Does metal coating improve the durability of silicone voice prostheses?

Structural and biological evaluation of lignin addition to simple and silver-doped hydroxyapatite thin films synthesized by matrix-assisted pulsed laser evaporation

We report on thin film deposition by matrix-assisted pulsed laser evaporation of simple hydroxyapatite (HA) or silver (Ag) doped HA combined with the natural biopolymer organosolv lignin (Lig) (Ag:HA-Lig). Solid cryogenic target of aqueous dispersions of Ag:HA-Lig composite and its counterpart without silver (HA-Lig) were prepared for evaporation using a KrF* excimer laser source. The expulsed material was assembled onto TiO2/Ti substrata or silicon wafers and subjected to physical-chemical investigations. Smooth, uniform films adherent to substratum were observed. The chemical analyses confirmed the presence of the HA components, but also evidenced traces of Ag and Lig. Deposited HA was Ca deficient, which is indicative of a film with increased solubility. Recorded X-ray Diffraction patterns were characteristic for amorphous films. Lig presence in thin films was undoubtedly proved by both X-ray Photoelectron and Fourier Transform Infra-Red Spectroscopy analyses. The microbiological evaluation showed that the newly assembled surfaces exhibited an inhibitory activity both on the initial steps of biofilm forming, and on mature bacterial and fungal biofilm development. The intensity of the anti-biofilm activity was positively influenced by the presence of the Lig and/or Ag, in the case of Staphylococcus aureus, Pseudomonas aeruginosa and Candida famata biofilms. The obtained surfaces exhibited a low cytotoxicity toward human mesenchymal stem cells, being therefore promising candidates for fabricating implantable biomaterials with increased biocompatibility and resistance to microbial colonization and further biofilm development.

Candida biofilm formation on voice prostheses

Laryngopharyngeal malignancy is treated with radiotherapy and/or surgery. When total laryngectomy is required, major laryngeal functions (phonation, airway control, swallowing and coughing) are affected. The insertion of a silicone rubber voice prosthesis in a surgically created tracheoesophageal puncture is the most effective method for voice rehabilitation. Silicone, as is the case with other synthetic materials such as polymethylmethacrylate, polyurethane, polyvinyl chloride, polypropylene and polystyrene, has the propensity to become rapidly colonized by micro-organisms (mainly Candida albicans) forming a biofilm, which leads to the failure of the devices. Silicone is used within voice prosthetic devices because of its flexible properties, which are essential for valve function. Valve failure, as well as compromising speech, may result in aspiration pneumonia, and repeated valve replacement may lead to either tract stenosis or insufficiency. Prevention and control of biofilm formation are therefore crucial for the lifespan of the prosthesis and promotion of tracheoesophageal tissue and lung health. To date, the mechanisms of biofilm formation on voice prostheses are not fully understood. Further studies are therefore required to identify factors influencing Candida biofilm formation. This review describes the factors known to influence biofilm formation on voice prostheses and current strategies employed to prolong their life by interfering with microbial colonization.

Functionalization of polydimethylsiloxane membranes to be used in the production of voice prostheses

The voice is produced by the vibration of vocal cords which are located in the larynx. Therefore, one of the major consequences for patients subjected to laryngectomy is losing their voice. In these cases, a synthetic one-way valve set (voice prosthesis) can be implanted in order to allow restoration of speech. Most voice prostheses are produced with silicone-based materials such as polydimethylsiloxane (PDMS). This material has excellent properties, such as optical transparency, chemical and biological inertness, non-toxicity, permeability to gases and excellent mechanical resistance that are fundamental for its application in the biomedical field. However, PDMS is very hydrophobic and this property causes protein adsorption which is followed by microbial adhesion and biofilm formation. To overcome these problems, surface modification of materials has been proposed in this study. A commercial silicone elastomer, Sylgard^TM 184 was used to prepare membranes whose surface was modified by grafting 2-hydroxyethylmethacrylate and methacrylic acid by low-pressure plasma treatment. The hydrophilicity, hydrophobic recovery and surface energy of the produced materials were determined. Furthermore, the cytotoxicity and antibacterial activity of the materials were also assessed. The results obtained revealed that the PDMS surface modification performed did not affect the material's biocompatibility, but decreased their hydrophobic character and bacterial adhesion and growth on its surface.

Voice following laryngeal cancer surgery: troubleshooting common problems after tracheoesophageal voice restoration

The introduction of tracheoesophageal voice restoration by Blom and Singer has provided laryngectomy patients with a successful alternative to the use of artificial larynx and esophageal speech. Although this method of communication provides for the rapid acquisition of intelligible, functional speech, there are common problems that may occur in these patients. Close follow-up of patients postoperatively along with thorough patient education is beneficial to improving long-term success with tracheoesophageal speech. The purpose of this article is to discuss common problems encountered in the treatment of patients who have undergone tracheoesophageal puncture and to provide systematic assessment and treatment guidelines that are essential to maintaining functional tracheoesophageal speech.

Mastoid Condition and Clinical Course of Cholesteatoma

This study was carried out to establish which type of cholesteatoma is controllable by conservative treatment from the viewpoint of mastoid ventilation. We examined the area of the air cell system and airspace (aeration) in the mastoid cavity by computed tomography and eustachian tube (ET) function by inflation-deflation test in 20 ears (20 patients) with severe attic retraction for over 12 months (retraction pocket group), 16 ears (16 patients) with cholesteatoma which could be controlled only by conservative treatment for over 12 months (nonsurgical group) and 43 ears (43 patients) which required surgery within a year in spite of similar conservative treatment (surgical group). The size of the mastoid air cell system in the retraction pocket group, nonsurgical group and surgical group was 2.9 +/- 1.3, 1.9 +/- 0.7 and 1.5 +/- 0.9 cm(2) on average, respectively, with no significant difference between both cholesteatoma groups (nonsurgical and surgical group). While aeration was observed in the mastoid in 17 of 20 ears (85.%) in the retraction pocket group and in 12 of 16 ears (75.0%) in the nonsurgical group, aeration was present only in 9 of 43 ears (26.5%) in the surgical group, being significantly less in the surgical group than in the nonsurgical group and the retraction pocket group. In all ears in the retraction pocket and nonsurgical groups, and 19 of 30 ears in the surgical group, ET function was poor, there being no significant difference among the three groups. The present clinical observations suggest that progressiveness of cholesteatoma could be related to the ventilatory conditions in the mastoid rather than ET function, and that conservative treatment may be effective when ears with cholesteatoma have aeration in the mastoid.