Cottle’s test and sign, associated history and clinical anatomy of the nasal valve

BENNINGER Brion. Department of Oral Maxillofacial Surgery, Department of Surgery, Department of Integrative Biosciences, Oregon Health & Science University, Portland, OR


Maurice H. Cottle (1898-1981) has been referred to as the father of modern rhinology. He pioneered several techniques associated with the “nasal valve.” The nasal valve is located within the nose and is not formally recognized by the terminologia anatomica, nor is it found in conventional anatomy texts. During quiet breathing, Cottle’s test is performed by placing fingers on the cheek and drawing it laterally from the midline, thus opening a region of the nasal valve. A literature search was conducted using journals, texts and websites to investigate Cottle’s test, sign and the anatomy of the nasal valve. Results revealed Heinberg and Kern in 1973 discovered an examination procedure that made breathing easier on the side the test was performed. They named it Cottle’s test. Mink in 1903,first described the nasal valve. Cottle’s test and sign, used universally by rhinologists, represents integrity of the nasal valve. The nasal valve is further divided into internal and external valves. When clinicians use the term nasal valve, this usually refers to the internal valve. The internal valve is also known as the limen vestibuli or the os internum. Testing has proven that this is the narrowest point of the nasal cavity marking the division between the external naries and the external turbinates. The external and internal valves are assessed clinically as separate entites. Each valve works as a collective unit and has clinical relevance regarding the pathology of the nose. In conclusion, Cottle’s test was discovered by Heinberg and Kern and has stood the test of time. The nasal valve has two distinct anatomical regions, which perhaps warrant formal recognition in anatomy texts due to its clinical relevance. The objective of this study is to investigate the history of Cottle’s test, sign and nasal valve anatomy.