The Role of the Nasal Passageways in Airway Disease (w/Dr. Peter Catalano)

**Overview** In this episode, I sit down with Dr. Peter Catalano - an otolaryngologist, rhinology fellowship director, and pioneer of minimally invasive nasal surgery. Dr. Catalano has held appointments at Mount Sinai School of Medicine, the Lahey Clinic, and Tufts University, and has spent over three decades developing and publishing on targeted nasal airway surgery. I've had the privilege of working with Dr. Catalano on a major article addressing mouth breathing, and our conversation here is one of the most important I've had on this platform. We go deep into the science of nasal airflow, the structural and institutional barriers preventing children from getting the care they need, and the very real consequences (neurological, behavioral, cardiovascular, and craniofacial) of untreated mouth breathing and sleep-disordered breathing. We also address the myths and dogmas that continue to persist in both the ENT and orthodontic worlds, and what it's going to take to break them down. If you've ever wondered why the two worlds of dentistry and medicine remain so siloed on this issue, or what it means for patients when they fall through the crack, this episode is for you. **Timestamps** **0:00** – Introduction and Dr. Catalano's background: ENT, skull base surgery, academic appointments at Mount Sinai, Lahey Clinic, and Tufts University **4:10** – How Dr. Catalano's career trajectory led him from engineering to medicine to rhinology — and the philosophy of fate and the "hidden angel" guiding his path **9:12** – The MicroShaver revolution: meeting Dr. Setliff in South Dakota and the aha moment that changed everything about minimally invasive sinus surgery **11:13** – The unexpected discovery: patients reporting they stopped snoring after sinus surgery, and how that led to a focus on nasal airway and sleep-disordered breathing **13:18** – *\[Ad] Early Orthodontic Treatment Comprehensive — a two-day hands-on immersive course with Dr. Daniel Camacho, Fort Lauderdale, FL, November 13–14. Click the link in the show notes to register.* **14:27** – The 2009 Singapore breakthrough: Dr. Deyun Wang and computational flow dynamics — why no one actually knew how air moved through the nose until then **19:32** – Why previous nasal surgeries failed for OSA, and what "follow the airflow" means for surgical targets between the eyes **20:30** – Why making big holes in sinuses made things worse — and why the sinuses don't actually ventilate during breathing **23:58** – How the superior airway and structures like the uncinate process and concha bullosa became key surgical targets, producing a 15–20% improvement in airflow **26:08** – The insurance dilemma and medical-legal risks that prevent ENTs from performing airway surgery — even when the data is clear **30:03** – The ferret studies and the "never operate under 16" dogma: how flawed 1980s animal models became entrenched standard of care for pediatric ENT surgery **35:48** – Parallels to hormone replacement therapy and the rampant hypocrisy in academic medicine — how good studies get buried and bad ones persist **40:55** – How Dr. Catalano fought back against an insurance company, changed their pediatric sinus surgery policy, and survived multiple attempts to have his medical license revoked **47:12** – The Harvold monkey studies: why the obligate nasal breather argument is wrong, why the studies are foundational, and what it means that no one could repeat them today **58:07** – Children don't just "outgrow" airway obstruction: why the lymphoid involution argument is true but dangerously misleading when 90% of craniofacial growth is complete by age 8 **1:13:57** – CBCT in ENT and orthodontic practice: why orthodontists need to learn to read the full image, how Dr. Catalano and Dr. John Walker found hidden tumors, and why rhinology-focused ENTs already use equivalent imaging **1:17:33** – Nocturnal enuresis and airway: the pituitary/ADH connection, why these children ask about bedwetting the moment they wake from surgery, and the anecdotal but compelling clinical evidence **1:27:15** – Swell body reduction: how a novel procedure Dr. Catalano pioneered in 2015 went from being met with rotten tomatoes at conferences to becoming standard of care **Closing** If this conversation resonated with you, I want to encourage you to share it with your colleagues, your dental and medical partners, and anyone who works with young patients who struggle to breathe. This is exactly the kind of interdisciplinary dialogue that can change outcomes for kids who are being told to wait it out. LINKS - Dr. Peter Catalano: Email: [catalanop9@gmail.com](mailto:catalanop9@gmail.com) - AJODO Article on Mouth Breathing: https://pubmed.ncbi.nlm.nih.gov/40057896/ - Join The DOC Community on Facebook for more great content and discussions (https://www.facebook.com/share/g/1Cb9rkQVde/) - Register for the In-person Early Treatment Comprehensive: https://www.earlyorthotreatment.com/ - Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ - Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ - Website: theorthocoach.com - YouTube: @theorthocoach - Email: drmike@theorthocoach.com - Instagram: @theorthocoach