Direct Biofilm Visualization in Voice Prosthesis

Voice prosthesis is the gold standard for post-laryngectomy voice rehabilitation. Surgical treatment and tracheo-esophageal (TE) puncture performed simultaneously is the best option [1]. In the post operative early speech therapy is necessary to voice restoration/rehabilitation. In these patients optimal results can be achieved, they can reach a better maximum phonation time, compared to those ones using esophageal speech and some of them are able to use hands-free tracheostoma breathing valve (Hakeem 2010). Voice prosthesis hygiene can be performed at home by the patients simply using a dedicated brush, nevertheless periodically replacement is required, usually by an ENT specialist, because of malfunctions, extrusion, common wall swelling, gastric filling [2, 3]. The main cause of malfunction is due to leakage phenomenon that consists in the passage of saliva, liquids or, sometimes even bolus through the device, passing from the esophagus to the lower airways. Leakage can be classified in intraprosthetic and periprosthetic. The first one is the most common cause of prosthesis malfunctioning (80% of all cases) and is caused by a disfunction of the silicone elements of the esophageal flange result of mycotic and bacterial biofilm colonization of the latter [4‐6] even though prostheses are made of medical grade elastomers such as silicone or polyurethane, in order to reduce microbial colonization. Periprosthetic leakage takes place in case of an enlargement of the tracheo-esophageal fistula and it occurs in 20–30% of all patients with voice prostheses over time [7]. Prosthesis’ smooth silicone surface in fact can be deteriorated by free radicals and extracellular enzymes produced by yeasts and bacteria, adjuvanted by proinflammatory enzymes, cytokines and several catabolites produced by the immune system [8]. …