Sarvestani Hasti Kamali, Ghazvini Roshanak Daie, Hashemi Seyed Jamal, Shoar Mohsen Gerami, Ansari Saham, Rafat Zahra, Ahmadi Aslan, Borghei Pedram, Elahi Miad, Foroushani Abbas Rahimi, Getso Muhammad Ibrahim, Aboutalebian Shima, Safari Fatemeh, Ardi Pegah
Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2022 Jan;51(1):151-159. doi: 10.18502/ijph.v51i1.8306.
Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device's lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis.
Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.
Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (<0.05).
White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost.
气管食管语音假体（TVP）一直是喉切除术后康复的金标准，能更快且优质地实现食管语音。真菌定植会缩短该装置的使用寿命，并导致假体功能障碍、渗漏及随后的呼吸道感染。因此，在本研究中，我们旨在调查真菌定植模式，并提出可延长语音假体使用寿命的预防措施。
从66例喉切除术后患者中取出因渗漏和/或误吸而失效的TVP并进行检查。这些患者于2018年4月至2020年1月被转诊至伊朗德黑兰耳鼻喉科主要中心阿米拉兰医院和拉苏尔医院。使用DNA测序技术评估真菌定植模式。此外，根据临床和实验室标准协会（CLSI）指南评估了对氟康唑、两性霉素B、制霉菌素和白醋的敏感性。
所有66个TVP（100%）均被来自上呼吸道的常驻真菌物种定植。糖尿病（31%）和吸烟（98%）分别是主要的基础疾病和诱发因素。从66个TVP中分离出的79种真菌病原体中，（n = 25，31.7%）最为常见。单独使用白醋时，最低抑菌浓度（MIC）值显著降低（<0.05）。
极低浓度的白醋可减少TVP上的真菌定植量且无任何不良影响；其广泛的可及性和可承受性可确保降低总体医疗成本。
