Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prostheses - An electron microscopical study

After total laryngectomy, voice can be restored with a silicone rubber trac heoesophageal voice prosthesis. However, biofilm formation and subsequent d eterioration of the silicone material of the prosthesis will limit device l ife by impairing valve function. To simulate the natural process of biofilm development under dynamic nutrient conditions, a modified Robbins device w as used to evaluate the biofilm-related valve dysfunction of the Groningen, Provox2, Blom-Singer indwelling, and VoiceMaster voice prostheses. Obstruc tion of the semicircular slit-valved Groningen prosthesis leading to increa sed airway resistance was caused not only by a buildup of deposits on the e sophageal 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 form ation on the valve seating. The esophageal flange of the VoiceMaster prosth esis was affected, but the tripod structure of the ball valve was fully col onized up to the titanium sleeve, which interfered with proper valve openin g and closure. These findings on biofilm formation could be used for the fu rther development and modification of critical design features of voice pro stheses to facilitate tracheoesophageall speech. (C) 2001 John Wiley & Sons , Inc.