title: Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prostheses--an electron microscopical study.
abstract: After total laryngectomy, voice can be restored with a silicone rubber tracheoesophageal voice prosthesis. However, biofilm formation and subsequent deterioration of the silicone material of the prosthesis will limit device life by impairing valve function. To simulate the natural process of biofilm development under dynamic nutrient conditions, a modified Robbins device was used to evaluate the biofilm-related valve dysfunction of the Groningen, Provox2, Blom-Singer indwelling, and VoiceMaster voice prostheses. Obstruction of the semicircular slit-valved Groningen prosthesis leading to increased airway resistance was caused not only by a buildup of deposits on the esophageal flange and valve hat, but also by accumulation of deposits on the semicircular valve seating. The hinged flap valved Provox2 and indwelling Blom-Singer prostheses failed to close sufficiently because of biofilm formation on the valve seating. The esophageal flange of the VoiceMaster prosthesis was affected, but the tripod structure of the ball valve was fully colonized up to the titanium sleeve, which interfered with proper valve opening and closure. These findings on biofilm formation could be used for the further development and modification of critical design features of voice prostheses to facilitate tracheoesophageal speech.
authors.affiliation: Department of Otorhinolaryngology, University Hospital Groningen, Hanzeplein 1, 9713 EZ Groningen, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Leunisse
authors.forename: R
authors.initials: R
authors.lastname: van Weissenbruch
authors.forename: H J
authors.initials: HJ
authors.lastname: Busscher
authors.forename: H C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: F
authors.initials: F
authors.lastname: Dijk
authors.forename: F W
authors.initials: FW
authors.lastname: Albers
mesh_terms: D001422:Bacterial Adhesion; D001672:Biocompatible Materials / Q000737:chemistry; D018441:Biofilms / Q000254:growth & development*; D002408:Catheters, Indwelling; D004866:Equipment Contamination; D006801:Humans; D007831:Larynx, Artificial / Q000382:microbiology*; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000517:prevention & control; D012826:Silicone Elastomers; D013499:Surface Properties; D013997:Time Factors
chemical_list: D001672:Biocompatible Materials; D012826:Silicone Elastomers