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.