One

The Worst Breathers in the Animal Kingdom

The patient arrived, pale and torpid, at 9:32 a.m. Male, middle-aged, 175 pounds. Talkative and friendly but visibly anxious. Pain: none. Fatigue: a little. Level of anxiety: moderate. Fears about progression and future symptoms: high.

Patient reported that he was raised in a modern suburban environment, bottle-fed at six months, and weaned onto jarred commercial foods. The lack of chewing associated with this soft diet stunted bone development in his dental arches and sinus cavity, leading to chronic nasal congestion.

By age 15, patient was subsisting on even softer, highly processed foods consisting mostly of white bread, sweetened fruit juices, canned vegetables, Steak-umms, Velveeta sandwiches, microwave taquitos, Hostess Sno Balls, and Reggie! bars. His mouth had become so underdeveloped it could not accommodate 32 permanent teeth; incisors and canines grew in crooked, requiring extractions, braces, retainers, and headgear to straighten. Three years of orthodontics made his small mouth even smaller, so his tongue no longer properly fit between his teeth. When he stuck it out, which he did often, visible imprints laced its sides, a precursor to snoring.

At 17, four impacted wisdom teeth were removed, which further decreased the size of his mouth while increasing his chances of developing the chronic nocturnal choking known as sleep apnea. As he aged into his 20s and 30s, his breathing became more labored and dysfunctional and his airways became more obstructed. His face would continue a vertical growth pattern that led to sagging eyes, doughy cheeks, a sloping forehead, and a protruding nose.

This atrophied, underdeveloped mouth, throat, and skull, unfortunately, belongs to me.

I'm lying on the examination chair in the Stanford Department of Otolaryngology Head and Neck Surgery Center looking at myself, looking into myself. For the past several minutes, Dr. Jayakar Nayak, a nasal and sinus surgeon, has been gingerly coaxing an endoscope camera through my right nasal cavity. He's gone so deep into my head that it's come out the other side, into my throat.

"Say eeee," he says. Nayak has a halo of black hair, square glasses, cushioned running shoes, and a white coat. But I'm not looking at his clothes, or his face. I'm wearing a pair of video goggles that are streaming a live feed of the journey through the rolling dunes, swampy marshes, and stalactites inside my severely damaged sinuses. I'm trying not to cough or choke or gag as that endoscope squirms a little farther down.

"Say eeee," Nayak repeats. I say it and watch as the soft tissue around my larynx, pink and fleshy and coated in slime, opens and closes like a stop-motion Georgia O'Keeffe flower.

This isn't a pleasure cruise. Twenty-five sextillion molecules (that's 250 with 20 zeros after it) take this same voyage 18 times a minute, 25,000 times a day. I've come here to see, feel, and learn where all this air is supposed to enter our bodies. And I've come to say goodbye to my nose for the next ten days.

For the past century, the prevailing belief in Western medicine was that the nose was more or less an ancillary organ. We should breathe out of it if we can, the thinking went, but if not, no problem. That's what the mouth is for.

Many doctors, researchers, and scientists still support this position. Breathing tubes, mouthbreathing, and nasal breathing are all just means to the same end. There are 27 departments at the National Institute...