What is the nasal valve?

The nasal valve is the narrowest part of your nasal airway—think of it as the “nozzle” of the nose where most airflow resistance occurs. Each side has an internal valve (between the septum and upper lateral cartilage) and an external valve (the nostril rim and lower cartilage). When the valve is too narrow or too weak, it can collapse inward during breathing, especially with deep inhalation, exercise, or sleep.

What is nasal valve collapse?

Nasal valve collapse (NVC) is a structural narrowing or weakening of the nasal valve that leads to chronic nasal obstruction. People often describe an “air hunger,” mouth breathing, or feeling like one side of the nose pinches shut. Symptoms typically worsen when you sniff in or when lying on your side, and improve when you lift the cheek or the side of the nose with a finger (Cottle or modified Cottle maneuver).

Common symptoms

  • Difficulty breathing through the nose (one or both sides)
  • Congestion that does not respond to allergy sprays or pills
  • Noisy breathing or snoring, especially at night
  • Dry mouth, sore throat, or fatigue from mouth breathing
  • Exercise intolerance due to limited nasal airflow
  • Relief with nasal strips or internal nasal dilators

Why does it happen?

  • Prior nasal trauma or fracture
  • Aging and loss of cartilage support/skin elasticity
  • Previous nasal or sinus surgery (including rhinoplasty or septoplasty)
  • Septal deviation forcing airflow through a narrowed angle
  • Weak or thin cartilage by anatomy
  • Inflammation from chronic rhinitis that unmasks structural weakness

How we diagnose NVC at Richmond ENT

Your visit begins with a careful history and focused exam by our board‑certified otolaryngologists.

Evaluation may include:

  • External inspection for valve collapse with gentle inspiration
  • Cottle/modified Cottle maneuvers to see if side‑wall support improves breathing
  • Anterior rhinoscopy and nasal endoscopy to visualize the internal valve, septum, and turbinates
  • Photographs documenting the nasal profile and valve area
  • In‑office CT scan (when appropriate) to evaluate anatomy and rule out sinus disease
  • A short trial of external or internal dilators may help confirm the diagnosis

Many medical therapies (antihistamines, steroid sprays) do not fix a structural valve problem—they help swelling, not support. When the valve is weak or too narrow, mechanical support or remodeling is usually required.

Treatment options

We tailor therapy to your anatomy, goals, and recovery preferences. Options range from temporary, non‑surgical aids to minimally invasive office procedures and definitive surgical repair.

Non‑procedural aids

  • Nasal strips or internal dilators – Simple, drug‑free support for sleep or exercise; helpful but temporary.
  • Allergy management – If you also have rhinitis, treating inflammation can enhance comfort, though it won’t correct structural weakness.

Office‑based minimally invasive procedures

  • VivAer – Temperature‑controlled remodeling of the internal nasal valve (CPT 30469) – Gently reshapes and stiffens the side wall to resist collapse, performed in the office with local anesthesia in about 20–30 minutes. Many patients notice improved airflow within weeks. Read more
  • Latera – Absorbable lateral wall implants (CPT 30468) – A small, dissolvable implant that reinforces the side wall from inside the nose. Over months, your body forms supportive collagen as the implant resorbs. Read more

Benefits

  • Performed in the office with local anesthesia
  • No external incisions; minimal downtime for most patients
  • May be combined with turbinate reduction (CPT 30140) or septoplasty (CPT 30520) for comprehensive airflow improvement

Considerations/Risks

  • Temporary swelling, crusting, or tenderness
  • Rare implant visibility or migration (for implant procedures)
  • Results depend on anatomy; some patients still benefit most from surgical grafting

Surgical valve repair (functional rhinoplasty)

When valve collapse is more severe or combined with significant septal deviation, surgical repair offers the most predictable, durable result.

Common surgical techniques

  • Spreader grafts to widen the internal valve angle (CPT 30465)
  • Butterfly or alar batten grafts to support the external valve/side wall
  • Septoplasty to straighten the septum and open the central airway (CPT 30520) Read more
  • Turbinoplasty to reduce turbinate bulk while preserving function (CPT 30140) Read more

Benefits

  • Strong, long‑term structural support
  • Corrects multiple issues (deviation + valve + tip/sidewall) in one setting

Considerations/Risks

  • Bruising and swelling for 1–2 weeks (varies)
  • Splints or sutures temporarily
  • Standard surgical risks (bleeding, infection, scarring, asymmetry, need for revision)

Our surgeons will review your imaging, exam findings, and aesthetic preferences to design a plan that optimizes both form and function.

What to expect: recovery & results

  • Office procedures: Most patients resume normal activity within 24–48 hours. Congestion and mild tenderness are common for a few days.
  • Surgery: Expect 1–2 weeks of visible swelling or bruising, with continued internal healing over several weeks. We provide detailed care instructions, saline rinses, and follow‑up visits to ensure a smooth recovery.
  • Results timeline: Many patients notice improvement within days to weeks. Full healing and final airflow gains may continue to evolve for several months as tissues settle.

Are you a candidate?

You may be a good candidate if you:

  • Feel your nose pinch in when you inhale
  • Get quick relief by lifting your cheek/nostril or by using a nasal strip
  • Have persistent obstruction despite allergy therapy
  • Have known septal deviation or prior nasal surgery

Not sure? A consultation with our team can clarify the diagnosis and map the least‑invasive path to durable relief.

Insurance & medical necessity

Nasal valve repair is often covered when obstruction is documented and symptoms persist despite medical therapy. Our team assists with the process by providing:

  • Nasal endoscopy findings and photographic documentation
  • Response to Cottle maneuvers and trial dilators
  • Records of failed medical management (e.g., sprays, antihistamines)
  • Imaging and sleep‑related symptoms when relevant

Coverage varies by plan. We’ll discuss your benefits and any prior authorization requirements before scheduling a procedure.

Why choose Richmond ENT?

  • Comprehensive in‑office evaluation with endoscopy and, when indicated, CT imaging
  • Minimally invasive options and advanced surgical repair tailored to your anatomy
  • Experienced functional rhinoplasty surgeons focused on both breathing and natural appearance
  • Research‑active practice with early adoption of innovative, evidence‑based therapies
  • Coordinated allergy and sinus care under one roof

Your care team

  • Michael Armstrong, MD – Otolaryngologist–Head & Neck Surgeon, Richmond ENT
  • Robert Thomas, MD – Otolaryngologist–Head & Neck Surgeon, Richmond ENT

Frequently asked questions

Will sprays fix nasal valve collapse?
Sprays reduce swelling but cannot add structural support. Many patients improve only when the valve is mechanically reinforced or remodeled.

Do I have to have surgery?
Not always. Many patients do well with office‑based remodeling or absorbable implants. We’ll help you choose the least invasive option that still provides lasting benefit.

Can I combine valve treatment with septoplasty or turbinate reduction?
Yes. Combining procedures often gives the best airflow when multiple sites contribute to obstruction.

How long do results last?
Surgical grafts offer the most durable support. Office procedures and implants are also long‑lasting for many patients, and can be repeated or revised if needed.

What about appearance?
Functional repairs are planned to maintain or subtly improve nasal shape. If cosmetic changes are desired, we can discuss options at the same time.

Preparing for your visit

  • Bring a list of prior nasal/sinus surgeries or injuries
  • List medications you’ve tried for congestion
  • Note situations that worsen breathing (sleeping side, exercise)
  • If nasal strips help, mention it—that’s a helpful diagnostic clue

Ready to breathe easier?

Request an appointment or call 804‑622-3782. Our team will guide you from diagnosis through the most effective, comfortable treatment for your nose.

This page is for educational purposes and does not replace a medical evaluation. Individual results and coverage vary. We’ll review the safest, most effective plan for you during your visit.