Nasal valve stenosis is a condition that significantly affects breathing, arising from the narrowing or collapse of the narrowest air passages inside the nose due to structural or functional problems. Because this narrowing restricts airflow through the nose, it complicates the seemingly simple act of breathing. You can liken it to the closing of a tiny “doorway” inside the nose. When this nasal valve region, which acts somewhat like a “checkpoint” for incoming air near the interior of our nostrils, does not function properly, extra effort is needed to breathe. As a result, mouth breathing increases, sleep quality can worsen, and shortness of breath may be felt even during daily activities.
What Is Nasal Valve Stenosis and How Does It Affect Breathing?
The nasal valve can be defined as the narrowest passage inside the nose—essentially the first “narrow corridor” air passes through when entering the nostrils. This narrow passage, formed by the upper and lower cartilage structures close to the nasal tip, facilitates comfortable breathing when properly open. However, weakening of the cartilages, trauma, aging, or congenital structural abnormalities can reduce the openness of this corridor.
Narrowing of this “tight corridor” makes airflow inside the nose more difficult, similar to trying to pass fluid through a bottle’s narrow neck. Imagine trying to pour a glass of water through a narrow straw instead of a wide funnel. When air is likewise forced through a very tight opening, pressure balance in the nose changes. Especially while inhaling, negative pressure increases, causing weak sidewalls to easily collapse inward. This phenomenon can also be explained by the “Bernoulli principle”: As air speeds up passing through a constricted area, its pressure drops, and the already delicate cartilage frame is pulled inward.
What Are the Common Symptoms of Nasal Valve Stenosis?
Nasal valve stenosis is a problem occurring at the narrowest passage inside the nose; when support from the cartilage or soft tissue around this passage is insufficient, a range of symptoms appears. The most common complaint is the feeling of “nasal congestion,” described as difficulty in breathing through the nose. This congestion may affect one side or both sides. Shortness of breath becomes particularly noticeable during exertion, sports, or rapid movements, as the nose demands more airflow in these situations.
Another frequently encountered symptom is the inward collapse of the “nasal wings” or visually noticeable movement at the sides of the nose. During strong inhalation, the lateral walls of the nose being drawn inward indicates that the valve region lacks adequate support. Many patients instinctively try to obtain temporary relief by pulling their nostrils outward with their fingers or using an adhesive strip, reducing the sense of inward collapse. In daily life, this is akin to performing a simple test known as the “Cottle maneuver.”
Additionally, chronic nasal congestion leads to increased mouth breathing. Because the mouth stays open during sleep, snoring or morning throat dryness is common. Dryness inside the nose may cause crusting (scabbing) and occasional nosebleeds. As breathing becomes more difficult, the body exerts more effort, which can result in fatigue, lack of concentration, or even headaches.
Although unilateral or asymmetric symptoms are most common, there are also cases of nasal valve stenosis affecting both nostrils simultaneously. These symptoms are often chronic and stubborn; they may not improve with simple nasal drops or short-term decongestant use. As these symptoms significantly reduce quality of daily life, professional evaluation is indicated.
What Causes Nasal Valve Stenosis?
There are many factors involved in the development of nasal valve stenosis. Essentially, there is insufficient cartilage strength in the area referred to as the nasal valve, or the anatomical angles in this region are inherently narrow. This weakness can be congenital or “genetic” in origin, or it may develop later. Any trauma involving the nose—such as a nasal fracture, a strong impact, or accidents—can weaken the cartilage and soft tissue in the valve area. During tissue healing following these traumas, scar tissue may form, narrowing the space and acting as a barrier that obstructs airflow.
Surgical interventions are also a significant factor. Particularly in rhinoplasty procedures, if too much bone and cartilage structure of the nose is removed or insufficient support is provided, nasal valve narrowing can occur. Although these surgeries aim to produce an aesthetic appearance, failing to properly support the nose’s breathing mechanism can weaken the nasal valve and increase the tendency for collapse. In some patients, the nasal tip becomes too thin or upturned after surgery, which reduces the angle of the nasal valve.
Another cause is the loss of cartilage elasticity as one ages. Over the years, just as cartilage in the joints and the skin’s elasticity diminish, the nasal cartilages also lose rigidity and resilience. Combined with thinning of subcutaneous tissue, this can lead to the nasal sidewalls more easily bending inward. Moreover, long-standing allergic rhinitis or chronic sinusitis can cause edema and structural changes in the nasal tissues, further narrowing the valve area.
Genetic disorders (such as a cleft lip and palate history) may also prevent proper nasal valve development from the start. In such cases, because the nasal anatomy does not complete its normal development, the valve angle is already weak or formed at an improper angle. Lastly, prolonged use of nasal piercings or any external manipulation that deforms the cartilages supporting the nasal wings can damage nasal valve structures. In short, nasal valve stenosis is a multifactorial problem that can emerge at various stages of life and through different pathways.
How Is Nasal Valve Stenosis Diagnosed?
Diagnosing nasal valve stenosis begins primarily by listening to the patient’s complaints and conducting a detailed physical examination. A statement like “When I pull the sides of my nose outward with my hands, I can breathe more easily” strongly suggests valve stenosis. Even this simple experience indicates a lack of structural support at that critical point in the nose, and that sideways traction opens the airway.
During the exam, physicians perform a simple test called the “Cottle maneuver.” With a finger or a small instrument, the lateral nasal wall is gently pulled outward. If the patient breathes more comfortably in that moment, nasal valve stenosis is suspected. Additionally, a more targeted technique known as the “Modified Cottle maneuver” can be used. Here, the physician uses a small instrument such as a cotton swab to gently lift the nasal sidewall, isolating the valve region, and evaluates changes in airflow.
At a more advanced stage, nasal endoscopy is used. With the help of a flexible endoscope, the nasal cavity and especially the valve area can be examined in detail. This provides both static (while at rest) and dynamic (while breathing) images. In certain cases, radiological imaging (MRI, CT, or cone-beam CT) may be useful for a detailed view of anatomical structures.
Additionally, tests such as rhinomanometry or acoustic rhinometry, which measure respiratory physiology, can be carried out. Rhinomanometry measures air pressure and flow rate in the nostrils, while acoustic rhinometry uses sound waves to determine cross-sectional areas inside the nose. Both methods provide objective measurements of nasal obstruction and are particularly valuable for pre- and post-surgery comparisons. These tests can also help rule out septal deviation, polyps, or other intranasal pathologies. With a definitive diagnosis, it becomes clearer how to proceed with treatment.
What Surgical Options Are Available to Treat Nasal Valve Stenosis?
Surgical approaches in treating nasal valve stenosis mostly aim to give structural support to this region. The key is thoroughly analyzing the patient’s nasal anatomy to determine precisely which tissue deficiency is causing the narrowing. Surgical interventions follow three main strategies: support, expansion, and reshaping.
Support Grafts (Spreader, Alar Batten, etc.)
One of the most common methods to strengthen cartilage support in the nasal valve area is placing thin cartilage pieces called “spreader grafts.” These grafts are placed between the upper lateral cartilage and the septum, keeping the internal nasal corridor open. Similarly, an “alar batten graft” is applied to prevent the collapse of the nasal wing. These grafts are often made from the patient’s own cartilage (for example, from the ear or rib). If the patient’s own tissue is not available, synthetic materials or cadaver-derived cartilage might be used.
Septoplasty and Turbinate Procedures
If septal deviation accompanies nasal valve stenosis, a septoplasty is performed to correct the crooked bony-cartilaginous wall, relieving extra pressure or deviation in the valve area. If enlargement or swelling of the turbinates—structures within the nose that regulate airflow—is present, a reduction procedure may be done to allow air to pass more comfortably.
Surgical Techniques and Implants (Suture Suspension, Bioabsorbable Implants, etc.)
In recent years, suture suspension techniques have gained popularity. In this method, the nasal sidewall is internally lifted upward and outward with special sutures, thereby increasing the valve opening. Bioabsorbable implants, meanwhile, provide temporary support to the nasal sidewall and are gradually absorbed by the body. Thus, while tissues heal, support persists, but since the implant is not permanent, no foreign body remains in the tissue long-term.
The success of any surgical approach largely depends on a detailed preoperative evaluation and selecting the right technique. Ideally, a single procedure that provides both functional and aesthetic improvements to the nose is best. Otherwise, revision surgeries may be necessary if insufficient support or excessive tissue removal leads to suboptimal results. A well-planned surgical intervention can substantially improve a patient’s quality of life and provide noticeable relief in breathing.
What Is the Recovery Process After Nasal Valve Surgery?
The recovery process for a patient who undergoes nasal valve surgery varies depending on the surgical technique used and the patient’s tissue healing capacity. Nonetheless, there are certain general stages:
Early Stage (First 48 Hours)
During the first two days post-surgery, mild blood leakage and a slight feeling of congestion in the nose are common. Keeping the head elevated, applying a cold compress, and resting can help minimize swelling and bruising. It’s important to protect the nose from trauma; thus, forceful nose blowing or strenuous exercise is not recommended.
First Week
During this period, if there are stitches or a splint, they may be removed or changed under medical supervision. In some surgical approaches, subtle external taping may be present; contact with water may be somewhat restricted. Also, any internal “splint” (small plastic or silicone support in the nose) is typically removed at the end of the first week or according to the doctor’s judgment. A portion of the swelling noticeably subsides by the end of the first week, but full resolution takes more time.
8–12 Weeks
In this mid-stage, the majority of internal nasal tissues heal. The effect of grafts placed in the valve area and any other surgical procedures become clearer. Patients can generally return to almost all aspects of daily life. However, it is still important to avoid sports activities that carry a risk of nasal impact.
Long Term (3–6 Months and Beyond)
The nasal anatomy truly starts to stabilize during this period. Patients often remark that nasal valve support has improved and breathing feels more comfortable. Especially for areas where grafts were placed, it may take a few more months for ossification and complete tissue adaptation. Once postoperative edema fully resolves in the long run, the functional and aesthetic results become apparent.
Who Is at Higher Risk for Nasal Valve Stenosis?
A range of factors influence susceptibility to nasal valve stenosis. Some individuals are inherently more vulnerable due to congenital anatomical features; for example, in people with thin nasal wings and weak cartilage, there is a higher likelihood of collapse in the valve area. Some are genetically predisposed to a nasal structure where the nasal bones are short and the upper lateral cartilages develop longer and more flexible, which can cause the valve angle to narrow at critical levels.
Age is also an important factor. As the years progress, cartilage elasticity decreases, and the soft tissues around the nose relax. Especially after one’s 50s and 60s, the signs of nasal valve stenosis can become more pronounced, putting older populations at greater risk due to a weakening of supportive structures in the nasal anatomy.
Those who have had prior nose surgeries are also at risk. Particularly in rhinoplasty procedures that involve raising the nasal tip or removing cartilage, if structural support around the nasal valve area is overlooked, stenosis may develop later. Similarly, in individuals who have suffered significant nasal trauma, improper cartilage healing or the formation of scar tissue can lead to narrowing in the valve area.
People with a history of allergies and chronic nasal inflammation (rhinitis, sinusitis) may experience persistent tissue edema and tissue thickening, ultimately setting the stage for permanent narrowing in the valve area. Finally, habits such as smoking that irritate the nasal mucosa disrupt the nose’s natural defense mechanisms, making the emergence of this narrowing more likely.
Op. Dr. Yunus Kaplan was born in Iskenderun in 1979. He graduated from the Gaziantep University Faculty of Medicine in 2001 and completed his specialization in Otolaryngology in 2009. He has worked at various public and private hospitals. Since 2020, he has been accepting patients in the field of rhinoplasty at his private clinic in Istanbul Nişantaşı.
