Complex breathing and sleeping disorders in kids

Lurie Children’s Division of Otolaryngology treats more children for ear, nose and throat conditions than any other hospital in Illinois. One important component of the division is its Aerodigestive Program, which provides comprehensive care to children with – among other conditions – disordered breathing and sleeping disorders. Dr. Taher Valika, the medical director of the program, discusses his expertise in complex airway and sleep surgeries, how children benefit from his work and the research he is doing in this area to enhance treatment options.

Featuring 

Taher Valika, MD, is a pediatric otolaryngologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and medical director of the hospital’s Aerodigestive Program. His academic expertise is in pediatric airway reconstruction and managing complex sleep related airway disorders.  
 
Learn more about Taher Valika, MD 

Topics Covered 

  • The Aerodigestive Program at Lurie Children’s provides care to children with complex airway disorders who require pulmonary, upper digestive tract, sleep, voice, and swallowing evaluations.  
  • The Aerodigestive surgical team sometimes provides surgeries to fix the airways of children with tracheostomy tubes, leading them to no longer need a tracheostomy tube to help them breathe. These complex surgeries can take 8-10 hours. 
  • In addition to being a clinician and surgeon, Dr. Taher Valika pursues research aiming to find better treatment options for kids with complex ENT-related conditions. He is currently working on using a 3D printer to create cartilage for airway implantation in a child, which could potentially improve surgical outcomes. 
  • Dr. Valika is passionate about finding new options for children with complex medical comorbidities. He developed a technique for that helps children with conditions such as trisomy 21 and cerebral palsy breathe better by fixing the back of their tongue.  

Additional Resources 

Transcription

Dr. Taher Valika: A lot of time medicine doesn't work. And that's the challenge of healthcare in general. You know, a lot of people will worry that, oh, what if my child needs surgery? But sometimes surgery is the easier answer than the medications that we prescribe. 
 
Maggie McKay: The division of otolaryngology at Ann and Robert H. Lurie Children's Hospital of Chicago, treats more children for ear nose and throat conditions than any other hospital in Illinois. One important component of the division is its Aerodigestive Program, which provides comprehensive care to children with among other conditions, disordered breathing and sleeping disorders. Today, we talk with Dr. Taher Valika, the medical director of the program, about his expertise in complex airway and sleep surgeries, how children benefit from his work and the research he's doing in this area to enhance treatment options. This is Precision, Perspectives on Children's Surgery, the podcast from Lurie Children's. 
 
I'm Maggie McKay. Welcome and thank you for being here today, Dr. Valika, I'm so interested to learn more about how you help children with these issues and the surgeon's role as well. To get started, will you please introduce yourself and tell us your title? 
 
Dr. Taher Valika: My name's Taher Valika. I'm a pediatric otolaryngologist at Lurie Children's Hospital. I'm also the medical director of the Aerodigestive program and the director of Upper Airway Surgery. 
 
Maggie McKay: As a specialist in complex breathing and sleeping disorders in children, what are some of these conditions? How common are they? 
 
Dr. Taher Valika: From sleeping disorders, a lot of these conditions really encompass the way kids sleep and snore at night. You may have heard your child having a snoring episode and some kids even pause. That's the biggest impact from a sleeping perspective. Kids with enlarged tonsils or adenoids can really cause snoring or sleep apnea, sleep apnea has a real big impact in children's cardiac health, pulmonary health, and even their neural development in terms of concentration and focus and behaviors. So it's really important that these complex sleeping disorders are really addressed. 
 
They're relatively common. Unfortunately, about five to 10% of kids snore and up to that population amount can actually have sleep apnea. In terms of the complex breathing, the other aspect of my specialty is really looking at children who have narrowed airways and create noisy breathing. Those conditions include laryngomalacia, having narrowing of the airway, including subglottic stenosis, or children with tracheostomies. Children with tracheostomies are very medically complex and have other medical comorbidities. 
 
These children with tracheostomies really need a high level of care to make sure that their trach remains safe and their airway remains safe because with time as their airways get better, their lungs heal, we have to get their tracheostomy tubes out. Some children need really complex surgeries that can take anywhere up to eight or 10 hours to fix their airways and get their tracheostomy tubes out. 
 
Maggie McKay: Wow. Eight to 10 hours. How did you get into the specialty Dr. Valika? 
 
Dr. Taher Valika: It's a passion. Way back in medical school was actually planning on going into cardiology or endocrinology. Eventually I found out I had ENT problems and had sinus surgery myself. Soon, other members of my family had otolaryngology issues. And we realized the more I thought about it as to help them out, the more interest I developed in my own field. As I progressed in my training career, I soon realized that I had a passion and niche for trying to challenge myself and push myself. I did pediatric ENT for the sole purpose of doing things that are actually quite challenging and finding my own whiteboard as a blank canvas to continue working and challenging the way of what innovation and norms are created in this field. 
 
Maggie McKay: And as an experienced surgeon, what are some of the key roles a surgeon plays in the treatment of these disorders? 
 
Dr. Taher Valika: A lot of time medicine doesn't work. And that's the challenge of healthcare in general. You know, a lot of people will worry that, oh, what if my child needs surgery? But sometimes surgery is the easier answer than the medications that we prescribe. As a surgeon, making sure that your child is the right candidate. And then is the right surgery for your child and making those decisions to ensure that we are always trying to optimize your child's care at the end of the day is the goal. 
 
Maggie McKay: Your research interests include patient outcomes, innovation and technology. So how do these topics relate to patient? 
 
Dr. Taher Valika: At the end of the day, the unique opportunity that I have here working at Lurie Children's allows me to interact with a complex medical patient population. Our goal is for families to have the best patient outcome. And the only way that comes is not by practicing good medicine or even great medicine. It's about continuing to push that barrier of medicine to see where we can end up. Innovation and technology in this day and age is exactly where the world is going. And if we aren't unable to utilize the new resources that we have, then we are only gonna be able to practice the same level of care that you can get anywhere else. I work at Lurie Children's not to practice the same level of care, but to give your child a better patient outcome. 
 
Maggie McKay: Can you tell us about the current research you are involved in at Lurie children's and the Stanley Manny Children's Research Institutes. How might it impact diagnosis and outcomes treatment for children with complex sleeping and airway disorders? 
 
Dr. Taher Valika: Research has become a backbone in my career. At this point, trying to find new ways to do the same things that we've always done is my mainstay and my goal. A lot of the work I've been doing is with 3d printing and looking at airway reconstruction, those surgeries that we talk about that take anywhere from six to 10 hours to rebuild a child's trachea has a lot of work that we put in. 
 
I'm currently working on some 3d printing where we are able to hopefully be able to print cartilage for your child and implant it into your child's airway without having to borrow the cartilage itself from your child. This may reduce our surgery outcomes from anywhere by 50% and have the same outcome at the end of the day. 
 
Maggie McKay: That is amazing. And so when you look 20 years ago, how has the field advanced, what does the future hold? 
 
Dr. Taher Valika: One of the things that entices me to work harder every single day is the fact that I feel our field has become complacent with some of renovation. When you work at an institution that has great care, it sometimes is easier to continue practicing great medicine. It's hard with technology and innovation to continue finding something new. And especially with healthcare and medicine, there's always a lack time. One of the works that I really embody is looking at children with complex sleep apnea. I recently developed a surgery and a new procedure that four years ago didn't exist. 
 
And what we've done is taken children with extremely complex medical comorbidities, such as children with trisomy 21 and cerebral palsy, and given them an option to breath better by fixing their back of their tongue. This is something that usually in the medical literature has at a failure rate of about 60 to 70%. In our data that we've looked at over the last three or four years, we've had the opportunity to take care of kids and improve their sleep by over 70%. And that is unlike anywhere else. And this is a surgery that we developed here. It's done the most here than anywhere else in the world. 
 
Maggie McKay: That's impressive. What gives you hope for pediatric patients with these conditions? 
 
Dr. Taher Valika: It's the future. Our children are our future and it's making an impact. That's going to impact this child's life for their entirety of their time. We have the unique opportunity to have an impact so early on in their life that every decision moving forward will have been impacted by that. 
 
Maggie McKay: Lurie Children's Aerodigestive Program is comprised of specialists in other fields that you work closely with for some patients, such as gastroenterology, pulmonary medicine, pediatric surgery, and speech and language therapists. How does it enhance care for patients to have all these specialists working together? 
 
Dr. Taher Valika: I think the beauty of all of the teams working together is that many of our patient population are going to see each of these specialists anyways. By having in a dedicated program where you work with the entire team, it's one visit, yet you get to see four different or five different specialists at the same time. Why lug your child around going to multiple appointments on multiple days when you can do that on a single day, in a single visit, and get a team-based approach. After we see your child in their digestive program, we actually sit down, we talk about your child from each of our vantage points and try to figure out what is the optimal condition that we are trying to fix. 
 
A lot of the work that we do with our GI team and pulmonary team, as well as our pediatric surgery and speech and language team, there's a lot of overlap. Why do unnecessary tests, unnecessary appointments? When we have all the specialists together who are looking at it from 10 different sets of eyes, to make sure that the best thing for your child is what's happening in front of us. 
 
Maggie McKay: That's gotta alleviate a lot of stress for parents because just the time and maybe people have to take time off from work to go to all these appointments. So to have them all at once, I would imagine invaluable. What makes this program unique and why do so many patients choose Lurie Children's for complex airway and sleep disorders? 
 
Dr. Taher Valika: The providers we have here. At the end of the day, really care for your child. The individuals at Lurie Children's not just at the physicians or the surgeons, but it's our nursing staff. Our medical assistants are check-in desk. This hospital is made for children. And the beauty of that is that we all look at it from that perspective to take care of your child. In terms of complex airway and sleep disorder, this institution was a powerhouse of … pediatric airway surgery. We've had generational legacies of other individuals who have come through here who have completed and developed complex airway surgeries and changed the wave for generations of children so far. 
 
Maggie McKay: Thank you so much, Dr. Valika. This has been so informative and we appreciate the work you do, and look forward to the future. 
 
Dr. Taher Valika: Thank you. 
 
Maggie McKay: To learn more, please visit Luriechildrens.org/ENT, or make an appointment by calling 1-800-KIDS-DOC. and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Precision, Perspectives on Children's Surgery, the podcast from Lurie Children's Hospital. I'm Maggie McKay. Be well. 




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