Biofilm on the tracheoesophageal voice prosthesis: considerations for oral decontamination

Abstract

Objectives The tracheoesophageal puncture (TEP) restores verbal communication after total laryngectomy using a one-way valved voice prosthesis (VP). Microbial colonization can shorten VP device life. Our aims were to investigate patterns of prosthetic and oral colonization, and record changes in VP device life after targeted decontamination. Materials and Methods We conducted a retrospective review of TEP clinic patients who underwent microbial analysis of the VP between 01/2003 and 07/2013. Two subgroups were analyzed: 1) patients with microbial analysis of the VP and the mouth were analyzed to identify patterns of common contamination, and 2) patients who were prescribed targeted oral decontamination on the basis of the microbial analysis of the VP were analyzed to evaluate effects on device life. Results Among 42 patients, 3 patients had only fungal, 5 only bacterial, and 33 had polyspecies fungal and bacterial colonization. In the TEP-oral microflora subgroup (n=15), 7 had common microorganisms in the mouth and on the VP. Among the decontamination subgroup (n=23), 6 patients received broad spectrum rinse, 16 antifungal agents and 13 antibiotics, or a combination thereof. After targeted decontamination, the median device life of prostheses improved from 7.89 to 10.82 weeks (p=0.260). Conclusion The majority of patients with a suboptimal VP device life in this pilot had polyspecies bacterial and fungal colonization. VPs rarely had fungal contamination alone (3%), and non-albicans fungal species were more common than expected. For these reasons, we are exploring the use of targeted decontamination regimens that were associated with 1.4-fold improvement in VP duration.

Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature

“…Candida biofilm formation on the prosthetic surface can lead to deterioration of prosthesis, loosening and leakage requiring replacement. Antifungal agents have been advocated to tackle this problem and help prolong the life span of the prostheses [19,20]. However, the long-term use of antimicrobial and antifungal agents can potentially induce the development of resistant strains and hence needs to use with caution.…”

Selective patient experience with the Blom‐Singer Dual Valve voice prosthesis

“…Candida albicans is a naturally occurring fungal species commonly isolated from voice prostheses and is considered to be one of the most prevalent causes of prosthesis failure. Today, nystatin is the most frequently administered antifungal treatment for the prevention of valve failure . The assessment of valve life with or without antifungal treatment was not the aim of this study, and patients who indicated the use of antifungal did not routinely report the quantity of medication use prior to or during the duration of the Dual Valve placement.…”

“…Today, nystatin is the most frequently administered antifungal treatment for the prevention of valve failure. 2,8 The assessment of valve life with or without antifungal treatment was not the aim of this study, and patients who indicated the use of antifungal did not routinely report the quantity of medication use prior to or during the duration of the Dual Valve placement. The use of antifungal medication could be evaluated in a subsequent study designed to capture that data.…”

“…Failure of the prosthesis is determined by the patient when they feel the valve no longer effectively provides them with speech restoration or otherwise malfunctions; it is not objectively determined to have failed by clinicians. Valve failure often occurs as a result of clogging of sputum or food, high differential esophageal pressure gradients, and/or malfunctioning of the valve, but one of the most common etiologies of decreased valve life is microbial colonization and subsequent biofilm plaque formation, which may progress to invasive growth into the silicone valve …”

“…Valve failure often occurs as a result of clogging of sputum or food, high differential esophageal pressure gradients, and/or malfunctioning of the valve, but one of the most common etiologies of decreased valve life is microbial colonization and subsequent biofilm plaque formation, which may progress to invasive growth into the silicone valve. 2 This study looks at the Blom-Singer Dual Valve prosthesis (InHealth Technologies, Carpinteria, CA) ( Fig. 1) .…”