Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngec-Tomy Patients



Sarvestani HK¹ ; Ghazvini RD¹ ; Hashemi SJ^{1, 2} ; Shoar MG¹ ; Ansari S³ ; Rafat Z⁴ ; Ahmadi A⁵ ; Borghei P⁶ ; Elahi M⁶ ; Foroushani AR⁷ ; Getso MI^{1, 8} ; Aboutalebian S⁹ ; Safari F¹⁰ ; Ardi P¹
Source: Iranian Journal of Public Health Published:2022

Abstract

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryn-gectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device’s lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis. Methods: Failed TVPs were removed-due to leakage and/or aspiration-from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Teh-ran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing tech-niques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated ac-cording to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (P<0.05). Conclusion: White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost. © 2022 Kamali Sarvestani et al.