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DEAR MAYO CLINIC: My nose always feels stuffed up, and I have a hard time breathing through my nose. It is especially bad at night when I lie down. I thought it was because of allergies, but medications do not help. The condition seems to be getting worse every year. My doctor thinks I may have a nasal valve collapse, and an implant can help. What is that, and will it change the shape of my nose?
ANSWER: Nasal obstruction happens when the 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 yourself, a structural issue, like an internal nasal valve collapse, could cause the nasal obstruction.
The internal nasal valve is the narrowest part of the nasal passageway 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 narrowing can significantly restrict your airflow.
Most of the time, nasal valve collapse is simply an anatomical variant. It can worsen or cause more symptoms with age due to the weakening of connective tissue. This could explain why you were less bothered by symptoms when you were younger. People also can develop a nasal valve collapse if they have a deviated septum, or have had a nasal injury or facial paralysis.
As you have discovered, nasal valve collapse can cause many uncomfortable symptoms, like feeling as if your nose is blocked or stuffed up all the time. It can lead to chronic headaches, dental decay, bad breath, difficulty breathing while exercising and poor sleep quality. It also can exacerbate snoring.
People often believe their symptoms are due to allergies, viral illness or sinusitis. Unlike those conditions, nasal valve collapse doesn't resolve after the illness is over or change during the seasons. It also is easily overlooked during a nasal exam, as other factors frequently contribute to the nasal obstruction, and looking in 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 internal nasal valve collapse. It uses a 2-centimeter absorbable implant to increase airflow and relieve symptoms.
The first step is to schedule a consultation with an otorhinolaryngologist to determine if you would benefit from the procedure. People who have found exterior nasal strips beneficial in reducing symptoms are likely good candidates for an absorbable nasal implant.
During the procedure, you will sit 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 outside wall of the nose. When the tube's tip reaches its target — typically the area just below where eyeglasses rest — the implant is released in 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 minor discomfort. You can resume regular activities the next day. You may have mild 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 continued support of the lateral nasal wall and airflow.
An absorbable nasal implant is not appropriate for everyone with nasal obstruction. A consultation with an otorhinolaryngologist will help determine the best treatment option to address the causes of your obstruction. For example, if you have a deviated septum and nasal valve collapse, both issues may need to be treated to resolve the obstruction.
Overall, people who had a nasal implant report experiencing less nasal congestion and less trouble breathing through the nose. They had improvements in getting enough air through the nose during exercise or exertion and higher quality sleep.
Talk with your primary care provider or otorhinolaryngologist if you have nasal obstruction and think an implant can help. — Dr. David Valencia, Otorhinolaryngology, Mayo Clinic Health System, La Crosse, Onalaska and Prairie du Chien, Wisconsin