Candida Biofilm Formation on Voice Prostheses

Laryngopharyngeal malignancy is treated with radiotherapy and/or surgery. When total laryngectomy is required major laryngeal functions (phonation, airway control, swallowing, and coughing) are affected. The insertion of a silicone rubber voice prosthesis in a surgically created tracheoesophageal puncture is the most effective method for voice rehabilitation. Silicone has the propensity to become rapidly colonised by microorganisms (mainly Candida albicans) forming a biofilm which leads to the failure of the devices. Valve failure, as well as compromising speech, may result in aspiration pneumonia, and repeated valve replacement may lead to either tract stenosis or insufficiency. Prevention and control of biofilm formation is therefore crucial for the lifespan of the prosthesis and promotion of tracheosophageal tissue and lung health. To date the mechanisms of biofilm formation on voice prostheses are not fully understood. Further studies are therefore required to identify factors influencing Candida biofilm formation. This review describes the factors known to influence biofilm formation on voice prosthesis and current strategies employed to prolong their life by interfering with microbial colonisation.