Does Your Breathing Improve When You Pull Your Cheek to the Side? What It May Reveal About the Nasal Valve

Imagine waking up with a persistent stuffy or congested nose. Breathing through one or both nostrils feels more difficult. You try blowing the congestion out, but nothing significant comes out of your nose that could potentially ease the congestion.

You turn to Dr, Google, and it suggests a simple home test: gently pull your cheek to the side, away from the nose. Lo and behold, the stuffiness eases, and you can breathe through your nose better.

So, what does this simple test reveal? If your breathing improves with this test, it may suggest the narrowing or collapse of the nasal valve.

Here at Easley ENT, we help patients understand nasal obstruction and how nasal valve collapse may be a contributing factor.

What Is the Nasal Valve?

The nasal valve is the narrowest part of the nasal airways. This area is located inside the nose where the nasal passages begin to open, and extends toward the back of the nose.

What this valve does is regulate and control how much air enters the nose, as well as helping to warm, moisten, and filter the air you breathe before it reaches the lungs.

Two distinct structures make up the nasal valve:

• Internal nasal valve, which is located deeper inside and slightly higher in the middle of the nose, and is formed by the nasal septum and upper cartilage
• External nasal valve, which is the outer opening of the nose and located closer to the bottom of the nose, formed by the nostril and the surrounding cartilage

The Cottle Maneuver and What It Reveals About the Nasal Valve

The Cottle maneuver is a simple bedside test that physicians may perform as part of the diagnosis for nasal valve collapse.

You perform the test by placing a finger on your cheek beside the nose and gently pulling to the side. This widens the nasal valve. If breathing noticeably improves, it may suggest the narrowing or collapsing of the nasal valve.

Improvement with the maneuver can be a clue of nasal valve collapse, not proof, as nasal obstruction can occur due to several other causes, such as tissue inflammation, a deviated septum, enlarged turbinates, or a combination of these factors.

An ENT evaluation can help assess your symptoms, evaluate the nasal valve directly, and determine what might be contributing to persistent nasal obstruction.

What Is Nasal Valve Collapse?

Nasal valve collapse is one possible cause of nasal obstruction, blockage, or restricted airflow in the nasal cavity. 

It occurs when the airways inside the nose, the nasal valve, narrow. These passages are already narrow, so small structural changes in the nose can significantly restrict airflow and breathing.

Nasal valve dysfunction may involve fixed narrowing, inward movement of weakened nasal tissues during inhalation, or a combination of both. The valve weakens or collapses inward during breathing, like a straw being pinched. This blocks airflow, makes it difficult to breathe through the nose, and creates a sense of persistent nasal congestion.

What Are the Common Symptoms of Nasal Valve Collapse?

Common symptoms of nasal valve collapse include the following:

• Persistent nasal blockage or congestion
• Difficulty breathing through one or both nostrils, which may worsen during physical activity or when lying down
• Mouth breathing
• Snoring
• Your nose looking different in some cases

What Are the Types of Nasal Valve Collapse?

Based on the two major sections of the nasal valve, there are two types of nasal valve collapse:

• Internal nasal valve collapse is the most common type of nasal valve collapse and involves the internal nasal valve.
• External nasal valve collapse is the rarer type and involves the external nasal valve. This type is easier to see because it causes one or both nostrils to collapse when breathing through the nose.

Moreover, based on the type of obstruction pattern, there are also two types of collapse:

• Static obstruction means that the nasal valve is narrow all the time, causing persistent tightness and obstruction.
• Dynamic obstruction means that the nasal valve collapses or weakens more during exercise, deep breathing, or sleep due to the stronger negative pressure. This type of collapse may feel okay at first but worsens the harder you inhale.

What Causes Nasal Valve Collapse?

The main cause of nasal valve collapse is weakened nasal sidewalls. When the nasal sidewalls become weak, they are more prone to collapsing during breathing. This causes the airways to narrow, making it difficult to breathe through the nose.

Other factors may also contribute to nasal valve collapse, including:

• Previous nasal injury or trauma
• Previous nasal surgery, such as a nose job
• A deviated septum
• Aging

When Is It Time to Seek Professional Medical Help?

It’s important to remember that breathing improvement with the Cottle maneuver does not by itself diagnose nasal valve collapse or dysfunction. There are many other potential causes for nasal obstruction. A positive response to the cheek-pull test is a clue, not definite proof.

Consider an ENT evaluation if you are noticing:

• Persistent or chronic nasal congestion that does not improve with standard treatments
• Breathing difficulties through the nose that interfere with daily activities, sleep, and comfort
• Your nostrils visibly pinch inward during breathing
• Reliance on mouth breathing due to persistent nasal blockage
• Frequent or recurring sinus symptoms alongside persistent nasal obstruction 

An ENT evaluation can help assess your symptoms and your nasal structure, as well as determine if nasal valve collapse is involved in nasal obstruction.

Conclusion: Understanding Nasal Obstruction and Nasal Valve Collapse

Easley ENT provides ear, nose, and throat care services, including comprehensive nasal evaluations for patients in Easley and the surrounding Upstate South Carolina communities.

If you are experiencing persistent nasal obstruction and breathing difficulties, contact our team to learn more about the potential for nasal valve collapse and discuss your treatment options.