Bio

Bio


Dr. Tulio A Valdez is a surgeon scientist born and raised in Colombia with a subspecialty interest in Pediatric Otolaryngology. He attended medical school at Universidad Javeriana in Bogota Colombia before undertaking his residency in Otolaryngology, Head and Neck Surgery in Boston. He completed his Pediatric Otolaryngology Fellowship at Texas Children’s Hospital (2007), Houston and obtained his Master’s in Clinical and Translational Research at the University of Connecticut.

Clinically, Dr. Valdez has an interest in airway surgery and swallowing disorders. He has a special interest in the management of sinus disease in cystic fibrosis. Dr. Valdez has co-authored one textbook and numerous book chapters and scientific manuscripts. Dr. Valdez continues his clinical research in these areas, particularly with a focus on aerodigestive disorders.

Scientifically, Dr. Valdez has developed various imaging methods to diagnose otitis media and cholesteatoma a middle ear condition that can lead to hearing loss. He was part of the Laser Biomedical Research Center at Massachusetts Institute of Technology. His research includes novel imaging modalities to better diagnose ear infections one of the most common pediatric problems. His research has now expanded to include better intraoperative imaging modalities in pediatric patients to improve surgical outcomes without the need for radiation exposure. 

Dr. Valdez believes in the multi-disciplinary collaborations to tackle medical problems and has co-invented various medical devices and surgical simulation models.

Academic Appointments


Patents


  • Tulio Valdez. "United States Patent 9986915 Systems and methods for a short wave infrared device", Jun 8, 2018

Teaching

2018-19 Courses


Stanford Advisees


Publications

All Publications


  • Teaching a tracheotomy handoff tool to pediatric first responders. International journal of pediatric otorhinolaryngology Murray, N., Valdez, T. A., Hughes, A. L., Kavanagh, K. R. 2018; 114: 120–23

    Abstract

    INTRODUCTION: The Critical Airway Risk Evaluation (CARE) system is an airway classification system we designed to improve handoffs between caregivers by describing the risk of a patient's airway above the tracheotomy tube, and therefore the correct resuscitation maneuvers in the event of an airway emergency. It is designed to quickly communicate 3 categories: 1-easily intubatable; 2-intubatable with specialized techniques or equipment; or 3-not intubatable. We have demonstrated previously that the system is easily taught to and used by pediatric otolaryngologists. For this system to be useful, it must be usable by a broader group, including first responders to a tracheostomy related airway emergency. The objective of this study is to analyze the reliability of teaching and ease of learning the CARE system among practicing otolaryngologists, otolaryngology residents, and pediatric residents.METHODS: A brief tutorial was designed to introduce the scale and was presented to practicing otolaryngologists, otolaryngology residents, and pediatrics residents. A 30-point questionnaire was administered in which patient's airways and airway management techniques were described. Participants were asked to classify each example according to the CARE system. Statistical analysis was performed using Student's t-test and Fleiss' kappa reliability.RESULTS: A total of 66 physicians participated in the study. The pediatric residents correctly identified the patients' airway class 89% of the time (26.6/30 ± SD = 2.9). Otolaryngology attendings and residents answered correctly 92% of the time (27.7/30 ± SD = 2.9), which was not statistically different (p = 0.23). Inter-rater reliability was also substantial among all groups, with a Fleiss' kappa greater than 0.7 for all groups.CONCLUSIONS: This study demonstrates that the system can be taught to pediatrics residents as effectively as it can be taught to otolaryngology residents and practicing otolaryngologists and, therefore, can be effectively utilized in inter-disciplinary handoffs to facilitate information transfer to potential first responders.

    View details for DOI 10.1016/j.ijporl.2018.08.003

    View details for PubMedID 30262348

  • Initial findings of shortwave infrared otoscopy in a pediatric population. International journal of pediatric otorhinolaryngology Valdez, T. A., Carr, J. A., Kavanagh, K. R., Schwartz, M., Blake, D., Bruns, O., Bawendi, M. 2018; 114: 15–19

    Abstract

    OBJECTIVE: To evaluate the feasibility of Shortwave infrared (SWIR) otoscopy in a pediatric population and establish differences with visible otoscopy.METHODS: Pediatric patients 3 years of age and older seen in the otolaryngology clinic with an audiogram and tympanogram obtained within a week of the visit were recruited for video otoscopy using visible light otoscopy and SWIR otoscopy. Videos were rated by two otolaryngologists based on ability to identify the promontory, ability to identify the ossicular chain and presence or absence of middle ear fluid.RESULTS: A total of 74 video recordings of ears were obtained in 20 patients. We obtained interpretable images in 63/74 (85.1%) ears. There was no statistical significance between ability to perform SWIR otoscopy versus white light video otoscopy as indicated by a p-value of 0.376. There was high inter-rater agreement for identification of both the promontory and the ossicular chain with Kappa values of 0.81 and 0.92 respectively. There was statistical significance between SWIR otoscopy and visible otoscopy in the ability to image the promontory (p = 0.012) and the ossicular chain (p = 0.010). Increased contrast of middle ear fluid was seen in SWIR otoscopy when compared to visible otoscopy.CONCLUSION: SWIR otoscopy is feasible in a pediatric population and could offer some advantages over visible light otoscopy such as better visualization of the middle ear structures through the tympanic membrane and increased contrast for middle ear effusions.

    View details for DOI 10.1016/j.ijporl.2018.08.024

    View details for PubMedID 30262355

  • 3-Dimensional printed haptic simulation model to teach incomplete cleft palate surgery in an international setting INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Cote, V., Schwartz, M., Vargas, J., Canfarotta, M., Kavanagh, K. R., Hamdan, U., Valdez, T. A. 2018; 113: 292–97

    Abstract

    Cleft palate is one of the most common congenital anomalies, yet surgical repair remains challenging and can lead to significant complications in the hands of inexperienced surgeons. There is a great need for the development of a simulation model that will allow surgeons worldwide to learn and practice the intricate skills needed for cleft palate surgery.1. To develop a low-cost incomplete cleft palate simulation model using additive manufacturing technology (3D printing). 2. To evaluate its validity and utility to teach palatoplasty in a global health care setting.Three-dimensional models of a soft palate cleft and an incomplete hard and soft palate cleft were developed using 3D printing and silicone casting. The cost and time of assembly of the 3D printed models were calculated. The models were then assessed for validity by cleft surgeons and trainees during a cleft mission in Ecuador. 3D models were assessed for resemblance to anatomy and tissue characteristics, the ability to incise the soft tissue, dissect and reposition the palatal flaps, and the ease of suture placement. Models were rated using the Likeness to Human Tissue Scale.Cleft palate simulators were successfully developed using 3D printing and silicone casting. Participants reported that models provided a realistic representation of human anatomy and were adequate for novice surgeons to practice the procedure. The models were portable, low cost, and easily assembled.The use of 3D printed haptic simulation models for teaching and learning cleft palate repair techniques could enhance skill acquisition and possibly improve surgical outcomes. In outreach settings, it could help achieve local, sustainable comprehensive care for cleft palate patients.

    View details for DOI 10.1016/j.ijporl.2018.08.016

    View details for Web of Science ID 000444666100057

    View details for PubMedID 30174004

  • iPhone otoscopes: Currently available, but reliable for tele-otoscopy in the hands of parents? INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Shah, M., Sohal, M., Valdez, T. A., Grindle, C. R. 2018; 106: 59–63

    Abstract

    Tele-otoscopy has been validated for tympanostomy surveillance and remote diagnosis when images are recorded by trained professionals. The CellScope iPhone Otoscope is a device that may be used for tele-otoscopy and it enables parents to record their children's ear examinations and send the films for remote physician diagnosis. This study aims to determine the ability to diagnose, and the reliability of the diagnosis when utilizing video exams obtained by a parent versus video exams obtained by an otolaryngologist.Parents of children ages 17 years or younger attempted recordings of the tympanic membrane of their children with the CellScope after a video tutorial; a physician subsequently used the device to record the same ear. Recordings occurred prior to standard pediatric otolaryngology office evaluation. Later, a remote pediatric otolaryngologist attempted diagnosis solely based on the videos, blinded to whether the examination was filmed by a parent or physician. Interrater reliability between video diagnosis and original diagnosis on pneumatic otoscopy was measured, and objective tympanic membrane landmarks visualized on the films were recorded.Eighty ears were enrolled and recorded. There was low interrater agreement (k = 0.42) between diagnosis based on parent videos as compared with pneumatic otoscopy. There was high agreement (k = 0.71) between diagnosis based on physician videos and pneumatic otoscopy. Physician videos and parent videos had only slight agreement on objective landmarks identified (k = 0.087).iPhone otoscopy provides reliable tele-otoscopy images in when used by trained professionals but, currently, images obtained by parents are not suitable for use in diagnosis.

    View details for DOI 10.1016/j.ijporl.2018.01.003

    View details for Web of Science ID 000427999600013

    View details for PubMedID 29447893

  • Using simulators to teach pediatric airway procedures in an international setting INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Schwartz, M. A., Kavanagh, K. R., Frampton, S. J., Bruce, I. A., Valdez, T. A. 2018; 104: 178–81

    Abstract

    There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology.The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting.Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale.Participants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models.The pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment.

    View details for DOI 10.1016/j.iporl.2017.11.006

    View details for Web of Science ID 000423646800036

    View details for PubMedID 29287862

  • Differential diagnosis of otitis media with effusion using label-free Raman spectroscopy: A pilot study. Journal of biophotonics Pandey, R., Zhang, C., Kang, J. W., Desai, P. M., Dasari, R. R., Barman, I., Valdez, T. A. 2017

    Abstract

    Otitis media with effusion (OME) is an important and common condition affecting hearing in pediatric patients characterized by the presence of fluid in the middle ear space. The fluid is normally described as serous or mucoid based on differences in the fluid viscosity. The differential diagnosis of two OMEs, namely serous and mucoid is of significant clinical value because while the former is self-limiting, surgical procedure is commonly required for the latter. However, accurate identification of fluid types remains a challenging target unattainable with current clinical modalities due to unavailability of nonperturbative molecular tools. Here, we report an emerging spectroscopy approach featuring Raman scattering and multivariate analysis of spectral patterns to discern serous and mucoid fluids, obtained from pediatric patients undergoing myringotomy and tube placement, by providing information of differentially expressed molecules with high specificity. We demonstrate the feasibility of Raman spectroscopy-based approach to categorize middle ear effusion based on the characteristic spectral markers, notably of mucin, with classification accuracy of 91% and 93% for serous and mucoid, respectively. Our findings pave the way for further development of such a tool for fully noninvasive application that will lead to objective and accurate diagnosis thereby reducing unnecessary visits and surgical procedures.

    View details for DOI 10.1002/jbio.201700259

    View details for PubMedID 29232053

  • Pediatric laryngeal simulator using 3D printed models: A novel technique LARYNGOSCOPE Kavanagh, K. R., Cote, V., Tsui, Y., Kudernatsch, S., Peterson, D. R., Valdez, T. A. 2017; 127 (4): E132-E137

    View details for DOI 10.1002/lary.26326

    View details for Web of Science ID 000397572700003

  • Tracheostomy for Severe Pediatric Obstructive Sleep Apnea: Indications and Outcomes. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Rizzi, C. J., Amin, J. D., Isaiah, A., Valdez, T. A., Jeyakumar, A., Smart, S. E., Pereira, K. D. 2017: 194599817702369-?

    Abstract

    Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged <18 years from January 1, 2010, to December 31, 2015, who underwent tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed. Results Twenty-nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, -2.2 to 6.2). Mean body mass index z score was -1.2 (95% CI, -4.9 to -2.5). Mean preoperative AHI was 60.2 (95% CI, -15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44-45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow-up was 30.6 months (95% CI, -10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9-73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, -9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%-100%). Conclusion OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.

    View details for DOI 10.1177/0194599817702369

    View details for PubMedID 28417683

  • Panel 8: Report on Recent Advances in Molecular and Cellular Biochemistry. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Preciado, D., Granath, A., Lin, J., Val, S., Kurabi, A., Johnston, N., Vijayasekaran, S., Valdez, T., Depireux, D., Hermansson, A. 2017; 156 (4_): S106-S113

    Abstract

    Objectives To update the medical literature on recent cellular and molecular advances in otitis media disease models with a principal focus on developments in the past 5 years. We also aim to explain recent translational advances in cellular and molecular biology that have influenced our understanding and management of otitis media. Data Sources PubMed-indexed peer-reviewed articles. Review Methods A comprehensive review of the literature was conducted with the term otitis media and the following search terms: molecular biology, cell biology, innate immunity, oxidative stress, mucins, molecular diagnostics. Included articles were published in the English language from January 1, 2010, to July 31, 2015. Implications for Practice The molecular understanding of otitis media disease progression has rapidly advanced over the last 5 years. The roles of inflammation, mucins, and cell signaling mechanisms have been elucidated and defined. Advances in the field provide a plethora of opportunities for innovative molecular targeting in the development of novel therapeutic strategies for otitis media.

    View details for DOI 10.1177/0194599816658290

    View details for PubMedID 28372528

  • Pediatric laryngeal simulator using 3D printed models: A novel technique. Laryngoscope Kavanagh, K. R., Cote, V., Tsui, Y., Kudernatsch, S., Peterson, D. R., Valdez, T. A. 2017; 127 (4): E132-E137

    Abstract

    Simulation to acquire and test technical skills is an essential component of medical education and residency training in both surgical and nonsurgical specialties. High-quality simulation education relies on the availability, accessibility, and reliability of models. The objective of this work was to describe a practical pediatric laryngeal model for use in otolaryngology residency training. Ideally, this model would be low-cost, have tactile properties resembling human tissue, and be reliably reproducible.Pediatric laryngeal models were developed using two manufacturing methods: direct three-dimensional (3D) printing of anatomical models and casted anatomical models using 3D-printed molds. Polylactic acid, acrylonitrile butadiene styrene, and high-impact polystyrene (HIPS) were used for the directly printed models, whereas a silicone elastomer (SE) was used for the casted models.The models were evaluated for anatomic quality, ease of manipulation, hardness, and cost of production. A tissue likeness scale was created to validate the simulation model. Fleiss' Kappa rating was performed to evaluate interrater agreement, and analysis of variance was performed to evaluate differences among the materials.The SE provided the most anatomically accurate models, with the tactile properties allowing for surgical manipulation of the larynx. Direct 3D printing was more cost-effective than the SE casting method but did not possess the material properties and tissue likeness necessary for surgical simulation.The SE models of the pediatric larynx created from a casting method demonstrated high quality anatomy, tactile properties comparable to human tissue, and easy manipulation with standard surgical instruments. Their use in a reliable, low-cost, accessible, modular simulation system provides a valuable training resource for otolaryngology residents.N/A. Laryngoscope, 127:E132-E137, 2017.

    View details for DOI 10.1002/lary.26326

    View details for PubMedID 27730649

  • Noninvasive Monitoring of Blood Glucose with Raman Spectroscopy ACCOUNTS OF CHEMICAL RESEARCH Pandey, R., Paidi, S. K., Valdez, T. A., Zhang, C., Spegazzini, N., Dasari, R. R., Barman, I. 2017; 50 (2): 264-272

    Abstract

    The successful development of a noninvasive blood glucose sensor that can operate reliably over sustained periods of time has been a much sought after but elusive goal in diabetes management. Since diabetes has no well-established cure, control of elevated glucose levels is critical for avoiding severe secondary health complications in multiple organs including the retina, kidney and vasculature. While fingerstick testing continues to be the mainstay of blood glucose detection, advances in electrochemical sensing-based minimally invasive approaches have opened the door for alternate methods that would considerably improve the quality of life for people with diabetes. In the quest for better sensing approaches, optical technologies have surfaced as attractive candidates as researchers have sought to exploit the endogenous contrast of glucose, notably its absorption, scattering, and polarization properties. Vibrational spectroscopy, especially spontaneous Raman scattering, has exhibited substantial promise due to its exquisite molecular specificity and minimal interference of water in the spectral profiles acquired from the blood-tissue matrix. Yet, it has hitherto been challenging to leverage the Raman scattering signatures of glucose for prediction in all but the most basic studies and under the least demanding conditions. In this Account, we discuss the newly developed array of methodologies that address the key challenges in measuring blood glucose accurately using Raman spectroscopy and unlock new prospects for translation to sustained noninvasive measurements in people with diabetes. Owing to the weak intensity of spontaneous Raman scattering, recent research has focused on enhancement of signals from the blood constituents by designing novel excitation-collection geometries and tissue modulation methods while our attempts have led to the incorporation of nonimaging optical elements. Additionally, invoking mass transfer modeling into chemometric algorithms has not only addressed the physiological lag between the actual blood glucose and the measured interstitial fluid glucose values but also offered a powerful tool for predictive measurements of hypoglycemia. This framework has recently been extended to provide longitudinal tracking of glucose concentration without necessitating extensive a priori concentration information. These findings are advanced by the results of recent glucose tolerance studies in human subjects, which also hint at the need for designing nonlinear calibration models that can account for subject-to-subject variations in skin heterogeneity and hematocrit levels. Together, the emerging evidence underscores the promise of a blood withdrawal-free optical platform-featuring a combination of high-throughput Raman spectroscopic instrumentation and data analysis of subtle variations in spectral expression-for diabetes screening in the clinic and, ultimately, for personalized monitoring.

    View details for DOI 10.1021/acs.accounts.6b00472

    View details for Web of Science ID 000394724500014

    View details for PubMedID 28071894

  • Using the shortwave infrared to image middle ear pathologies PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Carr, J. A., Valdez, T. A., Bruns, O. T., Bawendi, M. G. 2016; 113 (36): 9989-9994

    Abstract

    Visualizing structures deep inside opaque biological tissues is one of the central challenges in biomedical imaging. Optical imaging with visible light provides high resolution and sensitivity; however, scattering and absorption of light by tissue limits the imaging depth to superficial features. Imaging with shortwave infrared light (SWIR, 1-2 μm) shares many advantages of visible imaging, but light scattering in tissue is reduced, providing sufficient optical penetration depth to noninvasively interrogate subsurface tissue features. However, the clinical potential of this approach has been largely unexplored because suitable detectors, until recently, have been either unavailable or cost prohibitive. Here, taking advantage of newly available detector technology, we demonstrate the potential of SWIR light to improve diagnostics through the development of a medical otoscope for determining middle ear pathologies. We show that SWIR otoscopy has the potential to provide valuable diagnostic information complementary to that provided by visible pneumotoscopy. We show that in healthy adult human ears, deeper tissue penetration of SWIR light allows better visualization of middle ear structures through the tympanic membrane, including the ossicular chain, promontory, round window niche, and chorda tympani. In addition, we investigate the potential for detection of middle ear fluid, which has significant implications for diagnosing otitis media, the overdiagnosis of which is a primary factor in increased antibiotic resistance. Middle ear fluid shows strong light absorption between 1,400 and 1,550 nm, enabling straightforward fluid detection in a model using the SWIR otoscope. Moreover, our device is easily translatable to the clinic, as the ergonomics, visual output, and operation are similar to a conventional otoscope.

    View details for DOI 10.1073/pnas.1610529113

    View details for Web of Science ID 000383094500027

    View details for PubMedID 27551085

  • Volume estimation of tonsil phantoms using an oral camera with 3D imaging BIOMEDICAL OPTICS EXPRESS Das, A. J., Valdez, T. A., Vargas, J. A., Saksupapchon, P., Rachapudi, P., Ge, Z., Estrada, J. C., Raskar, R. 2016; 7 (4): 1445-1457

    Abstract

    Three-dimensional (3D) visualization of oral cavity and oropharyngeal anatomy may play an important role in the evaluation for obstructive sleep apnea (OSA). Although computed tomography (CT) and magnetic resonance (MRI) imaging are capable of providing 3D anatomical descriptions, this type of technology is not readily available in a clinic setting. Current imaging of the oropharynx is performed using a light source and tongue depressors. For better assessment of the inferior pole of the tonsils and tongue base flexible laryngoscopes are required which only provide a two dimensional (2D) rendering. As a result, clinical diagnosis is generally subjective in tonsillar hypertrophy where current physical examination has limitations. In this report, we designed a hand held portable oral camera with 3D imaging capability to reconstruct the anatomy of the oropharynx in tonsillar hypertrophy where the tonsils get enlarged and can lead to increased airway resistance. We were able to precisely reconstruct the 3D shape of the tonsils and from that estimate airway obstruction percentage and volume of the tonsils in 3D printed realistic models. Our results correlate well with Brodsky's classification of tonsillar hypertrophy as well as intraoperative volume estimations.

    View details for DOI 10.1364/BOE.7.001445

    View details for Web of Science ID 000373778900030

    View details for PubMedID 27446667

  • A short-wave infrared otoscope for middle ear disease diagnostics PHOTONIC THERAPEUTICS AND DIAGNOSTICS XII Carr, J. A., Valdez, T. A., Bruns, O. T., Bawendi, M. G. 2016; 9689

    View details for DOI 10.1117/12.2209719

    View details for Web of Science ID 000377396200066

  • Discerning the differential molecular pathology of proliferative middle ear lesions using Raman spectroscopy SCIENTIFIC REPORTS Pandey, R., Paidi, S. K., Kang, J. W., Spegazzini, N., Dasari, R. R., Valdez, T. A., Barman, I. 2015; 5

    Abstract

    Despite its widespread prevalence, middle ear pathology, especially the development of proliferative lesions, remains largely unexplored and poorly understood. Diagnostic evaluation is still predicated upon a high index of clinical suspicion on otoscopic examination of gross morphologic features. We report the first technique that has the potential to non-invasively identify two key lesions, namely cholesteatoma and myringosclerosis, by providing real-time information of differentially expressed molecules. In addition to revealing signatures consistent with the known pathobiology of these lesions, our observations provide the first evidence of the presence of carbonate- and silicate-substitutions in the calcium phosphate plaques found in myringosclerosis. Collectively, these results demonstrate the potential of Raman spectroscopy to not only provide new understanding of the etiology of these conditions by defining objective molecular markers but also aid in margin assessment to improve surgical outcome.

    View details for DOI 10.1038/srep13305

    View details for Web of Science ID 000359775900001

    View details for PubMedID 26289566

  • Nasal vestibulitis due to targeted therapies in cancer patients SUPPORTIVE CARE IN CANCER Ruiz, J. N., Belum, V. R., Boers-Doets, C. B., Kamboj, M., Babady, N. E., Tang, Y., Valdez, T. A., Lacouture, M. E. 2015; 23 (8): 2391-2398

    Abstract

    Cancer patients treated with targeted therapies (e.g., epidermal growth factor receptor inhibitors) are susceptible to dermatologic adverse events (AEs) including secondary skin infections. Whereas infections such as paronychia and cellulitis have been reported, nasal vestibulitis (NV) has not been described with the use of these agents. The aim of our study was to characterize NV in cancer patients treated with targeted therapies.We utilized a retrospective chart review of cancer patients who had been referred to dermatology and were diagnosed with NV. We recorded data including demographics, referral reason, underlying malignancy, targeted anticancer regimen, NV treatment, and nasal bacterial culture results.One Hundred Fifteen patients were included in the analysis, of which 13 % experienced multiple NV episodes. Skin rash was the most common reason (90 %) for a dermatology referral. The most common underlying malignancies were lung (43 %), breast (19 %), and colorectal (10 %) cancer. Sixty-eight percent of patients had been treated with an EGFRI-based regimen. Nasal cultures were obtained in 60 % of episodes, of which 94 % were positive for one or more organisms. Staphylococcus aureus was the most commonly isolated organism [methicillin-sensitive S. aureus 43 %; methicillin-resistant S. aureus 3 %].We report the incidence and characteristics of an unreported, yet frequent dermatologic condition in cancer patients treated with targeted therapies. These findings provide the basis for additional studies to describe the incidence, treatment, and consequences of this event. A better understanding of NV would mitigate its impact on patients' quality of life and risk for additional dermatologic AEs.

    View details for DOI 10.1007/s00520-014-2580-x

    View details for Web of Science ID 000356968100026

    View details for PubMedID 25876156

  • Detecting tympanostomy tubes from otoscopic images via offline and online training COMPUTERS IN BIOLOGY AND MEDICINE Wang, X., Valdez, T. A., Bi, J. 2015; 61: 107-118

    Abstract

    Tympanostomy tube placement has been commonly used nowadays as a surgical treatment for otitis media. Following the placement, regular scheduled follow-ups for checking the status of the tympanostomy tubes are important during the treatment. The complexity of performing the follow up care mainly lies on identifying the presence and patency of the tympanostomy tube. An automated tube detection program will largely reduce the care costs and enhance the clinical efficiency of the ear nose and throat specialists and general practitioners. In this paper, we develop a computer vision system that is able to automatically detect a tympanostomy tube in an otoscopic image of the ear drum. The system comprises an offline classifier training process followed by a real-time refinement stage performed at the point of care. The offline training process constructs a three-layer cascaded classifier with each layer reflecting specific characteristics of the tube. The real-time refinement process enables the end users to interact and adjust the system over time based on their otoscopic images and patient care. The support vector machine (SVM) algorithm has been applied to train all of the classifiers. Empirical evaluation of the proposed system on both high quality hospital images and low quality internet images demonstrates the effectiveness of the system. The offline classifier trained using 215 images could achieve a 90% accuracy in terms of classifying otoscopic images with and without a tympanostomy tube, and then the real-time refinement process could improve the classification accuracy by 3-5% based on additional 20 images.

    View details for DOI 10.1016/j.compbiomed.2015.03.025

    View details for Web of Science ID 000356108400011

    View details for PubMedID 25889718

  • Multi-color reflectance imaging of middle ear pathology in vivo ANALYTICAL AND BIOANALYTICAL CHEMISTRY Valdez, T. A., Spegazzini, N., Pandey, R., Longo, K., Grindle, C., Peterson, D., Barman, I. 2015; 407 (12): 3277-3283

    Abstract

    Otoscopic examination using white-light illumination has remained virtually unchanged for well over a century. However, the limited contrast of white-light otoscopy constrains the ability to make accurate assessment of middle ear pathology and is subject to significant observer variability. Here, we employ a modified otoscope with multi-color imaging capabilities for superior characterization of the middle ear constituents in vivo and for enhanced diagnosis of acute otitis media and cholesteatoma. In this pilot study, five patients undergoing surgery for tympanostomy tube placement and congenital cholesteatoma excision were imaged using the custom-designed multi-color video-rate reflectance imaging system. We show that the multi-color imaging approach offers an increase in image contrast, thereby enabling clear visualization of the middle ear constituents, especially of the tympanic membrane vascularity. Differential absorption at the multiple wavelengths provides a measure of biochemical and morphological information, and the rapid acquisition and analysis of these images aids in objective evaluation of the middle ear pathology. Our pilot study shows the potential of using label-free narrow-band reflectance imaging to differentiate middle ear pathological conditions from normal middle ear. This technique can aid in obtaining objective and reproducible diagnoses as well as provide assistance in guiding excisional procedures.

    View details for DOI 10.1007/s00216-015-8580-y

    View details for Web of Science ID 000352640300005

    View details for PubMedID 25753015

  • Current Trends in Perioperative Antibiotic Use: A Survey of Otolaryngologists OTOLARYNGOLOGY-HEAD AND NECK SURGERY Valdez, T. A., Marvin, K., Bennett, N. J., Lerer, T., Nolder, A. R., Buchinsky, F. J. 2015; 152 (1): 63-66

    Abstract

    This study describes the patterns of perioperative antimicrobial use by otolaryngologists during common otolaryngologic surgical procedures. Through the American Academy of Otolaryngology--Head and Neck Surgery Infectious Diseases Committee, a survey was developed to assess the current practice patterns regarding the use of perioperative antibiotics in otolaryngology. A total of 6903 surveys were sent out; 458 were fully or partially completed, and a total of 442 responses were included in the final analysis. Most physicians reported routinely prescribing antibiotics either preoperatively or postoperatively for 12 of the 17 procedures included in the questionnaire despite providers agreeing that there is not enough evidence to support their use. The most common procedure for which antibiotics were prescribed was laryngectomy (91.1%). Antibiotic use is a common practice during the perioperative period for otolaryngologic procedures; however, there is a discrepancy between utilization and evidence of benefit.

    View details for DOI 10.1177/0194599814554551

    View details for Web of Science ID 000347066300008

    View details for PubMedID 25305267

  • Development of the Connecticut Airway Risk Evaluation (CARE) system to improve handoff communication in pediatric patients with tracheotomy. JAMA otolaryngology-- head & neck surgery Lawrason Hughes, A., Murray, N., Valdez, T. A., Kelly, R., Kavanagh, K. 2014; 140 (1): 29-33

    Abstract

    National attention has focused on the importance of handoffs in medicine. Our practice during airway patient handoffs is to communicate a patient-specific emergency plan for airway reestablishment; patients who are not intubatable by standard means are at higher risk for failure. There is currently no standard classification system describing airway risk in tracheotomized patients.To introduce and assess the interrater reliability of a simple airway risk classification system, the Connecticut Airway Risk Evaluation (CARE) system.We created a novel classification system, the CARE system, based on ease of intubation and the need for ventilation: group 1, easily intubatable; group 2, intubatable with special equipment and/or maneuvers; group 3, not intubatable. A "v" was appended to any group number to indicate the need for mechanical ventilation. We performed a retrospective medical chart review of patients aged 0 to 18 years who were undergoing tracheotomy at our tertiary care pediatric hospital between January 2000 and April 2011. INTERVENTIONS Each patient's medical history, including airway disease and means of intubation, was reviewed by 4 raters. Patient airways were separately rated as CARE groups 1, 2, or 3, each group with or without a v appended, as appropriate, based on the available information.After the patients were assigned to an airway group by each of the 4 raters, the interrater reliability was calculated to determine the ease of use of the rating system.We identified complete data for 155 of 169 patients (92%), resulting in a total of 620 ratings. Based on the patient's ease of intubation, raters categorized tracheotomized patients into group 1 (70%, 432 of 620); group 2 (25%, 157 of 620); or group 3 (5%, 29 of 620), each with a v appended if appropriate. The interrater reliability was κ = 0.95.We propose an airway risk classification system for tracheotomized patients, CARE, that has high interrater reliability and is easy to use and interpret. As medical providers and national organizations place more focus on improvements in interprovider communication, the creation of an airway handoff tool is integral to improving patient safety and airway management strategies following tracheotomy complications.

    View details for DOI 10.1001/jamaoto.2013.5550

    View details for PubMedID 24203121

  • Bi modal Approach Using Spectroscopy and Digital Imaging to assist Otitis Media Diagnosis 2014 40TH ANNUAL NORTHEAST BIOENGINEERING CONFERENCE (NEBEC) Longo, K., Peterson, D., Valdez, T. A. 2014
  • Development of the Connecticut Airway Risk Evaluation (CARE) System to Improve Handoff Communication in Pediatric Patients With Tracheotomy JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Hughes, A. L., Murray, N., Valdez, T. A., Kelly, R., Kavanagh, K. 2014; 140 (1): 29-33
  • Phoma and Acremonium invasive fungal rhinosinusitis in congenital acute lymphocytic leukemia and literature review INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Roehm, C. E., Salazar, J. C., Hagstrom, N., Valdez, T. A. 2012; 76 (10): 1387-1391

    Abstract

    Invasive rhinocerebral fungal infections are a difficult and often fatal problem in children with hematologic malignancies, with increasing reports of rare pathogens. We describe a case of congenital acute lymphoblastic leukemia (ALL) and invasive fungal rhinosinusitis involving Acremonium and Phoma species, not previously reported in invasive pediatric fungal rhinosinusitis, and review all published cases of human Phoma infections.A literature and institutional review for Phoma spp. was completed including patient demographics, infection site, immune status, treatment and outcome.A female neonate with acute lymphoblastic leukemia presented with hyperleukocytosis and advanced invasive Phoma and Acremonium spp. rhinosinusitis. Despite aggressive medical and surgical therapy, the disease progressed to a rhinocerebral infection with a fatal outcome. Twenty cases of Phoma spp. were found in a complete literature search, including 6 females and 14 males from 18 months to 77 years old. Infections were superficial in fifteen patients and involved deeper tissue in five patients, with sites including cutaneous, subcutaneous and deep tissue sites (eye, lung, extremity deep tissue compartments).This case highlights the risks and grave prognosis of fulminant invasive fungal rhinosinusitis in the context of congenital leukemia, and the potential for rare fungal species in neonates with immunosuppression.

    View details for DOI 10.1016/j.ijporl.2012.06.026

    View details for Web of Science ID 000310048800001

    View details for PubMedID 22818128

  • Bacterial Tracheitis A Varied Entity PEDIATRIC EMERGENCY CARE Miranda, A. D., Valdez, T. A., Pereira, K. D. 2011; 27 (10): 950-953

    Abstract

    The objective of the study was to highlight the different presentations of bacterial tracheitis (BT), a potential life-threatening cause of airway obstruction in children.Case series.A review of medical records of 4 cases of BT who presented with differing signs and symptoms was performed.Clinical manifestations of 4 patients with BT are presented with corresponding endoscopic appearances of the airway. Two patients were afebrile and nontoxic, and 2 had an elevated white cell count. Three had different degrees of stridor. One had a respiratory arrest. Cultures grew Staphylococcus aureus in 2 and Moraxella catarrhalis in 1 and were mixed in 1 patient. None required intubation. All were successfully treated with antibiotics and bronchoscopic debridement of the membranes.Bacterial tracheitis needs a high index of suspicion because of its varied presentations. Certain forms have less severe clinical manifestations. These forms also require aggressive management as they can result in airway obstruction from membranes and edema.

    View details for DOI 10.1097/PEC.0b013e3182309d45

    View details for Web of Science ID 000295873400013

    View details for PubMedID 21975496

  • Evaluation of Pediatric Sensorineural Hearing Loss: A Survey of Pediatric Otolaryngologists ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Rutherford, K. D., Lerer, T. S., Schoem, S. R., Valdez, T. A. 2011; 120 (10): 674-681

    Abstract

    We sought to determine the trends in the evaluation of pediatric patients with sensorineural hearing loss (SNHL) and to determine evaluation patterns based on respondents' demographic data.All members of the American Society of Pediatric Otolaryngology were invited to voluntarily and anonymously complete an online survey. The survey was available from September 2009 to January 2010 and addressed demographic data and tests obtained in evaluating new pediatric patients with SNHL at different age points and with different degrees of hearing loss.The response rate was 22.9% (79 of 345). For all ages and all types of SNHL, the most common consultations were genetics (26% to 76%) and ophthalmology (31% to 66%) consultations. Computed tomography of the temporal bones (49% to 66%), genetic testing (25% to 68%), and electrocardiography (13% to 43%) were the most commonly performed tests. Although there was no consistent difference in practice patterns by gender or years of practice, there were differences in the use of thyroid function tests, TORCH titers, and autoimmune studies by hospital affiliation.Type of SNHL and age are factors in the evaluation of pediatric patients with SNHL. Additionally, evaluation patterns differ according to region and hospital affiliation. The results of this study may provide guidance for otolaryngologists in making information-based and cost-effective evaluations.

    View details for Web of Science ID 000296209100008

    View details for PubMedID 22097154

  • Preliminary Findings on the Effects of Topical Photoactivated Antimicrobial Methyl-delta-Aminolevulinic Acid on Murine Hearing Thresholds OTOLARYNGOLOGY-HEAD AND NECK SURGERY Roehm, C. E., Valdez, T. A., Parham, K. 2011; 144 (6): 959-961

    Abstract

    This study evaluates the ototoxicity of a potential novel ototopical antimicrobial, photoactivated methyl-δ-aminolevulinic acid (M-ALA). Ten CBA/J mice received intratympanic injections of 10 mM M-ALA and 640 nm light source illumination for 7 days, with contralateral ears receiving saline. Auditory-evoked brainstem response (ABR) thresholds (8, 16, 24, and 32 kHz) were determined preinjection and at 1, 30, and 90 days postinjection. Mean ABR thresholds were similar after intratympanic administration of M-ALA and saline (F ratio, 0.001; P = .971). ABR thresholds temporarily increased in both groups (F ratio, 28.52; P = .00) at day 1 postinjection of intratympanic treatments but returned to baseline at day 30 and 90. This temporary elevation was associated with tympanic membrane perforations and granulation tissue at the injection sites, which resolved by day 30 posttreatment. The preliminary findings indicate that intratympanic application of M-ALA with light activation over a 7-day course in a murine model does not produce measurable ototoxicity and is well tolerated.

    View details for DOI 10.1177/0194599811399850

    View details for Web of Science ID 000293998800025

    View details for PubMedID 21493320

  • Postcricoid Vascular Lesions: Histopathological and Immunohistochemical Diagnosis LARYNGOSCOPE Roehm, C. E., Chelius, D. C., Larrier, D., Hicks, M. J., Albright, J. T., Valdez, T. A. 2011; 121 (2): 397-403

    Abstract

    Postcricoid vascular lesions are a rare cause of dysphagia and stridor in the pediatric population. Currently, there is no clear consensus on what type of vascular lesions are common in the postcricoid area because adequate histological or immunohistochemistry studies are lacking. This study aimed to describe the histology and immunohistochemistry of postcricoid masses in our institutions' experience, and consolidate available data on the symptoms, management, and histology of these unusual malformations with a comprehensive literature review.Retrospective patient and literature review.A retrospective review of patients with postcricoid vascular lesions was performed at two pediatric tertiary care institutions. Histology and immunohistochemistry studies were performed in patients undergoing a lesion biopsy. A complete literature review of the English language was completed for cases involving vascular lesions of the postcricoid area.Four patients were identified in our study with postcricoid vascular lesions. All patients presented with symptoms of dysphagia and intermittent stridor. Histology and immunohistochemistry studies were performed in three patients. GLUT-1 was negative in all three patients, and CD34 was positive in all patients tested. Lewis Y antigen was performed in one patient and was negative. A description of 19 cases reported in the English literature is included.Patients with postcricoid vascular lesions usually present with mild to moderate feeding difficulties, and stridor or dyspnea with agitation. Histopathology and immunohistochemistry results suggest that postcricoid vascular lesions may often represent congenital vascular malformations instead of infantile hemangiomas.

    View details for DOI 10.1002/lary.21243

    View details for Web of Science ID 000287006400031

    View details for PubMedID 21271596

  • Enhanced Video Images for Tympanic Membrane Characterization 2011 ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY (EMBC) Cheng, L., Liu, J., Roehm, C. E., Valdez, T. A. 2011: 4002-4005

    Abstract

    The objective of this article is to introduce portable devices capable of providing video images of the tympanic membrane and tympanic cavity of the ear. Specifically, digital video otoscopy is introduced as an effective platform for tympanic membrane characterization. In addition, we show how digital image enhancement and segmentation processing techniques can be applied to the acquired images, which could provide more visual detail and objective clinical interpretation.

    View details for Web of Science ID 000298810003086

    View details for PubMedID 22255217

  • Microbiology of Third and Fourth Branchial Pouch Cysts LARYNGOSCOPE Pahlavan, S., Haque, W., Pereira, K., Larrier, D., Valdez, T. A. 2010; 120 (3): 458-462

    Abstract

    To identify the most common pathogens involved in infections of third and fourth branchial pouch cysts. Third and fourth branchial pouch cyst infections are an uncommon cause of anterior neck abscesses often confused with other entities, such as thyroglossal duct cysts and thyroid abscesses leading to misdiagnosis, recurrence, and increased morbidity related to a delay in diagnosis and appropriate treatment.Retrospective chart and literature review.Retrospective chart review case series of patients presenting to the Bobby R. Alford Department of Otolaryngology at Texas Children's Hospital from July 2004 to July 2008 with third and fourth branchial pouch cysts.A total of 11 patients were identified. All patients had left-sided lesions. Eikenella corrodens was found in 60% of cultures and was the most common organism identified in our patient group. Furthermore, 56% of the organisms isolated were anaerobic. All organisms with the exception of Staphylococcus aureus were identified as oral cavity flora.Third and fourth branchial pouch cysts provide a communication between the neck and the oral cavity through pyriform sinus tracts. The presence of oral cavity flora in a left anterior neck abscess should raise the suspicion of a branchial pouch anomaly, and subsequently alter therapeutic management.

    View details for DOI 10.1002/lary.20724

    View details for Web of Science ID 000275224200004

    View details for PubMedID 20014149

  • Kaposiform hemangioendothelioma (with Kasabach Merritt syndrome) of the head and neck: Case report and review of the literature INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Mukerji, S. S., Osborn, A. J., Roberts, J., Valdez, T. A. 2009; 73 (10): 1474-1476

    Abstract

    An infant initially diagnosed with a parotid hemangioma presented with stridor and thrombocytopenia. Diagnosis of Kaposiform hemangioendothelioma was confirmed with biopsy. The child succumbed to multi-system organ failure related to consumptive coagulopathy despite aggressive medical management. Kaposiform hemangioendothelioma is a rare head and neck tumor that may be mistaken for a hemangioma on preliminary diagnosis, which may lead to increased morbidity and mortality especially in the setting of Kasabach-Merritt phenomenon. A platelet count may provide an early and important clue to the possibility of coagulopathy; prompting physicians to look for a diagnosis other than a simple hemangioma.

    View details for DOI 10.1016/j.ijporl.2009.06.019

    View details for Web of Science ID 000270252100034

    View details for PubMedID 19643504

  • Sensorineural hearing loss in patients with inflammatory bowel disease AMERICAN JOURNAL OF OTOLARYNGOLOGY Karmody, C. S., Valdez, T. A., Desai, U., Blevins, N. H. 2009; 30 (3): 166-170

    Abstract

    The study aimed to discuss the association between sensorineural hearing loss (SNHL) and inflammatory bowel disease (IBD).We reviewed cases of patients with known IBD seen in an otolaryngology practice with documentation of all otologic data including age of onset, family history of otologic problems, exposure to noise, audiometric findings, and so on.Of 38 patients with a history of IBD, 22 had documented SNHL. Nineteen of these had no other identifiable etiology for their inner ear dysfunction. Fourteen of these patients had a diagnosis of ulcerative colitis and 5 had Crohn disease. Sixteen patients had bilateral SNHL, and 3 patients had unilateral SNHL. Only one patient had a lasting response of SNHL to medical treatment.This review suggests that SNHL is an extraintestinal association of IBD. As IBD is considered to be a local or systemic immunopathy, the associated SNHL might also be an expression of systemic immune dysfunction.

    View details for DOI 10.1016/j.amjoto.2008.04.009

    View details for Web of Science ID 000266175400006

    View details for PubMedID 19410121

  • Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19A isolates PEDIATRICS Ongkasuwan, J., Valdez, T. A., Hulten, K. G., Mason, E. O., Kaplan, S. L. 2008; 122 (1): 34-39

    Abstract

    We review the impact of pneumococcal conjugate vaccine on pneumococcal mastoiditis in children at Texas Children's Hospital.The medical charts (including the number of pneumococcal conjugate vaccine doses) for children with pneumococcal mastoiditis treated at Texas Children's Hospital between January 1995 and June 2007 were reviewed retrospectively. Isolates were serotyped with the capsular swelling method. Pulsed-field gel electrophoresis was performed on the 19A isolates and multilocus sequence typing on selected 19A clones.Forty-one pneumococcal mastoiditis cases were identified, and 19A (n = 19) was the most common serotype. Before the introduction of pneumococcal conjugate vaccine (from 1995 to December 1999), 0 of 12 cases were 19A. Between April 2000 and October 2006, 15 cases of pneumococcal mastoiditis occurred, and 5 were 19A. Fourteen cases of pneumococcal mastoiditis occurred between November 2006 and June 2007, all of which were 19A. Mastoiditis caused by 19A isolates was more likely to present with subperiosteal abscess and was more likely to need intraoperative mastoidectomy than was mastoiditis caused by non-19A isolates. Multidrug resistance was also common among the 19A isolates; 13 (68%) of the 19A isolates were resistant to all antibiotics tested routinely. Pulsed-field gel electrophoresis analysis placed 14 (74%) of the 19 serotype 19A isolates into a highly related group; 12 isolates were classified as closely related, and 2 were possibly related. Multilocus sequence typing analysis placed the pulsed-field gel electrophoresis cluster isolates into clonal complex 271 (sequence types 320 and 1451).At Texas Children's Hospital, 19A has become the predominant serotype causing pneumococcal mastoiditis, partly related to the emergence of multidrug-resistant clonal complex 271 strains. Subperiosteal abscesses and the need for mastoidectomy were more common in children with mastoiditis caused by serotype 19A isolates, compared with isolates of other serotypes.

    View details for DOI 10.1542/peds.2007-2703

    View details for Web of Science ID 000257271200006

    View details for PubMedID 18595984

  • Airway foreign bodies and brain abscesses: Report of two cases and review of the literature INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Roberts, J., Bartlett, A. H., Giannoni, C. M., Valdez, T. A. 2008; 72 (2): 265-269

    Abstract

    We report two cases of intracranial abscess in pediatric patients secondary to aspirated foreign bodies. Although foreign bodies are a significant cause of morbidity and mortality in the pediatric population, only four previous cases have been reported that resulted in a brain abscess. Our patients presented with neurological symptoms, and both were found to have a sharp foreign body in the bronchus. Both had brain abscesses caused by bacteria that normally colonize the aerodigestive tract with no other source of bacterial foci. When respiratory flora are isolated from brain abscesses in the absence of other possible sources, intrabronchial foreign body should be considered in evaluation of the etiology.

    View details for DOI 10.1016/j.ijporl.2007.10.006

    View details for Web of Science ID 000253088000019

    View details for PubMedID 18031834

  • Recurrent fetal rhabdomyoma of the head and neck INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Valdez, T. A., Desai, U., Volk, M. S. 2006; 70 (6): 1115-1118

    Abstract

    We present a case of a congenital fetal rhabdomyoma which recurred after surgical excision. A review of the patient's chart, imaging studies, operative reports and histologic findings were conducted. A congenital fetal rhabdomyoma involving the head and neck region diagnosed prenatally by ultrasound and MRI was surgically excised without complications. The patient presented with recurrence of the tumor fourteen months after the initial surgery. This case report is supplemented with a review of the relevant literature on congenital fetal rhabdomyoma. This is the fifth documented case of recurrence of a fetal rhabdomyoma. Extracardiac rhabdomyomas are extremely rare benign tumors. Complete excision of these lesions is curative with only a handful of recurrences documented in the literature. Close follow up and a complete workup to rule out rhabdomyosarcoma is warranted in all cases of recurrence.

    View details for DOI 10.1016/j.ijporl.2005.10.024

    View details for Web of Science ID 000237864100025

    View details for PubMedID 16406074

  • Early laryngeal inhalation injury and its correlation with late sequelae LARYNGOSCOPE Valdez, T. A., Desai, U., Ruhl, C. M., Nigri, P. T. 2006; 116 (2): 283-287

    Abstract

    Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries.This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution.Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted.All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction.The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness.

    View details for DOI 10.1097/01.mlg.0000197932.09386.0e

    View details for Web of Science ID 000235566100023

    View details for PubMedID 16467720

  • Spectroscopic detection and evaluation of morphologic and biochemical changes in early human oral carcinoma CANCER Muller, M. G., Valdez, T. A., Georgakoudi, I., Backman, V., Fuentes, C., Kabani, S., Laver, N., Wang, Z. M., BOONE, C. W., Dasari, R. R., Shapshay, S. M., Feld, M. S. 2003; 97 (7): 1681-1692

    Abstract

    Understanding the development and progression of head and neck squamous cell carcinoma is key in the quest for the early diagnosis and prevention of this type of malignancy. The current study correlated early biochemical and histologic changes in oral tissue with spectral features in fluorescence, reflectance, and light scattering spectra acquired in vivo to diagnose early stages of oral malignancies.A total of 91 tissue sites from 15 patients with varying degrees of malignancy (normal, dysplastic, and cancerous sites) and 8 healthy volunteers were analyzed with 3 spectroscopic techniques. Direct biochemical information regarding oral tissue native fluorophores was obtained with intrinsic fluorescence spectroscopy by fitting a linear combination of collagen and the reduced form of nicotinamide adenine dinucleotide (NADH) fluorescence spectra to the intrinsic tissue fluorescence spectra excited with 337 nanometer (nm) and 358-nm laser light. Diffuse reflectance spectroscopy was used to provide information regarding tissue absorption and structure, such as hemoglobin concentration and stroma density, by measuring the wavelength-dependent absorption and scattering coefficients. By subtracting the diffusely reflected component from the measured reflectance, light scattering spectroscopy (LSS) information resulting from single backscattering from epithelial cell nuclei was obtained. LSS provides information concerning the size distribution of cell nuclei.These optically extracted tissue parameters provide biochemical or structural information in vivo without the need for tissue excision, and can be used to diagnose tissue abnormalities. By combining the information provided by the three techniques, a method known as trimodal spectroscopy, a sensitivity and specificity of 96% and 96%, respectively, in distinguishing cancerous/dysplastic (mild, moderate, and severe) from normal tissue was achieved. In addition, the authors were able to distinguish dysplastic from cancerous tissue with a sensitivity of 64% and a specificity of 90%.The results of the current study demonstrated that Trimodal spectroscopy is a highly sensitive and specific technique with which to diagnose tissue abnormalities.

    View details for DOI 10.1002/cncr.11255

    View details for Web of Science ID 000181816600012

    View details for PubMedID 12655525

  • Idiopathic subglottic stenosis revisited ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Valdez, T. A., Shapshay, S. M. 2002; 111 (8): 690-695

    Abstract

    Idiopathic subglottic stenosis (ISS) is a rare inflammatory process of unknown cause, usually limited to the subglottic region and the first 2 tracheal rings. We performed a retrospective analysis of our experience with a series of patients with this condition. The study involved retrospective review of the records of patients with ISS. A series of criteria that included patient clinical history, laboratory tests, flexible nasolaryngoscopic examination, and biopsies were used to establish a diagnosis. Symptoms, treatment, and outcome were examined. A total of 16 patients were identified; 14 were female (87.5%), and 2 were male. The mean follow-up time was 75.5 months. Fourteen patients required surgical treatment for respiratory compromise. Nine of these cases have been controlled effectively with endoscopic laser techniques. Endoscopic management failed in 5 patients, and 2 patients underwent laryngotracheal resection and reconstruction. Mitomycin-C was used in 6 patients as an adjuvant to endoscopic laser surgery. Patients in whom endoscopic treatment failed were noted to have thicker (>1 cm) and more complex stenoses. The diagnosis of ISS is a diagnosis of exclusion. A complete workup of the patient must be performed to rule out other causes of stenosis. Endoscopic laser surgery is a valid initial approach for thinner, noncomplicated lesions. Patients with thicker, complex lesions in whom endoscopic treatment fails are best managed with laryngotracheal resection and reconstruction. However, adjuvant use of mitomycin-C may prove beneficial in the treatment of these patients. Estrogen may play a role in the pathogenesis of ISS by altering the wound healing response.

    View details for Web of Science ID 000177409700006

    View details for PubMedID 12184589

  • Pulsed-dye laser and retinoic acid delay progression of oral squamous cell carcinoma: A murine model LARYNGOSCOPE Shah, R. K., Valdez, T. A., Wang, Z., Shapshay, S. M. 2001; 111 (7): 1203-1208

    Abstract

    This study examined the role of the pulsed-dye laser (PDL) at 585 nm coupled with retinoic acid at therapeutic (5.0 mg/kg) and nontherapeutic (0.5 mg/kg) doses to delay the progression of cancer with a two-hit approach. The existing vasculature is selectively targeted by the laser, whereas retinoic acid inhibits future angiogenesis.Randomized, prospective study in a murine model.Twenty-five athymic nude mice were inoculated with oral squamous cell cancers on six flank sites and randomly divided into five groups: 1) control subjects, 2) treatment with 0.5 mg/kg retinoic acid (RA 0.5), 3) treatment with 5.0 mg/kg retinoic acid (RA 5.0), 4) treatment with RA 0.5 + PDL, and 5) treatment with RA 5.0 + PDL. The PDL groups received irradiation after inoculation. The retinoic acid was administered daily. The tumors were counted and measured for 14 days.The control group developed visible tumors in 50% of the inoculation sites at 3 days compared with 3 days (RA 0.5) and 4 days (RA 5.0) for the retinoic acid groups and 9 days (RA 0.5 + PDL) and 10 days (RA 5.0 + PDL) for the laser treatment groups. There was no tumor growth until day 7 in the RA 5.0 + PDL group. The tumor volume was statistically different between the treatment groups.This study demonstrated the superiority of a single treatment with the PDL coupled with retinoic acid to delay the progression of cancer when compared with treatment with retinoic acid alone, thus introducing a novel strategy in cancer control.

    View details for Web of Science ID 000169764500012

    View details for PubMedID 11568542

  • Anterior window laryngoplasty: A new anatomic approach for posterior glottic and subglottic stenosis ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Valdez, T. A., Wang, Z., Schumann, R., Shapshay, M. 2001; 110 (6): 519-523

    Abstract

    This study explores the feasibility of an anterior thyroid window as a new approach for posterior glottic stenosis. An anterior window was made on the thyroid cartilage of human cadaver larynges, with its superior edge below the level of the vocal cords and an inferior pedicle composed of the inferior border of the thyroid cartilage attached to the cricothyroid membrane, which was left intact. By obtaining direct exposure of the posterior glottis and cricoarytenoid joints, mucosal graft suturing and exploration of the joints were easily achieved with an operating microscope. This study demonstrates the anatomic feasibility of an anterior window laryngoplasty as an alternative approach to treating posterior glottic stenosis while preserving the cartilage framework and avoiding the anterior commissure. This technique may improve endolaryngeal manipulation by providing a closer and more direct exposure than do endoscopic techniques, and by having fewer possible complications than traditional open techniques.

    View details for Web of Science ID 000169238600005

    View details for PubMedID 11407842

  • A new loser treatment for vocal cord papilloma-585-nm pulsed dye OTOLARYNGOLOGY-HEAD AND NECK SURGERY Valdez, T. A., McMillan, K., Shapshay, S. M. 2001; 124 (4): 421-425

    Abstract

    Microvascular targeting with the 585- nm pulsed dye laser (PDL) may provide a new form of therapy to control symptoms caused by recurrent respiratory papillomatosis (RRP).Ten patients with RRP underwent 13 procedures under general anesthesia with the 585-nm PDL. A micromanipulator (11 procedures) and a flexible nasolaryngoscope (2 procedures) were used to deliver the laser pulses. Patients were followed postoperatively according to protocol.Clinical examination revealed regression of papillomas in all patients. Seven patients had complete regression after PDL surgery, and 2 patients had partial response to treatment. One patient was lost to follow-up. No complications were present during this prospective nonrandomized pilot study.Patients treated with PDL experienced regression of their papillomas. PDL may provide patients with RRP with an alternative treatment without the risks associated with CO(2) laser surgery. This procedure also has potential to be delivered on an outpatient basis with flexible fiberoptic laryngoscopes.

    View details for Web of Science ID 000168031100012

    View details for PubMedID 11283500

  • Pulsed dye laser treatment of laryngeal papillomas BRONCHOLOGY AND BRONCHOESOPHAGOLOGY: STATE OF THE ART Shapshay, S. M., Valdez, T. A. 2001; 1217: 90-94