title: Oxygen mask related nasal integument and osteocartilagenous disorders in F-16 fighter pilots.
abstract: BACKGROUND
  A preliminary survey showed half of the participating Royal Netherlands Air Force (RNLAF) F-16 fighter pilots to have nasal integument and osteocartilagenous disorders related to wearing in-flight oxygen masks.
  
  
  OBJECTIVE
  To make an inventory of these disorders and possible associated factors.
  
  
  METHODS
  All RNLAF F-16 pilots were requested to fill out a semi-structured questionnaire for a cross-sectional survey. Additionally, one squadron in The Netherlands and pilots in operational theater were asked to participate in a prospective study that required filling out a pain score after each flight. Pilot- and flight-related variables on all participants were collected from the RNLAF database. A linear mixed model was built to identify associated factors with the post-flight pain score.
  
  
  RESULTS
  The response rate to the survey was 83%. Ninety of the 108 participants (88%, 6 missing) reported tenderness, irritation, pain, erythema, skin lesions, callous skin, or swelling of nasal bridge integument or architecture. Seventy-two participants (71%, 6 missing) reported their symptoms to be troublesome after a mean of 6±3 out of 10 flights (0;10, 54 missing). Sixty-six pilots participated in scoring post-flight pain. Pain scores were significantly higher if a participant had ≥3 nasal disorders, after longer than average flights, after flying abroad, and after flying with night vision goggles (respectively +2.7 points, p = 0.003; +0.2 points, p = 0.027; +1.8 points, p = 0.001; +1.2 points p = 0.005). Longer than average NVG flights and more than average NVG hours per annum decreased painscores (respectively -0.8 points, p = 0.017; -0.04 points, p = 0.005).
  
  
  CONCLUSIONS
  The majority of the RNLAF F-16 fighter pilot community has nasal disorders in the contact area of the oxygen mask, including pain. Six pilot- or flight-related characteristics influence the experienced level of pain.
authors.affiliation: The Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center Utrecht, Utrecht, The Netherlands. jrcschreinemakers@gmail.com
authors.forename: J Rieneke C
authors.initials: JR
authors.lastname: Schreinemakers
authors.forename: Paul
authors.initials: P
authors.lastname: Westers
authors.forename: Pieter
authors.initials: P
authors.lastname: van Amerongen
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
mesh_terms: D000328:Adult; D000401:Aircraft; D002357:Cartilage Diseases / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D004890:Erythema / Q000473:pathology; D006801:Humans; D008397:Masks / Q000009:adverse effects*; D008875:Middle Aged; D008889:Military Personnel; D009666:Nose / Q000293:injuries* / Q000473:pathology; D009784:Occupational Diseases; D010100:Oxygen; D010146:Pain / Q000175:diagnosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010100:Oxygen