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NEUROLOGY &
SLEEP DISORDERS
Treating a Root Cause of
NASAL AIRWAY OBSTRUCTION:
The evolution of treatment modalities for nasal valve collapse
By Jose Barrera, MD
is estimated that more than 20 million weakness of the nasal cartilage. NVC can be read-
It Americans suffer from nasal airway ily diagnosed with the Modified Cottle Maneuver,
1
obstruction (NAO) , which limits air-
which is performed using a cerumen loop or
flow through the nose with significant curette to gently support the lateral wall cartilage
quality of life consequences. As nasal breathing on each side of the nose while the patient
2
delivers 70% of the airflow that the lungs receive, 3 breathes. If the patient experiences significant im-
NAO may significantly reduce the amount of air provement in breathing on inspiration, the Mod-
delivered to the lungs. Symptoms of NAO include ified Cottle Maneuver is indicative of NVC.
nasal congestion, labored nasal breathing, chal- In my experience treating individuals with
lenges getting enough air through the nose while NAO, I have found that many patients often
exercising, and trouble sleeping. 4 make the mistake of ignoring symptoms because
COLLAPSED VALVE
they may become accustomed to their nasal
How Nasal Valve Collapse (NVC) Can breathing issues, or compensate with mouth
Contribute to NAO breathing. It is also common for patients to mis-
NAO can result from even the slightest narrow- diagnose their symptoms for chronic allergies or
ing of the nasal passage; 5,6,7 common conditions sinusitis, and decide to soldier on with reduced
that contribute to NAO include septal deviation, nasal breathing.
turbinate hypertrophy and nasal valve collapse Treatment of NAO due to NVC has often in-
(NVC). NVC, which may equal or even exceed cluded vasoconstrictive and/or anti-inflammatory
8
septal deviation as the prime cause of NAO, oc- nasal sprays that do not correct NVC, and nasal
curs as a result of weak nasal cartilage collapsing strips or dilators that are ill-suited for daytime use
inward when a person inhales, 8,9 It may be due to and may irritate the skin and mucosa. Traditional
previous rhinoplasty, nasal trauma or congenital MODIFIED COTTLE NVC procedures (grafts) are less than ideal, as
MANEUVER
continued on page 24
22 San Antonio Medicine • August 2018
