Lifetime Of Voice Prostheses Research Articles

Speech efficacy, safety and factors affecting lifetime of voice prostheses in patients with laryngeal cancer: A systematic review and network meta-analysis of randomized controlled trials.

e18031Background: Prognosis of total laryngectomy following laryngeal tumors mostly SCC, reaches a five-year survival rate of 65-75%, making it treatment of choice. Total laryngectomy is accompanie...

Voice prosthetic biofilm formation and Candida morphogenic conversions in absence and presence of different bacterial strains and species on silicone-rubber.

Morphogenic conversion of Candida from a yeast to hyphal morphology plays a pivotal role in the pathogenicity of Candida species. Both Candida albicans and Candida tropicalis, in combination with a variety of different bacterial strains and species, appear in biofilms on silicone-rubber voice prostheses used in laryngectomized patients. Here we study biofilm formation on silicone-rubber by C. albicans or C. tropicalis in combination with different commensal bacterial strains and lactobacillus strains. In addition, hyphal formation in C. albicans and C. tropicalis, as stimulated by Rothia dentocariosa and lactobacilli was evaluated, as clinical studies outlined that these bacterial strains have opposite results on the clinical life-time of silicone-rubber voice prostheses. Biofilms were grown during eight days in a silicone-rubber tube, while passing the biofilms through episodes of nutritional feast and famine. Biofilms consisting of combinations of C. albicans and a bacterial strain comprised significantly less viable organisms than combinations comprising C. tropicalis. High percentages of Candida were found in biofilms grown in combination with lactobacilli. Interestingly, L. casei, with demonstrated favorable effects on the clinical life-time of voice prostheses, reduced the percentage hyphal formation in Candida biofilms as compared with Candida biofilms grown in absence of bacteria or grown in combination with R. dentocariosa, a bacterial strain whose presence is associated with short clinical life-times of voice prostheses.

Przyczyny i czas pomiędzy kolejnymi wymianami protez głosowych u chorych po laryngektomii – analiza 184 wymian u 42 chorych

IntroductionImplantation of the indwelling voice prosthesis has become the preferred method of voice rehabilitation after total laryngectomy. Frequent prosthesis dysfunction remains the major problem. AimAnalysis of the indwelling time and indications for multiple voice prosthesis replacements. MethodsForty two patients after total laryngectomy due to laryngeal cancer (6 women and 36 men, mean age 62.1±6.7 years) were included. 184 voice prosthesis replacements were analyzed (1271 patient-months). ResultsMean time between replacements was 260±150 days. The indwelling time decreased from 267 days to the first replacement to 100–160 days at eighth and subsequent exchanges (p<0.01). Most frequent indications for replacement were leakage of fluids through the prosthesis, phonation problems caused by mucosal overgrowth around the prosthesis, inaccurate sizing, deformation, and spontaneous extrusion. The lifetime of voice prostheses was positively correlated with patients’ age. Mycological culture of the smear taken from tracheoesophageal fistula at first replacement was positive in 34/41 cases, at the second in 29/31 cases, the third in 29/31, and at the fourth and subsequent replacements in all specimens. Most patients indicated the following factors as possible causes of a shortened lifetime of the prosthesis: use of alcohol and coffee (34% of responders), inappropriate dietary habits (sweets and tough foodstuff – 17%), cleaning of voice prosthesis discordant with the recommendations of the manufacturer (14%). ConclusionsAlthough our results confirm common indications for voice prosthesis replacement we also showed that the time between exchanges is gradually getting shorter. This observation could have implications for the current reimbursement practices.

Effect of dairy products on the lifetime of Provox2 voice prostheses in vitro and in vivo

Reduction of biofilm formation on tracheoesophageal voice prostheses by certain dairy products might extend their clinical lifetime. The purpose of this study was to determine the influence of certain dairy products on voice prosthetic biofilms and lifetimes in vitro and in vivo. The in vitro results were accomplished using an artificial throat. The lifetimes of Provox2 prostheses were evaluated in a patient group that daily consumed the evaluated products. Buttermilk and Yakult Light fermented milk decreased the amount of bacteria on voice prostheses but stimulated yeast prevalence in vitro. Concurrently, lifetimes of voice prostheses in patients consuming buttermilk were not significantly different, whereas patients consuming Yakult Light fermented milk drink had a significantly (p < .01) increased prosthesis lifetime by a factor of 3.76. Yakult Light fermented milk drink reduced biofilm formation on Provox2 prostheses in vitro and in vivo and significantly increased prosthesis lifetime. In vivo, no significant effects were observed for patients consuming buttermilk.

Effect of antifungal agents on indwelling voice prosthetic biofilms

Rehabilitating the lost voice of laryngectomy patients by insertion of a silicone rubber voice prosthesis is now generally considered to be superior to any other form of substitute voice production. However, a drawback of these implants is the rapid colonization by a mixed biofilm of bacteria and yeasts, mainly Candida species, leading to failure and frequent exchange of the implant. A strategy frequently applied by otolaryngologists is oropharyngeal yeast decontamination by using antifungal agents, despite the fact that there is no compelling evidence that prescription of antifungal agents will prolong the lifetime of voice prostheses. Moreover, the prophylactic use of antifungal agents contributes to the development of resistant strains. Alternative approaches to prolonging the lifetime of silicone rubber voice prostheses may be found in modification of the silicone rubber surface of the implant, diet supplementation with active, probiotic bacteria, or salivary substitutes with synthetic antimicrobial peptides. Curr Opin