Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngectomy Patients
-
Hasti Kamali sarvestani
,
Roshanak Daie Ghazvini
,
Syed Jamal Hashemi
,
Mohsen Geramishoar
,
Saham Ansari
,
Zahra Rafat
,
Aslan Ahmadi
,
Pedram Borghei
,
Miad Elahi
,
Abas Rahmi foroushani
,
Muhammad Ibrahim Getso
,
Shima Aboutalebian
,
Fatemeh Safari
,
Pegah Ardi
Abstract
Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, 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 Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according 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.
1. Somogyi-Ganss E, Chambers MS, Lewin JS, et al (2017). Biofilm on the trache-oesophageal voice prosthesis: considera-tions for oral decontamination. Eur Arch Otorhinolaryngol, 274(1):405-413.
2. Van Den Hoogen FJ, Oudes MJ, Homber-gen G, et al (1996). The Groningen, Nijdam, and Provox voice prostheses: a prospective clinical comparison based on 845 replacements. Acta Otolaryngol, 116(1):119-24.
3. Parker A, O'Leary I, Wight R, et al (1992). The Groningen valve voice prosthesis in Sheffield: a 4-year review. J Laryngol Otol, 106(2):154-6.
4. Khardori N, Yassien M (1995). Biofilms in device-related infections. J Ind Microbiol, 15(3):141-7.
5. Perry A (1997). The role of the speech and language therapist in voice restoration af-ter laryngectomy. J Laryngol Otol, 111(1):4-7.
6. Bauters TG, Moerman M, Vermeersch H (2002). Colonization of voice prostheses by albicans and non-albicans Candida spe-cies. Laryngoscope, 112(4):708-12.
7. van Weissenbruch R, Albers FW, Bouckaert S, et al (1997). Deterioration of the Provox silicone tracheoesophageal voice prosthesis: microbial aspects and struc-tural changes. Acta Otolaryngol, 117(3):452-8.
8. Van Weissenbruch R, Bouckaert S, Remon JP, et al (1997). Chemoprophylaxis of fungal deterioration of the Provox sili-cone tracheoesophageal prosthesis in post laryngectomy patients. Ann Otol Rhi-nol Laryngol, 106(4):329-37.
9. De Carpentier JP, Ryder WD, Saeed SR, et al (1996). Survival times of Provox valves. J Laryngol Otol, 110(1):37-42.
10. Kress P, Schafer P, Schwerdtfeger FP, et al (2014). Are modern voice prostheses bet-ter? A lifetime comparison of 749 voice prostheses. Eur Arch Otorhinolaryngol, 271(1):133-40.
11. Lorenz KJ, Maier H (2010). [Voice rehabili-tation after laryngectomy. Initial clinical experience with the Provox-Vega® voice prosthesis and the SmartInserter® sys-tem]. HNO, 58(12):1174-83.
12. Bozec A, Poissonnet G, Chamorey E, et al (2010). Results of vocal rehabilitation us-ing tracheoesophageal voice prosthesis after total laryngectomy and their predic-tive factors. Eur Arch Otorhinolaryngol, 267(5):751-8.
13. Makitie AA, Niemensivu R, Juvas A, et al (2003). Postlaryngectomy voice restora-tion using a voice prosthesis: a single in-stitution's ten-year experience. Ann Otol Rhinol Laryngol, 112(12):1007-10.
14. Leder SB, Erskine MC (1997). Voice resto-ration after laryngectomy: experience with the Blom-Singer extended-wear indwell-ing tracheoesophageal voice prosthesis. Head Neck, 19(6):487-93.
15. Lequeux T, Badreldin A, Saussez S, et al (2003). A comparison of survival lifetime of the Provox and the Provox2 voice prosthesis. J Laryngol Otol, 117(11):875-8.
16. Cornu AS, Vlantis AC, Elliott H, et al (2003). Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa. J Laryngol Otol, 117(1):56-9.
17. Hilgers FJ, Ackerstaff AH, Jacobi I, et al (2010). Prospective clinical phase II study of two new indwelling voice prostheses (Provox Vega 22.5 and 20 Fr) and a nov-el anterograde insertion device (Provox Smart Inserter). Laryngoscope, 120(6):1135-43.
18. Lorenz KJ, Grieser L, Ehrhart T, et al (2010). Role of reflux in tracheoesopha-geal fistula problems after laryngectomy. Ann Otol Rhinol Laryngol, 119(11):719-28.
19. Leunisse C, van Weissenbruch R, Busscher HJ, et al (2001). Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prosthe-ses--an electron microscopical study. J Bi-omed Mater Res, 58(5):556-63.
20. Lopez D, Vlamakis H, Kolter R (2010). Bio-films. Cold Spring Harb Perspect Biol, 2(7): a000398.
21. Mahieu HF, van Saene HK, Rosingh HJ, et al (1986). Candida vegetations on silicone voice prostheses. Arch Otolaryngol Head Neck Surg, 112(3):321-5.
22. Galli J, Calo L (2018). Biofilm in voice pros-thesis: A prospective cohort study and laboratory tests using sonication and SEM analysis. Clin Otolaryngol, 43(5):1260-1265.
23. Schuldt T, Dommerich S, Pau HW, et al (2010). Time course of microbial coloni-zation of different voice prostheses. Laryngorhinootologie, 89(10):606-11.
24. Bertl K, Zatorska B, Leonhard M, et al (2013). Oral microbial colonization in laryngectomized patients as a possible co-factor of biofilm formation on their voice prostheses. J Clin Periodontol, 40(9):833-40.
25. Talpaert MJ, Balfour A, Stevens S, et al (2015). Candida biofilm formation on voice prostheses. J Med Microbiol, 64(3):199-208.
26. Kumar S, Stecher G, Li M, et al (2018). MEGA X: molecular evolutionary genet-ics analysis across computing platforms. Mol Biol Evol, 35(6):1547-1549.
27. Oramahi HA, Yoshimura T (2013). Antifun-gal, and antisemitic activities of wood vinegar from Vitex pubescent Vahl. J Wood Sci, 59(4):344-350.
28. Clinical and laboratory standards institute (CLSI), Reference Method for Broth Di-lution Antifungal Susceptibility Testing of Yeasts; Approved Standard, third edition, Clinical and Laboratory Standards Insti-tute, Wayne, PA, USA, 2008 CLSI docu-ment M27–A3.
29. Clinical and laboratory standards institute (CLSI), Reference Method for Broth Di-lution Antifungal Susceptibility Testing of Yeasts: Fourth Informational Supple-ment, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 2012 CLSI document M27–S4.
30. Chaturvedi P, Syed S, Pawar P, et al (2014). Microbial colonization of Provox voice prosthesis in the Indian scenario. Indian J Cancer, 51(2):184-8.
31. Sardi J, Scorzoni L, Bernardi T, et al (2013). Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products, and new therapeutic options. J Med Microbiol, 62(1):10-24.
32. Mahieu HF, van Saene JJ, den Besten J, et al (1986). Oropharynx decontamination preventing Candida vegetation on voice prostheses. Arch Otolaryngol Head Neck Surg, 112(10):1090-2.
33. Izdebski K, Ross JC, Lee S (1987). Fungal colonization of tracheoesophageal voice prosthesis. Laryngoscope, 97(5):594-7.
34. G Jolanda Elving, Henny C van der Mei, Henk J Busscher, et al (2002). Compari-son of the microbial composition of voice prosthesis biofilms from patients requiring frequent versus infrequent re-placement. Ann Otol Rhinol Laryngo, 111(3):200-3.
35. Buijssen KJ, Harmsen HJ, van der Mei HC, et al (2007). Lactobacilli: Important in biofilm formation on voice prostheses. Otolaryngol Head Neck Surg, 137:505-7.
36. Sarwestani HK, Ghazvini RD, Hashemi SJ, et al (2019). Investigation of etiologic agents and clinical presentations of otomycosis at a tertiary referral center in Tehran, Iran. Iran J Public Health, 48(2):331-337.
37. Li L, Redding S, Dongari-Bagtzoglou A (2007). Candida glabrata, an emerging oral opportunistic pathogen. J Den Rse, 86(3):204-15.
38. Falagas ME, Betsi GI, Athanasiou S J (2006). Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Anti-microb Chemother, 58(2):266-72.
39. Martinez RC, Franceschini SA, Patta MC, et al (2009). Improved treatment of vulvo-vaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol, 48(3):269–74.
40. Zwolinska-Wcislo M, Brzozowski T, Mach T, et al (2006). Are probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studies. J Physiol Pharmacol, 57(9):35–49.
41. Gavazzi G, Krause K-H (2002). Aging and infection. Lancet Infect Dis, 2 (1):659-66.
42. Ahmed PI, Gleeson GA (1970). Changes in cigarette smoking habits between 1955 and 1966. US Department of Health, Educa-tion, and Welfare, Public Health Service.
43. Wynder EL, Covey LS, Mabuchi K, et al (1976). Environmental factors in cancer of the larynx. a second look. Cancer, 38(4):1591-601.
44. Manfredi M, Al-karaawi Z, McCullough MJ, et al (2002). The isolation, identification, and molecular analysis of Candida spp. isolated from the oral cavities of patients with diabetes mellitus. Oral Microbiol Immu-nol, 17 (9): 181–5.
45. Willis AM, Coulter WA, Sullivan DJ, et al (2000). Isolation of C. dubliniensis from in-sulin-using diabetes mellitus patients. J Oral Pathol Med, 29 (1): 86–90.
46. Aly FZ, Blackwell CC, Mackenzie DA, et al (1995). Identification of oral yeast species isolated from individuals with diabetes mellitus. Mycoses, 38 (3-4): 107–10.
47. Wiederhold NP (2017). Antifungal re-sistance: current trends and future strate-gies to combat. Infect Drug Resist, 29(10):249-259.
48. Raj VB, Madan Kumar PD, Balaji S (2017). Effectiveness of vinegar, lime, and salt-water as potential household decontami-nants for toothbrushes. J Indian Assoc Pub-lic Health Dent, 15 (1):8-10.
49. Al-Salihi SS, Jumaah IA (2017). The activity of Some Disinfectants, Detergents, and Essential Oils on Growth of the yeast Candida albicans. Al-Mustansiriyah J Sci, 28(1):25-34.
50. Jabir HB, Abbas FN, Khalaf RM (2011). In vitro assessment of the antifungal poten-tial of apple cider vinegar and acetic acid versus fluconazole in clinical isolates of otomycosis. Thi-Qar Medical Journal (TQMJ), 5(1):126-133.
2. Van Den Hoogen FJ, Oudes MJ, Homber-gen G, et al (1996). The Groningen, Nijdam, and Provox voice prostheses: a prospective clinical comparison based on 845 replacements. Acta Otolaryngol, 116(1):119-24.
3. Parker A, O'Leary I, Wight R, et al (1992). The Groningen valve voice prosthesis in Sheffield: a 4-year review. J Laryngol Otol, 106(2):154-6.
4. Khardori N, Yassien M (1995). Biofilms in device-related infections. J Ind Microbiol, 15(3):141-7.
5. Perry A (1997). The role of the speech and language therapist in voice restoration af-ter laryngectomy. J Laryngol Otol, 111(1):4-7.
6. Bauters TG, Moerman M, Vermeersch H (2002). Colonization of voice prostheses by albicans and non-albicans Candida spe-cies. Laryngoscope, 112(4):708-12.
7. van Weissenbruch R, Albers FW, Bouckaert S, et al (1997). Deterioration of the Provox silicone tracheoesophageal voice prosthesis: microbial aspects and struc-tural changes. Acta Otolaryngol, 117(3):452-8.
8. Van Weissenbruch R, Bouckaert S, Remon JP, et al (1997). Chemoprophylaxis of fungal deterioration of the Provox sili-cone tracheoesophageal prosthesis in post laryngectomy patients. Ann Otol Rhi-nol Laryngol, 106(4):329-37.
9. De Carpentier JP, Ryder WD, Saeed SR, et al (1996). Survival times of Provox valves. J Laryngol Otol, 110(1):37-42.
10. Kress P, Schafer P, Schwerdtfeger FP, et al (2014). Are modern voice prostheses bet-ter? A lifetime comparison of 749 voice prostheses. Eur Arch Otorhinolaryngol, 271(1):133-40.
11. Lorenz KJ, Maier H (2010). [Voice rehabili-tation after laryngectomy. Initial clinical experience with the Provox-Vega® voice prosthesis and the SmartInserter® sys-tem]. HNO, 58(12):1174-83.
12. Bozec A, Poissonnet G, Chamorey E, et al (2010). Results of vocal rehabilitation us-ing tracheoesophageal voice prosthesis after total laryngectomy and their predic-tive factors. Eur Arch Otorhinolaryngol, 267(5):751-8.
13. Makitie AA, Niemensivu R, Juvas A, et al (2003). Postlaryngectomy voice restora-tion using a voice prosthesis: a single in-stitution's ten-year experience. Ann Otol Rhinol Laryngol, 112(12):1007-10.
14. Leder SB, Erskine MC (1997). Voice resto-ration after laryngectomy: experience with the Blom-Singer extended-wear indwell-ing tracheoesophageal voice prosthesis. Head Neck, 19(6):487-93.
15. Lequeux T, Badreldin A, Saussez S, et al (2003). A comparison of survival lifetime of the Provox and the Provox2 voice prosthesis. J Laryngol Otol, 117(11):875-8.
16. Cornu AS, Vlantis AC, Elliott H, et al (2003). Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa. J Laryngol Otol, 117(1):56-9.
17. Hilgers FJ, Ackerstaff AH, Jacobi I, et al (2010). Prospective clinical phase II study of two new indwelling voice prostheses (Provox Vega 22.5 and 20 Fr) and a nov-el anterograde insertion device (Provox Smart Inserter). Laryngoscope, 120(6):1135-43.
18. Lorenz KJ, Grieser L, Ehrhart T, et al (2010). Role of reflux in tracheoesopha-geal fistula problems after laryngectomy. Ann Otol Rhinol Laryngol, 119(11):719-28.
19. Leunisse C, van Weissenbruch R, Busscher HJ, et al (2001). Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prosthe-ses--an electron microscopical study. J Bi-omed Mater Res, 58(5):556-63.
20. Lopez D, Vlamakis H, Kolter R (2010). Bio-films. Cold Spring Harb Perspect Biol, 2(7): a000398.
21. Mahieu HF, van Saene HK, Rosingh HJ, et al (1986). Candida vegetations on silicone voice prostheses. Arch Otolaryngol Head Neck Surg, 112(3):321-5.
22. Galli J, Calo L (2018). Biofilm in voice pros-thesis: A prospective cohort study and laboratory tests using sonication and SEM analysis. Clin Otolaryngol, 43(5):1260-1265.
23. Schuldt T, Dommerich S, Pau HW, et al (2010). Time course of microbial coloni-zation of different voice prostheses. Laryngorhinootologie, 89(10):606-11.
24. Bertl K, Zatorska B, Leonhard M, et al (2013). Oral microbial colonization in laryngectomized patients as a possible co-factor of biofilm formation on their voice prostheses. J Clin Periodontol, 40(9):833-40.
25. Talpaert MJ, Balfour A, Stevens S, et al (2015). Candida biofilm formation on voice prostheses. J Med Microbiol, 64(3):199-208.
26. Kumar S, Stecher G, Li M, et al (2018). MEGA X: molecular evolutionary genet-ics analysis across computing platforms. Mol Biol Evol, 35(6):1547-1549.
27. Oramahi HA, Yoshimura T (2013). Antifun-gal, and antisemitic activities of wood vinegar from Vitex pubescent Vahl. J Wood Sci, 59(4):344-350.
28. Clinical and laboratory standards institute (CLSI), Reference Method for Broth Di-lution Antifungal Susceptibility Testing of Yeasts; Approved Standard, third edition, Clinical and Laboratory Standards Insti-tute, Wayne, PA, USA, 2008 CLSI docu-ment M27–A3.
29. Clinical and laboratory standards institute (CLSI), Reference Method for Broth Di-lution Antifungal Susceptibility Testing of Yeasts: Fourth Informational Supple-ment, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 2012 CLSI document M27–S4.
30. Chaturvedi P, Syed S, Pawar P, et al (2014). Microbial colonization of Provox voice prosthesis in the Indian scenario. Indian J Cancer, 51(2):184-8.
31. Sardi J, Scorzoni L, Bernardi T, et al (2013). Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products, and new therapeutic options. J Med Microbiol, 62(1):10-24.
32. Mahieu HF, van Saene JJ, den Besten J, et al (1986). Oropharynx decontamination preventing Candida vegetation on voice prostheses. Arch Otolaryngol Head Neck Surg, 112(10):1090-2.
33. Izdebski K, Ross JC, Lee S (1987). Fungal colonization of tracheoesophageal voice prosthesis. Laryngoscope, 97(5):594-7.
34. G Jolanda Elving, Henny C van der Mei, Henk J Busscher, et al (2002). Compari-son of the microbial composition of voice prosthesis biofilms from patients requiring frequent versus infrequent re-placement. Ann Otol Rhinol Laryngo, 111(3):200-3.
35. Buijssen KJ, Harmsen HJ, van der Mei HC, et al (2007). Lactobacilli: Important in biofilm formation on voice prostheses. Otolaryngol Head Neck Surg, 137:505-7.
36. Sarwestani HK, Ghazvini RD, Hashemi SJ, et al (2019). Investigation of etiologic agents and clinical presentations of otomycosis at a tertiary referral center in Tehran, Iran. Iran J Public Health, 48(2):331-337.
37. Li L, Redding S, Dongari-Bagtzoglou A (2007). Candida glabrata, an emerging oral opportunistic pathogen. J Den Rse, 86(3):204-15.
38. Falagas ME, Betsi GI, Athanasiou S J (2006). Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Anti-microb Chemother, 58(2):266-72.
39. Martinez RC, Franceschini SA, Patta MC, et al (2009). Improved treatment of vulvo-vaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol, 48(3):269–74.
40. Zwolinska-Wcislo M, Brzozowski T, Mach T, et al (2006). Are probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studies. J Physiol Pharmacol, 57(9):35–49.
41. Gavazzi G, Krause K-H (2002). Aging and infection. Lancet Infect Dis, 2 (1):659-66.
42. Ahmed PI, Gleeson GA (1970). Changes in cigarette smoking habits between 1955 and 1966. US Department of Health, Educa-tion, and Welfare, Public Health Service.
43. Wynder EL, Covey LS, Mabuchi K, et al (1976). Environmental factors in cancer of the larynx. a second look. Cancer, 38(4):1591-601.
44. Manfredi M, Al-karaawi Z, McCullough MJ, et al (2002). The isolation, identification, and molecular analysis of Candida spp. isolated from the oral cavities of patients with diabetes mellitus. Oral Microbiol Immu-nol, 17 (9): 181–5.
45. Willis AM, Coulter WA, Sullivan DJ, et al (2000). Isolation of C. dubliniensis from in-sulin-using diabetes mellitus patients. J Oral Pathol Med, 29 (1): 86–90.
46. Aly FZ, Blackwell CC, Mackenzie DA, et al (1995). Identification of oral yeast species isolated from individuals with diabetes mellitus. Mycoses, 38 (3-4): 107–10.
47. Wiederhold NP (2017). Antifungal re-sistance: current trends and future strate-gies to combat. Infect Drug Resist, 29(10):249-259.
48. Raj VB, Madan Kumar PD, Balaji S (2017). Effectiveness of vinegar, lime, and salt-water as potential household decontami-nants for toothbrushes. J Indian Assoc Pub-lic Health Dent, 15 (1):8-10.
49. Al-Salihi SS, Jumaah IA (2017). The activity of Some Disinfectants, Detergents, and Essential Oils on Growth of the yeast Candida albicans. Al-Mustansiriyah J Sci, 28(1):25-34.
50. Jabir HB, Abbas FN, Khalaf RM (2011). In vitro assessment of the antifungal poten-tial of apple cider vinegar and acetic acid versus fluconazole in clinical isolates of otomycosis. Thi-Qar Medical Journal (TQMJ), 5(1):126-133.
| Files | ||
| Issue | Vol 51 No 1 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i1.8306 | |
| Keywords | ||
| Voice prostheses Fungal colonization Antifungal susceptibility test Candida | ||
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How to Cite
1.
Kamali sarvestani H, Daie Ghazvini R, Hashemi SJ, Geramishoar M, Ansari S, Rafat Z, Ahmadi A, Borghei P, Elahi M, Rahmi foroushani A, Getso MI, Aboutalebian S, Safari F, Ardi P. Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngectomy Patients. Iran J Public Health. 2022;51(1):151-159.
