Why Nasal Valve Collapse Is Often Missed – Even After ENT Review

mrtimbiggs4
Nov 13
2 min read

Many people live with nasal blockage for years, trying sprays without success. Even after seeing a GP or ENT specialist, they’re sometimes told that “everything looks normal.” But for a significant number of patients, the real problem lies in an area that’s easy to overlook, the nasal valve.

As a Consultant ENT and Rhinology Surgeon in Portsmouth and Fareham, I see many patients whose nasal valve collapse was missed on initial assessment. Recognising and treating it properly can make the difference between ongoing frustration and finally being able to breathe freely again.

What Is the Nasal Valve?

The nasal valve is the narrowest part of your nasal airway, just inside the nostrils, where cartilage, soft tissue, and the septum meet. It acts as the “bottleneck” for airflow.

When the sidewall is weak, narrow, or collapses inwards during breathing, airflow is severely restricted, even if the rest of the nasal passage looks healthy. This is called nasal valve collapse.

Why It’s Often Missed

Even experienced clinicians sometimes overlook nasal valve collapse because:

1️⃣ The nose looks normal at rest – Collapse often only happens during deep inhalation.

2️⃣ Standard scopes and imaging may appear normal – The internal nasal lining and septum can look fine.

3️⃣ Symptoms overlap with other causes – It can mimic allergic rhinitis, sinusitis, or septal deviation.

4️⃣ It’s not always taught in depth during general ENT training – Valve dysfunction is a subspecialist area within rhinology and facial plastics.

Many patients are told “your septum is straight” or “your CT scan looks normal,” yet still can’t breathe properly. That’s often the clue, when everything else seems fine but airflow feels limited, the valve is often the culprit.

Common Symptoms of Nasal Valve Collapse

One or both sides of the nose collapse inwards on breathing
Difficulty breathing through the nose, especially during exercise or sleep
Temporary improvement when lifting the cheek sideways (the “Cottle manoeuvre”)
Persistent blockage despite sprays or previous septoplasty
Little or no improvement with allergy treatment

How It’s Diagnosed

A specialist rhinologist will assess:

Airflow at rest and during deep inspiration
The shape and stability of the nasal sidewalls
Response to manual widening of the valve area

Diagnosis is clinical — based on careful examination and experience, not just imaging.

How It’s Fixed – Functional Rhinoplasty

The best treatment is usually a functional rhinoplasty or functional septorhinoplasty, where I:

Strengthen or widen the valve area using small cartilage grafts
Straighten the septum if needed
Reshape or stabilise the external framework
Drop a prominent hump, to then stabilise the upper lateral cartilages (dorsal preservation technique)

At Adnova Clinic, I use Piezo ultrasonic and dorsal preservation techniques for precision and minimal trauma. There is no nasal packing, and patients can breathe straight away after surgery.

Summary

If your nose looks normal but still feels blocked, nasal valve collapse may be the missing diagnosis. It’s a subtle but common cause of chronic nasal obstruction and it can be fixed safely and predictably with modern functional rhinoplasty.

For expert diagnosis and treatment in Portsmouth, Fareham, and Hampshire, book a consultation with Mr Tim Biggs, Consultant ENT & Rhinology Surgeon, at Adnova Clinic.