation may be obvious on examination, so it gets blamed — but if valve collapse is missed, septoplasty alone may fail.

This is the most common reason patients say:

“My septoplasty didn’t work.”

Why Septoplasty Doesn’t Fix Nasal Valve Collapse

Septoplasty straightens the septum, but it does not:

Strengthen weak sidewalls
Support the nasal valves
Prevent dynamic collapse

In fact, septal surgery can sometimes unmask or worsen valve collapse if support is reduced.

If valve collapse is present, the correct operation is functional septorhinoplasty, not repeat septoplasty.

How Specialists Tell the Difference

A proper assessment includes:

External nasal examination
Internal examination of the valves
Dynamic assessment while breathing
Functional questioning (exercise, sleep, inspiration)
Not just looking at scans

This level of assessment is best performed by a Consultant ENT surgeon with specialist rhinology expertise and furthermore, extensive septorhinoplasty/rhinoplasty experience.