Normally, the nasal valves should be robust and strong so that they can resist collapsing inward toward each other when you breathe in via your nose. However, when they become weak for any number of reasons, nasal valve collapse occurs. Nasal valve collapse refers to weakening of the nasal valves so that they begin to narrow further. Since the normal, baseline structure of the nasal valves is already narrow, any further narrowing can begin to restrict airflow through the nasal airways. This can lead to nasal obstruction, or an inability to breathe well via the nose. Depending on the extent of the collapse, you can have some degree of nasal obstruction or a completely obstructed nasal airway. Nasal valve collapse can occur to either the internal nasal valve or external valve or both. Nasal valve surgery is a procedure to keep the valve open and help you get more air into your airway.
A comprehensive medical history and physical exam with close examination of the outside and inside of your nose is undertaken to properly diagnose any issues with the nasal valves. Furthermore, to properly identify any issues within the nose, a small endoscope is used to properly visualize the small structures within the nose, front to back, in addition to identifying any other issues that may be present and causing nasal blockages such as a deviated septum, enlarged turbinates, nasal polyps, discharge, or inflammation suggestive of allergies. A common examination technique used during the consultation is the Cottle Maneuver. Here, an instrument known as a Cottle or long cotton swab is used to manually widen the internal or external nasal valve by pulling it to the side. If this maneuver results in improved nasal breathing, then it is a sign for nasal valve collapse.
Keep in mind, a nasal valve collapse alone need not be the sole reason for your symptoms. There is a large variety of other causes that can cause nasal obstructive symptoms and it is essential that you meet with a provider who will not only be able to address your nasal valve collapse issues but any other causes of your nasal symptoms as well. Dr. Harounian is an expert in all forms of nasal surgery and has extensive experience with conditions regarding the nose and sinuses. Furthermore, he has wide fund of knowledge with regards to other causes of nasal obstruction and will be able to not only diagnose and effectively treated any issues with your nasal valves, but also diagnose and address any other causes of nasal blockage as well.
There are several ways to treat nasal valve collapse depending on the extent of your symptoms and your goals. There are some medications that may be of use. For example, nasal steroid sprays such as Flonase or Nasacort can help reduce the mucosal swelling inside your nose and increase the space of your nasal passages, thereby optimizing your nasal breathing. In addition, nasal saline or saltwater rinses serve to clean the inside of your nose and rid your nose of any germs or allergens that may be causing an inflammatory process thereby also helping you breathe better. Furthermore, over-the-counter antihistamines may also act similarly in reducing internal nasal swelling to help you breathe better. Keep in mind that these medications do not actually change the structure of your nose or improve the support of weakened nasal valves.
To supplement, over-the-counter nasal valve dilators such as “Breathe-Rite” may be of benefit. The adhesive strips that you place on the outside of your nose serve to widen the nasal valve area. They are typically worn at night. Many are over the counter while some are custom made. Again, these dilators do not change the underlying structure of your nose or strengthen the nasal valves. In addition, once these dilating strips are taken off, you return to your baseline nasal breathing.
If the medications or aids fail to improve your nasal obstruction or you wish to discontinue your reliance on these supplements, then surgery is the next step to improve your breathing.
Prior to surgery, you will have to refrain from any smoking in addition to any medications that can thin your blood as well as any supplements such as vitamin E, garlic, ginkgo ginseng, ginger, saw palmetto, and fish oil. You will need to have someone accompany you after surgery. We understand that the idea of surgery is a heavy one to consider and can be daunting. Dr. Harounian takes every measure to assure that you feel comfortable and informed of the entire process and including the surgery before you leave the office and enter the operating room. He will meet with you to make sure you understand your condition and the treatments available. He will often welcome family members as well to have a group discussion to make sure everyone is on the same page. You will receive a handout detailing everything that is discussed beginning with what to do the day before your surgery to what you should be doing after your surgery and for the week following your surgery as well. You will receive a personalized bag with supplies that you will need for your aftercare.
Nasal Valve surgery is typically a same-day outpatient procedure that takes approximately 3-4 hours depending on the extent and severity of the nasal valve collapse. The surgery consists of three parts:
Anesthesia – Typically general anesthesia is used so that you are asleep and comfortable during the surgery.
Nasal valve repair/Rhinoplasty – During the surgery, special tools are used to remove any excess or problematic bone or cartilage, repair a deviated septum and harvest cartilage, and fortify/strengthen the nasal valves so as to widen the nasal passages. The cartilage that is harvested is used to reinforce the nasal valves and prevent them from collapsing. This cartilage can be harvested from your own septum, ears, rib, or from an organ donor.
Bandaging/dressing – You may have packing/bandages and sutures on either the inside or outside of the nose depending on the extent of the surgery.
It is important to note that nasal valve surgery can be combined with other nasal surgeries as well depending on your needs. In addition to nasal valve surgery, you can also have deviated septum surgery, sinus surgery, or cosmetic nasal surgery during the same procedure depending on your needs and goals.
There are a variety of risks associated with nasal valve Surgery.
-Bleeding
-Infection
-Risks of Anesthesia
-Septal perforation – a hole develops in septum
-Need for additional or revision surgery
-Persistence of nasal obstruction and/or symptoms
-Continuation of medical therapy after surgery
-Change in smell or taste
-Allergic reaction
-Scarring
Fortunately, they are rare but it is important to be informed of potential risks. Dr. Harounian has extensive training with nasal surgery and takes every precaution to reduce the chances of a risk occurring.
As nasal valve surgery is an outpatient procedure, you will go home the same day. You may feel some soreness and notice some bruising in addition to mild swelling on your nose for a couple of weeks. During this time, it may be difficult or uncomfortable to breathe through one or both sides of your nose as healing continues and the swelling subsides. You may have other types of surgery in conjunction with your nasal valve surgery. Depending on the additional procedures, the recovery time may be shorter or less. Dr. Harounian rarely needs to use packing inside the nose after surgery and patients can usually breathe through the nose very soon afterward. In most cases, you will be able to go back to work within the first week but avoid any physical exertion or heavy exercise for 2 to 3 weeks. Most patients fully recover within a month after nasal surgery. Keep in mind it can be several months before all the swelling has completed subsided.
Dr. Johnathan Harounian is an expert in all types of nasal conditions and nasal surgery including nasal valve collapse. An evaluation at one of our upper east side practices will let you know what is obstructing your nose and what can be done to improve your health and airway. Dr. Harounian will take a comprehensive history and perform a thorough examination of the inside and outside of your nose. Our staff will check your benefits and let you know what your responsibilities are.
For the most part, yes. Almost all insurances will cover the costs for functional problems with your nose. However, understandably insurance does not cover any cosmetic elements of nasal valve surgery. Dr. Harounian is a strong believer in making sure his patients are informed throughout the entire process starting from diagnosis to treatment. His office will perform a full check of your insurance plans and inform you well ahead of time of any financial responsibilities that you may have. There will ever be any surprises and all effort is taken to not only meet, but exceed your goals and expectations. Please feel free to contact us and let us know how we can help you.
