Nasal airway obstruction
Affects more than 20 million Americans.11
What is nasal airway obstruction?
Nasal breathing delivers approximately 70% of airflow to the lungs,24 but airway obstruction can limit airflow through the nose. More than 20 million Americans1 are estimated to suffer from nasal airway obstruction (NAO), which limits airflow through the nose with significant quality of life consequences.25
Symptoms may include:
- Nasal congestion or stuffiness
- Nasal blockage or obstruction
- Trouble breathing through the nose
- Trouble sleeping
- Difficulty getting enough air through the nose during exercise or exertion
What causes nasal airway obstruction?
Even slight narrowing of the nasal valve can lead to significant reduction in airflow.26,27,28 Structural blockages in three areas are common:
- Septum: The cartilage wall between the nostrils can bend and block the nasal passage.
- Turbinates: Ridges of bone and tissue inside the nose can limit airflow when enlarged.
- Lateral (side) wall: Weak or excessively flexible upper/lower cartilage in the outer nasal wall may cause it to collapse inward when a person inhales.
The most common conditions to impact patients are septal deviation, turbinate hypertrophy, and nasal valve collapse. Lateral wall collapse may equal or even exceed septal deviation as the prime cause of nasal airway obstruction.29,19
How does nasal airway obstruction affect quality of life?
A Nasal Obstruction Symptom Evaluation (NOSE) survey9 is an assessment tool that can help you understand how your patient’s breathing symptoms are affecting their quality of life. NOSE is a simple, five-question, validated survey that uses a 20-point scale to capture breathing symptoms, with higher scores indicating more severe symptoms than lower scores.
A score of 0 means no problems with nasal obstruction and a score of 100 means the worst possible problems with nasal obstruction. Instrument was not designed to be used with individual patient data or to predict outcome on individuals. Otolaryngology-Head and Neck Surgery: 162-163 STEWART el al February 2004.
Lipan MJ1, Most SP.Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg. 2013 15(5):358-61.
Stewart MG, Smith TL. Weaver EM et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Effectiveness (NOSE) study. Otolatyngol Head Neck Surg:2004; 130(3):283-90.
What is the prevalence of NAO contributors?
A multi-site market research study evaluating symptom severity for nasal airway obstruction (NAO) patients and the prevalence of anatomical causes was published in the June 2018 issue of ENT Journal. Results show that the prevalence of nasal valve collapse (NVC) is comparable to septal deviation and turbinate hypertrophy across all patients evaluated and in the subset of patients with severe/extreme Nasal Obstruction Symptom Evaluation (NOSE) scores.
The market research study included 1,906 patients with sinonasal complaints who were surveyed by 50 physicians in nine U.S. states. Key findings from the study include:
- A majority of patients had severe or extreme NAO based on NOSE scores (63%).
- The prevalence of NVC, septal deviation and inferior turbinate hypertrophy was 73%, 80% and 77%, respectively, in patients with severe or extreme NOSE scores. This market research study is the largest known prevalence assessment for anatomic contributors of NAO.
- NVC was present in 82% of patients with severe or extreme NAO who had previously undergone septoplasty and/or inferior turbinate reduction. This suggests that missed or untreated NVC may be associated with the persistence of NAO symptoms.
Is nasal valve collapse contributing to nasal airway obstruction?
A clinician may use a number of approaches to determine whether the lateral wall is contributing to a patient’s nasal airway obstruction. Examples include:
- Modified cottle maneuver
- Use of nasal strips during normal activity and sleep
If a patient’s symptoms improve from either of the above, they may benefit from support for the lateral nasal wall. The LATERA® absorbable nasal implant is indicated for supporting upper and lower lateral cartilage.
Physical exam: modified cottle maneuver
In order to confirm nasal valve collapse using the modified cottle maneuver, a cerumen loop or curette is used to gently support the lateral wall cartilage on each side of the nose while the patient breathes. A modified cottle maneuver is positive if the patient has significant improvement in breathing on inspiration.
Diagnosis: internal valve or external valve collapse?
Dean Toriumi, MD explains the difference between internal valve vs. external valve collapse and the surgical options available for each.