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Algorithm for Management of Nasal Valve Collapse


Purpose of Review

Nasal obstruction is a very common challenge in daily ENT clinical and surgical practice. A common source of lack of satisfaction after septoplasty could be the impairment of the nasal valve area in both static and dynamic conditions.

Recent Findings

Currently there is no consensus to a standard diagnostic algorithm for nasal valve collapse. We performed a review of the last 10 years of literature focused on recent innovations regarding physical examination, radiological diagnosis, subjective, and objective measurement of nasal valve collapse. Finally, we try to formulate a pre-surgical protocol, based on our experience, as well as a model follow-up to evaluate surgical outcomes.


Though there are numerous surgical techniques for the treatment of nasal valve collapse, ENT surgeons would have difficulty selecting the most indicated one. A standardized pre-operative assessment should be mandatory to address a tailored surgery to patient clinical features.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wang Y, Bonaparte JP. Diagnosis and management of septal deviation and nasal valve collapse - a survey of Canadian otolaryngologists. J Otolaryngol - Head Neck Surg. 2019;48(1):71.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gray LP. Deviated nasal septum incidence and etiology. Ann Otol Rhinol Laryngol. 1978;87(3_suppl2):3–20.

  3. Stewart M. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004;130(3):283–90.

    Article  PubMed  Google Scholar 

  4. Gillman GS, Egloff AM, Rivera-Serrano CM. Revision septoplasty: a prospective disease-specific outcome study: revision septoplasty. Laryngoscope. 2014;124(6):1290–5.

    Article  PubMed  Google Scholar 

  5. Tasca I, Compadretti GC. Study of nasal valvular stenosis by means of acoustic rhinometry using Ognibene internal dilator. Acta Otorhinolaryngol Ital. 2004;24(4):193–8 (PMID: 15688903).

    CAS  PubMed  Google Scholar 

  6. Osborn JL, Sacks R. Nasal obstruction. Am J Rhinol Allergy. 2013;27(3_suppl):S7-S8.

  7. Constantian MB. Differing characteristics in 100 consecutive secondary rhinoplasty patients following closed versus open surgical approaches. Plast Reconstr Surg. 2002;109(6):2097–111.

    Article  PubMed  Google Scholar 

  8. Aksoy F, Veyseller B, Yildirim YS, Acar H, Demirhan H, Ozturan O. Role of nasal muscles in nasal valve collapse. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2010;142(3):365–9.

    Article  Google Scholar 

  9. • Rhee JS, Weaver EM, Park SS, et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2010;143(1):48–59. . In this work, Rhee et al. questioned different authors regarding the management of NVC in order to obtain a shared diagnostic and post-operative work-up.

  10. •• Sinkler MA, Wehrle CJ, Elphingstone JW, Magidson E, Ritter EF, Brown JJ. Surgical management of the internal nasal valve: a review of surgical approaches. Aesthetic Plast Surg. 2021;45(3):1127–1136. Because of the huge widespread of different surgical techniques for NCV, treatment is mandatory to improve the diagnostic work-up.

  11. Patel B, Virk JS, Randhawa PS, Andrews PJ. The internal nasal valve: a validated grading system and operative guide. Eur Arch Otorhinolaryngol. 2018;275(11):2739–44.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Bloching MB. Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007;6:Doc07.

  13. Das A, Spiegel JH. Evaluation of validity and specificity of the Cottle maneuver in diagnosis of nasal valve collapse. Plast Reconstr Surg. 2020;146(2):277–80.

    CAS  Article  PubMed  Google Scholar 

  14. Moche JA, Cohen JC, Pearlman SJ. Axial computed tomography evaluation of the internal nasal valve correlates with clinical valve narrowing and patient complaint. Int Forum Allergy Rhinol. 2013;3(7):592–7.

    Article  PubMed  Google Scholar 

  15. Sedaghat AR, Kieff DA, Bergmark RW, Cunnane ME, Busaba NY. Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings. Int Forum Allergy Rhinol. 2015;5(3):258–62.

    Article  PubMed  Google Scholar 

  16. Bloom JD, Sridharan S, Hagiwara M, Babb JS, White WM, Constantinides M. Reformatted computed tomography to assess the internal nasal valve and association with physical examination. Arch Facial Plast Surg. 2012;14(5):331–5.

    Article  PubMed  Google Scholar 

  17. Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2004;130(2):157–63.

    Article  Google Scholar 

  18. Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2017;156(5):809–15.

    Article  Google Scholar 

  19. Kordjian HH, Schousboe LP. Sixty-three patient-based survey-can Sino-Nasal Outcome Test-22 be a suitable evaluation method for septoplasty and turbinectomy? Clin Otolaryngol Off J ENT-UK Off J Neth Soc Oto-Rhino-Laryngol Cervico-Facial Surg. 2017;42(6):1373–7.

    CAS  Article  Google Scholar 

  20. Poirrier AL, Ahluwalia S, Goodson A, Ellis M, Bentley M, Andrews P. Is the Sino-Nasal Outcome Test-22 a suitable evaluation for septorhinoplasty? Laryngoscope. 2013;123(1):76–81.

    Article  PubMed  Google Scholar 

  21. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23(3):1–298.

  22. Manickavasagam J, Wong S, Varabei V, Raghavan U. Nasal valve surgery: assessment of quality of life with the Glasgow Benefit Inventory. Ear Nose Throat J. 2014;93(4–5):174–176, 180.

  23. Valsamidis K, Titelis K, Rachovitsas D, Konstantinidis I, Markou K, Triaridis S. Long-term evaluation of nasal septoplasty followed by inferior turbinate cauterization for the treatment of nasal obstruction using objective and subjective methods. Int Arch Otorhinolaryngol. 2018;22(3):284–90.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ziai H, Bonaparte JP. Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse. J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale. 2018;47(1):15.

    Article  Google Scholar 

  25. Staibano P, Bonaparte JP. The relationship between the Ottawa Valve Collapse Scale (OVCS) and clinical outcomes in septoplasty patients. J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale. 2020;49(1):14.

    Article  Google Scholar 

  26. Hamilton GS. The external nasal valve. Facial Plast Surg Clin N Am. 2017;25(2):179–94.

    Article  Google Scholar 

  27. Kenyon GS. Objective measurement of the external nasal valve. Clin Otolaryngol Off J ENT-UK Off J Neth Soc Oto-Rhino-Laryngol Cervico-Facial Surg. 2015;40(1):67.

    CAS  Article  Google Scholar 

  28. Spielmann PM, White PS, Hussain SSM. Surgical techniques for the treatment of nasal valve collapse: a systematic review. Laryngoscope. 2009;119(7):1281–90.

    Article  PubMed  Google Scholar 

  29. Vogt K, Wernecke KD, Behrbohm H, Gubisch W, Argale M. Four-phase rhinomanometry: a multicentric retrospective analysis of 36,563 clinical measurements. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2016;273(5):1185–98.,technicalupdatescouldenhanceitsdiagnosticvalue.

    Article  Google Scholar 

  30. Maalouf R, Bequignon E, Devars du Mayne M, et al. A functional tool to differentiate nasal valve collapse from other causes of nasal obstruction: the FRIED test. J Appl Physiol Bethesda Md 1985. 2016;121(1):343–347.

  31. Shelton DM, Eiser NM. Evaluation of active anterior and posterior rhinomanometry in normal subjects. Clin Otolaryngol Allied Sci. 1992;17(2):178–82.

    CAS  Article  PubMed  Google Scholar 

  32. Hilberg O, Jackson AC, Swift DL, Pedersen OF. Acoustic rhinometry: evaluation of nasal cavity geometry by acoustic reflection. J Appl Physiol Bethesda Md 1985. 1989;66(1):295–303.

  33. Malm L. Rhinomanometric assessment for rhinologic surgery. Ear Nose Throat J. 1992;71(1):11–16, 19.

  34. Casale M, Cusimano V, Salvinelli F, Setola R, Soda P. Video-rhino-hygrometer (VRH). Conf Proc Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Conf. 2006;2006:543–6.

    Article  Google Scholar 

  35. Tasca I, Ceroni Compadretti G, Sorace F. Nasal valve surgery. Acta Otorhinolaryngol Ital Organo Uff Della Soc Ital Otorinolaringol E Chir Cerv-facc. 2013;33(3):196–201.

    CAS  Google Scholar 

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Correspondence to P. Greco.

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The authors declare no competing interests.

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The studies relevant to this review that were performed by the authors are in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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This article is part of the Topical collection on FACIAL PLASTICS: Functional Rhinoplasty

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Greco, P., Caccamo, G. & Tasca, I. Algorithm for Management of Nasal Valve Collapse. Curr Otorhinolaryngol Rep 10, 140–147 (2022).

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  • Nasal valve collapse
  • Rhinomanometry
  • Acoustic rhinometry
  • Septoplasty
  • Rhinoplasty