Nasal disease and quality of life in athletes

The effect of radiofrequency therapy for nasal valve collapse in endurance athletes: A STROBE analysis

OBJECTIVE

Conducting a prospective pilot study to investigate the effect of temperature-controlled radiofrequency treatment of the nasal valve in endurance athletes with internal nasal valve collapse.

MATERIAL AND METHODS

Twenty-five endurance athletes with nasal valve collapse were recruited from 2018 to 2020. Eight of the 25 patients dropped out of the study due to different reasons (injured due to non-nasal causes before postoperative measurement, refusal of surgery in the short term, termination due to corona pandemic), so that 17 study participants completed the study. We investigated NOSE questionnaire and rhinomanometry before and after radiofrequency treatment of the internal nasal valve (Vivaer radiofrequency probe). In addition, an exhaustive treadmill test before and after radiofrequency treatment was performed. The collected measurements were registered and compared with paired t-test. A Cohen's dz was performed for significant results. The normal distribution was confirmed by using the Kolmogorov-Smirnov test and Q-Q plots.

RESULTS

There was a significant improvement in the NOSE score (P<0.001, Cohen's dz=1.03) and no serious side effects. No significant differences were seen before and after the treatment in rhinomanometry and spiroergometry.

CONCLUSION

Due to the low side effects and the subjective improvement in nasal breathing according to the NOSE score, the technique could perhaps represent a promising non-invasive therapy for improving nasal breathing in endurance athletes. However, no significant improvement was observed in the objective parameters. Larger study cohorts are required to investigate the effect in more detail.

Exercise and Sinonasal Diseases: Key Interactions and Management Pearls

The nose filters, moistens, and warms inspired air at rest and during activity. Exercise is associated with an increase in nasal airflow and a decrease in resistance to that flow. Mechanistically, changes in the nasal mucosa during exercise may increase neutrophilic infiltration, impair olfaction, and prolong mucociliary transport time. The increased exposure to substances in the exercise environment may also produce rhinitis. Clinically, the prevalence of rhinitis and upper airway infections is increased in athletes. Allergic and non-allergic rhinitis, and rhinosinusitis may be diagnosed clinically, with other studies supporting the diagnosis; their main treatments are topical steroids, antihistamines, and saline.

Insights into exercise-induced rhinitis based on nasal aerodynamics induced by airway morphology

BACKGROUND

Exercise-induced rhinitis (EIR) is a poorly understood phenomenon that may be related to increased inspiratory airflow. Characterization of the development of EIR is important to understand contributing factors.

OBJECTIVE

To characterize how different nasal morphologies respond to airflow-related variables during rapid/deep inspiratory conditions.

METHODS

Subject-specific nasal airways were reconstructed from radiographic images. Unilateral airways were classified as Standard, Notched, or Elongated accord to their distinct nasal vestibule morphology. Computational fluid dynamics simulations were performed at various airflow rates.

RESULTS

For all simulated flow rates, average resistance at the nasal vestibule, airflow velocity and wall sheer stress were highest in Notched. Average mucosal heat flux was highest in Standard. Notched phenotypes showed lower mean percent increases from 10 L/min to 50 L/min in all computed variables.

CONCLUSION

Resistance values and airflow velocities depicted a more constricted nasal vestibule in the Notched phenotypes, while perception of nasal mucosal cooling (heat flux) favored the Standard phenotypes. Different nasal phenotypes may predispose to EIR.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

Tackling nasal symptoms in athletes: Moving towards personalized medicine

Adequate nasal breathing is indispensable for athletes, and nasal symptoms have been shown to interfere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease, and therefore, adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symptoms are more prevalent in athletes compared to the general population and certain sports environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on unmet needs for the management and prevention of these symptoms in athletes within the concept of precision medicine.

Diagnosis and management of nasal obstruction in the athlete. A narrative review by subgroup B of the IOC Consensus Group on "Acute Respiratory Illness in the Athlete"

Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.

Exercise and Rhinitis in Athletes

Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.