Can Nasal Congestion and Airflow Acceleration Occur at the Same Time?
Following septorhinoplasty surgery performed abroad, the patient experienced a collapse in the right nasal wing, particularly during inspiration, and a concurrent sensation of cold, dry air. Upon examination, the patient was found to have stenosis in the right nasal valve region (the collapse was evident during inspiration, and the Cottle Maneuver test was positive). The patient underwent right inferior turbinate outfracture and turbinate reduction with radiofrequency at the same clinic. The patient reported that her symptoms improved when she performed the cylinder cotton test with the nasal flap opening device and the tape or device simultaneously. While nasal congestion resolved with the tape or device opening the nasal valve alone, she reported an increased sensation of cold, dry air inside the nose, and impaired sleep quality. Endoscopic examination revealed lateralization and decreased volume of the right inferior turbinate, a greater than normal distance between the turbinate and septum, and dry mucosa, particularly in the right nasal cavity. Endoscopic examination of the patient's left nasal cavity was normal. The patient was scheduled to undergo the following procedures:
- Right Submucosal Costal Cartilage Implantation (Inferior Meatus Augmentation Procedure (IMAP)),
- Open Technique Nasal Valve Surgery
- Right Inferior Turbinate Medialization
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| The image above was recorded during an endoscopic nasal examination. Following the Right Submucosal Costal Cartilage Implantation (Inferior Meatus Augmentation Procedure (IMAP)), the right inferior meatus was narrowed and augmented. Purple suture material at the incision site is indicated by green arrows. The right inferior turbinate was medialized, and the right ansal airway was narrowed (yellow arrow). However, since the internal silicone splint remained in the nose for 1 week, an ellipsoidal compression area is observed due to the pressure effect. |
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| The image above shows cartilage grafts prepared with cartilage obtained from the rib. |
What is the Nasal Valve and Why is it So Important?
The narrowest air passage in the nose is called the nasal valve. Since most inhaled air passes through this area, even a small narrowing in the nasal valve can lead to serious breathing difficulties. Therefore, the nasal valve is one of the most critical anatomical areas for nasal breathing.
Weakness, collapse, or narrowing in the nasal valve area can reduce airflow, causing patients to experience constant nasal congestion. Symptoms become more pronounced, especially during exercise or when trying to take deep breaths.
What are the Symptoms of Nasal Valve Collapse?
People with nasal valve collapse usually complain of unilateral or bilateral nasal congestion. However, this congestion is often different from classic nasal turbinate hypertrophy or septal deviation. Patients may notice that the side walls of their nose are pulled inward, especially when breathing.
Snoring at night, sleeping with the mouth open, shortness of breath during exercise, and a constant need to clear the nose are also common symptoms. Some patients report that their breathing becomes significantly easier when they pull their nostrils outwards.
What Causes Nasal Valve Collapse?
Nasal valve collapse can be congenital or acquired. Trauma, previous nasal surgeries, age-related tissue weakening, and certain connective tissue diseases are among the most common causes.
Especially after older rhinoplasty techniques involving excessive cartilage removal, a loss of support can occur in the nasal sidewalls. This can cause the nasal valve area to collapse inwards due to the effect of negative pressure during breathing.
How is Nasal Valve Collapse Diagnosed?
Diagnosis is usually made through a detailed ENT examination and endoscopic evaluation. During the examination, the patient is asked to take a deep breath, and the movement of the nasal sidewalls is observed.
Simple examination methods such as the Cottle test and the modified Cottle test can also aid in diagnosis. However, nowadays, endoscopic evaluation and dynamic examination methods provide more reliable information in the diagnosis of nasal valve collapse.
Can Nasal Valve Collapse Be Treated Non-Surgically?
In mild cases, nasal dilators, nasal strips, or certain special support devices may provide temporary relief. However, these methods do not eliminate the anatomical problem, and their effects are generally limited to the duration of use.
In patients with significant structural collapse, a permanent solution is often achieved through surgical treatment. The treatment plan is determined according to the patient's anatomical characteristics and the severity of the collapse.
Surgical Methods in the Treatment of Nasal Valve Collapse
The aim of surgical treatment is to restore support to the nasal valve area and widen the airway. For this purpose, spreader grafts, alar batten grafts, lateral crural strut grafts, or various suture techniques can be used.
When the correct technique is chosen, both breathing function improves and nasal aesthetics can be preserved. Thanks to functional rhinoplasty approaches today, long-term and successful results are achieved in the vast majority of patients.
What is Nasal Hyperventilation?
Nasal hyperventilation is a condition resulting from an excess amount or speed of airflow through the nose, which can lead to a paradoxical feeling of shortness of breath. Patients often feel they cannot breathe adequately even though they know their noses are clear.
This condition is particularly common after inferior turbinate reduction surgery, in cases of empty nose syndrome, or in individuals with an excessively wide nasal airway. The problem is less about the amount of airflow and more about the disruption of the nose's mechanisms for sensing and regulating airflow.
Why Does Too Much Air Passing Through the Nose Cause Shortness of Breath?
Normally, the nose slows, directs, humidifies, and warms the airflow. Furthermore, nerve endings in the nasal mucosa constantly send information to the brain regarding the amount and temperature of the air passing through.
When the nasal airway is excessively widened, the airflow can lose its natural turbulence and may move much faster than normal in some areas. This can lead to incorrect or insufficient stimulation of the sensors inside the nose. In conclusion, a person may experience a feeling of "no air coming in" even though they are objectively getting enough air.
The Relationship Between Nasal Hyperventilation and Empty Nose Syndrome
A significant number of patients with empty nose syndrome have been found to have airflow disorders similar to nasal hyperventilation. Especially after excessive reduction of the inferior turbinates, airflow may follow abnormal paths within the nose.
In these patients, accelerated airflow, mucosal dryness, decreased trigeminal nerve stimulation, and misinterpretation of the breathing sensation by the brain may all play a role. Therefore, some patients may say their noses are very clear while simultaneously experiencing an intense feeling of suffocation.
What are the Symptoms of Nasal Hyperventilation?
The most common symptom is paradoxical nasal congestion. The patient feels insufficient breathing despite knowing their nose is clear. A constant need for deep breaths, frequent sighing, a feeling of air hunger, and anxiety-like complaints may also occur.
Some patients report that symptoms worsen, especially when exposed to air conditioning, wind, or cold air. Difficulty falling asleep at night, breath tracking, and constantly checking one's breathing are also common.
How Does Nasal Hyperventilation Affect the Brain and Respiratory Centers?
The nose is not just an airway; it is also a sensory organ that plays a vital role in controlling breathing. Signals from the nose reach the respiratory centers in the brainstem, contributing to the sensation of breathing.
When the natural flow of nasal air is disrupted, these signals can also change. Some researchers believe that nasal hyperventilation may trigger a "I'm not getting enough air" perception in the brain, leading to more frequent and deeper breaths.
How is Nasal Hyperventilation Treated?
Treatment varies depending on the underlying cause. If the problem is related to an excessively wide nasal cavity or empty nose syndrome, surgery or filler injections aimed at reorganizing airflow may be considered.
Mucosal moisturizing treatments, respiratory rehabilitation, controlled breathing exercises, and in some cases, psychological support are also important parts of treatment. The goal is not only to alter the airway but also to enable the patient to regain a normal feeling of breathing.
Nasal Hyperventilation and Air Hunger
One of the most bothersome consequences of nasal hyperventilation is a feeling of air hunger. Patients describe this as "I'm breathing, but it feels like oxygen isn't reaching me," or "My nose is very clear, but I feel like I'm going to suffocate."
This sensation arises not only from airflow but also from trigeminal nerve impulses, carbon dioxide balance, mucosal receptors, and the central nervous system's perception of breathing. Therefore, nasal hyperventilation should be considered not only an anatomical problem but also a neurophysiological one.
Search results link for articles on nasal valve collapse prepared by Dr. Murat Enöz and published on this website (you can also access previous articles by clicking "more posts" at the bottom of the page) >> https://www.ent-istanbul.com/2018/03/nasal-valve-collapse-treatment.html
Search results link for articles on nasal hyperventilation prepared by Dr. Murat Enöz and published on this website (you can also access previous articles by clicking "more posts" at the bottom of the page) >> https://www.ent-istanbul.com/search?q=nasal+hyperventilation
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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