title: Effects of a Mask on Breathing Impairment During a Fencing Assault: A Case Series Study.
abstract: BACKGROUND
  Fencers often complain of progressive difficulty in breathing during matches, which is generally attributed to restricted air, light and heat circulation from wearing a mask. Physiologically, the nasal structure generates airflow resistance that can reach -50% of the total respiratory resistance.
  
  
  OBJECTIVE
  This study aims to investigate the presence of nasal obstruction in fencers and the relationship with the use of mask.
  
  
  METHODS
  An observational study on 40 fencers (18 males, 22 females) was conducted. Fencers perform a usual assault, wearing the mask and standardized physical exercises (running, sprints and obstacles) without the mask. ENT examination with a nasal flexible fiberscope, Anterior Active Rhinomanometry (AAR) and Peak Nasal Inspiratory Flow (PNIF) measurement before and after physical activity with or without the mask was recorded.
  
  
  RESULTS
  Before physical exercise, the total nasal airway resistance mean value for AAR was 0.33 ± 0.17 Pa/cm(3)/s at 150 Pa. After a match with the mask, the mean value was 0.28 ± 0.16 Pa/cm(3)/s. After normal physical exercises without mask, the mean value was 0.24 ± 0.15 Pa/cm(3)/s. Using t tests, statistically significant difference between nasal resistance before and after physical activity (P < 0.05) was observed, but no significant difference in nasal resistance between the basal value and that taken after a match wearing the masks (P = 0.1265). PNIF values significantly increase with exercise (P < 0.05).
  
  
  CONCLUSIONS
  Our study shows that wearing the mask causes increased breathing impairment in fencers, when compared with similar physical activity without the mask.
authors.affiliation: ENT Department, University of Siena, Siena, Italy.
authors.forename: Desiderio
authors.initials: D
authors.lastname: Passali
authors.affiliation: ENT Department, University of Siena, Siena, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Cambi
authors.affiliation: ENT Department, University of Siena, Siena, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Salerni
authors.affiliation: ENT Department, University of Siena, Siena, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Stortini
authors.affiliation: ENT Department, University of Siena, Siena, Italy.
authors.forename: Luisa Maria
authors.initials: LM
authors.lastname: Bellussi
authors.affiliation: ENT Department, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Passali
keywords: Fencing; Nasal Obstruction; Peak Nasal Inspiratory Flow; Rhinomanometry