Bio

Bio


Dr. Tulio A Valdez is a surgeon scientist born and raised in Barranquilla, 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


  • Associate Professor - Med Center Line, Otolaryngology - Head & Neck Surgery Divisions

Teaching

2017-18 Courses


Publications

All Publications


  • 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

  • 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

  • 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

  • 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

  • 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