In this episode Dr. Stacy sits down with Vanderbilt-trained ENT and sleep specialist Dr. Keith Matheny for a wide-ranging, real-world conversation about the airway—starting where many discussions skip: the nose. They unpack why nasal obstruction (fixed and functional) is often minimized in sleep care, how “CPAP intolerance” is frequently a nasal problem in disguise, and why the nasal valve is commonly missed even by clinicians—sometimes because the tools used to examine the nose temporarily “fix” the problem.

 Dr. Matheny shares practical, current ENT options that don’t require major surgery, including in-office radiofrequency treatments that can address nasal valve issues, turbinates, and septal swell bodies with minimal downtime. From there, the conversation expands into pediatric airway concerns, the long-term cost of “waiting it out,” and how chronic mouth breathing can shape growth, sleep quality, and even the labels kids accumulate.

They finish with a compelling vision for what’s next: true medical-dental collaboration—sleep boards, shared language, better screening, and models that make treatment more accessible for patients. And, because Dr. Matheny is also “The Grill Doctor,” the episode closes with pizza wedges, skiing attempts, grilled salmon, and a seasoning drop coming soon!!


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CHAPTERS:

00:00 – Welcome + Why Dr. Matheny Had to Be on the Show
00:46 – Structure vs. Function in Airway Care
02:48 – Meet Dr. Keith Matheny: ENT, Sleep, Patents… and BBQ
06:40 – Authenticity in Healthcare: Patients Need a Real Human
08:22 – ENT + Dentistry: Same Playground, Not Enough Collaboration
09:22 – “The Nose Doesn’t Matter” in Sleep? Let’s Talk About That
13:49 – Nasal Valve Collapse + The Cottle Maneuver (Why It’s Missed)
17:22 – Septal Swell Bodies: The Obstruction People Overlook
22:16 – In-Office Radiofrequency: What It Treats + What Recovery Is Like
25:10 – Kids, Mouth Breathing, and the Cost of Waiting
41:38 – The “Sleep Board” Idea: Copying Oncology’s Team Model
47:35 – Keith’s Model: Sleep Dentist Inside the ENT Office (Insurance + Access)


🌟 Key Learnings 

• The nose is central to sleep-disordered breathing—literally and functionally, even when some clinicians downplay it.
• “CPAP intolerance” often points to nasal obstruction, fixed or functional, because most CPAP is delivered at least partially through the nose.
• Functional nasal obstruction can look “fine” at rest, then collapse during inspiration/expiration due to weak cartilage or mobile tissue.
• Nasal valve collapse is frequently missed, partly because putting a speculum in the nose can temporarily “fix” the collapse during an exam.
• Septal swell bodies are an under-recognized contributor to obstruction and inflammation and have become a bigger topic only in the last ~6–10 years.
• Small increases in airway diameter can feel huge (Keith references aerodynamics/“to the fourth power” effect on perceived breathing).
• In-office radiofrequency procedures can treat turbinates/valve/swell bodies with minimal downtime and can also help chronic rhinitis/post-nasal drip.
• “Wait until adolescence” can cost years of sleep and development—kids may “outgrow” adenoids, but not the consequences of chronic mouth breathing and fragmented sleep.
• Mouth breathing can affect craniofacial growth, sleep quality, school performance, and lead to labels like ADHD-type behavior patterns.
• Medical-dental collaboration isn’t optional in sleep care—better screening, shared language, and structured collaboration models are needed.
• Keith shares a practical collaboration model: bringing a sleep dentist into the ENT office as a delegate/contractor so oral appliances can be billed through medical insurance (state-dependent/legal-dependent).
• CPAP in growing children can influence midface growth, similar to orthodontic “headgear effects,” which makes coordination with airway-minded dentistry/orthodontics critical.

This is the ASAP Pathway Podcast, Airway, Sleep, and Pediatric Pathway, where sleep and airway health take center stage, one breath at a time. VISIT: ASAP Pathway Please subscribe, share, and tune in to future episodes of how we can help children live their best lives, one breath, and restful night's sleep at a time. Don't miss this exciting launch into a world of knowledge and transformation.Because Kids Can't Wait...

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