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Understanding Human Microbiota Offers Novel and Promising Therapeutic Options against Candida Infections. Pathogens 2021; 10:pathogens10020183. [PMID: 33572162 PMCID: PMC7915436 DOI: 10.3390/pathogens10020183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Human fungal pathogens particularly of Candida species are one of the major causes of hospital acquired infections in immunocompromised patients. The limited arsenal of antifungal drugs to treat Candida infections with concomitant evolution of multidrug resistant strains further complicates the management of these infections. Therefore, deployment of novel strategies to surmount the Candida infections requires immediate attention. The human body is a dynamic ecosystem having microbiota usually involving symbionts that benefit from the host, but in turn may act as commensal organisms or affect positively (mutualism) or negatively (pathogenic) the physiology and nourishment of the host. The composition of human microbiota has garnered a lot of recent attention, and despite the common occurrence of Candida spp. within the microbiota, there is still an incomplete picture of relationships between Candida spp. and other microorganism, as well as how such associations are governed. These relationships could be important to have a more holistic understanding of the human microbiota and its connection to Candida infections. Understanding the mechanisms behind commensalism and pathogenesis is vital for the development of efficient therapeutic strategies for these Candida infections. The concept of host-microbiota crosstalk plays critical roles in human health and microbiota dysbiosis and is responsible for various pathologies. Through this review, we attempted to analyze the types of human microbiota and provide an update on the current understanding in the context of health and Candida infections. The information in this article will help as a resource for development of targeted microbial therapies such as pre-/pro-biotics and microbiota transplant that has gained advantage in recent times over antibiotics and established as novel therapeutic strategy.
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Montelongo-Jauregui D, Lopez-Ribot JL. Candida Interactions with the Oral Bacterial Microbiota. J Fungi (Basel) 2018; 4:jof4040122. [PMID: 30400279 PMCID: PMC6308928 DOI: 10.3390/jof4040122] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023] Open
Abstract
The human oral cavity is normally colonized by a wide range of microorganisms, including bacteria, fungi, Archaea, viruses, and protozoa. Within the different oral microenvironments these organisms are often found as part of highly organized microbial communities termed biofilms, which display consortial behavior. Formation and maintenance of these biofilms are highly dependent on the direct interactions between the different members of the microbiota, as well as on the released factors that influence the surrounding microbial populations. These complex biofilm dynamics influence oral health and disease. In the latest years there has been an increased recognition of the important role that interkingdom interactions, in particular those between fungi and bacteria, play within the oral cavity. Candida spp., and in particular C. albicans, are among the most important fungi colonizing the oral cavity of humans and have been found to participate in these complex microbial oral biofilms. C. albicans has been reported to interact with individual members of the oral bacterial microbiota, leading to either synergistic or antagonistic relationships. In this review we describe some of the better characterized interactions between Candida spp. and oral bacteria.
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Affiliation(s)
- Daniel Montelongo-Jauregui
- Department of Biology, South Texas Center for Emerging Infections Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA.
| | - Jose L Lopez-Ribot
- Department of Biology, South Texas Center for Emerging Infections Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA.
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Uppuluri P, Busscher HJ, Chakladar J, van der Mei HC, Chaffin WL. Transcriptional Profiling of C. albicans in a Two Species Biofilm with Rothia dentocariosa. Front Cell Infect Microbiol 2017; 7:311. [PMID: 28752078 PMCID: PMC5508013 DOI: 10.3389/fcimb.2017.00311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/26/2017] [Indexed: 11/13/2022] Open
Abstract
Biofilms on silicone rubber voice prostheses are the major cause for frequent failure and replacement of these devices. The presence of both bacterial and yeast strains has been suggested to be crucial for the development of voice prosthetic biofilms. Polymicrobial biofilms that include Candida albicans and Rothia dentocariosa are the leading cause of voice prosthesis failure. An in vitro biofilm comprising these two organisms was developed on silicone rubber, a material used for Groningen button voice prosthesis. We found that this biofilm environment was not conducive for C. albicans growth or differentiation. Global transcriptional analyses of C. albicans biofilm cells grown with R. dentocariosa revealed that genes with functions related to cell cycle progression and hyphal development were repressed >2-fold. The mixed species biofilms were more compact and less robust compared to C. albicans mono-species biofilms, even when developed under conditions of continuous nutrient flow. Under these conditions R. dentocariosa also significantly inhibited C. albicans biofilm dispersal. Preferential adherence of R. dentocariosa to candidal hyphae was mediated by the adhesin Als3.
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Affiliation(s)
- Priya Uppuluri
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, TorranceTorrance, CA, United States
| | - Henk J Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center GroningenGroningen, Netherlands
| | - Jaideep Chakladar
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, TorranceTorrance, CA, United States
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center GroningenGroningen, Netherlands
| | - W LaJean Chaffin
- Microbiology and Immunology, Texas Tech University Health Sciences CenterLubbock, TX, United States
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Abstract
Fungal biofilms have become an increasingly important clinical problem. The widespread use of antibiotics, frequent use of indwelling medical devices, and a trend toward increased patient immunosuppression have resulted in a creation of opportunity for clinically important yeasts and molds to form biofilms. This review will discuss the diversity and importance of fungal biofilms in the context of clinical medicine, provide novel insights into the clinical management of fungal biofilm infection, present evidence why these structures are recalcitrant to antifungal therapy, and discuss how our knowledge and understanding may lead to novel therapeutic intervention.
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Chandra J, Mukherjee PK. Candida Biofilms: Development, Architecture, and Resistance. Microbiol Spectr 2015; 3:10.1128/microbiolspec.MB-0020-2015. [PMID: 26350306 PMCID: PMC4566167 DOI: 10.1128/microbiolspec.mb-0020-2015] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Indexed: 12/17/2022] Open
Abstract
Intravascular device-related infections are often associated with biofilms (microbial communities encased within a polysaccharide-rich extracellular matrix) formed by pathogens on the surfaces of these devices. Candida species are the most common fungi isolated from catheter-, denture-, and voice prosthesis-associated infections and also are commonly isolated from contact lens-related infections (e.g., fungal keratitis). These biofilms exhibit decreased susceptibility to most antimicrobial agents, which contributes to the persistence of infection. Recent technological advances have facilitated the development of novel approaches to investigate the formation of biofilms and identify specific markers for biofilms. These studies have provided extensive knowledge of the effect of different variables, including growth time, nutrients, and physiological conditions, on biofilm formation, morphology, and architecture. In this article, we will focus on fungal biofilms (mainly Candida biofilms) and provide an update on the development, architecture, and resistance mechanisms of biofilms.
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Affiliation(s)
- Jyotsna Chandra
- Center for Medical Mycology and Mycology Reference Laboratory, Department of Dermatology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH 44106
| | - Pranab K Mukherjee
- Center for Medical Mycology and Mycology Reference Laboratory, Department of Dermatology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH 44106
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Williams C, Ramage G. Fungal biofilms in human disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 831:11-27. [PMID: 25384660 DOI: 10.1007/978-3-319-09782-4_2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Craig Williams
- Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK,
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Ramage G, Robertson SN, Williams C. Strength in numbers: antifungal strategies against fungal biofilms. Int J Antimicrob Agents 2014; 43:114-20. [DOI: 10.1016/j.ijantimicag.2013.10.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
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Kramp B, Dommerich S. Tracheostomy cannulas and voice prosthesis. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc05. [PMID: 22073098 PMCID: PMC3199818 DOI: 10.3205/cto000057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cannulas and voice prostheses are mechanical aids for patients who had to undergo tracheotomy or laryngectomy for different reasons. For better understanding of the function of those artificial devices, first the indications and particularities of the previous surgical intervention are described in the context of this review. Despite the established procedure of percutaneous dilatation tracheotomy e.g. in intensive care units, the application of epithelised tracheostomas has its own position, especially when airway obstruction is persistent (e.g. caused by traumata, inflammations, or tumors) and a longer artificial ventilation or special care of the patient are required. In order to keep the airways open after tracheotomy, tracheostomy cannulas of different materials with different functions are available. For each patient the most appropriate type of cannula must be found. Voice prostheses are meanwhile the device of choice for rapid and efficient voice rehabilitation after laryngectomy. Individual sizes and materials allow adaptation of the voice prostheses to the individual anatomical situation of the patients. The combined application of voice prostheses with HME (Head and Moisture Exchanger) allows a good vocal as well as pulmonary rehabilitation. Precondition for efficient voice prosthesis is the observation of certain surgical principles during laryngectomy. The duration of the prosthesis mainly depends on material properties and biofilms, mostly consisting of funguses and bacteries. The quality of voice with valve prosthesis is clearly superior to esophagus prosthesis or electro-laryngeal voice. Whenever possible, tracheostoma valves for free-hand speech should be applied. Physicians taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost.
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Rodrigues L, Banat IM, Teixeira J, Oliveira R. Strategies for the prevention of microbial biofilm formation on silicone rubber voice prostheses. J Biomed Mater Res B Appl Biomater 2007; 81:358-70. [PMID: 17022068 DOI: 10.1002/jbm.b.30673] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Total laryngectomy, a surgical treatment for extensive cancer of larynx, which alters swallowing and respiration in patients, is followed up with a surgical voice restoration procedure comprising tracheoesophageal puncture techniques with insertion of a "voice prosthesis" to improve successful voice rehabilitation. However, microbial colonization is a major drawback of these devices. Antimicrobials are usually used to prevent the colonization of silicone rubber voice prostheses by microorganisms. However, long-term medication induces the development of resistant strains with all associated risks and the development of alternative prophylactic and therapeutic agents, including probiotics and biosurfactants, have been suggested. The inhibition of microbial growth on surfaces can also be achieved by several other techniques involving the modification of physicochemical properties of the biomaterial surface or the covalently binding of antimicrobial agents to the biomaterial surface. An overview of the different approaches investigated to date and future perspectives to reduce the frequent replacements of voice prostheses in laryngectomized patients through microbial biofilm retardation is presented and discussed.
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Affiliation(s)
- Lígia Rodrigues
- Centro de Engenharia Biológica, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
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Schwandt LQ, Tjong-Ayong HJ, van Weissenbruch R, der Mei HC, Albers FWJ. Differences in aerodynamic characteristics of new and dysfunctional Provox 2 voice prostheses in vivo. Eur Arch Otorhinolaryngol 2006; 263:518-23. [PMID: 16421748 DOI: 10.1007/s00405-005-0001-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 09/02/2005] [Accepted: 09/07/2005] [Indexed: 11/30/2022]
Abstract
Tracheoesophageal voice prostheses need to be replaced due to increased airflow resistance or retrograde leakage of fluid into the trachea as a consequence of biofilm formation. Previous in vitro studies show a change of aerodynamic features of biofilm covered voice prostheses after removal of the prostheses out of the patient. To assess these changes in an in situ situation, aerodynamic characteristics were measured within 45 patients at the beginning and at the end of the wearing process of the Provox 2 voice prosthesis. As a consequence, the influence of biofilm formation on aerodynamic characteristics can be evaluated. In the majority of cases, leakage through the prosthesis was the reason for replacement. No differences were found in the total flow, volume range and intratracheal pressure (ITP) of the voice prostheses measured. The airflow resistance of biofilm covered prostheses was significantly reduced compared to new clean prostheses. However, no correlation was found between the extent of biofilm and the different aerodynamic features measured. Biofilm formation on the Provox 2 is responsible for both reduction in airflow resistance and leakage through the prosthesis by deterioration of the silicone rubber material.
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Affiliation(s)
- Leonora Q Schwandt
- Department of Otorhinolaryngology, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9713 Groningen, The Netherlands.
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Mukherjee PK, Zhou G, Munyon R, Ghannoum MA. Candida biofilm: a well-designed protected environment. Med Mycol 2005; 43:191-208. [PMID: 16010846 DOI: 10.1080/13693780500107554] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Biofilms are colonies of microbial cells encased in a self-produced organic polymeric matrix and represent a common mode of microbial growth. Microbes growing as biofilm are highly resistant to commonly used antimicrobial drugs. Recently, microbial biofilms have gained prominence because of the increase in infections related to indwelling medical devices (IMD). Candida albicans, the pathogenic fungus which is a major cause of morbidity and mortality in blood stream infections, is the most common fungal pathogen isolated from patients with IMD-associated infections. Biofilm formation by Candida species is believed to contribute to invasiveness of these fungal species. We discuss experimental methods used to study fungal biofilms as well as the biology of biofilm formation by clinically relevant Candida species. Recent advances that are discussed in this review include the role of specific, differentially expressed genes and proteins, quorum sensing molecule in C. albicans biofilms, and the correlation between biofilm formation and fungal pathogenesis.
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Affiliation(s)
- Pranab K Mukherjee
- Center for Medical Mycology, Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106-5028, USA
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Schwandt LQ, van Weissenbruch R, van der Mei HC, Busscher HJ, Albers FWJ. Effect of dairy products on the lifetime of Provox2 voice prostheses in vitro and in vivo. Head Neck 2005; 27:471-7. [PMID: 15825199 DOI: 10.1002/hed.20180] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Reduction of biofilm formation on tracheoesophageal voice prostheses by certain dairy products might extend their clinical lifetime. The purpose of this study was to determine the influence of certain dairy products on voice prosthetic biofilms and lifetimes in vitro and in vivo. METHODS The in vitro results were accomplished using an artificial throat. The lifetimes of Provox2 prostheses were evaluated in a patient group that daily consumed the evaluated products. RESULTS Buttermilk and Yakult Light fermented milk decreased the amount of bacteria on voice prostheses but stimulated yeast prevalence in vitro. Concurrently, lifetimes of voice prostheses in patients consuming buttermilk were not significantly different, whereas patients consuming Yakult Light fermented milk drink had a significantly (p < .01) increased prosthesis lifetime by a factor of 3.76. CONCLUSION Yakult Light fermented milk drink reduced biofilm formation on Provox2 prostheses in vitro and in vivo and significantly increased prosthesis lifetime. In vivo, no significant effects were observed for patients consuming buttermilk.
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Affiliation(s)
- Leonora Q Schwandt
- Department of Otorhinolaryngology, University Medical Centre Groningen, P. O. Box 30.001, 9700 RB Groningen, The Netherlands
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Oosterhof JJ, Elving GJ, Stokroos I, van Nieuw Amerongen A, van der Mei HC, Busscher HJ, van Weissenbruch R, Albers FW. The influence of antimicrobial peptides and mucolytics on the integrity of biofilms consisting of bacteria and yeasts as affecting voice prosthetic air flow resistances. BIOFOULING 2003; 19:347-353. [PMID: 14768463 DOI: 10.1080/08927010310001612054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The integrity of biofilms on voice prostheses used to rehabilitate speech in laryngectomized patients causes unwanted increases in airflow resistance, impeding speech. Biofilm integrity is ensured by extracellular polymeric substances (EPS). This study aimed to determine whether synthetic salivary peptides or mucolytics, including N-acetylcysteine and ascorbic acid, influence the integrity of voice prosthetic biofilms. Biofilms were grown on voice prostheses in an artificial throat model and exposed to synthetic salivary peptides, mucolytics and two different antiseptics (chlorhexidine and Triclosan). Synthetic salivary peptides did not reduce the air flow resistance of voice prostheses afterm biofilm formation. Although both chlorhexidine and Triclosan reduced microbial numbers on the prostheses, only the Triclosan-containing positive control reduced the air flow resistance. Unlike ascorbic acid, the mucolytic N-acetylcysteine removed most EPS from the biofilms and induced a decrease in air flow resistance.
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Affiliation(s)
- Janine J Oosterhof
- Department of Biomedical Engineering, University of Groningen, Department of Otorhinolaryngology, University Hospital of Groningen, Groningen, The Netherlands
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Free RH, Van der Mei HC, Elving GJ, Van Weissenbruch R, Albers FWJ, Busscher HJ. Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro. Acta Otolaryngol 2003; 123:547-51. [PMID: 12797592 DOI: 10.1080/0036554021000028118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study investigates the effect of regular airflow, as an isolated single factor, through Groningen and Provox2 voice prostheses on biofilm formation. MATERIAL AND METHODS Groningen and Provox2 voice prostheses were placed in a modified Robbins device and inoculated with the total microflora from an explanted Groningen voice prosthesis. After 3 days, prostheses were either flushed 3 times per day with the Provox flush, treated with an airflow using an increasing order of air pressure (10, 15 and 20 cmH2O) or vigorously perfused by means of imitated coughing (air pressure 20 cmH2O). As a control, prostheses were left undisturbed to promote biofilm growth. Following flushing, blowing or coughing, each artificial throat was perfused with 200 ml of phosphate-buffered saline. This procedure was repeated three times a day for 9 days. At the end of each day, the artificial throats were filled with growth medium for 30 min and left empty during the night after draining. After 12 days the microflora on each voice prosthesis was quantified by plating on blood agar for bacteria and on de Man, Rogosa and Sharpe agar for yeasts. RESULTS The use of the Provox flush reduced bacterial prevalence on Groningen and Provox2 voice prostheses to 71% and 45% of the control values, respectively, without affecting the number of yeasts. Increasing airflows and imitated coughing yielded reductions of 45-70% in bacterial and yeast prevalence on Provox2 voice prostheses. On the Groningen voice prostheses the effects of increasing airflows and imitated coughing were less pronounced: reductions in bacterial and yeast prevalence of 56-87% were observed. CONCLUSION This study shows that use of the Provox flush has a cleansing effect, especially on Provox2 voice prostheses, and furthermore suggests that daily airflow through voice prostheses as part of a daily maintenance scheme reduces biofilm formation and can be expected to prolong the life of these devices.
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Affiliation(s)
- R H Free
- Department of Otorhinolaryngology, University Hospital Groningen, Groningen, The Netherlands.
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Stafford FW. Current indications and complications of tracheoesophageal puncture for voice restoration after laryngectomy. Curr Opin Otolaryngol Head Neck Surg 2003; 11:89-95. [PMID: 14515085 DOI: 10.1097/00020840-200304000-00005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgical voice restoration by valved tracheoesophageal fistula is undoubtedly the most successful method of voice restoration for laryngectomy patients, is one of the most important developments in head and neck surgery, and has resulted in a greatly enhanced quality of life for most patients who have undergone this debilitating procedure. In developed countries, it is now unacceptable to perform laryngectomy without giving patients the opportunity to undergo surgical voice restoration. Successful voice acquisition should be achievable in approximately 80% of patients. Success rates will be highest and problems most effectively dealt with under the auspices of a properly organized surgical voice restoration program within a specialist head and neck cancer unit with a well structured specialist multidisciplinary team. This article reviews recent publications addressing indications for surgical voice restoration by tracheoesophageal puncture, expected success rates, and reasons for failure and complications and ways to manage them in the context of the author's own experience.
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Affiliation(s)
- Frank W Stafford
- Department of Otolaryngology/Head and Neck Surgery, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK.
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