What is Nasal Airway Obstruction?

Nasal breathing delivers approximately 70% of airflow to the lungs.1 More than 20 million Americans2 are estimated to suffer from nasal airway obstruction (NAO), which limits airflow through the nose with significant quality of life consequences.3

Symptoms may include:

  • Nasal congestion or stuffiness
  • Nasal blockage or obstruction
  • Trouble breathing through your nose
  • Trouble sleeping
  • Unable to get enough air through your nose during exercise or exertion


“If you think of the global management of nasal obstruction, you’re talking about the septum, turbinates, but you can’t forget the lateral wall. Just keep it in mind whenever you’re examining your patients and you’ll be surprised at how frequently you see it.”

-Dean M. Toriumi, MD |
University of Illinois at Chicago
Past President,  AAFPRS

What Causes Nasal Airway Obstruction?

Even slight narrowing of the nasal valve can lead to significant reduction in airflow.4,5,6 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.7,8

Is Quality of Life Affected by Nasal Airway Obstruction?

A Nasal Obstruction Symptom Evaluation (NOSE) survey9 is an assessment tool to capture how your patient’s breathing symptoms are affecting their quality of life. NOSE is a simple five question validated survey and uses a 20-point scale to capture breathing symptoms, with higher scores indicating more severe symptoms than lower scores.

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, he/she may benefit from support for the lateral nasal wall. The LATERA implant is indicated for supporting upper and lower lateral cartilage.

Learn About LATERA


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.