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ENT · Nose and paranasal sinuses: internal nasal valve
Sample itemA patient has nasal obstruction on inspiration with narrowing of the nasal sidewalls on deep breath. Gentle lateral traction of the cheek improves breathing. Which structure is responsible?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. The internal nasal valve between the upper lateral cartilage and the septum
The internal nasal valve, between the caudal edge of the upper lateral cartilage and the septum is the narrowest part of the nasal airway. In the Cottle manoeuvre, lateral traction on the cheek opens it, and improved airflow indicates valve collapse as the cause.
Option by option
A. The choanal mucosa
Choanal obstruction does not change with cheek traction.
B. The internal nasal valve between the upper lateral cartilage and the septum (correct)
Correct. Improvement on the Cottle manoeuvre localises the problem to the internal valve.
C. The ostiomeatal complex
The ostiomeatal complex drains sinuses and is not the airway valve.
D. The posterior end of the inferior turbinate
A turbinate problem is fixed and does not alter with cheek traction.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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