Doctors Warn: The Disease That Can Make Your Nose Collapse

When the Nose Collapses: The Rare Autoimmune Disease That Eats Away at Cartilage

When a woman’s nose mysteriously began to sink inward, doctors at first suspected trauma or infection. But what they eventually uncovered was far rarer — and far more devastating.
Her immune system had begun attacking her own cartilage. Within months, her nose, once straight and defined, had caved in on itself. Breathing became difficult. Pain spread to her ears and chest. The diagnosis: Relapsing Polychondritis — an autoimmune condition so rare that most physicians never encounter a single case in their careers.

A Disease That Attacks the Body’s Structure
Relapsing Polychondritis (RP) is an autoimmune disorder that inflames and destroys cartilage — the flexible tissue that shapes the nose, ears, trachea, and joints.
Over time, repeated attacks of inflammation cause the cartilage to soften, collapse, or disappear entirely.

Cartilage is what gives the nose its bridge, keeps the ears upright, supports the voice box, and maintains open airways in the lungs. When this tissue is targeted by the immune system, the results are as catastrophic as they are visible.

The disease is not new — it was first described decades ago — but it remains one of the great medical mysteries. Scientists still do not know why the immune system begins this self-destructive behavior. What they do know is that the consequences can be life-changing, disfiguring, and at times, fatal.

When the Nose Falls In
The collapse of the nasal bridge is perhaps the most striking — and heartbreaking — feature of relapsing polychondritis.
Doctors call it a “saddle-nose deformity”, referring to the shape left behind when the central support of the nose caves in, leaving a flattened, concave profile.

For patients, the change is both cosmetic and functional. The loss of nasal cartilage affects airflow, making breathing through the nose difficult. Chronic crusting, nasal blockage, and sinus infections often follow.

What makes this deformity so disturbing is not just its appearance — it’s the fact that the nose literally falls because its structural foundation is being destroyed from within.

In one documented case that gained international attention, a woman in her 30s noticed her nose gradually sinking over several months. Her doctors discovered that the cartilage inside her nose had thinned to the point of collapse. She also had ear inflammation and joint pain — classic signs of relapsing polychondritis.

Her nose could later be reconstructed surgically, but only after the disease was brought under control with strong immunosuppressive medication.

How It Starts
The early signs of relapsing polychondritis can be deceptively mild. Many patients begin with pain, redness, and swelling in one or both ears — often mistaken for an infection. Others notice tenderness in the nose, hoarseness, or unexplained joint pain.

In the nose, the immune system targets the septal cartilage, which divides the nostrils and provides central support. As inflammation eats away at this tissue, it loses its rigidity. Over time, gravity and pressure cause the nasal bridge to collapse, resulting in the characteristic saddle-nose deformity.

But the nose is only one of the disease’s targets. RP can affect nearly every part of the body where cartilage exists — from the ribs to the windpipe to the eyes.

A Disease That Changes Faces — and Lives
What makes RP particularly cruel is that it doesn’t just cause pain; it changes how people look and breathe.

Patients who develop severe nasal collapse may find their facial features dramatically altered. Those with ear involvement often develop floppy or misshapen ears as cartilage erodes. When the trachea or bronchial tubes are involved, the damage can be life-threatening — airways can narrow or even collapse.

Doctors describe patients who once looked healthy and vibrant, returning months later appearing older, gaunter, their facial structure altered. Some compare the experience to the slow erosion of bone in leprosy — except here, it’s the body’s immune system waging war against itself.

The Silent Invasion of the Airways
While the visible changes in RP are alarming, the most dangerous effects often occur deep inside the body.
The larynx and trachea — structures that depend on cartilage to stay open — are frequent targets.

Inflammation here can cause hoarseness, coughing, or wheezing that mimics asthma. As the disease progresses, the airway can narrow dangerously, leading to difficulty breathing or even respiratory collapse.

In some severe cases, patients have required emergency tracheostomies or airway stents to keep breathing. These are not rare exceptions — airway involvement is a leading cause of death in relapsing polychondritis.

That’s why, for clinicians, early recognition is everything. A patient who complains of recurring ear pain, nasal tenderness, and hoarseness may not have three unrelated problems — they may have one unifying autoimmune process that explains them all.

Why Diagnosis Is So Difficult
Relapsing polychondritis is one of medicine’s ultimate chameleons. Its symptoms can mimic dozens of other conditions — from infections to allergies to arthritis.

There is no single test that confirms RP. Diagnosis depends on a combination of clinical signs, patient history, and exclusion of other causes. Blood tests may show inflammation, but nothing specific to this disease.

As a result, many patients go years before receiving a correct diagnosis. Some are treated for sinus infections, lupus, or rheumatoid arthritis before someone finally connects the dots.

By then, irreversible damage may have occurred. Once cartilage is destroyed, it cannot regenerate.

What Doctors Look For
Doctors diagnose RP based on a characteristic combination of symptoms that tend to appear together.
Typical red flags include:

• Painful, red, and swollen ears (especially when the soft earlobe is spared)
  
  
• Tenderness or collapse of the nasal bridge
  
  
• Hoarseness or difficulty breathing from airway inflammation
  
  
• Eye redness, pain, or sensitivity to light
  
  
• Joint pain and swelling that comes and goes
  
  
• Hearing loss or dizziness
  

When two or more cartilage-rich areas are affected — especially the nose and ears — relapsing polychondritis becomes a strong possibility.

Imaging studies can help visualize the extent of cartilage loss, while tissue biopsies from affected areas sometimes confirm the diagnosis. However, because biopsy is invasive and often unnecessary, it is not always performed.

When the Airway Fights Back
One of the most alarming manifestations of RP is airway collapse.
Cartilage rings in the trachea, which normally hold the windpipe open like the frame of a tunnel, can weaken and soften. The airway may begin to buckle during breathing, producing wheezing that’s often mistaken for asthma.

Unlike typical asthma, however, these patients do not respond to bronchodilators. Their obstruction is mechanical, not muscular. In advanced cases, even minor respiratory infections can tip the balance toward airway failure.

In such cases, ENT and thoracic surgeons may need to insert stents or create a surgical airway. These interventions are lifesaving but come with risks — infections, stent migration, or scarring.

Preventing this progression requires aggressive early control of inflammation.

The Science Behind the Attack
Although its cause remains unknown, researchers suspect that relapsing polychondritis is an autoimmune reaction directed against type II collagen, a protein found in cartilage.
For reasons still unclear, the immune system begins identifying cartilage as foreign. It releases antibodies and inflammatory cells that attack cartilage tissue, breaking down its structure.

Genetic factors may contribute, and some patients have associations with other autoimmune diseases like vasculitis, lupus, or rheumatoid arthritis. Environmental triggers, infections, or trauma might ignite the initial immune response in susceptible individuals.

Once inflammation begins, it becomes self-perpetuating. Each flare damages more cartilage, setting off a cycle of destruction and repair that ultimately fails.

Treatment: Stopping the Immune Fire
Because there’s no cure, treatment focuses on suppressing the immune system and controlling inflammation.

Most patients begin with high-dose corticosteroids to stop acute flares. Once inflammation stabilizes, long-term maintenance therapy usually involves immunosuppressive medications such as methotrexate, azathioprine, or mycophenolate.

For those with severe or resistant disease — especially involving the airway or heart — newer biologic drugs are sometimes used, including anti-TNF and IL-6 inhibitors. These agents target specific inflammatory pathways responsible for tissue destruction.

However, medical therapy can only halt ongoing inflammation. It cannot rebuild destroyed cartilage.

For patients with saddle-nose deformity, surgery becomes the next step — but timing is critical. Surgeons usually wait until the disease is quiet before performing reconstruction, as active inflammation can destroy new grafts.

Because the immune system may also attack implanted cartilage, many reconstructive surgeons prefer bone grafts or synthetic materials rather than cartilage from other parts of the patient’s body.

A Disease That Demands Teamwork
Managing RP requires a multidisciplinary approach. Rheumatologists, ENT specialists, pulmonologists, ophthalmologists, and plastic surgeons may all be involved at various stages.

Patients must be closely monitored for signs of airway involvement or ocular complications. Hearing tests, pulmonary imaging, and cardiac evaluations are part of comprehensive follow-up.

Even after remission, relapse is common. Hence the name: relapsing polychondritis.

Patients learn to recognize the earliest signs of a flare — ear tenderness, nasal discomfort, sore throat — and report them immediately. Early treatment can prevent another round of destruction.

Living with the Disease
Beyond its physical effects, relapsing polychondritis leaves emotional scars.
For many patients, the change in appearance from nasal or ear collapse is devastating. Facial reconstructive surgery can restore structure, but the psychological trauma of losing parts of one’s own body to an autoimmune attack runs deep.

Support groups, counseling, and mental health care are vital aspects of treatment. For many, the disease becomes a lifelong balancing act between managing medications and preserving quality of life.

A Message to Clinicians
For physicians, the story of relapsing polychondritis is a reminder to look beyond the obvious.
When a patient presents with recurrent ear inflammation, nasal pain, or unexplained airway symptoms, it may not be coincidence. It may be cartilage under siege.

Early diagnosis can mean the difference between preserving structure and watching it collapse.
In medicine, we often think of autoimmune disease as invisible — affecting joints, cells, or blood markers.
RP is different. It’s autoimmune destruction you can see.

When the Face Tells the Story
The “sunken nose” may be the most visible clue, but it tells a much bigger story — of a disease that disassembles the framework of the human body, one piece of cartilage at a time.

What begins as ear pain or nasal tenderness can quietly evolve into airway collapse or facial disfigurement. Yet, with awareness and early intervention, much of this damage can be prevented.

For now, the challenge remains recognition.
Doctors who understand the warning signs — and patients who report them early — hold the best chance of stopping this rare disease before it reshapes a life forever.