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.