DEAR MAYO CLINIC: I still have a stuffy nose and have trouble breathing through my nose. It’s especially bad at night when I go to bed. I thought it was due to allergies, but the meds aren’t helping. The condition seems to get worse every year. My doctor thinks I may have a nasal valve collapse and an implant may help. What is it, and will it change the shape of my nose?
ANSWER: Nasal obstruction occurs when airflow through the nose is blocked in some way. In some people, it is caused by swelling of the nasal passages due to a cold; allergies; or exposure to irritants, such as smoke or dust. In others like you, a structural problem, such as a collapsed internal nasal valve, could cause nasal obstruction.
The internal nasal valve is the narrowest part of the nasal passage and is about 1 centimeter inside the nostrils. Internal nasal valve collapse can be caused by poorly positioned or weak cartilage. Just a small amount of shrinkage can significantly restrict your airflow.
Most of the time, nasal valve collapse is simply an anatomical variant. It can get worse or cause more symptoms with age due to weakening of connective tissue. This could explain why you were less bothered by symptoms when you were younger. People can also develop nasal valve collapse if they have a deviated septum or have suffered a nasal injury or facial paralysis.
As you have discovered, nasal valve collapse can cause many uncomfortable symptoms, such as feeling like your nose is stuffy or stuffy all the time. This can lead to chronic headaches, tooth decay, bad breath, difficulty breathing during exercise, and poor quality sleep. It can also exacerbate snoring.
People often believe their symptoms are due to allergies, a viral illness, or sinusitis. Unlike these conditions, nasal valve collapse does not resolve after the illness ends or does not change over the seasons. It is also easily overlooked during a nasal exam, as other factors frequently contribute to nasal obstruction, and looking into the nose with a speculum or otoscope bypasses the internal nasal valve.
An absorbable nasal implant known as Latera is a new, minimally invasive treatment option for nasal obstruction caused by collapse of the internal nasal valve. It uses a 2 centimeter resorbable implant to increase airflow and relieve symptoms.
The first step is to schedule a consultation with an otolaryngologist to determine if you would benefit from the procedure. People who have found outer nasal strips beneficial in reducing symptoms are likely good candidates for an absorbable nasal implant.
During the procedure, you will be seated in an examination chair and the inside of your nose will be numbed with a local anesthetic. A hollow tube containing the implant is inserted into the outer wall of the nose. When the tip of the tube reaches its target – usually the area just below where the glasses sit – the implant is released into its supporting position. Then the tube is removed. The implant is made of polydioxanone, which has been used in absorbable sutures and other medical applications for decades.
During the treatment, you will feel some pressure and slight discomfort. You can resume your usual activities the next day. You may have slight bruising and inflammation, but these issues should resolve quickly.
The implant will not change the shape of your nose. You and others will not be able to see it through your skin.
Over the next 18 months, the implant is absorbed by your body and replaced with naturally occurring collagen in your body. This results in continuous support of the lateral nasal wall and airflow.
An absorbable nasal implant is not suitable for all people with nasal obstruction. A consultation with an otolaryngologist will help determine the best treatment option to address the causes of your obstruction. For example, if you have a deviated septum and a collapsed nasal valve, both issues may need to be treated to resolve the obstruction.
Overall, people who had a nasal implant report having less nasal congestion and less difficulty breathing through their nose. They had improvements in getting enough air through the nose during exercise or exertion and better quality sleep.
Talk to your primary care provider or ear, nose and throat doctor if you have a nasal obstruction and think an implant might help. — Dr. David Valencia, Otorhinolaryngology, Mayo Clinic Health System, La Crosse, Onalaska and Prairie du Chien, Wisconsin
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