title: Vibratory stimulus reduces in vitro biofilm formation on tracheoesophageal voice prostheses.
abstract: Demonstrate that biofilm formation will be reduced on tracheoesophageal prostheses when vibratory stimulus is applied, compared to controls receiving no vibratory stimulus, in a dynamic in vitro model of biofilm accumulation simulating the interface across the tracheoesophageal puncture site.
  
  
  
  Prospective, randomized, controlled, crossover in university laboratory.
  
  
  
  Ex vivo tracheoesophageal prostheses were obtained from university-affiliated speech language pathologists at Indiana University School of Medicine, Indianapolis. Prostheses demonstrating physical integrity and an absence of gross biofilm accumulation were utilized. Sixteen prostheses were cleansed and sterilized prior to random placement by length in two modified Robbins devices arranged in parallel. Each device was seeded with a polymicrobial oral flora on day 1 and received basal artificial salivary flow continuously with three growth medium meals daily. One device was randomly selected for vibratory stimulus, and 2 minutes of vibration was applied to each prosthesis before and after meals for 5 days. The prostheses were explanted and sonicated, and the biofilm cultured for enumeration. This process was repeated after study arm crossover.
  
  
  
  Tracheoesophageal prostheses in the dynamic model receiving vibratory stimulus demonstrated reduced gross biofilm accumulation and a significant biofilm colony forming unit per milliliter reduction of 5.56-fold compared to nonvibratory controls (P < 0.001). Significant reductions were observed within length subgroups.
  
  
  
  Application of vibratory stimulus around meal times significantly reduces biofilm accumulation on tracheoesophageal prostheses in a dynamic in vitro model. Further research using this vibratory stimulus method in vivo will be required to determine if reduced biofilm accumulation correlates with longer device lifespan.
  
  
  
  NA Laryngoscope, 126:2752-2757, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Wannemuehler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lobo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.|Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Texas, U.S.A.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Johnson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Deig
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Jonathan Y
authors.initials: JY
authors.lastname: Ting
authors.affiliation: Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, Indiana.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gregory
mesh_terms: D018441:Biofilms / Q000254:growth & development*; D018592:Cross-Over Studies; D006801:Humans; D066298:In Vitro Techniques; D007831:Larynx, Artificial / Q000382:microbiology*; D011446:Prospective Studies; D011474:Prosthesis Design; D014732:Vibration
keywords: TEP; Tracheoesophageal; biofilm; prosthesis; vibration; voice