2. Role of sinonasal disease on wellbeing and performances in athletes
Thanks to filtration, humidification and heating of the inhaled air, nasal breathing is more comfortable than oral breathing and human beings are innate nose breathers at rest. The nasal septum and turbinates that are responsible for these functions, create a high-resistance airway passage inside the nose. During exercise, this resistance leads to an increased breathing effort sensation and when this sensation becomes too uncomfortable, the individual will switch from nasal to oral breathing6. Time points at which this occurs are very variable among subjects, but it is believed to occur when laminar nasal airflow becomes turbulent 7. Oral breathing has been shown to be more efficient than nasal breathing 8 which means that blocking the nose does not form a limiting factor when looking at objective exercise parameters such as VO2max9. Notwithstanding, multiple studies have shown a clear impact of nasal symptoms on patients’ quality of life (QOL)10-12 and consequently on athletic performances; Katelaris surveyed 214 Olympic athletes and found that 41 % suffered from a seasonal allergic rhinitis (AR) with significantly lower QOL scores than non-allergic athletes, which improved as the pollen count declined 13. Walker recently published that QOL related to nasal symptoms (measured by the SNOT-22 questionnaire) was significantly reduced in athletes compared to sedentary controls3 and lower in athletes suffering from nasal symptoms compared to healthy athletes 14. Surda demonstrated that this effect was greatest in swimmers (measured by the rhinoconjunctivitis quality of life questionnaire [RQLQ])15. The reduced RQLQ results in swimmers were confirmed by Bougault who even showed a normalization of nasal symptoms and QOL after a 2-week resting period 4. Nasal dysfunction has also been associated with a direct reduction in athletic performances; a recent German study questioning over 600 athletes demonstrated that more than 80 % of athletes suffering from AR reported a decrease in athletic performance during the pollen season16. Another study questioned recreational athletes suffering from exercise-induced rhinitis and found that around 45 % of these individuals stated their nasal symptoms adversely affected their athletic performances in a moderate or severe way 17. Since rhinitis has a known detrimental effect on sleep quality18, it can be extrapolated that it indirectly leads to competitive defeats 19.
Types and prevalence of nasal dysfunction in athletes
Nasal dysfunction can arise from either mucosal dysfunction or deformity of the anatomical structures (Figure 1). Mucosal dysfunction can be induced by multiple factors and can either present as rhinitis which causes symptoms of nasal obstruction, rhinorrhea, nasal itch and sneezing 20, while rhinosinusitis patients have additional symptoms of facial pain and smell loss. 21.